July 2010

Name Of Column Author Title Article TypeNews Views Pat Sanders Primary Purpose News & EventsVoicePoints Anna Choi-Farshi, MS,CCC-SLP Elements In Clinical Pathway Education-MedPractically Speaking Elizabeth Finchem Them & Us EducationMy Neck Of The Woods Elspeth Thomson Changes ExperienceTravel With Larys Pat Sanders IAL Annual Meeting & Voice Institute Travel (Photos)The Speechless Poet Len A.Hynds A Beachmaster Called Whispers Prose & PoetryNew Members Listing Welcome News & Events

Primary Purpose Our primary purpose is to provide practical and educational information and support by way of the Internet tolaryngectomees and to all persons diagnosed with or treated for cancer that affects the larynx or those who havesuffered damage to the vocal cords. We include caregivers in our membership. Support is directed toward creatingunderstanding, providing educational opportunities and rehabilitation assistance. Through contact with otherpatients, caregivers and medical personnel, we offer the opportunity to learn.

At our WebWhispers Dinner, I talked briefly about our primary purpose and explained that everything we do is

geared for that purpose. We don't ask for or get a lot of money and we spend little, but when we need somethingthat we think will advance our educational opportunities or communication with each other, the purse strings areopen. The main place you find this is improving our communication, archives, the website, or software.

Over the years, we tried to make changes when something didn't work as well as we hoped. We found someneeded changes by following the trend of what you were doing. When you left us or put yourself on vacationbecause you were getting too much mail, we started to note that hardly anyone left the one-a-day digest for thatreason, so without mentioning it to the list in general, we changed our method for new members coming in to enrollthem into the WW Digest list. It seemed to please most new members.

Because we could not get people to stop sending old messages attached to their letters (clogging up the archivesand digest mail), we signed on for a new feature that truncates the old message on 'most' email messages. If yousend one without a subject or with the whole digest number as the subject, the computer sends a message backletting you know that you need to do that over. Some people get offended and think the moderators wrote thismessage. No, we can blame that one on the computer catching your error in not having an appropriate title.

We get feedback from you and we try to understand what you need and plan how we can do it, if possible. We willfollow the rules evenly for all.

So enjoy your email list and/or the forum, where there is more latitude. Learn from each other and we will learnfrom you.

Enjoy,Pat W SandersWebWhispers President

VoicePoints written by professionals Coordinated by Meaghan Kane Benjamin, M.A., CCC-SLP meaghan.benjamin@mac.com

Elements in a laryngectomy clinical pathway

In the past 30 years healthcare facilities have faced continued pressure to adopt cost cutting measures. They havedealt with diminishing resources, while maintaining or increasing quality of patient care. Driving this process havebeen changes in hospital reimbursement. At the same time, complexity within the healthcare system has grownwith acceptance of a more multidisciplinary model of care, and a push towards standardization. Clinical pathwayswere adopted from models in the engineering and construction fields to meet the challenges of a changinghealthcare environment (Coffey et al 2005). The clinical pathway model is a way of conceptualizing the “best casescenario” for laryngectomee care, extending from the time of determination of surgery through outpatient care. Itaims to reduce costs, primarily by reducing length of stay (LOS) and readmission rates. As a result the post-operative inpatient recuperative period is shorter compared to 15-20 years ago. This decreases patients’ chancesof meeting goals for speech and swallow before discharge. Therefore, early initiation of speech therapy for pre-operative patient education and the speech pathologist in the home healthcare agency and/or rehabilitation facilityafter discharge have a greater role for to help the patient meet functional goals for communication.

Coffey et al., defined a clinical (or critical) pathway as “an optimal sequencing and timing of interventions byphysicians, nurses, and other staff for a particular diagnosis or procedure designed to minimize delays andresource utilization to maximize quality of care” (Coffey et al. 2005). It outlines assessments, tests, safety, activity,medications, patient and family teaching, discharge planning in a visual representation with a timeline. Clinical

pathways encompassed interventions across all disciplines in a comprehensive manner to conserve hospitalresources, standardize care, and to identify factors predictive of variances. Although research supporting criticalpathway efficacy has been mixed, their use is now generally accepted in healthcare.

