Whispers on the Web - March 2013

2/27/13 9:13 AMWhispers on the Web - March 2013

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March 2013

Name Of Column Author Title Article TypeNews Views Pat Sanders Timeline News & EventsVoicePoints Beth Anke & Emily Poole B-S Voice Prosthesis Solutions Education-MedBetween Friends Donna McGary Lary Camp CommentarySpeaking Out Members Travel with Limitations OpinionTravel With Larys Jack Henslee Medical Tourism EducationalThe Speechless Poet Len A Hynds An Old Man & A Nurses Response Prose & PoetryBits, Bytes & No Butts! Frank Klett Passwords & New PCs Computers

INDEX AND LINKS TO EACH ISSUE MAY BE FOUND AT: http://webwhispers.org/news/WotWIndex.asp

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TIMELINE Some months ago, I answered a long time friend in the lary world, who asked how and when I got to WebWhispers,with a brief timeline and I just came across it. I would like to know others timelines.

Timeline for me.. 3/31/1995 Laryngectomy, after radiation failed. Got first computer the day I came home fromhospital. There was no WebWhispers and not even the beginning of a Dutch's group.

Fall, 1995, got online and found Compuserv Cancer Forum (where I met Henslee and Librizzi ... were 7 of us larysstuck in with lung and other respiratory cancers)Joined the local group... where I met Chas Lamar, Phil Clemmons & Scotty Chandler

Jan, 1996, sent out my first notice of local meeting wth a new and short HeadLines, which became my newsletter.

Jan, 1997, was the first to write in to the new listserv LARYNX-C. Heard immediately from a few others who hadjoined but had not sent a message. About a month later, Dutch came into that group and mentioned what he had juststarted a website on Larynx Cancer. The guys on Compuserv also mentioned a guy named Dutch.

I took the word back to my local group and Chas, Phil and Scotty all went and joined him. At the meeting in earlyAUG,1997 they told me they went there, so I said... I'll do it as soon as I can... and I was sitting here the night beforemy birthday and remembered. He didn't ask at that time for birth year but for age and I thought it was funny because Ihad a year to play with! There were 67 larys at that time, some of whom I had sent to the group!

Spring 1998, we had a contest for a name and no one ever remembered who came up with WebWhispers for ournew list and website. We incorporated. I did not want to be an officer but did a lot of work with them. Joe Casey wasour first pres, Dutch v-p and webmaster, Terry D, treas and Darlene, sec. I took over the Hints section and wasturning it into what became the Library and by then had responsibility for the newsletter. (I brought David B in forthat). All of this happened when Joe died near the end of 1999 and Carter Cooper became pres.. Then Carter diedsuddenly of a massive stroke in the late Spring 2000. At Carter's death, Murray became pres and said, "Youpromised that you would help if I ever needed it"... so I became VP and my first job was to set up the WW Dinner forthe Nashville IAL.

For over 6 years, I worked as VP and backed up Dutch on Moderating. Dutch died Nov 1, 2006 almost 10 years sincehe started his outreach to meet and share with other laryngectomees. Murray resigned a few weeks later and, Ibecame pres ... so it has been another 6+ years.

In this time, we have grown to over 3,300 members, with over 2,200 of those being patient members. Our websitereceives 25,000 to 30,000 pageviews a month. We get 30-40 new members a month.

Enjoy,Pat W SandersWebWhispers President




WebWhispers President

Blom-Singer Voice Prosthesis SolutionsBethany Anke, M.A. CCC-SLP & Emily Poole, M.A. CCC-SLP

One size doesn’t fit all. The laryngectomee population is diverse and each individual has specific needs. For years,Dr. Eric Blom personally customized Blom-Singer voice prostheses to manage specific needs. The summary belowdescribes the many options now commercially available to clinicians and their patients to effectively managetracheoesophageal puncture related issues. (*These descriptions are intended to work as a guide not to replacediagnostic assessment and clinical judgment.)

Duckbill Voice Prosthesis: A patient changeable device. Pulmonary air pressure opens the device similar to theway a duck’s bill opens. The tapered esophageal tip and soft esophageal flange are designed to reduce traumaduring insertion/removal. Due to the duckbill design, some patients may notice that it requires greater effort to voice.Conversely, it may be more resistant to central leakage due to pressure related issues or central leakage due toangled tracheosophageal tracts.

Low Pressure Voice Prosthesis: A patient changeable device. This voice prosthesis has a 1-way flap valve design.The tracheal and esophageal flanges are a soft material to allow ease of insertion/removal by patients and it uses thegel cap insertion system to facilitate atraumatic insertion. It generally requires less phonatory effort than a duckbillprosthesis. The low pressure is available in many special options such as Increased Resistance and Special Length.

