whispers on the web - january 2004

3/31/08 1:32 PMWhispers on the Web - January 2004

of 16http://www.webwhispers.org/news/jan2004.htm

January 2004

Name Of Column Author Title Article TypeRoger's Ramblings Roger Jordan Scooting Around ExperiencesVoicePoints Jeff Searl, Ph.D. Yeast InTE Prostheses Education-MedMusings From The President Murray Allan Happy New Year Greeting News & EventsNews, Views, & Plain Talk Pat Sanders What Is The IAL Annual Meeting ExperiencesBits, Buts, & Bytes Dutch Computer Tips ExperiencesWelcome New Members Listing Welcome News & Events

Roger's Ramblings by Roger Jordan(Laryngectomy - 1993)

SCOOTIN' AROUND

Although I have very weak legs due to having encephalitis, similar to polio,when I was in the Air Force and find walking or standing for any length of timedifficult, I have attended the last several IAL meetings with no problems. Ihave done a lot of other traveling as well. My secret? I have an electric powerscooter. In fact I have two of them.

I bought a very light weight one, only 65 lbs., that I useexclusively for air travel. The airlines check it as baggage,I ride it right to the gate and it is delivered to me at the gateof my final destination. If I have to change planes, theairlines all provide wheelchair service from gate to gate. Once I get my luggage and clear customs, if applicable, Istow the luggage to the cab area. The scooter handle barsfold down and the seat easily comes off so it will fit in thetrunk of most vehicles (no tools needed). As I recall, I paidabout $1700 for the unit.



about $1700 for the unit.

At home, I have a larger scooter, a Pride Celebrity 3wheel, pictured at right, which is faster and has a largerbasket for carrying things. It, however weighs about 165lbs. and I put a Bruno lift in my Safari GMC van to load andunload it. I do prefer the larger unit, as I weigh over 200lbs. myself and the lighter travel scooter, though rated for250 lbs., strains on even a moderate grade, and the batterycharge doesn't last nearly as long.

Anyone with trouble walkingshould consider getting a scooter. In many cases theVA, Medicare, or private insurance will pay most of thecost, including the lift for a van. The VA will also pay$9,000 for the first time purchase of a van needed by aservice connected disabled veteran to transport his or

her scooter. I was unaware of this benefit when I got my first scooter andbought the van myself. The VA did install the power lift. I bought the lightweight scooter from a scooter dealer near Tampa. But there are many brandsof both types of scooter and they all advertise extensively.

I wholeheartedly recommend getting one. It will return those who need oneto the world of the mobile population. In fact, Joy can't keep up with me instores or malls. At Disney World in Orlando, I outran Joy and my daughterand her husband. And as a side benefit, scooter users and their entire partygo the head of the line at Disney. On that occasion, I drove to Orlando so hadmy larger scooter with me. An overnight charge of the battery lasted all daywith no slowing down. With my smaller scooter, I would have had to plug it inperiodically during the day. In Las Vegas, for example, I would plug in at lunchin a restaurant and again at dinner. Each time, this would provide sufficientpower for a few more hours.



There is a fascinating world out there. The opportunity to meet and learnfrom so many other larys is just a part of it, albeit a very important part to us. So get a scooter and hop aboard.

************************

WebWhispers members Bob and LesleyHerbst from New Haven, CT, found thatthey, too, needed some reliable "scooterassistance" recently. Unfortunately,Lesley had injured her leg just prior tothe WebWhispers 2003 CaribbeanCruise. Undaunted, they arranged with acompany for a rental "scooter" to bewaiting in their cabin aboard the"Navigator of the Seas" and then Lesley"scooted" virtually everywhere shewished to go while on the cruise. Whenthey disembarked back in Miami, they just left the scooter intheir cabin for the company's representative to pick up. Remarkably hassle-free!! Amazingly, the company that Boband Lesley used was "CareVacations, Ltd" in Leduc, Alberta,Canada!! Their web site is at:http://www.carevacations.com/. Ed.

