Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
Pat Sanders, Editor
ORAL ADAPTERS by Dorothy Lennox
Let's talk oral adapters for the electrolarynx or tubes for the Cooper-Rand.
There are two main choices - "soft" tubes and "capped tubes". The soft tubes are usually cut up pieces of the kind of tubing used inside beverage machines to dispense milk or juice. The capped tubes are saliva ejectors. You could probably get some of these from your dentist. On this type, be sure that the ends are securely fastened - or a least a very firm press fit. Perhaps the manufacturers are doing better nowadays - but a few years ago we were selecting a brand to use and found we had to be very careful as there were many brands of saliva ejectors where the caps were not well adhered or were a fairly loose press fit and could bump off quite easily. Of course, for a laryngectomee, the only danger would be swallowing a plastic cap no bigger than many multivitamin pills - but for a speech pathologist doing a demo, it could mean choking on a cap.
Choosing between the two types is mainly a matter of personal preference - there are advantages to each. With the soft tube, the end is smaller/softer in the mouth and easier to manipulate with tongue and teeth. Cutting off the sound and then letting it start again with your teeth rather than the button can be helpful in pronouncing some sounds and achieving easy, less robot-like speech. On the other hand, with just the one open end, some people have a problem with blocking the sound with tongue or cheek - and some people have a difficult time keeping it in position. Another possibility is aquarium tubing. Many pet supply stores have the tubing in the right diameter and it tends to be harder than the usual soft tubes, but not as hard (no wire in it) as the capped tubes, and with no end cap, of course.
With the capped tubes, the slots all around will help avoid unintentional blocking and most of them will keep whatever bend you use fairly well. But the end of the tube will be larger and harder in the mouth and the small slots will get blocked more easily with saliva or food. Many of the tube selections with oral adapters include both types. It has been our experience that people prefer the soft to the capped tubes about 4 to 1, but each person should definitely try both types.
Another thing to consider is the length of the tube which can make a difference to the sound, so it is wise to experiment with a few tubes, cutting them to different lengths to see if you like the sound better one way or another. The tube may be easier for you to use in a length that is different from what someone else might prefer.
When using a tube in an oral adapter, be sure that the tube is a close fit in the opening of the adapter and that it is pushed in only as far as the hole in the material goes - do not push it all the way in to block the internal cavity of the adapter or to hit the head of the instrument.
The capped tubes with the wires that run through them will have to be cut with wire cutters. Most people use 4 or 6 inch tubes - some people like to cut them down to only a couple of inches - and some people prefer a longer tube. We have capped tubes available at 8" and on a custom basis up to 16". The very long tubes, while perhaps cutting down the sound volume somewhat, can be helpful to people who have a difficult time with hand and arm mobility - you can rest your hand on your chest and don't have to hold it all the way up to the neck.
You will want to get the end of the tube at least an inch or a little more into the mouth beyond your teeth, coming in from the side, with the tube above the tongue, pointing to the roof of the mouth. The idea is to get the sound into the open part of your oral cavity and leave the front of the tongue as free as possible to shape words without interference from the tube. Placement can make a major difference in intelligibility.
Coming in from the front of the mouth over the tip of the tongue, as we have seen some people do, will usually make for speech that is garbled and difficult to understand. If someone tries using an oral tube with that type of placement, it is easy to see that they would have a poor opinion of an oral unit.
So if you are having a difficult time with an instrument on the neck and have not had good luck with oral placement, consider going back and trying the oral placement again. Work on better positioning of the tube, experiment with tube type and length. Practice. Most people who have reasonable control of their tongues can learn to speak quite well with oral placement using proper techniques and a little practice.
Dorothy Lennox Luminaud, Inc. <firstname.lastname@example.org>
Calibrating Your Hygrometer — You Can Do It!
Getting Accurate Relative Humidity Readings -You should make sure that your hygrometer provides accurate readings. The technical term for this is calibration. When you calibrate your hygrometer, you are testing its accuracy by comparing it with an independent standard.
Calibration Made Simple - All hygrometers should be calibrated. Some are not properly set when they leave the factory. Others, even the best models on the market, may experience what is known as drift, which means that they do not hold their accuracy over long periods and need to be re-calibrated. Calibration is easy. A step-by-step procedure using everyday household items is described below. The basic principle is to create a small-scale environment where the relative humidity is known. Place your hygrometer in this environment and compare its reading to the known humidity level.
EQUIPMENT AND INGREDIENTS NEEDED
About ½ cup - table salt
About ¼ cup - tap water
a coffee cup or mug
A gallon size clear Ziploc® bag or a well-sealed pressure cooker
Step 1. Check your hygrometer. If your hygrometer has a pointer, look for screws or knobs on it that will allow you to move the pointer. If there are none, or if you have an electronic hygrometer, physical adjustment will not be possible, but you can still calibrate.
Step 2. Prepare the mixture. Place the tap water and the table salt in the coffee cup and stir for about a minute.
Step 3. Put the bag or pressure cooker in a draft-free place and out of direct sunlight, where the room temperature is likely to remain even. Put the coffee cup and your hygrometer inside the plastic bag or pressure cooker, and seal tightly. (Note that salty water can damage your hygrometer if it comes in direct contact with it.)