The following Indwelling Devices Must Be Placed by a Licensed Healthcare Practitioner:

Classic Indwelling Voice Prosthesis: 1-way flap design similar to that of the Low Pressure Prosthesis but with



Classic Indwelling Voice Prosthesis: 1-way flap design similar to that of the Low Pressure Prosthesis but withlarger tracheal and esophageal flanges to reduce the risk of accidental dislodgement. The Classic Indwelling isavailable in a variety of lengths, diameters, and special options to meet many different needs.

Advantage Hard and Soft Valve Assembly Indwelling Prostheses: Designed for patients with early valve failuredue to candida and biofilm colonization. Both the Advantage Hard Valve Assembly and Soft Valve Assembly havesilver oxide in the silicone to slow candida growth. The hard valve assembly has the added benefit of the titaniumring. In addition to slowing candida growth, the hard valve assembly also has a higher “cracking pressure” which canmake it a good choice for patients who need a “stronger” flap valve due to pressure issues and open the flap valvetoo easily.

Dual Valve Indwelling Voice Prosthesis: Designed for patients with early valve failure due to candida and biofilmcolonization. The Dual Valve has 2 flap valves; one on the esophageal side and one on the tracheal side. When theesophageal flap valve fails, the tracheal flap valve is there as “back-up.” The flap valves were designed to openwithout any additional phonatory effort and both flap valves are imbedded with silver oxide to slow candida growth.During clinical trials around the USA, patients reported significantly extended wear time with the Dual Valve.

Special Length Indwelling: Provides an option for the “perfect” fitting prosthesis. The Special Length Prosthesismay solve the problem of peripheral leakage if the reason for leakage is because the prosthesis is too long andpistoning within the tract. Examples of Special Length sizes include 5mm, 7mm, 11mm, and 13mm.

Large Esophageal Flange Indwelling: This prosthesis provides a “seal” of the esophageal mucosa to preventleakage around the prosthesis. The increased surface area of the enlarged esophageal flange provides extraprotection for the patient so liquid/food/saliva cannot pass around the device. In order for this option to be effective, asnug flange-to-flange fit is needed. The large esophageal flange can also be used to transition a patient from a largerdiameter voice prosthesis to a smaller diameter vice prosthesis.

Large Flange (Esophageal and Tracheal) Indwelling: The LF voice prosthesis is ideal for patients with poor tissueintegrity, irregular TE puncture tracts, and leakage around the voice prosthesis. This prosthesis provides a “doubleseal” of the tract on both sides to prevent leakage. The LF should be a snug flange-to-flange fit. This is also a goodoption for downsizing from a large diameter prosthesis to a smaller diameter prosthesis.

Increased Resistance Indwelling: This is prosthesis has a flap valve that is weighted heavily and can help patientswho open the flap too easily, experience leakage due to pressure issues, and those with excess stomach gas.Patients may notice an increase in effort while speaking because it takes more force to open a “heavier”/increasedresistance valve.

Large Esophageal Flange/Increased Resistance Indwelling: This special option is helpful for someone withleakage through and around the prosthesis due to a pressure issue. The large flange protects/seals the tissue whilethe increased resistance flap valve resists unintentional opening.

TEP Occluder and TEP Occluder with Large Esophageal Flange: The TEP Occluder is a “leak-proof” device thatdoes not allow for TE voicing. The shaft of the device is sealed shut to prevent central leakage. The Large FlangeTEP Occluder is designed to manage peripheral leakage and eliminate central leakage. These devices are goodoptions for patients with chronic aspiration who cannot undergo TEP closure.



Lary Camp

I attended my first IAL annual meeting in Boston, September 2005. It was a revelation. I wrote this for mycolumn the next month:

… it was a bit of a shock to walk into the Park Plaza in Boston and hear that distinctive buzz and rasp all around me. Iheard myself at every turn. I saw myself and I was nonplussed. You could have knocked me over with a feather. Andyet I was strangely disquieted. I couldn’t possibly sound like these people. Face it, Donna, we have seen the enemy,and it is us! I still was hearing my old voice in my head and it was very hard to accept that wasn’t me anymore. I knewit…but sometimes it was just too much sitting in a class with all those terribly well-meaning SLP’s…I mean nodisrespect - you all were great - but we have lost our voice and trying to learn to speak again is a mighty task and oneI hope and pray you never have to learn. It was hard for me to be the center of all that concern and well-meaning pity.

