Internet Laryngectomee Support
Winterizing our Stomas
Like to plan ahead? If so, you might want to mark your
calendars for June of 2003. The Voice Institute begins on June 24th, with
the AM beginning on the 26th. Both conclude on June 28th.
Poet T. S. Eliot began his classic poem "The Waste Land" with
the line, "April is the cruelest month." But many laryngectomees would
nominate one of the winter months as tougher on us. The reason is all of
that cold and dry air.
Colder air cannot hold as much moisture, so both the outdoor
and indoor air tends to be drier during the winter.
In addition to
furnaces drying out indoor air, most people set the indoor temperature
approximately ten degrees cooler in winter than in summer. We have also
learned that our breathing system works best with air which is at 100% relative
humidity and about body temperature, 98 degrees Fahrenheit (27 degrees Celsius).
So the cooler and drier air of winter is likely to produce
that tight feeling in the stoma area, increased mucus production as our system
tries to protect the linings of our tracheas and lungs from drying out by
producing more, and cracking and even some bleeding in our tracheas and the
bronchial passages within our lungs.
Many laryngectomees cope with winter by running a portable
humidifier indoors or making sure the humidifier attached to a furnace is
operating properly. Monitoring indoor humidity can also
be done with a fairly inexpensive gauge (see
http://www.webwhispers.org/news/dec2000.htm). But increasing the
humidity past 55% is unhealthy, so many laryngectomees also increase humidity at
the stoma level by either dampening a cloth or foam stoma cover, or wearing an
HME (heat/moisture exchange) filter which works by retaining moisture in the
lungs from escaping via exhaled air.
But coping with the humidity issue is just half of the
problem. What about the temperature of air as we venture into the great
outdoors? WebWhispers member Margo Ziegler, who knows something about
winters since she lives in Minnesota, offers this tip:
by Margo Ziegler
I am not a laryngectomee, but do have a trach and have some
similar stoma problems that laryngectomees have. One is the problem of
being out in the cold weather. And, because I have muscle spasms in my
cold air really affects my being able to breathe in the cold. A
friend of mine made a suggestion which I tried over the weekend and I want to
pass it along in case it might benefit someone out there.
I heated up my BedBuddy (a device I normally wear around my
neck for neck ache) in the microwave. I then wrapped it around my neck
with the warm part just under my trach. I then wrapped a large winter
scarf in place to hold it in position. Then I put on my regular winter
gear and was able to be outside in the cold (temp. 27) for 25 minutes!
I never have been able to do that since my trach was put in
back in 1996. The longest I was able to be outside at that temp. was for
about 10 minutes and my spasms would start up and close off air. I know
the extra 15 minutes may not seem like much, but it was great for me to last
that long outside playing with my dog.
It was a GREAT help to me and possibly will be for someone
out there. BedBuddies are sold all over. They are like a bean bag
type thing for wrapping around various parts of your body. Good luck and I
hope this might help someone who suffers from the cold air like I do.
Margo can be reached at
Radiation and Fatigue -
"Q: I am going to start radiation next week. What should I expect, and what can
I do to decrease the fatigue?
A: Fatigue related to radiation treatments usually starts
about the 2nd or 3rd week of treatment, and may continue for up to 3 months or
longer afterwards. It is important to take good care of yourself.
This means eating a well balanced diet, drinking lots of fluid, sleeping well at
night, and doing exercise as tolerated, such as walking regularly. Once
you start feeling fatigued, then you should match your activity to how you feel.
You should identify the activities or tasks that you have to do, and ask someone
else to do the other tasks." (From
IAL 2003 Meeting Set for
A local joke is that if you go to heaven you will first have to
change planes in Atlanta. But since Atlanta is a major airline hub
outstanding airfares should be available for those who will fly in.
The headquarters hotel is the Sheraton Colony Square in the
heart of downtown Atlanta. The Greater Atlanta VoiceMasters club is the
host group, and with all of the talented people in this club it is a guarantee
that the convention will be an outstanding one.