Step 4. Check your RH reading. After 8 to 12 hours, note your hygrometer's RH reading. It should read about 75%, the standard. If it does, you do not need to adjust it. If it does not read close to 75%, note the difference between your hygrometer reading and 75%.
Step 5. Correct to the standard 75% if your hygrometer is adjustable. If your hygrometer cannot be adjusted, record the difference you noted. In the future, each time you take a reading from your hygrometer, you will need to add or subtract that difference.
How Often Should You Calibrate? - Once you have calibrated your hygrometer, you can be confident that you are getting accurate readings. Even so, you should re-calibrate your hygrometer at least once a year, especially if it is a mechanical instrument, to make sure that it continues to work properly.
About 95% of this information came from this site and we appreciate being able to bring it to you:
This article was originally published in HeadLines in February, 1999. It is re-published in honor and in memory of Scotty Chandler 9/27/47 - 10/05/02
HUMOROUS EDUCATION by Scotty Chandler
From a page called “On The Lighter Side”, part of the Larynx Cancer Group site on the Internet, Dutch Helms states “after all, laughter is the best medicine”. One of our members, Frank Morgan, tells the story of talking to a group of ladies, near Liverpool England, about cancer. He was using the Optivox electrolarynx with the oral tube. One lady asked if he could change his voice by changing the end of his device? He asked “Why would I want to do that?” and she replied “So you could speak in German or maybe French?” Another of our members, Tor Wold of Norway was speaking with some friends of his own children when one of the friends asked what the other button was for on his Servox. He replied that one was for speaking in English and the other was for Norwegian!
This is the kind of quick response that is humorous yet educational for those who give
anti-smoking classes. I will go a step further and say, “humor is often the best way to educate others”, especially school children, to the things we must adapt to as laryngectomees. It is possibly the best way to tell them of the ill effects of tobacco in a way that helps them to remember what they’ve heard. We hope that it deters them from ever starting smoking, dipping, or chewing smokeless tobacco, which causes oral cancer.
Recently, I had the chance to speak to over 150 students, 15 to 18 years old, in groups of about 30 each, explaining the ill effects and problems of our type of cancer. I had to speak about thirty minutes in each of five classes, using visual aids: slides showing the normal anatomy of the throat, a laryngectomee’s throat, the drawing with the TEP, all taken from the photos in “Self Help for Laryngectomees”. I also demonstrated, with humor akin to Star Wars, the use of the Servox as an alternative way of speaking, both with the adapter and holding it to the neck. Explaining that T’s, P’s, and H’s were hard to pronounce, especially with the adapter, I talked about the length of time it took me to learn to speak so that others could understand me fairly well. Then, I told of the surgery for the TEP, which made my speech somewhat more normal. Following with a question and answer session, I was able to stress smoking as the main cause for the surgery to remove the larynx.
One particularly ‘bright inquisitive student’ asked, “If they took your larynx out and this is another way of speaking why do you still speak with such a southern accent?” Caught off guard on that one, I had to explain, “they didn’t take the Country and Southern out of me, just the larynx!”. I told them it does take a lot of practice to speak whichever type of alternative speech you choose, South, East, North or West!
I explained that enunciating and pronouncing words was much harder when anything interferes with the ability to move your tongue and, then, I asked them to try to talk clearly while holding the tip of their tongue. After the laugh was over, I pointed out that could happen for real if they smoked, dipped or chewed the smokeless tobaccos and got cancer of the tongue.
It being time to lighten it back up, I told them that I had cramps in my Right wrist from talking too much so I was going to talk Left Handed a while, which wouldn’t be quite as good as my Right Handed talking because I hadn’t practiced as much! We had a lot of laughs and fun while hopefully getting the nonsmoking message across.
Above and Beyond
Joe Johnson shared the following email that he sent to Dr. Glenn Peters regarding the special service he received from one of Dr. Peters administrative office employees.
Email To: Glenn E. Peters, M.D.
Subject: Michelle Dickerson
Know you are hard at work but needed to let you know what a wonderful person Michelle is. I called her this morning seeking guidance on fastest way to get VA requested info to them concerning my laryngectomy in 1989.
As you may recall, I applied for VA consideration on increasing my level of disability over a year ago under the Agent Orange program plus losing mobility, due to arthritis and diabetic feet ulcers (even had to have a toe amputated). Well, Michelle suggested I fax a copy of the VA letter to her so she could deal directly with VA rep if need be.
I complied with her directions and also faxed a signed VA Release of Information Form in case she should need it. Upon receiving the paperwork, she called me and said she would gather all the data this afternoon and get in touch with VA tomorrow.
Now that is what I call performance above and beyond the normal duty requirements. She could have just as easily shunted me off to other departments such as Records or whatever. Instead she chose to treat me as an individual who needed help and went out of her way to meet my needs. She is truly a credit to your organization and I hope to one day be able to thank her personally. My wife, Ann, also shares these feelings.
Best Wishes, Joe H. Johnson, Col USAF (ret)
PS I would like to copy this to Pat Sanders for possible mention in the newsletter if you approve. Thanks again. Joe
PPS for Pat. Michelle then called me the next day to let me know she had faxed the material and called VA rep who acknowledged receipt.
(Dr. Peters answer: No problem. I think she is a jewel and I don't care who knows it. GEP)
Please attend your local support group. Learn and share.