Internet Laryngectomee Support
December 2002

Nat Quick - Laryngectomee Artist

    He just could not catch his breath.  That was the problem.  Unlike so may laryngectomees who begin with a sore throat and hoarseness which won't go away, for Nat Quick of Petaluma, California, he just could not seem to be able to catch his breath.  He initially wrote it off as too much smoking.  But it kept getting worse.

     It got to the point where he could not walk across a room without having to sit down to catch his breath.  Finally he was rushed to the hospital after passing out.  The initial diagnosis was a probable lung infection.  But a few days later, in February, 1997, a laryngoscope showed the need for emergency surgery.  As luck would have it, ENT surgeon Dr. Mark Singer (co-inventor along with Dr. Eric Blom of the modern TEP voice prosthesis), was on call that Saturday.  Although he did not know it at the time, he subsequently discovered that he could not have been in more capable hands. 

    After the surgery Nat also worked with and befriended Dr. Singer's SLP (Speech-Language Pathologist) colleague, Dr. Carla Gress (who has subsequently moved from California to Virginia).  Nat did not speak for seven months and was limited to what he could write down on a tablet.  But then, after passing the insufflation test* to see if he was a candidate for the TEP, Dr. Singer did his puncture procedure and installed his prosthesis.  He was fortunate to be among those who speak immediately

     Francis Nathaniel Quick, Jr., known to all as just "Nat," was born in 1942 in Sumter, South Carolina.  He was clearly destined from the beginning to be an artist.  At the age of four, he won the unofficial "Mom's List for Pencil Drawing Award" for his rendition of a "B29 Super Fortress Bomber on Bed Sheet."  His love of art, planes, and other things mechanical was clearly evident from the very beginning.  Nat had a natural mechanical aptitude and that special insight to be able to visualize two dimensional objects in his mind in three dimensions.


    Nat trained for three and a half years as a machinist and was a tool and die maker.  He worked in that occupation for six years.  But art continued to be his passion. 

     Nat's artwork has been extraordinarily varied.  In addition to canvas, his creations have appeared on automobiles, helmets, corporate stationery, magazine covers, leather jackets, uniforms, signs, album covers, walls, concert posters, business cards, t-shirts, and even airplanes.  His satisfied customers include Don "Big Daddy" Garlits, Kenny "Bud King" Berstein, Raymond "Blue Max" Beadle, Don "The Snake" Prudhome, Shirley Muldowney, John Force and Mickey Thompson are among those whose race cars have displayed his art designs.  Other happy customers have included the rock band "Jefferson Starship" (renamed from "Jefferson Airplane"), Frank "Dago Red" Taylor and his racing airplane, an automobile dealership, Revel Models, and many others.


     Nat has worked on a number of commissioned works depicting moments in World War II aviation history including the famed "Black Sheep Squadron" (see "Black Sheep in the family - Fred Losch" in the May 2002 issue of the IAL News, http://www.larynxlink.com/Main/newslett.htm).  He is currently working on a painting which depicts the 1943 shooting down of one of the bombers in which Japanese Admiral Yamamoto was traveling after the U.S. had broken the Japanese code and learned of his travel plans.  The shooting down of the plane was viewed as "payback" for the role the Admiral had played in the attack on Pearl Harbor.  The painting depicts one of the Japanese bombers going down after being hit by gunfire from Captain B. F. Holmes' P38G "Lightning" fighter near Bougainville Island in the south Pacific.

    Concerning how life has changed for him since becoming a laryngectomee, Nat replied, "I am in better shape now than ever" (having quit smoking, etc.)  "I have met some wonderful people I never would have met, and many positive things have happened to me."  "I am blessed."

Nat Quick can be reached at n.quick@comcast.net

* An insufflation test is conducted by an ENT physician prior to the TEP (Tracheo-Esophageal Puncture) surgery.  The TEP surgery creates a passageway between the trachea (from just inside the stoma,) and through to the esophagus.  A prosthesis, which is simply a small hollow silicon tube with a one-way valve on the end which is in the esophagus, is then installed in the puncture tract.  With the insufflation test, air is injected down the patient's nose via a tube connected to his or her stoma, or mechanically by a pump.  The goal is for the patient to direct this air upwards to vibrate the upper part of the esophagus.  If unsuccessful, additional work may be required to relax the muscle surrounding the esophagus, etc.  See graphic and expanded explanation of the insufflation test on page 14 in the September, 2002, issue of the IAL News, http://www.larynxlink.com/Main/newslett.htm.