At our facility, care of the laryngectomee is guided by the Massachusetts Eye and Ear Infirmary LaryngectomyClinical Pathway (MEEI LCP). The MEEI LCP was developed by staff in 1992 (Belkner & Craffey 2004). A numberof factors have influenced the MEEI LCP since that time. There have been changes in expectations for functionalreturn of communication and swallow, timing of placement of the tracheoesophageal puncture (TEP) prosthesis,changes in approaches to pharyngeal reconstruction, and changes in technology for post-laryngectomyrehabilitation. Perhaps the most significant change has been the LOS. When the MEEI LCP was established, theaverage LOS was 11 days; since then it has dropped to 6-7 days. As sequencing and timing of interventions havechanged according to the MEEI LCP, our practice patterns had to evolve to maximize successful outcomes forrehabilitation.

Although inpatient clinical pathways traditionally started from the time of admission or surgical procedure (Coffey etal. 2005), there are advantages in beginning teaching at the time of determination of surgery date (Chen 2000;Belker & Craffey 2004). Here at MEEI, whenever possible, a speech therapy session is scheduled on the samedate of pre-operative testing (i.e. laboratory testing, medical clearance), focusing on patient education, teachingand counseling, including a potential meeting with a laryngectomee volunteer. Caregivers are strongly encouragedto attend this session. At this time we may initiate the process for the patients to obtain their own electrolarynx. Ifthe patient is amenable, a tour of the adult inpatient unit is conducted and introduced to various members of themultidisciplinary inpatient team.

Typical practice at MEEI includes a primary tracheoesophageal puncture created during the laryngectomyprocedure. Insertion of a 20 French 12 mm sterile indwelling prosthesis (InHealth Technologies, Carpinteria, CA) isplaced by the surgeon. After recovery in the post-anesthesia care unit, patients are transferred to the intermediatecare unit (IMCU) for a typical length of 2 days. Primary patient care concerns usually are pain management,nutrition, communication, and emotional care (Belker & Craffey 2004). During this time patients receive humidifiedair via mist mask over the stoma, and stomal care by nursing. The patient may use a Provox laryngectomy tubewith neck ties or application of the Optiderm adhesive base with a heat moisture (HME) cassette (Atos Medical,Hornby, Sweden). The patient is NPO and receives enteral feeding through a percutaneous endoscopicgastrostomy (PEG) or nasogastric (NG) feeding tube. Depending on the patient’s alertness and/or pain level theclinician may briefly visit the patient and/or family to review plan of care post-surgery.

During post-operative day 2 or 3, ideally instruction of the electrolarynx with the intra-oral speaking tube is typicallyinitiated with review of education materials (i.e. instructional video and illustrations). Short therapy visits (i.e. 30-45minutes) every day, are optimal as fatigue and/or motivation are often barriers to active participation. Patients witha primary TEP placement receive a TEP dilator and/or a red rubber catheter, in case the prosthesis dislodges.Instructions for dilator insertion may be reviewed with the patient and written instructions are given.

At the time of discharge, usually on day 6 or 7, most patients are mastering voicing (i.e. “on/off” activation of theelectrolarynx) and speech intelligibility and cannot communicate at their maximum functional level. Continuedspeech therapy services are recommended after discharge to home through a home healthcare agency, or arehabilitation unit. The key function of speech therapy at this time is patient education regarding post-surgicalchanges to speech, swallow, respiration, gustation and olfaction. Goals may focus on increasing speechintelligibility and voicing with the electrolarynx with the intra-oral speaking tube towards a conversational level infunctional situations (i.e. over the phone, in a store). Specifics may include strategies for working with obstruents(plosives, fricatives, and affricates) and glottal fricatives or stops (Graham 1997). If the patients are dischargedhome at this time, they may leave prior to initiation of PO diet and need carry out their own with tube feedings,stoma care, and monitoring overall health.

At the initial post-operative follow up with the surgeon, the presence of pharyngocutaneous fistula is ruled out viaa barium swallow scheduled on the same day (Graville et al 2009). The patient ideally will visit with a speechpathologist at our clinic to review training on the electrolarynx if necessary, follow up on anyapplications/reimbursement forms for the electrolarynx that were given during the pre-operative period, and reviewtracheostoma care, stoma filters and HME systems, if not already in use. This visit provides the patient andcaregivers a forum to address any concerns or to gain additional help.

