Kirklin Clinic Head & Neck Cancer Support,  Birmingham, AL
Distributed by American Cancer Society
Pat Sanders, Editor
FoUrth Quarter, 2007



Tammy L. Wigginton M.S., CCC/SLP
Mark Finfrock, RT



Coughing is the typical way a person clears the airway but, after laryngectomy, the ability to produce an effective cough can become impaired. When the ability to cough is compromised, secretions collect in the airway and lungs. This buildup of secretions can result in shortness of breath, mucus plugging, pneumonia, and, potentially, respiratory arrest.


After laryngectomy, the body's natural filtration and humidification systems have been bypassed, so it is essential to supplement these functions using stoma protection such as covers and HMEs. Providing ample humidification and hydration are also critical to lung health. It is important for laryngectomees to protect their stomas and airways and to drink plenty of water.


To aid in removal of secretions, a physician or nurse may prescribe the use of a suction machine. If recommended, a suction machine should be obtained from a reliable resource.


Rental or purchase of a suction machine is a service, which is generally covered by insurance companies. However, each person should check with their own insurance provider. Home Health agencies and/or medical equipment companies generally have suction machines available. Although suction machines may be rented, if long term or permanent use of the equipment will be necessary, it may be more cost effective to purchase, rather then renting, one for a prolonged period of time. If you do choose to purchase a machine find out if you will be responsible for purchasing your own suction canisters and catheters or if the Home Health agency can continue to provide these for you. Also remember; if you purchase a machine you will likely be required to pay for machine repairs and upkeep. There are advantages and disadvantages to owning a suction machine vs. renting one.


Suction machines are available in many different models. Portable suction machines are handy for individuals who are on-the-go or who need frequent suctioning and may be away from home for extended periods of time. Suction machines are generally simple to use and are composed of 6 primary parts:


  • The vacuum pump generates suction and is powered by batteries or electricity from a wall outlet.
  • The regulation knob adjusts the vacuum pressure to the appropriate setting.
  • The pressure gauge indicates the vacuum pressure setting.
  • Connecting tubing attaches the machine to the reservoir bottle and the suction catheter.
  • The reservoir bottle holds the suctioned secretions.
  • The suction catheter is the thin flexible tubing, which is placed into the stoma to remove secretions. The suction catheter should be the type with a thumb vent to control the suction.


Proper training of suctioning technique and equipment use is essential. This article is an overview of suctioning techniques and procedures. It is not intended to be a substitute for hands-on training under the supervision of a qualified healthcare professional.


Although some patients do suction themselves, a caretaker typically performs suctioning. Suctioning often results in an unpleasant and volatile cough, especially for new laryngectomees. Touching the area around the stoma and the trachea generally triggers a reflexive cough. Although this is normal, many laryngectomees do become desensitized over time and most laryngectomees cough less when they suction themselves. This is good incentive for learning to suction ones self. While suctioning may be uncomfortable, it should never be painful.

Prior to beginning the suctioning process, have all supplies at hand including gloves, towels, suction catheters, a cup of clean water for flushing the catheter, and saline solution to flush the trachea. Hook up the equipment according to the manufacture's recommendations. Adjust the suction pressure to between 80-120 mm Hg. Confirm the setting by kinking the connecting tubing and reading the gauge. Higher suction pressure can be ineffective and could cause lung collapse.


Before suctioning, clean and remove dry secretions from around the stoma. Do not introduce dried secretions from around the stoma into the trachea. Make sure the settings are appropriate and the equipment is functioning properly. Gently introduce the catheter into the stoma with the thumb port open. Advance the catheter until resistance is felt. It is important the catheter is not forced or jammed into the airway. This may cause damage to the fragile tissues that line the airway.


Occlude the thumb port on the catheter and withdraw the catheter with a slight circular motion. Do not linger, and do not advance the catheter while suctioning. Never suction longer than 10-15 seconds.

It is often helpful for the person doing the suction to hold their breath as they suction the patient. When the person providing the suctioning needs to take a breath, it is very likely the patient also needs to take a breath.


Examine suctioned secretions. Note the color and consistency. Rinse the catheter and allow the patient to recover before making additional passes. Changes in color, consistency or odor may indicate an infection. If an infection is suspected the physician or nurse practitioner should be notified. Bloody secretions are very common in the days and first few weeks immediately following surgery and small amount of blood noted in secretions is not abnormal. However, larger quantities of blood mixed in with secretions may indicate trauma or damage from the suctioning procedure. If this is the case, the suctioning technique needs to be modified. Excessive amounts of blood during or after suctioning, or bleeding, which will not stop, is abnormal. Excessive bleeding may indicate a more serious issue or medical condition and requires immediate medical attention.


If the secretions are very thick, 3-5 cc's of sterile saline can be instilled or aerosolized into the stoma. Remember, introducing saline into the stoma will trigger a cough, so stand clear and/or be prepared to cover the stoma to prevent secretions from splattering.