Laryngectomees Lose Two
Pioneers - Paul Schriffignano and Elsie McQueen Chapman
The laryngectomee community recently lost two of our
pioneers, Paul Schriffignano of New Jersey, and Elsie McQueen Chapman, longtime
resident of San Francisco, but living in Arizona at the time of her death.
Paul Schriffignano became the second Executive Secretary of
the International Association of Laryngectomees in 1976 following the retirement
of Jack Ranney. The title was changed to Executive Director in 1986, and
Paul served in that capacity for several more years. At the time of his
laryngectomy, Paul was a police captain.
Elsie McQueen Chapman worked with Hazel Waldron, Teckla Tibbs,
and Mrs. I. E. Tenholder in establishing the first IAL fashion show which was
held at the 1963 IAL Annual Meeting. In later years it evolved into the
IAL "Fun Show," which continues today. She was also an outstanding
esophageal speech teacher and served in this capacity to laryngectomee, and now
SLP, Joanne Fenn, who had become a laryngectomee at age three.
Both Paul and Elsie lived into their eighth decades of life
and contributed much to the cause of laryngectomee rehabilitation.
Rehabilitation and HMEs
For decades, the concept of "total laryngectomee
rehabilitation" has been the dominant ideal and goal for laryngectomees in the
U.S. and elsewhere in the world. Additionally, there is evidence that some
form of the concept has existed for as long as people have survived the surgical
removal of their larynges. It is the clear focus of organizations like the
International Association of Laryngectomees and can be seen in the IAL Bylaws:
"Each member organization shall
cooperate with quasi-medical agencies and organizations whether they be public,
private or government, if they are able to assist in the total rehabilitation of
laryngectomees." (Article IV, Section C, Number 6.)
"To explore programs and projects
designed to improve communication skills and lead to the total rehabilitation of
laryngectomees." (Article VIII, Section A, Subsection 6,
Rehabilitation Committee, Part a.)
"Total laryngectomee rehabilitation" (TLR) seeks to return
laryngectomees to as much of the lives they enjoyed before losing their larynges
as is possible for each individual. Voice restoration has been a primary focus,
but psychological, social and vocational rehabilitation have also been themes
linked with the TLR concept.
Two other goals have been less prominent in the United States
than in Europe, and these are the restoration of the ability to smell and
improved breathing function. While the U.S. has been a pioneer in voice
restoration through the development and refinement of artificial larynges and
the TEP (tracheo-esophageal puncture) prosthesis, it has lagged behind developed
countries in these two areas. And it is to respiratory rehabilitation that
HME (heat/moisture exchange) filters have been designed to address.
Heat/Moisture Exchange (HME) filters are a type of stoma
cover which help laryngectomees partially restore functions previously performed
by our noses and upper airways. They might be thought of as "artificial
noses." As the name implies, an “exchange” of heat and moisture occurs in
the HME filter as a laryngectomee inhales and exhales. During exhalation,
warmth and humidity are conveyed from the lungs and deposited into the filter.
During inhalation, the warmth and moisture are picked back up by incoming air
and returned to the lungs.
HMEs are receiving more attention in the U.S. as the results
of research which has been conducted in several European countries becomes more
widely known, and certainly because they are now covered by Medicare.
Before the laryngectomy, the upper half of the breathing
system filtered, humidified and warmed incoming air. It also provided
resistance so that the lungs fully inflated. This helped maintain lung
capacity, and facilitated an efficient exchange of gasses in the lungs (oxygen
added to the blood stream and carbon dioxide removed). Prior to the
laryngectomy, by the time the inhaled air reached the lungs it was saturated
with moisture and its temperature was close to the body temperature of 98
degrees Fahrenheit (37 Celsius). Air at 100% relative humidity and 98
degrees is ideal for oxygen/carbon dioxide gas exchange. After the
laryngectomy, the incoming air was dirtier, drier and cooler.
The resistance function of the nose and upper airway might be
a little more difficult to understand than dirtier, drier and cooler air and the
problems those produce for laryngectomees.