I talk very well using my Servox and love my new T-shirt from Jim Lauder that says “Servox…We have ways ofmaking you talk.” I loved being around people who didn’t blink an eye or struggle to understand me, but I wasdisquieted. And I was disquieted that I was disquieted. I was uncomfortable seeing so many mirror images of myselfcoughing and clearing and discreetly and bravely managing while we buzzed and burped and otherwise talked andlaughed and flirted and generally carried on as if nothing was amiss. Because something is amiss and it is my voice -it is amissing!!

Although I admit that I bobbed and dodged a bit, the experience was invaluable. I look forward to the next IAL. Isuspect I won’t be so taken aback by the many mirror images of myself.

As I re-read that now, it is pretty obvious I was still grieving the changes in my life, but after four and halfyears of treatments and multiple procedures hoping to salvage my airway or at the least some use of myvocal cords it had become apparent that I was out of options. I had learned in Boston from no less an expertthan Dr. Blum that I was likely not a candidate for a TEP due to the radiation damage. Frankly, I was verydisappointed and began second guessing myself and all the decisions I had made since my diagnosis. Isuspect that I am not the only person to go to an IAL meeting and have mixed feelings.I have no such qualms about them these days. I have been to Chicago, Burlington and San Mateo since thenand I am truly looking forward to Spokane this June since I have missed the last three. These are my people,my tribe and I treasure their company.

In June of 2006 I wrote this as I prepared to head to Chicago. Clearly my attitude had improved!

Make new friends, but keep the old;One is silver and the other gold.

When I was a Girl Scout many years ago, I learned that song…meant to be sung as a round. It was best done arounda campfire at sleepover camp where you did make many new friends and fortified old ones. I did not love school - Idid well enough but always felt just a bit out of place. I was not one of the “popular kids” but I wasn’t unpopular,



did well enough but always felt just a bit out of place. I was not one of the “popular kids” but I wasn’t unpopular,either. Nor, thankfully, was I picked on - which has to be one of the worst fates ever to befall a child. But at summercamp, I was in my element! I was free to re-invent myself…to be bravely non-conformist…even a bit rascally! Duringthe school year I was the Superintendent’s daughter, at camp I could be the “Merry Prankster”. There is camaraderiein the conspiracy that we feel when we break away from our everyday lives with other people who are doing the verysame thing.

Now I have only been to one IAL Annual Meeting, but I have to say there are some similarities! During most of theyear, we are in the minority. We, hopefully, aren’t being picked on, but we certainly are different from just abouteverybody else around us. I use an EL [electrolarynx] and just today, while on the phone, I was called ‘Sir”(repeatedly). Just for the record I am a woman and I think I do a pretty good job with my trusty Servox. Even my sonnoted recently, after I had been sick, “You sound good, Mom, like you are back to your old self…which is kind ofweird to be able to tell, but I can”. I have a lary friend who uses ES [esophageal speech], very proficiently, I mightadd, whose pet peeve on the phone is being called “Ma’am”. It is especially disconcerting for him since he is a hunky6 ft tall construction worker who rides a Harley. Thankfully he has a very well developed sense of humor.

At the annual meetings and in our local support groups and here at WebWhispers we are not in the minority, we areone of many. Each of these groups serves a little different purpose and we each use them differently, according toour own needs. Even that changes over time. In all these places we are free to be ourselves, to re-invent ourselves, ifnecessary, and to celebrate what is, for many of us, a new lease on life.

If there is one recurrent theme on the WW List (after the ubiquitous mucus, maintaining a proper seal, and prosthesisproblems) it is just how tremendously useful and comforting it is to have this “family”.

That got me thinking. Human beings are social animals. We need to belong and we need to be with our kind. Andwhile I completely understand the family metaphor, given the size and disparity of WW these days I wonder ifperhaps tribe might not be more appropriate. A tribe is made up of many smaller family groups who all share acommon bond. They work together for the common good but have separate roles. They have squabbles amongfactions, power struggles and tribal councils where the elders try to resolve the issues. I KNOW that soundssuspiciously like one of those reality shows, but to my knowledge, we haven’t voted too many off the island!!Seriously, we are a very special tribe. We have been marked in a way that sets us apart from the general population.We have our warriors, brave souls who keep pushing the envelope and live to tell us their latest adventures, we haveour teachers and nurturers, we have our medicine men and priestesses who keep our spirits strong and we have ourelders to pass along our knowledge.

