Kirklin Clinic Head & Neck Cancer Support,  Birmingham, AL
Distributed by American Cancer Society
Pat Sanders, Editor
FoUrth Quarter, 2008



Stretching and Strengthening #2


Hi again! I am Shari Aizenman, a massage therapist in Atlanta, GA and Birmingham, AL, for twenty-two years. This is the second in a series for you and your health. In this series, we are focusing on stretching the muscles and associated soft tissues in your body and, while stretched out, strengthening those same muscles for optimal results.

In the first article in this series, found in HeadLines, Second Quarter, 2008, I focused on the upper body; arms, shoulders, and a little of your torso. In this article, I will focus on the torso and neck. If you have any questions regarding whether this or any of the exercises I offer are right for you, please consult your physician. Remember that intuition is a powerful partner; if something doesn't feel right - don't do it!

First, you will need a couple of tools to assist you in this series. A sturdy chair and a yardstick should work just fine. If you have some light "weights", you can also use them to assist you. If not, get two equally-sized cans of something out of the pantry. Start by sitting in the chair with plenty of room around you for moving and doing some warm-up stretches with the focus on your breath. Place the yardstick and weights within easy reach.

Sit with your feet planted firmly on the floor and your back well supported. Allow your head to lead your spine into length (as I explained in the first article in this series). Inhale as you separate each vertebra, lifting from the crown of your head, feeling your ribs expand outward and then relaxing as you allow your breath to escape. Stay as tall as possible through your spine. Now, with feet flat on the floor, breathe deeply and stretch your hands out to your sides, then over your head, hold for a few seconds and then slowly bring your hands back to a resting position. Repeat three times. Then stretch your arms in front of you and over your head, this time letting your eyes follow your fingertips up and then down. Repeat three times. Then do single windmills forward and backward, allowing your head to follow your fingertips as far as possible as you make large circles with your arms, engaging your shoulders as much as possible.

Move toward the front edge of the chair, remembering not to sit as to make the chair unstable. Now grasp the yardstick with both hands together in the center. Gently raise the yardstick in front of your chest and turn your torso at the waist, moving in a horizontal plane toward the left as far as is comfortable. Then turn toward the right, moving through the center as far as you can go. Keep moving left and right, gently pulling the yardstick for stretching assistance with the right hand as you turn right, and the left hand as you turn left. Make ten of these movements in each direction and then rest the yardstick on your lap. Breathe and rest your arms for a moment.

Again, lift the stick and hold it one foot from each end. Repeat the previous exercise, turning as far as possible in each direction a few times. Then move your hands to the ends of the stick and complete the exercise by making the horizontal circles ten times in each direction. Put the stick down, stand up and stretch your arms over your head, fingers reaching for the sky and go up on your toes, looking up toward your fingertips. Breathe and relax.

Now, still standing, lift your "weights" and hold your arms down at your sides. Letting the weights guide you, turn your torso, right hand going toward the rear and turn your body to the right, your head following in this circle, going so far around as you need to in order to lift your left foot to your toes. When you have gone as far as possible, take a breath and reverse the circle and turn toward the left, going all the way around and pushing through the turn by going up onto your right toes. Your hip may lift a little from the floor when you are at the end of the circle. Do this exercise four times in each direction, carefully listening to your body and knowing your limits. When you have completed the exercise, gently put down your weights and relax a moment. You may want to repeat the torso turns without the weights or if you're really up to it, lift the weights and repeat the torso turns with them.

Next, take up the weights and stand in a relaxed position, feet spread more than hips' width apart (don't lock your knees). Arms at your sides, allow the weights to guide your body, arm hanging, to the floor to the right, bending at the waist, ribs to hipbone, first dropping your right shoulder toward the floor, then allowing your ear to follow toward your shoulder. Then, keeping your spine long, allow your head to bend over as far as is comfortable, making an arc with your body, not twisting at all. Slowly raise your head, your ear, your shoulder and your hand with the weight until you are back at neutral and stretch up through your spine. Take a breath and repeat on the left side. Do this exercise four times in each direction, remembering to breathe. (Holding your breath during any of these exercises may make you lightheaded.) When you have completed this move, put the weights down and repeat the exercise without them.

Good job! Have a seat on the end of the chair, sitting with your head leading your spine into length. This exercise can be done with or without weights. Rest your left hand on your lap. Take your right hand (with one of the weights) and hold it to your right shoulder, elbow sticking straight out to the side. Raise the weight straight skyward, gently grazing your right ear with your fingers, until your arm is fully extended. Then, bend your elbow and hang your arm over the top of your head, resting your wrist on your head. Bend your body toward the floor to the right, allowing your elbow to guide you. This will stretch out the left side of your neck, so be careful to go slowly and keep your balance. When you have stretched as far as is comfortable, bring yourself back to upright, leading with your head and neck. Bring your arm straight up and then back to your lap. Do this exercise three times and repeat on the other side.