VoicePoints coordinated by Dr. Dan Kelly, Associate Professor ( [email protected] ) Department of Otolaryngology, Head & Neck Surgery 7700 University Court, Suite 3900, West Chester, OH 45069

[ ? 2004 Jeff Searl, Ph.D. ]

Yeast Colonization of Tracheoesophageal VoiceProsthesesBy: Jeff Searl, Ph.D., Assistant Professor, Bowling Green State University, BowlingGreen, Ohio

Over the past 25 years, tracheoesophageal (TE) speech has becomeone of the primary communication options available to individuals after

http://www.carevacations.com/



one of the primary communication options available to individuals afterlaryngectomy. The resulting speech can be quite intelligible in most TEusers and a large percentage of laryngectomees that try TE speech stickwith this method for the long-term. However, one persistent difficulty thatsome TE users face is premature failure of a voice prosthesis because of abuild-up of yeast on or near the valve. When this happens, the valve maynot function properly. As most TE users are aware, there is a small one-way valve housed inside the voice prosthesis. When voice is not beingproduced or when swallowing, this valve is in the closed position. Thismeans that the voice prosthesis is blocked by the valve so that saliva andliquids are unable to flow from the esophagus to the trachea. Duringspeech, air is directed into the voice prosthesis from the trachea, pushingthe one-way valve open, allowing air into the esophagus to be used forproducing voice.

What Happens When Yeast Builds-up on a Voice Prosthesis?

If yeast builds-up on the voice prosthesis, particularly if it is on or nearthe one-way valve, the opening and closing of the valve can be affected. Some TE speakers may experience leakage of fluids (either saliva orliquids being swallowed) through the prosthesis because the yeast colonyis preventing the valve from closing. This usually causes the person tocough and is generally considered to be unhealthy for the lungs if theliquids make it to the lungs over a long period of time. Although perhapsless common, in other TE speakers the yeast build-up can interfere withthe opening of the valve when they try to talk. If the yeast colony is in justthe right spot it may only let the valve open partially which could reducethe amount of air flowing from the trachea to the esophagus when they tryto speak. This could negatively affect their voice (e.g., decreasedloudness, trouble starting the voice, no sound coming out, having to workharder to get voice, etc.).

Where Does it Come From?

The mouth is the primary source of yeast that can ultimately grow onthe voice prosthesis. Yeast is actually a term for fungi. All individuals,whether they have a laryngectomee or not, have a certain amount of yeastorganisms (as well as bacteria and other things) in their mouth. Yeast issaid to colonize when there is more than the usual growth of the fungus ina given location. An example that many people are familiar with is oralthrush, which is usually a whitish, feathery, sore patch that can show upon the tongue or other parts of the mouth and throat. Yeast from themouth is carried into the throat and then the esophagus when a person



mouth is carried into the throat and then the esophagus when a personswallows saliva. In TE users, this creates the possibility of yeast cominginto contact with the voice prosthesis where it can attach and grow.

There are a number of different species of yeast. The type of yeast most commonly referenced whendiscussing voice prosthesis colonization is Candidaalbicans, which is present throughout the gastrointestinaltract in all individuals. However, while the albicansvariety may be the most common, it is not the only typeof Candida that has been identified on TE voiceprostheses (a study from Belgium by Dr. Bauters and colleagues [2002]identified four different Candida species with relatively highconcentrations).

Individuals who have undergone laryngectomy are at risk for a higherthan normal concentration of yeast in the mouth, and those who haveundergone radiation therapy are at an even higher risk. Following the totallaryngectomy procedure, the trachea is turned to the front of the neck andis open to the outside air at the stoma. This separates the lower airway(trachea and lungs) from the upper airway (throat, mouth, and nose). Because of this, airflow in the mouth is quite different than it was beforethe surgery since a laryngectomee, of course, now breaths through thestoma and not the nose and mouth. This change in air flow can alter theoral ?flora,? or the make-up of bacteria and other organisms that arenormally present in the mouth. Once such change occur, there can be anincrease in yeast growth. Undergoing radiation therapy in the head andneck region increases the risk of yeast proliferation. Chemotherapy, or anyother treatment or medical condition that suppresses the immune system,also increases the chance of yeast colonization. There are other thingsthat can increase the risk of excessive yeast in the body (including themouth) including over-use of antibiotics, severe burns, diabetes, andtuberculosis.

What Can be Done to Help?

The issue of managing or eliminating yeast colonization on TEprostheses has been a focus of concern for TE users, the ENTs and speechpathologists who treat them, and to researchers. Below are several stepsthat may help laryngectomees who have persistent problems with TE valvefailure because of yeast growth. The approaches are divided into threecategories: medications, voice prosthesis considerations, and ?other.?