Once the surgeon has given clearance for use of the TEP prosthesis, we may spend several visits with the patientfocusing on finessing the stomal seal for adequate voicing, increasing intelligibility with TEP speech, and teaching

care of the prosthesis. Length and frequency of visits depend on the patient’s ability to learn and adapt behaviors,presence of social/familial supports, ease in achieving voicing with the neoglottis, and ease of reaching the facility.Training to use an HME system is important, not only for pulmonary health and rehabilitation, but also as a steptowards use of a secondary valve over the stoma to redirect the pulmonary airflow and bypass digital occlusionwith an Adjustable Tracheostoma Valve II (ATSV II) (InHealth Technologies) or Provox FreeHands HME (AtosMedical, Hornby, Sweden).

As discussed in several previous “Voicepoints” articles, the laryngectomy surgery may have a profound effect onpatient’s psychological well-being. It can be debilitating especially in terms of its effects on self-image due tochanges in appearance, voice, swallowing and social/emotional domains. Quality of life (QOL) instrumentationshould be incorporated into the clinical pathway as a way of monitoring patient’s perception and satisfaction enroute to successful return of function. Successful adjustment to post-laryngectomee changes takes time. Thespeech pathologist is in an ideal position to help identify barriers to rehabilitation, as they are a health professionalthat usually sees the laryngectomee on a consistent basis. During follow up with the speech pathologist QOLinstrumentation during stages of anticipated progress maybe beneficial for shaping goals for long-termrehabilitation including proper referrals to other disciplines.

Briefly, there are many health related quality of life instruments specific to head and neck cancer, and severalspecifically related to swallowing and speech QOL (Ward and van As-Brooks 2007). The University of WashingtonQuality of Life (UWQOL) (Rogers et al. 1999) is an example of widely used instrumentation used for head andneck quality of life. However, one literature review suggests only the European Organization for Research andTreatment of Cancer Head and Neck module (EORTC H&N35) (Bjordal et al. 1999), the University of MichiganHead and Neck Quality-of-Life Questionnaire (Terrell et al. 1997), and the Head and Neck Cancer Inventory (Funket al. 2003) fulfill the criteria laid out by the Scientific Advisory Committee of the Medical Outcomes Trust (Pusic2007). Whatever QOL instrumentation is used, there is a trend towards incorporating them to help monitor patients’progress to help increase quality of care for them.

The clinical pathway model can be used as a tool for the speech pathologist to deliver comprehensive care in anincreasingly complex and fast-paced healthcare environment. The goal of delivering patient care in an efficient andcost-effective manner will persist, as reimbursement trends continue to place pressure on healthcare facilities tocut costs. By adjusting our practice patterns to start interventions earlier and extend them out longer, speechpathologists can help counteract some of the stressors of a shorter LOS on the patient and caregiver. Thisincludes a growing burden on patients to be more independent with their own care with less time and resources ascompared to before, which can delay successful return of function. Speech pathologists in the home healthcareagency or rehabilitation facility will play a large role in the rehabilitation of communication, as patients no longermeet their functional goals at the time of discharge. This is especially true for those patients who may need totravel farther to reach the head and neck clinic or have other barriers limiting access to the clinic. Speechpathologists can benefit from QOL instrumentation to monitor patient progress, and make appropriate referrals asneeded, to help in successful return of function.

Anna Choi-Farshi, MS, CCC-SLPSenior Speech PathologistVoice and Speech LaboratoryMassachusetts Eye and Ear InfirmaryBoston, MA

REFERENCES: Belkner L, & Craffey A. Giving voice. Advance for Nurses. May 24, 2004. Vol 4 (12); 15-33.

Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ,Meyza JW, Bredart A, Soderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P,Bottomly A, Kaasa S. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neckcancer spcific module (EORTC QLQ-H&N35) in head and neck patients. European Journal of Cancer 36 (2000);1796-1807.