Always be sure to follow the recommendations for cleaning from the equipment provider. Clean the equipment after use so it will be ready the next time it is needed. This can reduce the patient's chances of getting an infection.



  • Get appropriate training from a qualified healthcare professional. Have the healthcare professional observe your technique a couple of times before trying this on your own.
  • Always protect yourself and the patient from germs, which may be present. Thoroughly wash your hands before and after suctioning. If you are suctioning someone you may wish to wear gloves, something to protect your clothing and glasses to provide eye protection.
  • Make sure you have good lighting so you can see what you are doing.
  • Never stand in the "line of fire". Stimulation of the trachea usually elicits a projectile cough. Stand to the side while suctioning.
  • Keep the equipment clean and properly stored when not in use.
  • Report changes in secretion color, consistency or smell to your physician.



Camp Newhope Can Help a Child through this Difficult Time



Cancer is a word that none of us want to hear. Just imagine if you are a child and your mom or dad has just been told they have cancer. It's a frightening time for the entire family. It's a time of not knowing. It's a time when a loved one possibly faces surgery, radiation and/or chemotherapy. A child doesn't understand what is going to happen or what the word "Cancer" really means.


If you have a child who is dealing with a family member's cancer diagnosis, Camp Newhope can be a valuable resource to you and your family. Camp Newhope is a free one-day camp for children of cancer patients. The next session of Camp Newhope will be held on Saturday, November 10, 2007, at YMCA Camp Hargis in Chelsea, Alabama. The objective of this camp program is to bring children of cancer patients together to honor their feelings and support them through their time of difficulty.


Camp Newhope is a community outreach program of the Alabama Foundation for Oncology. The camp was founded in June 2002, by a young lady who had faced cancer with her mom and dad. She wanted to offer hope to other children. The camp is made possible by the volunteer efforts of professional counselors, social workers, and clergy. Group sharing, big group games, artistic expression, and art therapy exercises are used to bring children closer to understanding their fears and concerns about cancer and offer a supportive and nurturing camp environment. Activities promote expression and open the way for discussion from a child's perspective. Campers will also enjoy other activities such as horseback riding, canoeing, and hiking at the November camp. In addition, Rev It Up 2007, a motorcycle ride benefiting Camp Newhope, will take place. The children will be eating lunch with the bikers and given the opportunity to have their picture made on a "bike".


Frequently Ask Questions:

  • Who can come to Camp Newhope? Camp Newhope is open to any child who has a family member currently going through treatment for cancer or a loved one who is a survivor. This could be the parent, grandparent, aunt, uncle, or sibling of the child.
  • How much does camp cost? Camp Newhope is free.
  • How often is the camp held? Camp Newhope is held in June and November of each year.
  • Where is camp held? Camp Newhope is held at YMCA Camp Hargis in Chelsea, Alabama. Detailed directions will be given to the camper once they are registered.
  • What are the hours of Camp Newhope? Camp is held from 9:00 a.m. until 4:00 p.m.
  • How can I register for camp? To register for Camp Newhope, contact The Alabama Foundation for Oncology at (205) 877-2225 or (205) 877-2224.
  • How can I participate in the Rev It Up 2007 benefit ride? Contact the Alabama Foundation for Oncology to request a registration form. Cost for the ride is $40.00 for one rider, which includes ride pin, lunch and t-shirt. Cost for two riders is $70.00, which includes 2 pins, lunch for two and 2 t-shirts.


Let us help your child face their fears about cancer with other children who have the same fears. To obtain more information about Camp Newhope contact directors Sissy Hobbs at (205) 877-2225 or Jen Batson at (205) 877-2224 or visit our website at www.alfoundationforoncology.org. They can also provide detailed information about the "Rev It Up 2007" benefit ride.

Human Nature vs. Nature of the Human

by Debi Austin



I recently received an email from a young lady, who had attended a conference where I was a speaker, regarding her grandmother. I called and went to visit this lady who has been a laryngectomee for almost a year. She is feisty; doing pretty well as far as healing goes but has Parkinson's and is partially blind. She's not too good with her speech aid because she has trouble finding a sweet spot. However, she is persistent and does keep trying. I tried to adjust it for her but it was not working the best it could.


I put a new straw in my Cooper-Rand and away she went. This was easy for her to use, she was very clear and it was great. Her dog, who had been frightened by the other sound, came right to her after we adjusted the pitch and volume.
Then she told me she wanted a TEP. I sat there stunned. I asked if she had read or heard all the facts and information regarding this piece of medical technology? Her comment was, "It will make me sound human." How could I not sound like the voice of doom dealing with this kind of irresponsible information? Sound like a human? Yes, define that. Are you going to sound like Eartha Kitt, Marilyn, ooh, how about Madonna? You are NOT going to sound like the person they wheeled into the operating room.