Medication

The recommendation offered Dr. EricBlom and others for TE users with yeastcolonization problems involves use of atype of medication broadly classified as anantimycotic. TE users must consult withtheir ENT doctor about the use of themedication, but typically the procedure thatis recommended involves swishing 1tsp ofthe oral suspension of Nystatin (an

antimycotic) for a minimum of 4 minutes in the mouth twice a day. TheNystatin can be swallowed or spit out after swishing. This helps to reducethe yeast present in the mouth. There are other antimycotic medicationssuch as miconazole and fluconazole that might also have a role inmanaging the problem. In a study from the Netherlands (Weissenbruch etal., 1997), researchers reported that a slow-release miconazole tabletadhered to the cheek on the inside of the mouth helped extend the life ofthe voice prostheses being used. Some antifungal lozenges area alsoused to control oral candidiasis (e.g., Clotrimazole, Amphotericin B.). Again, a medical doctor would need to be consulted to see if anymedications are appropriate for a given laryngectomee.

Voice Prosthesis Considerations

The type of TE voice prosthesis used may also be a consideration forindividuals dealing with re-current yeast colonization. There has been alongstanding effort to develop a voice prosthesis that is resistant to yeast. One manufacturer has recently put on the market an indwelling prosthesisin which the valve is manufactured from silicone that has a small amount ofsilver oxide in it. Silver oxide is known to have anti-fungal properties andso should help limit yeast development. This product is just now showingup in the clinical population and so it is expected that more and more willbe published in the literature about the effectiveness of the device.

Another TE prosthesis on the market that may be more resistant tothe growth of yeast is the Voice Master (developed in the Netherlands byDr. P. Schouwenburg). This particular device is not widely used, at leastnot in the United States. However, the body of the prosthesis consists of atitanium sleeve which is apparently resistant to the growth of candida.



Another suggestion frequently made by laryngectomees and speechpathologists who work in this area is for regular cleaning of theprosthesis. The specific definition of ?regular? cleaning may be open todebate, but a general rule of thumb is that the longer the interval betweenchanging and cleaning the prosthesis, the higher the likelihood of troubleto expect from yeast colonization. For those laryngectomees who changetheir own prosthesis (that is, those NOT using an indwelling device),besides regular cleaning of the device, soaking in a peroxide has beensuggested as a means of killing yeast cells on the silicone. This is notspecifically recommended by the prosthesis manufactures and it isunknown how the peroxide (or other soaking solutions that are sometimesdiscussed such as bleach solutions) might degrade the silicone materialitself, although a number of laryngectomees and speech-pathologists havesuggested this method.

Other Things

This last set of suggestions is just a short-list of some of the ideasoffered by laryngectomees themselves or the professionals involved intheir care. A number of individuals have increased their intake of yogurtand feel that this helps reduce the yeast colonization problem. This isused to help manage yeast issues in other parts of the body and may dothe same for problems involving the TE prosthesis. As long as you likeeating yogurt (it must have the live acidophilus bacteria), this seems like aworthwhile thing to try although it may not help some people. You canalso get the acidophilus bacteria ( Lactobacillus acidophilus) in otherforms at some health food stores. Others have suggested cutting back offoods that might promote yeast growth if there is already a smallpopulation of candida organisms present. For example, sugar is known topromote yeast growth, at least when other conditions are favorable. So,some have suggested that cutting back on sugar-laden products may be ofsome use in limiting growth. In contrast, others have suggested that itmay be worthwhile to create an inhospitable environment for yeast growthvia the food that is eaten (e.g., acidic types of substances). However, Ihave not seen any specific research literature addressing dietary issuesand TE voice prosthesis yeast colonization.

The primary message is that there are things that can be done to helplimit, and in many cases eliminate, problems with TE voice prosthesisfailure secondary to yeast colonization. Use of Nystatin (and possiblyother antimycotic medications) is a fairly well accepted technique that hasbeen found useful by a number of individuals. The development of fungus



been found useful by a number of individuals. The development of fungusresistant voice prosthesis also represents a nice advancement for helpingto manage the problem and more information on theses prostheses shouldbe forthcoming in the literature. Finally, laryngectomees themselves (andtheir speech pathologists) are often a vary resourceful lot. They will likelycontinue to explore their own ideas about ways to help manage theproblem. One must be careful of accepting all the suggestions offeredeven if it seems to make sense, checking with others (most notably yourdoctor and speech pathologist) in order to avoid any unintended harms.

Murray's Mumbles ... Musings from thePresident

I wish everyone the healthiest and happiestyear for 2004. Wow, 2003 sure skipped by

quickly, didn't it?