Prior to the laryngectomy, the nose provided 80% of the
resistance to breathing; with the mouth, larynx and trachea providing the rest.
By providing resistance the lungs had to move air a further distance, and past
curved and sticky mucus covered surfaces which resisted the air flow. This
consequently made us "work" harder to breathe. We had to breathe more
deeply to move the amount of air we needed. This helped maintain lung
capacity (the volume of air our lungs could hold), and the efficiency of the gas
exchange in the lungs where oxygen is added to the blood stream and carbon
dioxide is removed. The quantity of oxygen in the blood of laryngectomees
is measurably reduced if they do not compensate for the loss of resistance.
And our breathing efficiency typically declines, particularly in the months
immediately following the surgery.
All laryngectomees can use an HME regardless of their method
of speech. There are basically two different types of HMEs, and two major
ways to attach them to the stoma. One HME type is designed for TEP
prosthesis speakers who cover their stomas (occlude) with a finger or thumb in
order to speak. This same type filter can be used by traditional
esophageal speakers or those who use ALs (artificial larynges). It
consists of a housing and a filter.
A second type of HME is for TEP prosthesis speakers. It
combines the HME filter with a hands-free valve. The hands-free valve
closes when the TEP prosthesis user exhales, and air is redirected into the
prosthesis without having to cover the stoma with a finger or thumb (hence the
There are two basic ways to attach an HME or HME/hands-free
valve combination. In one, the housing is glued to the skin around the
stoma, and the HME snaps into the circular hole in middle of the housing.
Some systems have reusable housings and the user applies the
glue in liquid form to the housing and then lets it dry. Other housings
are pre-glued and are disposable after using them for a day or two.
In either case, the skin surface around the stoma is first
cleaned in order to get good adhesion. Many use rubbing alcohol for this
purpose. Some of those with sensitive skin also use a product such as
“Skin Prep” or “Skin Shield” as a barrier between their skin and the housing
glue. Several suppliers have pre-glued disposable housings which use
special formula glue for those with sensitive skin.
A second method for using an HME filter is to combine it with
a laryngectomee tube (vent, button). Two laryngectomee tubes/vents/buttons
which are designed to accommodate an HME filter are the Lary Tube from ATOS, and
the Barton-Mayo Button from Bivona and InHealth. The Trachi-Naze Plus system combines a
lary tube with a finger occluded HME. Both the ATOS Provox filter cassette HME
and the InHealth Blom-Singer HME fit into these tubes. (See
"Hands-Free/Glue-Free" article in the October 2000 issue of the WWJ for more
details about using the hands-free valve with the Lary Tube or the Barton-Mayo
In addition to helping maintain the cleanliness, temperature,
humidity and resistance to the air we breathe, HMEs have other benefits.
In addition to mucus reduction, another of the most important of these is that
many laryngectomees who speak via the TEP (tracheo-esophageal puncture)
prosthesis report that their voicing is improved through the use of the finger
occluded HME or the hands-free valve/HME combination. In the case of the
finger occluded ones, it takes less pressure to get a good seal around the stoma
to get a good and loud enough voice, and less pressure is applied to the entire
area. This often results in speech being easier to produce as well as more
clear to your listener.
Heat/moisture exchange filters (MHEs) need to be tried for a
period of time. Using them continuously for at least one week is the
minimum time they should be tried. The reason is that unless you just had
your laryngectomy, you have gotten used to the lack of resistance to air moving
in and out of your stoma. You may find the initial experience a little
unpleasant and feel that the HME is restricting airflow. It is, but in
beneficial ways. It takes time to get past this sensation and for you to
adjust to it.
But in addition to this feeling, it also takes time for the
HMEs to demonstrate some of their most important benefits such as reduced
coughing and mucus production. And these benefits are unlikely to become
obvious to you for a week, or even longer. A major mistake would be to try
them for a day or less and conclude that they restrict your airflow.
Research has shown that laryngectomees are more likely to stick with the use of
HMEs if they are introduced right after the laryngectomy. The longer we go
without using anything which provides resistance the more difficult it becomes
to stick with them. We have simply gotten used to less restricted airflow
and the sensation of having to work harder to get air is felt by many to be
uncomfortable until they have adjusted to it.