You have to find your own peace, heal, and move forward with a productive life! People that need to sound like they did before this amazing turn of events have just that: a need. Stop looking back, it isn't there anymore; move forward with this wonderful gift of life. Live out-loud, dance, choose adventure! You have the opportunity to make the world take notice or you can sit on the side and try not to be noticed because you have all the control at this point.
The TEP is a wonderful invention for the people for whom it works. Yes, it takes practice, like any other type of speech, but it is not the "cure all" for every laryngectomee! Not everyone is going to sound like Angelina or Jimmy Stewart! Not everyone is going to sound good; not everyone is going to sound "human"; not everyone can even produce sound. And a woman with Parkinson's will not be capable of the upkeep. Being partially sighted might be a bit of a draw back, too. But some irresponsible "do gooder" told her she would sound human.


There is a saying, "First do no harm." Sounds simple enough but some people just can't help bullying, acting tyrannical, or just being mean because it can be so easy. Did you ever hear, "This hurts me more than it hurts you?" Yeah, right! What are these people thinking? All to often we think we can do or say anything because it is for someone's own good. According to which expert? And what qualifies them to deem what is best? Education? Experience? Personal progress?
One of the greatest men I ever knew spoke with esophageal speech, then, a TEP, and at the end an EL. Did it change his message? No. Did it change who he was? No. Did it change the way people felt about him? No. If it did, they were a waste of his time. For whatever reason, we get mislead, misguided, and confused over sound when ability should be the priority. What choice gives you the very best ease and comfort communicating? That should be the main concern. "I love you" in any form is far more important than the sound. OK, maybe Tony Bennett would make a difference. LOL...


I have been around esophageal speakers that I could not understand. I had a TEP for a year, most of the time I couldn't understand me (ooh, but I sounded "human"? I did not!). I was very good with my Cooper-Rand, but a Tru-Tone or Servox escaped me. My double chin may have had something to do with it, but scar tissue played an evil roll.


It is wonderful when a product made for us works and fits our lives and lifestyle. It is nothing short of bullying to believe and sell people on the idea that any product will work for everyone. I like laryngectomee conferences and support groups for the basic reason of seeing what is out there, being able to see or hear what works, and being able to talk to the person that it is working for. To assume that what has worked for me will work for everyone is irresponsible, thoughtless, and hurtful.


While WebWhispers is a support group and we are online to exchange valuable information, we should not make blanket statements that could affect the newbie's process of decision-making. We are here to "First do no harm!"


Some emails, while addressed to the list, need to be answered in private. They are the ones that appear to be blanket statements, but, in reality, they are personal choices for personal reasons and should be treated as such. There is not one path, which is always best for all people, but there are many paths and we do not need to confine others to one.
Human nature says that we each survive using the best way possible with what we have to work with.



Belling the Cat (from Aesop's Fables)



Long ago, the mice had a general council to consider what measures they could take to outwit their common enemy, the Cat. Some said this, and some said that; but at last a young mouse got up and said he had a proposal to make, which he thought would meet the case. "You will all agree," said he, "that our chief danger consists in the sly and treacherous manner in which the enemy approaches us. Now, if we could receive some signal of her approach, we could easily escape from her. I venture, therefore, to propose that a small bell be procured, and attached by a ribbon round the neck of the Cat. By this means we should always know when she was about, and could easily retire while she was in the neighborhood."


This proposal met with general applause, until an old mouse got up and said: "That is all very well, but who is to Bell the Cat?" The mice looked at one another and nobody spoke. Then the old mouse said: "It is easy to propose impossible remedies."




Kirklin Clinic Head & Neck Support Group
No meetings until further notice
In the interim, we suggest that you join WebWhispers if you have an email address.
We are also invited to attend an All Cancers group with a luncheon every third Tuesday.  Call or email Pat Sanders if interested.  (See below)


HeadLines Newsletter:
B’ham:  Pat Sanders,   205-980-8416; pat@choralmusic.com
Kirklin Clinic Otolaryngology :        205-801-8456 FAX
Glenn E. Peters, M.D.       Glenn.Peters@ccc.uab.edu
William Carroll, M.D.        william.carroll@ccc.uab.edu
Nancy Lewis McColloch, Speech Pathologist ;  205-801-8460;  nlewis@uabmc.edu     



http://webwhispers.org  is a site with helpful information on what to do before and after a laryngectomy. It includes educational sections on larynx cancer as well as a complete Library of Information, lists of Suppliers, the monthly newsletter, Whispers on the Web, and HeadLines This is the largest internet support group for laryngectomees and is a member club of the IAL

The Official site of the International Association of Laryngectomees

http://www.larynxlink.com  Information is available for the IAL Annual Meeting &Voice Institute held annually in various locations. Educational and Fun.

A Laryngectomee site from the United Kingdom

http://www.laryngectomees.inuk.com  presents information from all over the world and HeadLines newsletter is carried on their site under Letters from America.


For cancer information call 800.ACS.2345 or visit our Web site at www.cancer.org
American Cancer Society in Birmingham:   nprice@cancer.org



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