If you are able to go to “Lary Summer Camp” this year try to shortsheet someone, extra points if it’s a member of theboard, and snag a S’More. In Boston , there actually was a sing-a-long . Maybe this time suggest Kum By Ya orperhaps a round of Make New Friends, because you certainly will. But just make sure to let those old friends knowhow special they are - this tribe has to stick together.

Here is some information Pat put together you may find helpful if you are thinking of joining us in Spokane,June 5-9.

The IAL site now has the IAL News to be downloaded (there are applications in their newsletter if you receivethe snail mail version)http://theial.com/ial If you look to the left vertical panel, note Online Registration and Mail in Registrationforms, as well as Hotel Information and the Frank Batten VI Scholarship.

Hotel reservations should be made early. Prices are reasonable but tell them you need the IAL price. On theother hand, airfares are high this year.

On the WebWhispers site, we have the signup for our WW Dinner and the cost, time, menu, etc: http://webwhispers.org/activities/2013WebWhispersAwardsDinner.asp Those who sign up for this Dinner arealso invited to a pre-dinner reception (furnished every year by Bruce Medical.)

If you sign up for the Voice Institute, you may want to check:WEBWHISPERS "VI" PROJECT

http://theial.com/ial

http://webwhispers.org/activities/2013WebWhispersAwardsDinner.asp



WEBWHISPERS "VI" PROJECTA Plan for Continuing Education for WW member laryngectomeeshttp://webwhispers.org/services/voice-institute-scholarship.aspOur requirements are that each individual attend all planned classes for their category and, for those whomeet those requirements you can sign up and receive a check for $100 (Awarded at the WW Dinner from theEdmund and Lillian Lauder Laryngectomee Support Fund, sponsored and underwritten by LauderEnterprises of San Antonio, TX)

We do need to know if you plan to attend. We have several travel grants (both from InHealth and Atos) andthe BOD has been asked to choose who will receive them. They will go to members who do attend. This issolved by most of you signing up for the WW Dinner early enough to be in consideration.

In addition, Pat is looking at the possibility of arranging two different tours, one for Tuesday morning andperhaps a Winery tour for Wednesday morning. So far, it looks like the cost will be $45 for either one. Having4 hour tours in the morning will let those of us who are committed to helping out, get back in time to do so.

If you can take the time and can afford it, we highly recommend that you attend these meetings every year.

Hope to see you there!

During my recent WW Cruise and the travels associated with it I noticed a lot of people (travelers) with varying degrees ofphysical limitations navigate the numerous challenges travel posed to some of them. My attention was partly out ofcuriosity but also driven a little by the thought that I may also have to face some of the same challenges in the future, as Ialready do a lesser extent now. This I thought would make a fascinating subject for Speaking Out and might even result insome great advice for input to our library. Jack Henslee

So the March question is:

If you have any physical limitations or special needs that affect your ability to travel,and how do you deal with them?

http://webwhispers.org/services/voice-institute-scholarship.asp



Loyd Enochs, Evansville, IN, Denver, CO (work) - December 2009

Navigating Security I travel every other week for business (work 10 days, home 4 days) and the only real issue I have is the new scannerswhich require hands-over-head. I ask the TSA folks if I may use the old style metal detector and 95% of the time they say"no problem". In the other 5%, I simply request the manual pat-down. Everyone should remember that the manual pat-down is always an option if you don't want the extra radiation treatment!

Other than that, I just keep my standard "go-bag" with me (mirror, forceps, etc.) and press on with pride :)

Steve Staton, Sun City, CA - 2007

I have a limitation when it comes to traveling. Everyone says that a moist climate is the best for a Lary, not so sure thatapplies to me.

I live in a desert type of climate, rip roaring hot in the summer, and frigid in the winter. In the house I keep the humidityaround 45%, but I spend a lot of time outside, gardening, dogs , friends coming over. It's all good in this arid climate, noexcessive mucus, no coughing attacks, nada.

When I visit a moist climate, which is supposed to be great for us, I have it all, coughing, gagging, mucus, nose running,the entire nine yards. We love San Francisco, Santa Barbara, Balboa Island, Costa Rica, and Hawaii, but they wipe meout, I still go, but it's a tough one. About an hour on the beach does it for me.

The reason we continue to go to these places is the natural beauty, and the friends that we've made over the years, butit's always great to return to this dry, clear, clean place we call home.

Maybe it's just whatever climate we're used to, but I do best when it's dry. Don't understand it myself.

Pat Sanders, Birmingham, AL - 1995

Commercial airplanes have very low humidity (less than the Sahara).