Summary of Head and Neck Cancers - Larynx Cancer

    An article appearing in the November issue of the Cancer Control: Journal of the Moffitt Cancer Center by Muhyi Al-Sarraf, MD, summarized the treatment during the last decade of locally advanced head and neck cancers including cancer of the larynx.  Despite the fact that the incidence of head and neck cancers has generally increased over this time period, overall survival rates have improved as has quality of life along with the preservation of organs including the larynx.  One encouraging statistic is that patients with head and neck cancers have enjoyed the greatest decline in mortality rates for cancer during the period 1990-1997.  Further improvements are expected as a result of the development of new chemotherapy drugs, drug combinations, combinations of drugs given along with radiation therapy, treatments which better target just the tumor, and better sequencing of various treatments.

     The drug cisplatin enjoys widespread use in combination with radiation since it acts to make cancer cells more vulnerable to radiation and since it has fewer side effects than many of the alternatives.  Some other cancer drugs have mucositis (inflammation of the mucus membrane such as in the trachea, esophagus, or stoma) as a side effect.  Dr. Al-Sarraf reports that at the present time cisplatin given by itself on a three week schedule is the most common drug given in combination with radiation in the U.S.  Another common drug given along with radiation is carboplatin. 

    For patients with inoperable cancers (called unresectable tumors), the standard treatment is now chemotherapy along with radiation.  Radiation alone has been shown to be inadequate.  Many treatment centers give an initial dose of chemotherapy, and then combine radiation with chemotherapy. 

     The conventional treatment for advanced larynx cancers was surgery or combination of surgery and radiation.  Dr. Al-Sarraf reported that patients who respond well to a cisplatin-based combination chemotherapy continue to respond favorably to radiation therapy.  However, those who do not respond to the chemotherapy also tend to not respond to radiation.  As a consequence, he and his colleagues offer chemotherapy first to patients with advance stage larynx cancer.  Those who do not respond go immediately to surgery.  He concluded by stating that induction chemotherapy (given initially) combined with concurrent chemotherapy along with radiation was the best non-surgical approach to dealing with later stage larynx cancers. 

    It should be remembered that Dr. Sarraf's report applies to later stage tumors and not stage one cancers where radiation has been a successful treatment when used by itself.

Cancer Sucks!
by Tammy Wigginton, CCC/SLP

     The other day I was telling a colleague that a mutual laryngectomee patient of ours was going to have a biopsy next week. The doctor observed a "suspicious" growth during her routine otolaryngology follow-up.  My colleague said, "Oh that is so sad, so unfair.  You know she never even smoked."  I didn't say anything at the time, because frankly I didn't trust myself.  However, I thought to myself "If she had been a smoker would the circumstances be somehow less sad?"  I find I am equally saddened when a person is diagnosed with laryngeal cancer regardless of his/her social history. 

     It seems the general population, and perhaps even health care workers, have less empathy for head and neck cancer patients/survivors than they do for other cancer patients.  This seems very unfair to me in light of the fact that we have all made poor lifestyle choices that may or may not negatively affect our health somewhere down the road.  We all know tobacco is unhealthy.  We all know we should avoid excessive alcohol consumption.  We know we should exercise, watch our diets, get at least eight hours of sleep at night, drink eight glasses of water a day, reduce our stress, and get annual checkups.  Yet, how many of us always do exactly what we should do?  Not many of us, and I include myself.  How many of us know people who reportedly had "healthy" lifestyles and developed some sort of cancer anyway?  How many of us know people who make all the wrong lifestyle choices and yet manage to outlive most of their friends and family with "healthy" lifestyles?