Chen AY, Callender D, Mansyur C, Reyna KM, Limitone E, Goepfert H. The Impact of Clinical Pathways on thePractice of Head and Neck Oncologic Surgery. Arch Otolaryngol Head Neck Surg. Vol. 126, March 2000; 322-326.

Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An Introduction to Critical Paths. QualManage Health Care. Fall 1992; 45-52.

Funk GF, Karnell LH, Christensen AJ, Moran PJ, Ricks J. Comprehensive head and neck oncology health statusassessment. Head & Neck July 2003; 561-575.

Graham MS. The Clinician’s Guide to Alaryngeal Speech. Butterworth-Heinemann. 1997.

Graville DJ, Palmer AD, Wax MK, Andersen PE. Tracheoesophageal Voice restoration After Salvage TotalLaryngectomy. Perspectives on Voice and Voice Disorders. American Speech-Language Hearing Association. July2009 (19) 58-65.

Pusic A, Liu JC, Chen CM, Cano S, Davidge K, Klassen A, Branski R, Patel S, Kraus D, Cordeiro PG. Asystematic review of patient-reported outcome measures in head and neck cancer surgery. Otolaryngology – Headand Neck Surgery 2007; 136: 525-535.

Rogers SN, Lowe D, Brown JS, Vaughan ED. The University of Washington Head and Neck Cancer Measure as apredictor of outcome following primary surgery for oral cancer. Head & Neck. August 1999; 394-401.

Terrell JE, Nanavati KA, Esclamado RM, Bishop JK, Bradford CR, Wolf GT. Head and neck cancer-specific qualityof life. Arch Otolaryng Head Neck Surg. 123; 1997; 1125-1132.

Ward EC, & van As-Brooks, CJ. Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes. PluralPublishing. 2007.

“Them” and Us

It important to participate in activities that are not in any way involved with laryngectomee rehabilitation if we are tobe truly totally rehabilitated. So much of my time is reserved for the IAL, WebWhispers, several local supportgroups, and individual laryngectomees that I have to pay attention to keeping a balance for myself. As an avidreader some of my favorite activities include book reviews and my local library book club discussions. We recentlyread and discussed a novel that was popular in the late 60’s and early 70’s entitled “Them”, by Joyce Carol Oates.The story is mainly focused on what it was like to live in Detroit from the early 40’s on.

I am well familiar with many of the neighborhoods because I grew up there. This was a very personal trip for medown memory lane, but the heart of the book deals with “them and us”. Too often it becomes ‘them versus us’ thatis a matter of taking sides. It is there at every level of our daily lives. It’s pure politics. No matter if we’re looking at

conflict that is personal, family, local, organizational, or even war on the world’s stage. Another example is teamsports that can go well beyond a spirit of sportsmanship with ‘them vs. us’, as we often see on TV today.

As the song goes from the musical, South Pacific, “You have to be taught to hate all the people your relativeshate. You have to be carefully taught.” That is an act of taking sides that is probably familiar to most of us. We canalso be carefully taught not to hate. I was lucky enough to grow up in my grandmother’s home on a block inDetroit that had immigrant families from many different countries, cultures and religions. They were neighbors andclose friends. Yet, it was Detroit during a period of race riots.

I vividly recall being kept home from Kindergarten for over a week because school was closed for safety reasonsdue to the unrest. I knew at an early age that away from the safety of my block there was a very angry ‘them vs.us’ running the streets, and there was bloodshed.

This deep anger and hatred has contributed to the destruction of a once beautiful, progressive city…sometimescalled the Motor City. As a descendant of the earliest French explorers, and “the King’s daughters” that weretrained and sent to help them civilize the new country over 300 years ago, I hold a deep desire to see the city’srebirth. It will take personal, corporate and political effort for a true renaissance, but renewal is possible. The landand location that my forefathers discovered and built on is still there to be fashioned into a model city for familiesand commerce once more.

After reading “Them” I find myself analyzing conversations, statements and reports, and almost always find a ‘themvs. us’ somewhere in the situation. Even in the book club discussion about this very book it was evident withcomments such as, “This would never happen in a Jewish or Italian family… it is cultural.” Really? Hhmmm…fromwhat I’ve witnessed in my lifetime this generality doesn’t fit the truth. By the age of ten I was keenly aware of wifebeatings, child molestation, infidelity, fights and killings at weddings that paired two opposing cultures, and suicidesfrom several different cultures and religions from Italian to Japanese. ‘Them/us’ still exists.