I was listening to the two doctors on Fox, Sunday morning, and they were talking about it being no fun to come back froma vacation sick. They suggested that part of the problem was the flying home and getting dehydrated. They suggest youdrink water before you fly so you are well hydrated, then ask for water on the plane and drink it all...stay hydrated. Onementioned you can't carry water on the airplane but I have noticed that you can buy water after you have passed throughsecurity. Also,if you carry an empty bottle or container, you can go to the water fountain and get water to take on theplane with you.

To add something special for larys, a little spray bottle, that holds a few ounces will let you spray around the stoma andbreathe in the mist. I wear a heavy stoma cover and wet it down. It helps to stay healthy. A dry trachea is moresusceptible to germs. Even non-larys are given the suggestion to spray their skin to help hydrate.

Barbara Reibeling, Brighton, MI - 2012

Oxygen and hme’s. Bibs /covers for same when go out.



Jim Wold, Chicago, IL - 2005

I have been a lary since 2005 and managed to travel even with my emphysema until I got hit with an infection in 2011. Iwas hospitalized several times and had 2 surgeries on my stoma and wound up with a skin flap to go over the clavicalthat the infection invaded. Ever since then I have been on 24/7 oxygen and have not been able to travel away from homefor more than 5 hours as that is the longest I can make my portable oxygen tank last.

I really would love to be able to travel again but am uncertain as to how to take care of my oxygen needs. Any feedbackwould be welcome as I so want to go somewhere - anywhere, Thanks.

Libby Fitzgerald, Sherman, CT - Lary since 1998 - Cancer survivor since 1993

I've been a laryngectomee for 13 years and for most of that time I've flown on airplanes, gone on cruises, attended IALconventions and enjoyed a wide variety of experiences. Being a lary did not prevent any of this. At this time, due toongoing lung issues, I have breathing limitations that require using liquid oxygen 24/7. I can no longer fly or go on cruisesdue to the inflammable danger of the liquid oxygen. I have portable oxygen tanks that hold 3 hours each, so I can gaugetravel time between destinations, go shopping or to appointments.

It is possible to travel away from home within certain ranges. The company that supplies your oxygen can arrange tohave another company provide a large oxygen tank at whatever your destination be it a private home or a hotel. They canalso be sure there are respiratory specialists available at your new location should the need arise. If you own awheelchair, it's probably a good idea to bring it with you in case some long walking distances are required. Otherwise,when going shopping, you can use a shopping cart to load your portable tank onto along with the items you're buying.

As for medications, I use an insulated lunch bag and bring more meds than I know I'll need in case of an unexpecteddelay in returning home and I always carry a copy of my whole medication list. If you require additional equipment, bringthat with you as well. It's better to have more than you need than not be able to find something at your new location.

There will always be changes, but you can adapt to them and still enjoy new experiences. Please feel free to contact medirectly if you have additional questions.

Marlene Haynes, Webb City, MO - 1996

I thought I'd add my thoughts on this subject. My limitations, this year, pertain to severe arthritis pain, kidney failure dietand the inability to talk or eat. I will be tugging along my meds and magic bullet and baby cereal. I also travel with coffeecreamer to use as milk in cereals, different kinds of baby food in case I get stuck, where I can't use my magic bullet.

I'm in hopes this year I'll be able to find a place to sit through a lot of the activities at the IAL, walking and standing in painis no fun but I will not let my limitations prevent me from attending the greatest meeting of the year.

Terry Duga, Indianapolis, IN - 1995

I have not traveled in a while. I suspect that when I start traveling again I will have some special needs.

Last May, I had hip replacement surgey. I now have a titanium rod in my leg holdin a new ball for the hip joint. It, I amsure, will drive the metal detectors crazy. I have a card from my Doctor to show TSA so that I can be wanded. I haven'tflown yet, but it should be interesting when I do.



flown yet, but it should be interesting when I do.

I suspect I will need the card when I cruise and decide to go on excursions.

AH, being bionic is not always easy.

Bob Bauer, Hayward, CA - Class '08 & '10

I had my surgery, at Stanford, in 2008 and a second one in 2010. I use TEP speech with the ATOS hands free HME. I'mfortunate that I don't have any physical limitations to deal with. I hope the following will be of some help.

My wife and I have cruised and traveled, by plane and ship, numerous times since my surgery. When I travel by plane, ifover water, I carry my Mustang Hi-Lift auto-inflatable life jacket. You can bring it on board the plane and it fits nicely underthe seat in front of you. The ones on the planes will not keep your stoma above water where the Mustang will (seeattached photos). I always bring it when on board ship.

