Pat Sanders, Editor
Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
October, 2001

BACK TO THE BASICS                                                                         by Pat Sanders

So, you have been talking and being understood by everyone for 5 years,10 years, or more? Why should you even bother to read an article on speech? Because you are the person who is having to repeat what you just said. You may be wondering what is the matter with other people that they don't listen to you the way they once did? Maybe that's not the problem. Are you not speaking as clearly as you once did? Have you forgotten that no matter how good you get, you still have work to do? Do you ever practice anymore? Does there come a time when you get so good, or so comfortable with your speech, that you get careless? YES , to all of the above. And, YES, I do mean you and me!

Letter From Max

Max Hoyt was at the Voice Institute and wrote the following shortly after he got home:

"My wife and I were very often at odds about my speech or lack of it. I would say

something and she wouldn't hear it. If I wouldn't say anything for a few seconds she would come back with enough for me to know she did hear what I said, or so I thought. I knew she could hear me so I was beginning to think she just turned me off. I knew better but that was the easy way out.

My first experience with a SLP after surgery was with one who believed my quality of speech would be equal to my knowledge of what constituted speech for a "Laryngectomized" person. I soon became a believer, worked at it, and acquired what I thought was good speech. That was over 7 years ago.

This past year I found myself being asked to repeat a lot of my statements. That was occurring with others as well as my wife. I recalled the philosophy of my first SLP and decided to sign up for the Voice Institute. My learning curve started up on the first day. Some of the culprits were the soft constants, fric’in fricatives ( as Dr. Salmon called them), background noise, and mumbling. If this wasn’t enough, I found myself trying to talk with a mouthful of food.

All of these things when put together spelled disaster for me and speech. By the end of the second VI day, I realized the problem with communicating was mine. Since that evening, I have had only one occasion when my wife has not heard the beginning of my speech. I don’t talk with the microwave going or water running in the kitchen. I roll up the windows in the car when we are traveling together. I face the person with whom I am trying to converse and I am getting good responses.

As I write this I realize it all sounds very mundane but for this Lary, I will be forever grateful for the VI experience. It isn’t very scientific but it works for me. Max"

Everyday Solutions

As a laryngectomee and a 'speaker' who uses both the AL and the TEP and a 'listener', who is around a lot of laryngectomees, I try to stay aware of speech problems. When I speak to a group, I am never misunderstood. Why? Because I face a quiet attentive audience, speak carefully, go slowly on a difficult word or phrase, hesitate to let the listener's ear catch up with the phrasing, and often use an amplifier to extend my reach. I am usually demonstrating both the AL and TEP and use phrases to show what we can and cannot do well. Even knowing all of this, when I am with a friend, I still find myself talking as though I had all of the capabilities of speech that my friend does. I answer from the next room, talk over the engine noise in the car while I am driving, rattle on without looking at the person I am with and talk through lunch, stopping almost after every bite or two to let the food go on down so I can add to the conversation. Slows down lunch considerably and I am always the last to finish. We interrupt each other just as we did for years. And I often have to repeat my words. I need to treat my friend the way I do an audience and my friend needs to be an attentive audience to me.

Let's go back to the simple things. Don't play the car radio and try to talk over it. The engine noise is difficult enough. At home, the TV has a mute button so don't compete with the program by trying to talk over it. The microwave or the exhaust fan make a steady drone that partially covers your voice. Does your mate call from the other room to ask a question? Do you get irritated when you have to answer the second time after the first time isn't heard? Do you drop your voice as you turn away and find the end of your sentence is lost? Does anyone get irritated because you mumble. If someone says, "What do you want for dinner?", do you answer something like, "Wy-on-we-ave-uh Pizza?" Now, I can guarantee your wife heard the last word (and is probably on the telephone calling in the order) but does it occur to either of you that the rest was unintelligible and that , if it had not been an answer with such a clear one word answer, she would have said, "What? I didn't hear you." Well, of course, she HEARD you. She didn't UNDERSTAND you. Why? She was in the other room, the TV was on in the house, the window was open with kids playing next door, you mumbled and didn't make the effort to separate and enunciate your words, and you were not looking at each other to read expressions and body language. Actually, you never would have had Pizza delivered if she hadn't picked up on the one clear word…and didn't want to cook that night anyway.

Many of the accommodations we made when we first learned to speak with our new softer voices need to be in use daily even 10 years later. I have attended three IAL Annual Meetings. We need to go back and attend these meetings, listen to others talk, attend the lectures, sit in on Voice Institute courses, or sign up as a VI pupil to learn what we missed learning in the first place or what we have gotten careless about. This is time well spent.