     Many people would like to believe they will never have to worry about throat cancer because they do not smoke and they drink in moderation.  Yet, I have seen plenty of laryngeal cancer patients who quit smoking thirty years ago or who never smoked or drank alcohol at all and "mysteriously" developed throat cancer.  Minutes into a preoperative consultation, people have informed me "I never smoked!" as if to imply, "God or the Universe has made a terrible error."  "I don't deserve throat cancer.  Only smokers get throat cancer."  I have also counseled people who have made unfortunate lifestyle choices that may have contributed to the development of their throat cancer.  Many of these people hang their heads in shame and tell me "I smoked a pack a day for 30 years."  This implies to me that they feel as they are "being punished by God or the Universe" and they feel as if they "deserve throat cancer."  As far as I am concerned, in the "laryngeal cancer boat" there is no "nonsmoking or "smoking" sections.  All laryngeal cancer patients are in the same boat and deserve the same degree of empathy and compassion regardless of their tobacco/alcohol history.

     Over the years I have observed my head and neck cancer patients in the company of others.  Without fail they are asked, "Did/do you smoke?  Wouldn't it be nice if life were that easy?  I don't think laryngeal cancer patients should feel any more or less guilty than any other cancer patient.  In general, only head and neck and lung cancer patients are expected to respond to smug questions by nonmedical personnel regarding their tobacco history. Does the general population ask breast or prostate cancer patients "did you smoke?"  Do people routinely ask colon cancer patients whether or not they "ate plenty of leafy green vegetables?"  No!  That would be considered impolite and very insensitive.  However, it is perfectly acceptable for a complete stranger to ask a laryngectomee "were you a smoker?", i.e., "Isn't it YOUR OWN FAULT that you developed cancer and lost your natural voice?"

     Unfortunately, or fortunately, cancer is not fair.  Cancer is just a disease, not a social indictment or punishment.  If we all got exactly what we deserved based upon our lifestyle choices more than a few of us would be down at the cancer clinic and/or the free clinic on a routine basis.  NOBODY deserves cancer no matter what lifestyle choices he or she may have made.  Do smoking and excessive alcohol use contribute to the development of laryngeal cancer?  We believe it does.  However, there are also other factors involved in the development of cancer: heredity, exposure to environmental toxins and irritants, gastroesophageal reflux disease, etc.

     My general advice to my smoking laryngeal cancer patients is: "Nobody deserves cancer.  If you have made poor lifestyle choices, forgive yourself.  Concentrate on your recovery.  Make better lifestyle choices and begin today by putting your past behind you.  Guilt is a useless emotion.  It is a waste of energy and will hamper your recovery.  Focus on the positive.  " I give my nonsmoking/non-drinking laryngeal cancer patients pretty much the same advice: "Nobody deserves cancer.  Don't waste a lot of energy trying to figure out "what you may have done wrong" or "what may have caused this."  We may never know.  Continue to make healthy lifestyle choices and continue now by putting worry behind you.  Worry is a useless emotion that will hamper your recovery.  Focus on the positive." 

     When someone asks me about the tobacco history of one of my laryngectomee patients/friends, I ask them "does it really matter, because cancer is cancer."  A new laryngectomee friend of mine has a bumper sticker on his car that really sums it up: Cancer Sucks!

Tammy Wigginton is a speech/language pathologist at the University of Virginia Medical School in Charlottesville, Virginia, and she is a member of the International Association of Laryngectomees Board of Directors.  She can be reached at Tammywigginton@cs.com


The Other Artificial Larynx- the Pneumatic

     The word "pneumatic" comes from the Greek word pneumatikos, meaning air or breath; pneumatic devices are those powered by air, and pneumatic artificial larynges are powered by the exhaled breath of a laryngectomee. 

    The cup-like part of the pneumatic AL is put over the stoma and you breathe out.  Your exhaled breath vibrates a reed or rubber diaphragm and a tone is produced.  This tone is then transmitted via a vinyl tube into the back of your mouth.  You then use your teeth and tongue as usual to form the various sounds of speech.  This is the same idea as the electric larynx which conveys the electronically produced tone into your neck or mouth via an oral adapter or from an intraoral AL such as the Cooper-Rand.  But you produce the tone by supplying the air pressure to vibrate the reed or membrane.