In my carry on bag I have all my meds and all my supplies needed to support my stoma for the length of my trip. I havethe supplies in a plastic fishing tackle box that will fit in an attache case (see attached photos). I also have a 'Day Pack', ina snack sized zip lock bag, which contains everything I need in case I have to change my base plate while out on a daytrip. I have changed my base plate at the airport while waiting for my flight. Not to worry, people take a quick glance andgo on there merry way.

So, once you're able to, don't be an "Ole' Stick in the Mud", get out there and have some fun. Best wishes to all my fellowLary's.



Medical Tourism In the Feb 2013 “Speaking Out” column of Whispers on the Web, we had a nice discussion regarding dental problemssome of us may have had and how we addressed them. While there were some excellent posts, I particularly likedDave Aitchison’s post regarding dental work done in Mexico because I have long thought about the possibility ofgetting implants done in Costa Rica, or just dentures if/when it becomes necessary, which is more likely to happenthan not happen.

I have now been to Costa Rica 8 times and have a pretty good understanding of the culture and the fact that theyhave a great medical system at no cost to them. There are some minor problems with delayed treatments for electivenon-emergency procedures, and some patients purchase private insurance as a supplement to the social securitysystem available to all. In fact it’s also available to non-citizen residents at about $60 a month, which is one reason somany people retire there.

This is definitely not a 3rd world country when it comes medical care and that includes dentistry. The first time I wentthere was in 1996 and our tour guide said that Costa Rica had the highest per capita ratio of dentists than any othercountry in the world. Education was free and most post grad work was done at dental schools in the US or Europewhich meant that “many” of them have received the same (or maybe better) training as your local dentist.



which meant that “many” of them have received the same (or maybe better) training as your local dentist.

Medical Tourism plays a significant role in Costa Rica, as well as in India, Thailand, Philippines, Mexico, El Salvador,and other countries. Most Americans/Canadians that seek these services do so for elective cosmetic or dentalprocedures although some also seek more serious surgeries for various reasons. My interest however was in dentalwork and that was primarily in regard to “Implants.” So I did some research and have the following to report to thosethat may be interested, but first the caveat; “The following is not a recommendation nor an endorsement for anymedical treatment. It is simply my understanding of information I’ve found on the internet or been told by others. Youmust always use due diligence when making any medical decision… even here in the USA!”

I was told many years ago that, if you needed a full set of dentures, you could fly to Costa Rica, get a set of dentures,and take a 5 day vacation while there for the same price as the dentures alone would cost in the USA. Well priceshave changed a lot since then, especially the airfare and hotels, but it appears that you can probably still fly there andget the dentures "without the vacation" for the same price if you live in CA. BUT, If you live in FL you’d probably savean additional amount equal to 2-3 nights at a local hotel because airfare from FL is about half that from CA. My questis for implants, if I’m a candidate, and we are talking about huge savings in that department.

For the uninformed (as I was), implants are more complicated than imagined, and there are different kinds at differentprices. Trying to nail down a cost is also a little difficult because most websites don’t give a price and, when they do,it’s not clear exactly what is provided at that price. Before I started researching I had assumed that a quote for animplant included everything, and sometimes it does, but that may not be the case. For example a quote in one CostaRica site lists implants for a regular 2 stage implant at $600-$770 but that only covers the implant itself (an artificialroot to hold a tooth, bridge, or partial. But, the abutment that actually holds the tooth isn’t listed and the actual crown(tooth) is an additional $450 on average for a standard porcelain crown. Now that’s just to have one tooth totallyimplanted. If (as in my case ) you want implants to anchor a denture, partial or bridge, then you have to also factor inthe cost of those items. This table shows some price comparisons from one website which appear to be a closeaverage of what I’ve researched in CA. Other US prices vary according to where you live.



In general, it appears that you can get quality implants done in Costa Rica for about 60% of the US cost or maybe alittle higher if you choose the most qualified doctor/clinic. I am fairly confident that this savings is not based on areduced skill level but rather a different standard of living. For example the cost of office rental and utilities would beabout 25% for comparable space here, their staff and technicians earn 30-50% less money, low tax rates, and theydon’t pay huge liability insurance. All of this adds up to big savings for people that want to travel there.

There are numerous sites on the web that will give you a detailed quote and I would suggest that. The procedure isthat you provide xrays (physical or electronic) and other information that will enable them to recommendation exactlywhat you require and give you a fixed price. The only difference you might have to pay would if the jaw needs morebone grafted.