Time to stretch out your neck. Just as before, but without the weight, take your right hand over your head and this time, grasp the left side of your head just over your left ear with your fingers. Use the right hand to bring your head, ear first, as far over as is comfortable toward your right shoulder. Hold this stretch for a count of five and return to neutral. Repeat for a total of three stretches and repeat on the other side.

Come back to a standing position. Hold the yardstick at its mid-point in your left hand . Stretch your left arm out all the way out to your side and sweep the yardstick at chest level all the way across your body, stretching out as far as possible, and bring it back toward you as if stirring a large pot of soup. You will be making clockwise movements, and the yardstick will be sticking straight up. Make five large, and then five smaller circles, stretching out to scrape the sides of the soup pot. Go slowly. Switch hands and repeat.

Take the yardstick at its midpoint once again, with your left hand, and lift your arm above your head. The stick should be horizontal to the ground. Make five large circles above your head, stretching your arm up from your shoulder as you move the stick first in one direction, then five circles in the other direction. Lower your arm and repeat on the other side. Put the yardstick down. When you have completed this exercise, stretch your sides and arms out by doing jumping jacks-but without jumping. Spread out your legs, relax your knees, and clap your hands above the top of your head, then bring your arms down to your sides and repeat five times.

To complete this workout, raise your right hand skyward and stretch your arm up, then let your side stretch and go up on your right toe, opening up your right side as you consciously make more space on your side. Bring your arm down and repeat on the left side.

Remember to let your intuition be your guide to exercising. Relax and take time to breathe!



(Advice from the editor after consulting with Shari. If you are having muscle weakness in hand and arm as many of us do after surgery, be careful about lifting a weight over your head because a can could slip from your grasp.  The exercises are more effective with weights but can be done without them and still get muscles moving again. PS)


Ten Years and Living Well

by Janna Eyer


My 10th anniversary is in a couple of days.  I had never seen or even heard of a lary prior to my cancer, although I vaguely knew the generic term "throat cancer".   I was in Fairbanks, Alaska where there was no support group and I didn't meet the couple of other larys in the area for several months.

 In Anchorage, for post op radiation, I met my first lary (thank you, Belva) and saw a ray of light.  She told me about WebWhispers, although it was several months before I got around to looking it up.  Big mistake, wish I'd known about WebWhispers before surgery or accessed it sooner. Three years later I moved to a rural coastal area, where I've never seen or heard another lary, within 100 miles.  

I believe I've always had good medical care but that my docs weren't versed in the day-to-day living of being a lary; WebWhispers steps up to that plate. WebWhispers has provided information I would have no other way of obtaining. Despite the stats, the complications of surgery and ramifications with other health issues made me believe that life was shortened.  Then, a good friend, one I met on WebWhispers who had her surgery after me, died.  That was hard, and it was a confirmation of my fears.  HOWEVER, a steady diet of WebWhispers has driven home the point that there can be decades of life after surgery with my abilities minimally impacted.  For me, reading comments from people who've been around for a long time post-op helped in my early recovery and on-going maintenance.

I have an excellent cough and sometimes  use saline - I have a suction machine that I keep available.  I don't need it daily but when I do need it, it does the trick.  I just got a new nebulizer after not using one for years and am finding it helpful.   While we are all larys, we are all different.   Besides being larys, we may have other health issues that the list isn't aware of that effects our being a lary. I have found that my lungs, my breathing, and need of equipment, changes over time, even when I'm healthy.

I used to feel almost guilty when I would read about other larys who zipped through surgery and went back to work and a full life in weeks. Not me. Personally I found it a little intimidating when I first joined the list.  What was I doing wrong?  Did I have a bad doc or team?  How come I needed a peg tube, more surgeries, etc?  Was I being a wimp?  I don't have the answers to specifics but this is what I know:  ten years later, I am alive and healthy.   It took time, a lot of it, and some trial and error.  As people say, recovery can be a process of days, weeks, months, or years.   We are all different and should try anything available to use to recover and maintain ourselves to our optimum.  So if 90% of larys don't use a suction machine, I'm in the 10% that does, at least occasionally; if 90% use saline, I'm in that 90%.   My advice is to listen to other larys but don't depend on them to be able to decide your own road to being the best you can. We keep on learning.

Where I still live, in that rural area on the coast of Washington, we were hit by a horrendous storm;  I thought it would never end. 40' waves and gusts up to126mph.   The ocean roared, I thought of tsunami, of drowning.   Trees and telephone poles were down, cutting us off from the rest of the world.  Since every year, we have several power outages lasting 4-12 hrs, I was prepared for that. 

I heat by wood, have a crank radio, batteries,  food, candles, board games--all set.  I use a digital Servox as my primary, nondigital as my backup, speech mode.  I don't particularly like the sound I make, but it has been my choice of speech the last few years.  I keep them in the charger when not in use, so they were both charged up when the electricity went out.  After the storm passed I was amazed to find my house intact and the huge pines surrounding my house firmly rooted but it was clear that clean up and restoration of power was going to take time.  The news said 1-2 weeks.  Since I don't live in an urban area, two weeks was probably my time frame.  Fortunately our water supply wasn't compromised as it was in other parts of the county.   I conserved my talking, using hand and my very limited esophageal speech.   I am one of those who uses a suction machine every now and then.  I had been on antibiotics for a bacterial infection in my lungs  for three days and had been suctioning the extra mucus.  