I don’t have a suggestion for how to correct the ‘them/us’ we find in our daily lives. The fact that we begin to noticeit at all is a start. It may serve as an opportunity to choose another response that can affect a small change thatwill grow in a positive way forward over the long run. Is it too optimistic to believe that peace on earth begins withevery one of us? It is a possibility we can control.

I experienced a lovely ‘them/us’ moment for my birthday recently when my daughter called so my 4 ½ year oldgrandson could wish me a happy birthday. He also asked to talk to me once more to add that he graduated frompre-school, and he jumped into the pool all by himself that day. (This is his 3rd summer swimming in their condo’spool.) He was very proud. When he finished my daughter told me that during bedtime story reading they talkedabout it being my birthday. They decided they should call me to wish me a happy birthday because, “She wasyour Mommy, and without Gramma there wouldn’t be an ‘us’”.

That simple thought leaves us in a fine position to practice gratitude for all those who have made it possible for usto be, to grow, or to recover. We can begin to think of others with differing ideas and problem solving skills as teammembers who contribute. Showing up and engaging are requirements if anything positive is to come out ofwhatever is happening in our lives.

In closing, we are all aware that there are those who practice positive living, and those who embrace negativeattitudes daily whether they are cognizant of it or not. The positive is refreshing and uplifting. The negative is like adaily dose of poison. Years ago, during a discussion regarding the givers and takers in this world, I heard one ofthe best questions ever asked, “What do you bring to the party?”

Elizabeth FinchemTucson, AZ 10/78

ChangesElspeth Thomson

I never imagined that I would ever become a carer. When I first met my husband, David, even although there aresixteen years between us, the possibility that someday I would be his carer never entered my head. As a result ofDavid's cancer our relationship changed for a time. I did not choose to be a carer, it was a position I found myselfin due to circumstances that neither of us could control. His illness had a significant impact on our relationship andI hated it. I did not hate him, I hated the position I found myself in; I hated cancer and what it was doing to David,to me and to our strong loving relationship. I resented this horrible disease and what it had done to us.

To be told David had cancer was too shocking to comprehend. I could not believe that this was happening. WHY?WHY? WHY? I kept asking myself. I was ignorant about cancer. I have been lucky in that nobody in my immediatefamily has been affected by the disease. David had two brothers who each died of different cancers but I neverthought for one minute that it would have such an impact on my life.. Once I got over the initial shock, I thoughtDavid is strong and he is a stubborn man; he won't let this beat him, if anybody can fight this he can.

At the beginning of his treatment, life went on as normal. David coped well with the radiotherapy, he was nevertired and still managed to potter around in his garden and continued to eat quite well up until about the last weekof his treatment. He had two treatments to go when he suffered respiratory arrest due to an allergic reaction tomorphine. That is when things started to change. David became depressed and very withdrawn. I used to watchhim reading his newspaper, knowing full well that he wasn't reading it or he would stare at the television not takinganything in. He made no effort to do anything and he only spoke when I spoke to him. This went on for monthsand was so frustrating I used to scream and shout. I was on an emotional roller coaster with anger, guilt, sadnessall playing a part. My beloved David had gone from me and I could not bring him back. This was all happeningprior to his surgery and when we were told that David would need a total laryngectomy I just did not know how tofeel. David has never been a man to show his emotions and on that day when we were told he cried, my bigstrong husband cried, I was overwhelmed with sadness.

After David's surgery his depression became worse. I became depressed, we were both in a situation none of uswanted to be in and we could not find a way out of it. Our roles had reversed. To me, sometimes it felt like I waslooking after a child. I had no independence, I was too frightened to go out and leave him alone. David relied onme for everything, medication, stoma cleaning, even showering. I missed our physical relationship, not just thesexual aspect but the hugs and cuddles that made me feel wanted, I was not disgusted by the stoma, that wasnever an issue for me, but I do feel David was embarrassed about it. Physical intimacy had always played a bigpart in our relationship but now I was too tired and scared. David had so many problems after the laryngectomy asexual relationship was the last thing on both our minds.