Now there are numerous factors that dictate exactly what you 'need' to be done as opposed to what you 'want' done.Some examples are:1. You still have some good strong teeth.2. You need teeth pulled.3. Jaw bone is too thin in places or in general.4. Your health and possible radiation damage to the bone.

The radiation issue is a big one and my research indicates a lot of disagreement among oral surgeons. Some saynever, some say it depends on the dosage and the field, some factor in how long ago the radiation was (some say thelonger the better and others say the longer the worse the risk), and some say ok with HBO treatments while othersmay feel different. This whole radiation issue is still evolving based on what I’ve read and experienced. Ten years ago,one oral surgeon refused to even pull one of my teeth, another said ok but I had to go on antibiotics before and after,and recently they only required antibiotics after the extraction. So, if you had had radiation, be sure to tell them andthen make sure you are comfortable with their recommendation (that’s for any dentist). What could go wrong is calledOsteoradionecrosis (ORN), which in it’s worse manifestation would result in the total destruction of the jaw bone. Notsomething you want to experience.

One last thing that you may not be aware of regarding implants. Generally there are three similar but differentprotocols used:1. Immediate load Dental Implant; With this procedure you must have had the teeth removed about 4 months beforethe procedure is done. Then they insert the implant and place a temporary crown on it while your new permanentcrown, partial, or whatever are being made. You will normally come back in 3-5 days to have it installed.2. Two stage dental implants; In this case the process is much longer. On the first visit you have just the implantinserted and if necessary you can also have teeth pulled at that time. Then after 4-6 months you return to have theteeth placed. So when you calculate your total cost you need to factor in 2 trips as opposed to one trip for the work.

Probably still a big savings and another nice vacation.3. Mini Implants; These are about half the size as regular implants and can be used to replace a missing tooth but themore common use is to provide an anchor for dentures. This entire process is done in about 2 hrs…period! I haveunable to find out “why” they don’t require more healing time other than they are smaller.

So depending on your financial situation, and what you want, it is certainly possible to travel to Costa Rica, or evenMexico, at a greatly reduced price and still get a quality result. For those of you that can afford a full mouth restorationand are considering it you could be talking about a savings of $30,000 plus. Wouldn’t you like to spend that money orless on a fabulous vacation plus still get your teeth. Something to consider.



less on a fabulous vacation plus still get your teeth. Something to consider.

Jack Henslee

An Old Man & A Nurse's Response

I cannot claim the original of this poem by some anonymous poet that was sent to me by my daughter Pat. It is sotrue of old people in sheltered accommodation. I just had to work on it, so first is my revised version.

I circulated it to some of the many nurses I know, being bionic and having friends in many departments and thesecond poem, also revised, was sent back by Sam Rose (Samantha), a cancer specialist nurse, which is the perfectresponse. Len Hynds

An Old Man

Oh what do you see nurse, what do you see,what do you think, when you’re looking at me ?A foolish old man, who’s not very wise,uncertain of habit, with his faraway eyes.

Who dribbles his food, and makes no reply,when you say in a loud voice, “ I do wish you’d try.”



when you say in a loud voice, “ I do wish you’d try.”Who seems not to notice the things that you do,and forever is losing a sock or a shoe.

Who resisting or not, let’s you do as you will,with bathing and feeding, the long day to fill.Is that what you’re thinking, is that what you see?Then open your eyes, you’re not looking at me.

I’ll tell you, nurse, as I sit so still,doing your bidding, doing your will.When I was ten, with a father and mother,with brothers and sisters who loved one another.

Then a young boy of sixteen, with wings on his feet,and dreaming that soon, a lover he’ll meet.A groom soon at twenty, my heart gives a leap,remembering the vows that I promised to keep.

At twenty- five, I had young of my own,To guide and provide them a happy home.At forty, my young had grown and were gone,but my lady’s beside me, our ageing’s begun.

Dark days are now upon me, my wife is sadly dead.I look upon the future, and shudder with such dread.The body it so crumbles, grace and vigour they depart.There is only just a stone, where once I had a heart.

But in-side this battered carcass, a young man he still dwells,and ever so occasionally, this weary heart it swells.I remember the joys and I remember the pain,and think of the joy of living life again.

So open your eyes please, nurse, and see,not a foolish old man,look closer, see me.

A NURSE’S RESPONSEBy Anon.

What do we see you ask, what do we see?Yes, we are thinking when looking at thee.We may seem to be hard when we hurry and fuss,but there’s many of you, and too few of us.

We would like more time to sit and talk,to bathe you and feed you, and help you to walk.to hear of your lives and the things you have done.Your childhood, your husband, your daughter, your son.