In addition to the necessity to speak distinctly, many of us are getting older and our hearing is not necessarily as good as it once was. I am one of those so when I am visiting with other laryngectomees, I have a harder time understanding slurred words and voices that go soft at the end of a sentence.

What is Articulation

What is Articulation? It is the process by which words are formed and sounds are shaped and if you do not do this reasonably well, listeners will not understand what you are saying. If you have Lauder's book, "Self Help For The Laryngectomee", there are exercises that you can read out loud. This book is excellent for all types of speech. Use the practice pages If you are serious about wanting to be understood, record yourself and listen. If you have difficulty with certain phrases, ask your SLP for help. That is their specialty.

Recently, someone asked what method of speech another lary was using. I had to think before I could answer because I could not "picture" the person speaking as well as I could "hear" what they said. When someone speaks so clearly and articulates so well that you understand every word, it is likely that you will hear what they say and not notice what method they use to say it.

Tips for Talking

On the Internet, I found the Top 7 Tips For Developing The Voice That Wins by Dr. June Johnson, [http://www.voicepoweronline.com/about.html] , a well known author and communication coach. Some of these tips apply to us as well:

Articulate your consonants. A recent Gallup Poll listed mumbling as the most annoying habit of speech. Consonants are what make speech intelligible, the "bread and butter" of speech. If people have to work to understand what you're saying, they'll stop listening.

Pronounce all syllables. You will sound more professional when you do. Missing syllables make for sloppy, lazy speech. Avoid pronunciations such as "innernet," "comtuble," "inneresing," "gummint," "reglar," "secetary," or "yesday" Fading away or dropping ends of sentences will leave the listener in the dark. If the point is important enough to be made, it's important enough to be heard.

She also suggests you talk to or with people, not at them and that you do daily maintenance of your voice… and she is writing for people with their original voices. Imagine how much more necessary these suggestions are for us.

Communication is an important part of us. For those of us who are fortunate enough to be able to speak again, treasure this rebirth and use it to the full extent of your abilities. The quality of our relationships and our lives is affected by the clarity of our communications.


Your local clubs try to help newcomers who have not yet received an artificial larynx or people who have their unit in for repairs by having a loan closet with loaners available. Sometimes people who face laryngectomy would like to learn before their surgery. There are people who have no insurance and cannot afford to buy their new "voice". When possible, that loan is made permanent.

I was furnished with a Servox right after my laryngectomy and was able to get a new one after 5 years and convert my old one to a loaner. I did not know that I could do that until Jim Lauder of Lauder Enterprises told me about Medicare furnishing a second one after 5 years. The day I passed 5 years, I notified Jim and my SLP that I wanted another. I can't tell you how many people have enjoyed the use of my old one.

Right now we have one Servox in the loan closet so if anyone has a loaner and doesn't need it anymore, please get it back to us or to the club from whom you borrowed it. If those who have lost their loved one have an instrument packed away, we would appreciate their donation so that others may talk. If people would order the second one when covered by Medicare or Insurance and donate the old one to their local club, we might be able to help more people.

This applies to almost all local support groups. There are a few states where you can get ALs free but most of us are struggling to keep a loan closet going for our local clubs. Most areas have absolutely nothing. I just received an email from Montgomery, AL, where they are trying to find a loaner. Here, we have someone in the hospital right now with no way to speak. I have one loaner left here for the whole city of Birmingham and surrounding area. I just heard from Bob Hodge at our online group, WebWhispers, that WW is down to two Servox not loaned out. We all need help.

Please contact me, call your local club, or write WebWhispers. We are all in the same boat. Thanks for helping. Pat Sanders (pat@choralmusic.com)  205-995-8822

Precautions for Visitation

In talking with our Nurse Manager on the floor at UAB where most laryngectomees are cared for, I asked about visiting patients who have infectious diseases such as Hepatitis or HIV. She was explaining that even more common were other types of infections, such as bacterial, so I asked Dr. Glenn Peters if there were precautions we should take to protect ourselves when calling on these patients.

His comment was, "Nothing really special is warranted except some good common sense. I would avoid direct contact with body fluids such as blood and mucus and certainly do a hand wash when done. If fooling around with a stoma or a speech prosthesis, I would wear gloves and probably eye protection. "Casual" contact does not pose a risk. Remember that people with HIV are more susceptible to infections than the normal person so we need to protect THEM as well as ourselves."

It seems it would be a good idea to stop and wash up on the way in to protect the patient from our germs and on the way out to protect ourselves.



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