Those with breathing problems such as COPD (Chronic
Obstructive Pulmonary Disease), emphysema, asthma, etc., should not try an HME
without approval from your MD. But trying them has been made easy since
the three major HME producers will send you a free sample kit of their HMEs (but
not the hands-free valve/HME combinations) upon request.
If you wish to try them, you might consider trying those
which have the least resistance first, and then move to those with greater
resistance. This would suggest trying the Blom-Singer (or ATOS HiFlo
cassette) first, and then to the ATOS Regular cassette, and finally to the
Kapitex filters. The Kapitex nighttime filter provides the greatest
resistance, so it should probably be tried last after you have gotten used to
the feeling of added resistance to air flow, and it should only be used during
HMEs cannot completely restore the functions of the nose and
upper airway in conditioning the air we breathe to the standards we enjoyed
prior to becoming laryngectomees. They can, however, make a significant
different in reducing coughing and excessive mucus production, and deliver a
better quality of air to our lungs than the alternative stoma covers. They
can also make a noticeable improvement in voicing for many, and they can help
maintain lung function. While some laryngectomees will decide that they
are not worth the additional hassle of using them or their cost, every
laryngectomee should at least consider giving them a fair trial.
Warnings Effective in Canada
Full-color graphics of how cancer affects the mouth, lungs,
heart and brain had made more than half of Canadian smokers think more about the
health effects of smoking. This is according to a research study conducted
under the auspices of the Canadian Cancer Society. And these images have
also played a significant role in the decision by 38% of smokers who attempted
to quit in 2001.
The graphics cover half of both sides of each pack sold in
Canada. Images include pictures of a diseased mouth, a brain after a
stroke, a damaged heart, a lung tumor, and even a limp cigarette which warns of
smoking-caused impotence. Warnings inside each package offer tips on
quitting. The warnings were begun about a year ago and replaced written
messages similar to cigarette package warnings in the United States.
Smokers and nonsmokers identified the warning depicting a
diseased mouth and the picture of a lung tumor as most effective at discouraging
Similar bills were introduced in the United States in 2000 by
U.S. Sen. Frank Lautenberg, D-New Jersey. But he has since retired and the
proposal has not come before Congress under the Bush administration.
However, following the release of the Canadian study two members of the House of
Representatives, James V. Hansen, R-Utah, and Marty Meehan, D-Massachusetts,
said recently that they will introduce legislation to require larger
picture-based health warnings on U.S. tobacco products.
The World Health Organization is examining picture-based
warnings as a possible worldwide requirement through an international treaty,
and Brazil and the European Community are looking at the idea.
According to the Reuters news service, cigarette companies,
which are severely restricted on where and how they can advertise their
products, have resorted to desperate tactics to get around the laws. These
included setting up a smoking tent in Toronto's financial district last summer.
The tent featured comfortable chairs, television and air conditioning. Two
cigarette manufacturers have introduced in-store display racks that try to cover
up the warnings, while one firm attempted to market containers of tobacco which
do not show the graphic images.
Smokers have also started Internet sites where less graphic
labels can be downloaded and used to cover the ones on the cigarette packs.
An image with a smiley face describes smoking as cool, while a skull and
crossbones picture says happily that "smoking preserves meat."
(Basic information for this article came from CNN and Reuters.)
by Judy Greiwe
Welcome New Members
We welcome the 21 new members who joined us in January 2002:
New Orleans, LA
|Jill Cochran - SLP
|Jennifer Conway -
Cave Spring, GA
Lady Lake, FL
Zimmerman George - Vendor
West End, NC
|Antje Hinrichs - SLP
|O. Allen Kingen
Crystal Lake, IL
Sherrills Ford, NC
Havasu Lake, CA
Staten Island, NY
As a charitable organization, as described in IRS § 501(c)(3), the
WebWhispers Nu-Voice Club
is eligible to receive tax-deductible contributions
in accordance with IRS