I don't really know when things began to change for the better. It certainly did not just happen overnight; it took a

long time and a lot of effort on both our parts to get to where we are now. I still do the caring bit for David but notto the extent I once did. He still needs help with his stoma and showering but things have improved dramatically.Our sexual and physical relationship has been restored, David and I are both feeling the better for theantidepressants we were prescribed. When I read articles on advice about being a carer one of the things thatalways pops up is for the carer to have some "ME" time. It is a wonderful idea if you can do it. I am not one ofthese people, why? I don't know, but I do know I am not alone.

David and I have come a long way since he was first diagnosed with cancer of the larynx in March of 2008. It hasbeen a long and sometimes difficult journey which I would not wish on anyone, but we have managed to comethrough it. We love each other and I am here for the duration. We do not know what the future holds but onething I do know is we are going to enjoy our life together. We are going back on holiday next month to Wales tovisit dear friends that we would never have known if it had not been for David's cancer. I find it so strange thatsomething so good has come out of something so terrible. David and I were meant to be together and we alwayswill be, through good times and bad.

NOTES FROM CLARKSVILLE, IN IAL Annual Meeting & Voice Institute The IAL 2010 was held in Clarksville, IN and total attendance was 254, according to IAL President, Bob Herbst.The VI seemed to have a larger percentage than the AM but those figures were not available. In the Delegatesmeeting 38 delegates met the quorum requirements.

The previous office holders were reelected, excepting Torbjorn Bull-Njaa, who requested his name be withdrawnbecause he felt International in the title of the organization was not accurate and he was disappointed with theinterest expressed in expanding toward that direction. Elizabeth Finchem is filling the 1 year term.

The announcement was made for the location of the 2011 IAL and it will be held at the:

Holiday Inn : KANSAS CITY SE - WATERPARK9103 EAST 39TH STREET, KANSAS CITY, MO 64133Pets AllowedHigh-speed Internet AccessHealth/Fitness Center On-SiteWater ParkOutdoor Pool - Indoor Pool

Rates will be $85 per night, plus taxes and fees.Internet access is freeBreakfast is includedFree shuttle for 3 days

There was a long presentation explaining how the IAL arrived at the financial situation they find themselves in. Thetrouble has come in the most recent years, since the books were balanced and audits done in 2006... however, for2007 and 2008, the books were not completed, some bills were not paid and nothing could be reconciled. Theynow have a problem with penalties from the IRS for failure to file and this came at the same time that the ACSdecided they could no longer contribute $10,000 a year to the IAL. They are attempting to reduce the budget andcut expenses and have already started to do so.

They have promised to post to their site on the Internet with the rest of the financial information. You might checktheir site for this information.http://www.theial.com/ial/

Food and Entertainment We started with chilled wine and icy beer (really nice in that hot weather!) at the reception held by Bruce Medicalbefore being allowed to find our places at the tables, where each person had a new stoma cover gift from Bruceand our program for the dinner, much like the one last year. I need to request that our webmaster, Len Librizzi putthese online, because they are beautiful. A folded program with a snapshot of Dutch on the front, pictures of yourBOD and some of the department heads inside the cover, a list of the Awards opposite and on the back, a listingof memorials of those we lost over the last year.

This WW dinner was delicious. Of course, part of my reason for thinking that is, "This is my kind of food!" If youwant to see the menu and a brief report on attendance, please check out our WW Dinner page athttp://www.webwhispers.org/activities/2010ww-annual-dinner.asp You will find the comments under the alphabeticallisting of attendees. We had a good group with mixed old members and newcomers. Having the gift of extradinners from Jim Lauder was of great help. By Monday, we were guessing at how many to guarantee on our dinnercontract.

We had awards in our program that were a bit different this year. We had ordered some items, such as hats andbriefcases and they were given as part of the "Thanks" to the people that helped us and to some of our loyalworkers.

Checks were given out from the Lauder Scholarship Fund to 7 members who had signed up for the VI and theScholarship, and InHealth's Richard Crum handed out the 4 checks for the Dutch Helms Travel Grant. These 4were really surprised and grateful.