My digital servox was red lite--no voicing; my nondigital was very weak.  I was trying to decide if I should go to one of the shelters that was operating off a generator and ask them to charge batteries for me but felt that they had such limited resources that I shouldn't bother. Only a week had passed when we got back electric power (and a nice warm shower!). I kind of think of it as an extended camping trip to nowhere.   This is what I learned: My Servox quickly charged up enough to talk and my voice was strong and great to have!   I need to remember, that during those times when I'm tired of the Servox "voice".  I am so fortunate to have it. But I also need to consider stepping up on trying to learn esophageal speech or buying the extender for the Servox to use 9v batteries (and then remember to keep 9v on hand.)  I don't need a suction machine. It is helpful, but not necessary; ditto my humidifier (although I always keep a pot of water on the stove).  A pen flashlight to look down my stoma is absolutely necessary for me and also helps me find the bathroom in the dark. Also, I admit that I am totally computer dependent.

When I have read about catastrophic events like Katrina I wondered if I could have survived as a lary.  Although my inconvenience was only a week, what I know now is that I could survive and still take good care of myself.  Being a lary has not only become normal over the last years, it's a piece of cake.  My biggest task now is figuring out what I want to accomplish in the next 20 years.  




Hints from WebWhispers.org Library and Email List


1. I have difficulty swallowing pills and found some chewable vitamins that I like. The multi-vitamin (2 a day) is from GNC . Another I like in chewable is calcium/magnesium Nutrical Hearts from Nature's Plus which I get at the Health Food Store. Vitamin C comes in all flavors of chewable. Powders that mix and make a drink are also neat and easy.
2. I also have another idea which I do. I take powered brand All One Multiple Vitamins & Minerals. I mix mine with milk or strawberry milk. Its a very complete vitiamin and they have one kind for seniors.
3. Here is a hint for people who cannot swallow large pills, such as calcium or multivitamins. I was working hard at crushing them, even with a mortar and pestle. This took hard work to pulverize them until I had a brainstorm, and took out my mini food processor and VOILA, in no time flat I was ready to mix in applesauce. In 15 minutes I can do enough for a week. I put my daily dose into saved sealable small prescription containers. I do one day at a time, so I don't miscalculate the accurate daily dosage. This job is now easy and effortless.
4. Capsules can be opened and poured into a hollow in a spoonful of apple sauce or pudding.
5. My capsules for Prilosec (or the capsule generic) are full of little granules. I use a teaspoon, snip part of the way through the middle of the capsule with sharp pointed scissors, then break it open and let the granules fall into the teaspoon. I usually use the teaspoon to pour the granules on the back of my tongue and take a swallow or two of water...and they are gone.
6. This is something I learned myself so possibly is already practiced. I used to only use water to wash down food or medication after putting it in my mouth. I now take a pre-food or pre-medication sip, which pre-lubricates my tract and then wash down with more water, if needed. The food or tablets have been going down well.
7. This is just a helpful hint if you get a pill stuck. Yogurt (plain or without chunky fruit) will help dislodge the pill. Hope this will help! It worked for us.
8. I like all these ideas for swallowing pills. You may also use a pill chopping device, which I bought at a small local pharmacy, or a mortar and pestle to grind them like I did in the early days when I had a feeding tube. I've even put them in water, but the doc says not to do that because they lose their effectiveness. Because I did not know about the chewable/liquid vitamins from the health foodstore at first, I took generic children's chewables, which were cheaper, anyway. They don't pack as much punch, though.
9. One small caution about crushing medications. There are a number of them which are of the time-release type and are designed to gradually release the medication over an extended period of time. Some are stomach irritants and are designed to dissolve in the intestines. One way to rule this problem out is to ask your pharmacist if any of your medications are of the time-release type.
10. I take about 11 pills a day...some quite doozies in size. This is what works for me: pop the pills into the mouth, preferably "coated" with yogurt, Jell-O or pudding, tuck in my chin, place my tongue behind my bottom teeth and swallow hard. I drink water in-between and afterward. I do have one pill I take with milk because of the size and irritation to my throat. When I get one "stuck", I take a bite of cracker or cookie (guess which I prefer). Pills also slide down easy with Pasta or smashed ?potatoes.
11. Check out your drugstore. They now have inexpensive gadgets that will cut pills in half or quarters (cut, then cut again). They also have one to crush pills.
12. Buy some drinkable aloe vera and sip an ounce twice daily. I had problems with swallowing but they have improved a lot since I started the aloe vera routine. I am using the Lily of the Desert brand from the health food store but I am sure that others would work as well.


We add to hints in the Library regularly, so please check:


Kirklin Clinic Head & Neck Support Group
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.




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