But time is against us, there’s too much to do,patients too many, and nurses too few.We grieve when we see you so sad and alone,with nobody near you, no friends of your own.

We feel all your pain, and know of your fear,that nobody cares, now your end is so near.



that nobody cares, now your end is so near.But nurses are people with feelings as well,And when we’re together, you’ll often hear tell,

Of the dearest old gran in the very end bed,and that lovely old dad, and the things that he said.We speak with compassion and feel so sad, when we think of your lives, and the joy you’ve had.

When the time has arrived for you to depart,you leave us behind with an ache in our heart.When you sleep the long sleep, no more worry or care,there are other old people and we must be there.

So please understand, if we hurry and fuss,there are so many of you, and so few of us.

Singing in the RainOne of our all time feel good movies! You can watch anytime it’s on and it never loses its entertaining merits. "Sowhat?" you ask. In trying to come up with easy-to-remember, but hard-to-hack passwords, I use things I enjoy andwon’t forget such as “Singing in the Rain” as a password for something like banking. You get the idea...a passwordcan be anything you want (almost) and the longer it is, the better. Think of your favorite songs, movies, pets, or kids,and you’re in business. Instead of one word, use a simple phrase you’ll easily remember.

I make it a point to change my passwords the 1st of each month ...you can do it every 90 days if you prefer, but neverkeep passwords longer than that for your own security. Be sure to have a separate password for your banking andmake it a forced action to change it every month, regardless of any other accounts and passwords you might have.

Most browsers have an option for you to select so that the browser remembers your passwords and the informationyou fill in on forms. If you select his option be certain to change your passwords on a regular basis.I prefer a thirdparty password manager such as Lastpass or Roboform since they offer a bit more security. If you are usingWindows 8 and Internet Explorer 10 the following link will give you some guidance.http://techtalk.pcpitstop.com/2013/02/11/managing-passwords-in-internet-explorer-10/?winclub-IEpass=Windows 8

http://techtalk.pcpitstop.com/2013/02/11/managing-passwords-in-internet-explorer-10/?winclub-IEpass=Windows%208



If you have upgraded to Windows 8, I am sure you have formed an opinion on the new User Interface (UI). Thisversion of windows has caused quite a stir in the tech communities. If you are a Windows user now and are happywith your system there is no reason for you to upgrade since your version will be supported for quite a few moreyears. The discount period for upgrading expired on 31 January 2013 so buying a retail copy now is in the $199ballpark. If you are buying a new PC most will come with Windows 8 installed.

Many of the common remarks on Windows 8 has been the drastic change in the non-Windows-like appearance, toomuch change for some folks. This has led to users seeking alternatives to Windows. I will cover these options more inlater issues and I continue to post them in "Computer & Internet Stuff" on our Webwhispers Forum so be sure tocheck in to the forum.

Chromebooks have been Amazon’s top seller in the laptops category now for several months. The Chromebookconcept was developed by Google as a simplistic and minimalist alternative to the Windows operating systems.The Chromebook operating system developed by Google is actually a Linux variant and the user works from abrowser (Chrome) based desktop. Pricing has been especially attractive since a complete Chromebook laptop startsat $199 and may go up to $399, depending on manufacturer.http://www.makeuseof.com/tag/samsung-chromebook-series-3-review-and-giveaway/?utm_campaign=newsletter&utm_source=2012-02-18

In the Market for a new PC?

Looking to buy a new PC or Mac in the near future? The link below is a well thought out buying guide that can helpyou sort through some of the technical and usability issues.http://www.lockergnome.com/windows/2010/01/12/tips-for-buying-a-new-computer/How do you know if you need a new computer...the easy answer is a question. Does your system do what you needto do? If so, why change? Unless you want to take advantage of some of the new technologies that are available.Which Operating System suits your needs best is a major consideration when buying a new system and ShermanDeForest does an excellent job of breaking down the differences for you in this link.http://www.lockergnome.com/decisions/2012/04/23/which-os-is-best-that-is-a-trick-question/

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 [email protected] Managing Editor - Pat Wertz Sanders Editor - Donna McGary

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 be

http://www.makeuseof.com/tag/samsung-chromebook-series-3-review-and-giveaway/?utm_campaign=newsletter&utm_source=2012-02-18

http://www.lockergnome.com/windows/2010/01/12/tips-for-buying-a-new-computer/

http://www.lockergnome.com/decisions/2012/04/23/which-os-is-best-that-is-a-trick-question/

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Whispers on the Web - March 2013

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