When we got to the end of the awards, Mike Rosenkranz had asked to speak and he was the lucky one that got toexplain why they were presenting me with a wonderful engraved manure fork (a real one). It seemed to havesomething to do with my job of cleaning the crap out of WW.

I would like to add that the IAL Banquet on Saturday night was a buffet and again was excellent. The entertainmentwas wonderful, with an Elvis impersonator, backed up by DJ music and our own Tony Talmich on the drums. Greatfun and good music. (By the way, our own Gino Ronconi brought his drums up from here for Tony to use!)

And there is always next year.

WebWhispers Information Table Pat & Roy Boyd Charles & Juanita Moore

Sourou Pindra, Nancy Widen,R Falkenburg, Ron Leek

SLP Students / Brian LaGrant Pat & Roy Boyd

R Smiley Charles & Juanita Moore Pat & Mike

SLP Students Donald Six West TexasSLPs

Susan Reeves MJ Renner & Zilpha Bosone Bob & Leslie Herbst

Sandra Gregg & Elizabeth Finchem Barb & Don Slauson Hank & Luci Luniewski

Nancy Blair & Karen Griffin Herb Simon & Vicki Metz Buck Martin & Gino Ronconi

Janice Paul & Tema Title Herb, Judy Griewe & Mike R Gino-Jeanene-Pat-Mike-Barb-Ed-Yvette

Jeff Vaden Hogen WW Caps Mikw Rosenkranz

Torbjourn & Buck DiAnna Miller Ed Chapman

Elvis & Tony Talmich John-Libby Fitzgerald Kay Allison

Majella Best Mary Jane Renner & Zilpha Bosone Mike Rosenkranz

Pat Sanders & Mike Rosenkranz Pat Sanders & Susan Reeves Paul Winkle

Reed Otto & William Wilham Vendor Area Dr. Lewin Lecture

At the Derby At the Derby At the Derby

Swimming We just had the greatest and most fun swim demo at the IAL that I have ever attended. We had 4 people come inthe water that had not been in a pool since their laryngectomy and they left with grins on their faces and hope for abetter life than they thought they were facing. Dr. Philip Doyle brought a whole class of student SLPs to see thisand they marched in and sat where they could see clearly. He video taped the whole thing and we will be able tohave some of that on our site along with the ones we already have online in the How We LIve section of theLibrary. He was delighted later with what he had taped and with the expressions on the faces of the SLPs intraining.

This was one of the best years we have had. This was an indoor pool with balconies that looked down into it sowe not only had an audience sitting just off poolside, we had a large number watching from above. I would guesswe had a dozen people swimming... all of us carefully in the shallow end and watching so we didn't bump into eachother. Elizabeth was in the pool, doing demos and teaching. Tony and Jeff came in. I need to see pictures so I canremember how many. There were a lot of pictures taken.

Terrie Hall was there. Last year she went under for the first time and she was so excited she cried...we cried withher. This year, she brought Tom Herring and taught him to occlude and go under a few times. After that, Tom,

who had been a good swimmer before, knew just what he had to do to be safe. He was laughing and I imaginethey will be there every year!

Bob Herbst brought his wonderful BellyBoat that we have played with in previous years, but after floating for a little,he came up near me, got out of his boat, occluded and went straight under. I was laughing and said to him,"Couldn't stand it, could you?"

Early on, there was a gentleman who had his lary surgery 6 months prior. They had a swimming pool and he saidhis wife would not let him set it up. So we went over by where she was sitting and I explained how he should getused to going under the water with the stoma occluded and then gradually dip a little deeper. To practice, first,which he did with his friend standing by in the pool (another lary) and get comfortable with it. Then I explainedagain that it is different than when you have both hands to maneuver and you have to be aware that you cannotuse the hand you are occluding with. So he stretched out in the water with us standing right there and then broughthimself upright with one hand, with us holding gently. He never quit smiling the rest of the time.

His wife came over to talk to me and she was so moved. She thanked me for giving her the confidence to let himdo this, and him the confidence to get a part of his life back again.

We want to thank the swimmers who attended - Elizabeth Finchem, Pat Sanders, Bob Herbst, Terrie Hall, TomHerring, Belinda Elmore, Jeff Vanden Hagen, Tony Talmich and Bill Schmalz. "Thanks for being there!"