     Probably the best known pneumatic artificial larynx is the "Tokyo."  The story is that an American laryngectomee member of the merchant marine, Al St. Germaine, got the idea by playing around with a party noise maker and tubing.  He took the contraption he had invented ashore in Japan and found someone interested in further developing and producing it.  The "Tokyo" is technically a far cry from his original idea, but its design has survived through the years and been widely imitated.

     When it was available, the Tokyo cost over $100.  As far as we know and at this time, the Tokyo is no longer available in the U.S.  The previous distributor, Clyde Welch in Iowa, retired.  A significantly less expensive pneumatic costs about $30, but is currently only available in Japan.  At the present time the only pneumatic AL readily available in the U.S. is the ToneAire II from Communicative Medical.  The current sale price is $50.



     Some of the advantages of the pneumatic include that they are initially inexpensive and continue to be.  There are no batteries to buy or expensive replacement parts such as with the TEP.  The pneumatics also tend to be louder than unamplified TEP speech.  A major advantage of the pneumatics over electronic ALs is that to use them requires lung power.  Unlike electronic ALs, regular use should help retain breathing capacity.

     The major disadvantages include that, unlike the TEP, it is conspicuous.  Even with the bell shaped part concealed under a cloth stoma cover, it is obvious that it is being used.  It also cannot be used hands-free, and your hand always holds the cup-like part as you cover the stoma to speak, and then lift it to breathe.  Another disadvantage is that the ability to articulate clearly with the tube in your mouth is challenging.  Perhaps your mother or teacher told you to not speak with something in your mouth and any AL which requires a tube in the mouth presents this problem.

     But certainly the pneumatic AL is an interesting alternative form of alaryngeal speech, and may be attractive to some as a back-up.    Click on the photo of John Chaloner to the left to hear him use the pneumatic AL.  The sample reflects his distinctive Australian accent.  Like any other artificial larynx, the pneumatic will convey whatever your accent or dialect happens to be.

     You can see the ToneAire II at http://www.communicativemedical.com

(Photo of John Chaloner and the voice sample are courtesy of Communicative Medical. Tokyo photo is courtesy Clyde Welch, and the AL from Japan is courtesy of Ichiro Takemoto)
 

Welcome New Members 

     We welcome the 23 new members who joined us during November 2002:

 

Stanley Bates
Winston-Salem, NC
esrobot@bellsouth.net
Ronald Batty
Balderton, Newark, UK
  ronald.batty@ntlworld.com   
Bernard Beetles
Fleetwood, Lancashire, UK
bernardwbeetles@onetel.net
Michael Capelle
Elmhurst, IL
mjcap12@addressisp.com
Tom Clark
Channahon, IL
TGCL47@aol.com
James Cochran
Olive Branch, MS
  lighthouse_ms@msn.com   
Maurice Cullen
Macroon, Co. Cork, Ireland
cullen4@eircom.net
Bryan Edmands
Leeds, W. Yorkshire, UK
Bryanedmands@aol.com
John Egan
South Orange, NJ
tillou305@cs.com
Elizabeth Farrant
Cowley, Oxford, UK
lizfarr@ntlworld.com
Mary Glisson
Bainbridge, GA
scamper@vol.com
Tony Hicks
Liverpool, UK
Jim68Jan234@aol.com
Arthur Jacobs
Omaha, NE
lindjac1@aol.com
Dr. Peter Lee
Northwood, Middlesex, UK
Leeonics@aol.com
Gloria Lokos
Lacey, WA
glorialokos@msn.com
Gerald Moore
Redford, MI
ghmoore@mailstation.com
George Olsen
Gardnerville, NV
olsenbng@pyramid.net
Venus Radford - Caregiver
Terrace, BC, Canada
bugfly@telus.net
Mary Silvestri - Caregiver
Central Village, CT
myattsil@hotmail.com
Suzanne Walters
Buffalo, NY
TutuBapa@aol.com
Charles Wardell
Mesa. AZ
straw57berry@worldnet.att.net
Mike Warren
Spalding, Lincolnshire, UK
  mike@warren1847.fsnet.co.uk   
Mary Wegener
Chilliwack, BC, Canada
ahaus1923@hotmail.com
 

 


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