September 1999

September 1999

The Voice of Courage
PUBLISHED TO ENLIGHTEN THE NEW LARYNGECTOMEES ABOUT THEIR FUTURE LIFE, SINCE MID 1972

By Dean Rosecrans P.O. Box 310 Nampa, Idaho 83653 1-800-237-3699 09/10/99

Rehabilitation | Medicare Limits |

| Rehabilitation |

Rehabilitation is acceptance. Have you accepted your life as a laryngectomee? I was recently in Reno at the IAL convention and met a few people that are still at the first stage of rehabilitation, years after surgery.

Denial is the first stage, and acceptance is the last, with bargaining and others. Where are you on your journey to acceptance? Prior to laryngectomy surgery, did you rush to answer the telephone? Ask yourself, how many things do you let others do for you since your surgery.

Rehabilitation is getting back to normal as quickly as possible. Normally it takes a minimum of 90 days, about the same time it takes to train your neck muscles to accept air for esophageal speech.

The conventional wisdom for removal of the larynx is to get rid of the cancer as quickly as possible and do the radiation after surgery. It eliminates the necessity of dealing with irradiated skin, which is hard to manipulate and worse to heal. Trying to learn or use esophageal speech during the radiation period or for at least 90 days after radiation is attempting failure

Radiation dries out the tissue and trying to use esophageal speech takes all of the saliva one can muster. I had laryngectomy surgery 29 years ago when the wisdom was to radiate first. This dried out the tumor and gave the tumor definition for ease of removal.

It takes 60 to 90 days for the neck tissue to settle down from the surgery only then can one try to train these disturbed muscles to accept air into the esophagus for speech.

With me it was much longer because I had fistulas in most of the suture holes, which meant I was on a feeding tube for the first 60 days. Today things are much easier. At that time the only way to view the larynx was for the Doctor to get a firm grip on the tongue with a tissue and use a dental mirror. With the modern use of fiber optics much more can be seen and much easier. I digress.

Acceptance, how close are you? I met in Reno many laryngectomees who had a TEP. Several with the new low pressure - no hands system They could speak quietly using esophageal speech and carried an artificial larynx. Where are these people in their rehabilitation?

If these people would select one type of communication and have the courage to use it 24 hours a day, a giant step towards rehabilitation would be taken. Using three types or four is confusing.

First type at home in a quiet setting (esophageal), second type, in a formal situation (no hands TEP) third type, after the blow out, using a finger or thumb to cover the stoma and finally when the music starts (the artificial larynx).

There is no acceptance here. A laryngectomee cannot take over any conversation without the respect of others because their speech is limited.

Even with an artificial larynx it is difficult to take over but many try and are completely shut out. Any type of communication must have your complete confidence and to build confidence is to use one type, daily, all the time.

Switching between different types is a mistake. Keep an A/L for emergency. I lived in Los Angeles when I was learning a new type of speech. Driving in Los Angeles seemed to be all I did so I started singing along with the radio.

Many hours alone in a car became, not only a learning experience but a pleasurable learning experience. You can't hum anymore so alone or in a crowd start singing, You are alive and on your way on acceptance (rehabilitation).

| Medicare Limits |

2000 is a great number and it the next corner. I would imagine that insurance companies will take a page out of Medicare's book and limit the number of orders a beneficiary can make to one every 90 days. It makes sense. Why have a bunch of small orders when limiting orders to 4 per year makes more sense.

If you use two Foam Filters per day an order should be placed every 90 days for 180, $60.00. Your portion is $12.00 after the deductible. If you are active and use more than two per day or normally have a cold in a 90 day period it is best to order more. The next time you visit your doctor it might be a good idea to ask for a new prescription detailing exactly the amount you expect to use per day.

All of our products are covered under the same HFCA code so if you use foam & adhesive and/or foam or cloth covers also, it is best to go by the dollar amount to determine the number used per day. Divide the dollar amount by 30 which is two per day. Remember a new deductible starts January 1, 2000. Can you believe that?