This article could not have been done without the help from Marlene Haynes, Charlie Moore, Vicki Metz and JohanMånsson from Atos who were kind enough to supply the photos.

I can hardly wait till next year.Pat Sanders

Whispers On the Web, and the whole of the organisation is of such great help to Laryngectomees world wide , I

wanted to offer my thoughts on the confidence the organisation brings, in the way of a poem. I have written it inthe Italian Villanelle Style.

A BEACHMASTER CALLED WHISPERSBy Len A.Hynds

I regarded my life, like 'D' Day,when we first went ashore in fright.

'Whispers' was there to point the way,standing so firm, amidst the fray,

so conscious of our nervous plight. I regarded my life, like 'D' Day.

" Get off the beach with no delay, beneath those dunes, within your sight." ' Whispers ' was there to point the way,

Saying firmly, " Your here to stay." Encouraging those with faces white.

I did regard my life like 'D' Day.

" Get off the beach" I heard him say. Bullets, minefields, fearful spite.

'Whispers ' was there to point the way. Beneath those dunes we safely lay.He stands there still, a shining light.

I regarded my life ,like 'D' Day. 'Whispers ' was there to point the way.

I have called 'Whispers' him, but of course our leading lights are ladies, so it could be changed easily enough.

[Editor’s note- Given that our founder, Dutch, was a military man himself, I think he would have loved this poemand as such, “Whispers” is perfect just the way Len has immortalized him.]

Welcome To Our New Members:

I would like to extend a "Warm Welcome" to our most recently accepted laryngectomees, caregivers, vendors,and professionals who have joined our WebWhispers community within this past month. There is a great wealth ofknowledge and information to be accessed and obtained from our website, email lists, and newsletters. If everthere should be questions, concerns or suggestions, please feel free to submit them to us from the "Contacts"page of our website.

Thanks and best wishes to all,

Michael CsapoVP Internet ActivitiesWebWhispers, Inc.

We welcome the 28 new members who joined us during June 2010:

Lynn BargHouston, TX

DeWayne BoesenKenesaw, NE

Bill L. BosticAustin, TX

John W. BurkeVictoria, BC, CAN

Jerry ClarkeJacksonville, OR

Franklin E. FisherLakewood, WA

Katherine Gabel - (Vendor)Athens, TX

Byron (Barney) HeadyJonesboro, AR

Nina Lara - (Caregiver)Jacksonville, OR

Bent Lassen - (Returning Member)Otterup, Denmark

Bruce W. LoweMoweaqua, IL

Bernie ManskiErie, PA

Lisa MartinezPensacola, FL

Judy NorrisPowell, WY

Tony SarrattSan Antonio, TX

Johnny ShawHull, TX

Judy Shaw - (Caregiver)Hull, TX

Bill A. SmithSanta Barbara, CA

Karen Smith - (Caregiver)Santa Barbara, CA

Gary Gene SteinerDolan Springs, AZ

Holly Swan - (SLP)Palmerton, PA

Kenneth E. TaylorZephyrhills, FL

Sandra Taylor - (Caregiver)Zephyrhills, FL

Amanda Thayer - (Caregiver)Newton, MS

Billie Sue Thompson - (Caregiver)Danville, VA

John ThompsonDanville, VA

Maryanne B. TillotOxford, CT

Sheree Ware - (Caregiver)Cordova, TN

WebWhispers is an Internet based support group. Please check our home page for information about theWebWhispers group, our email lists, membership, or officers.For newsletter questions, comments or contributions, please write to editor@webwhispers.org Managing Editor - Pat Wertz Sanders Editor - Donna McGary Webmaster - Len Librizzi

Disclaimer: The information offered via WebWhispers is not intended as a substitute for professional medical help oradvice but is to be used only as an aid in understanding current medical knowledge. A physician shouldalways be consulted for any health problem or medical condition. The statements, comments, and/oropinions expressed in the articles in Whispers on the Web are those of the authors only and are not to beconstrued as those of the WebWhispers management, its general membership, or this newsletter's editorialstaff.

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 § 170.

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