Rehabilitation | Medicare Limits |

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September 1999
The Voice of Courage PUBLISHED TO ENLIGHTEN THE NEW LARYNGECTOMEES ABOUT THEIR FUTURE LIFE, SINCE MID 1972 By Dean Rosecrans P.O. Box 310 Nampa, Idaho 83653 1-800-237-3699 09/10/99
Rehabilitation \| Medicare Limits \|
\| Rehabilitation \| Rehabilitation is acceptance. Have you accepted your life as a laryngectomee? I was recently in Reno at the IAL convention and met a few people that are still at the first stage of rehabilitation, years after surgery. Denial is the first stage, and acceptance is the last, with bargaining and others. Where are you on your journey to acceptance? Prior to laryngectomy surgery, did you rush to answer the telephone? Ask yourself, how many things do you let others do for you since your surgery. Rehabilitation is getting back to normal as quickly as possible. Normally it takes a minimum of 90 days, about the same time it takes to train your neck muscles to accept air for esophageal speech. The conventional wisdom for removal of the larynx is to get rid of the cancer as quickly as possible and do the radiation after surgery. It eliminates the necessity of dealing with irradiated skin, which is hard to manipulate and worse to heal. Trying to learn or use esophageal speech during the radiation period or for at least 90 days after radiation is attempting failure Radiation dries out the tissue and trying to use esophageal speech takes all of the saliva one can muster. I had laryngectomy surgery 29 years ago when the wisdom was to radiate first. This dried out the tumor and gave the tumor definition for ease of removal. It takes 60 to 90 days for the neck tissue to settle down from the surgery only then can one try to train these disturbed muscles to accept air into the esophagus for speech. With me it was much longer because I had fistulas in most of the suture holes, which meant I was on a feeding tube for the first 60 days. Today things are much easier. At that time the only way to view the larynx was for the Doctor to get a firm grip on the tongue with a tissue and use a dental mirror. With the modern use of fiber optics much more can be seen and much easier. I digress. Acceptance, how close are you? I met in Reno many laryngectomees who had a TEP. Several with the new low pressure - no hands system They could speak quietly using esophageal speech and carried an artificial larynx. Where are these people in their rehabilitation? If these people would select one type of communication and have the courage to use it 24 hours a day, a giant step towards rehabilitation would be taken. Using three types or four is confusing. First type at home in a quiet setting (esophageal), second type, in a formal situation (no hands TEP) third type, after the blow out, using a finger or thumb to cover the stoma and finally when the music starts (the artificial larynx). There is no acceptance here. A laryngectomee cannot take over any conversation without the respect of others because their speech is limited. Even with an artificial larynx it is difficult to take over but many try and are completely shut out. Any type of communication must have your complete confidence and to build confidence is to use one type, daily, all the time. Switching between different types is a mistake. Keep an A/L for emergency. I lived in Los Angeles when I was learning a new type of speech. Driving in Los Angeles seemed to be all I did so I started singing along with the radio. Many hours alone in a car became, not only a learning experience but a pleasurable learning experience. You can't hum anymore so alone or in a crowd start singing, You are alive and on your way on acceptance (rehabilitation).		\| Medicare Limits \| 2000 is a great number and it the next corner. I would imagine that insurance companies will take a page out of Medicare's book and limit the number of orders a beneficiary can make to one every 90 days. It makes sense. Why have a bunch of small orders when limiting orders to 4 per year makes more sense. If you use two Foam Filters per day an order should be placed every 90 days for 180, $60.00. Your portion is $12.00 after the deductible. If you are active and use more than two per day or normally have a cold in a 90 day period it is best to order more. The next time you visit your doctor it might be a good idea to ask for a new prescription detailing exactly the amount you expect to use per day. All of our products are covered under the same HFCA code so if you use foam & adhesive and/or foam or cloth covers also, it is best to go by the dollar amount to determine the number used per day. Divide the dollar amount by 30 which is two per day. Remember a new deductible starts January 1, 2000. Can you believe that?
Rehabilitation \| Medicare Limits \|