A special HAPPY NEW YEAR goes from me to the WWExecutive Committee, Dutch, Pat, Terry and Libby. AlthoughI'm a shy, introverted guy <grin> who has troubleexpressing his feelings, I can say that I love all you guys! We know what brought us together - throat cancer. Whoknew that we would form such a bond that it will last for alifetime? Although laryngeal cancer is not the best thing tobe stuck with I think we have been blessed as we have metand been able to help so many of those afflicted.

In 1998, when I had my surgery I was at a complete lossas to what to do. I was 63 years old and recently retired. Ifound WW in December 1998 and the rest is history. I alsobecame president of our local club and devoted many hoursto this group and visitations to our newbies. ThenI discovered the IAL, became active with that group, and amnow the acting VP. SOMEONE decided what I'd do with myretirement time!

All the people I have met and that have touched me sincemy laryngectomy have been incredible. Yes, there havebeen some tough times with members passing but therehave been many better times with new members who have a



have been many better times with new members who have aTEP inserted and are able to TALK! What a thrill to see theirfaces when they say their first words and to see themprogress as they get better and better.

I cannot close without thanking Dutch again for the greatefforts he took in founding WW. I don't think he even knowshow many lives he has touched and will touch for thebetter. We are truly thankful for his brilliant idea to assistthose who virtually had nowhere to go.

I am delighted that I am able to take this journey with youtogether. It makes me extremely happy!

Happy Holidays and PEACE ON EARTH!

Murray Allan, PresidentWebWhispers Nu-Voice [email protected]

News, Views, & Plain

Talk by Pat Wertz Sanders, WebWhispers VP - WebInformation

What is the IAL Annual Meeting? We had a great article by Dr. Ed Stone about the Voice Institute in lastmonth's issue of Whispers on the Web but there are some people who want toknow what the Annual Meeting has to offer, when to sign up and what to dothere!

Murray Allan had this to say about the next meeting site, " Currently, inaddition to being WebWhispers President, I am active as Chair of the Annual

mailto:[email protected]



addition to being WebWhispers President, I am active as Chair of the AnnualMeeting committee of the IAL which is holding its annual convention inAnaheim, CA from July 6 to 10, 2004 (Voice Institute: 6-10 July, AnnualMeeting: 7-10 July). The convention is being held at the beautiful AnaheimSheraton which is just three minutes from Disneyland by shuttle. What a greatchance it is for everyone to gather with their friends and enjoy the wonders ofthis marvelous attraction at the same time. We are trying to obtain reducedrate passes for evenings at Disneyland. I have attended the hotel for an interimmeeting and it is truly a first class establishment with a staff to match. If youcan possibly make it, don't miss this great meeting."

Here are some personal thoughts. Do your registration online or by snailmail well in advance (see Dutch's column in this issue for how-to). Thendecide what day you are going and make your hotel and airline reservations If you don't have anyone to share a room, the IAL or other WW members maybe able to help with that. You will be able to visit the IAL registration desk atthe hotel on Wednesday afternoon (July 7th) for early registration but officiallyThursday is the start of the AM. You will be given a nametag with ribbons,some of which indicate that you are a newcomer or a delegate! There isalways a "goody" bag with an assortment of nibbles and gifts.

The AM schedule shown on the web at the present time is underconstruction and there will be a lot of additions and changes made asspeakers are confirmed but it will give you a general idea. There will beopening ceremonies and they are always exciting and impressive. This eventis shared by both the VI and the AM attendees. At various times during theentire convention, there will be shared activities. At other times, there will be speakers in the AM section, or a choice of activities with some businessmeetings going on at the same time. It can be a little like a 3 ring circus withlots of things going on. In addition, you may choose to attend the VI classes ifyou sit in the back, observe and listen. Since you are not signed up for the VI,this is a courtesy extended to you if space allows.

Some AM speakers will be professional and some will be laryngectomeesor other parties with expertise in their field. I have been asked to lead adiscussion this year for the AM and I suggested the topic of Newsletters. Iwould hope to have in attendance other editors with copies of their newslettersand people who want to start a local newsletter or need ideas for existingones. We can share with each other and each go home a little wiser.

Vendors will have tables set up and it is difficult to find enough time to seeeverything. Plan to spend time there looking, asking questions, andsometimes trying new products. You get to see products you had only heard



about. Lots of literature is laid out for the taking and there are usually somenice give-away items so carry your goody bag.

There will be some evening activities, usually including a Meet and Greetand a Sing-a-long. On Friday evening, there will be a reception and dinner forWebWhispers. Details and cost will be announced later. Remember thatSaturday evening's IAL banquet is already paid for with your IAL or VIregistration and it is always superb so plan to go.

Check over Dutch's article below to go to the web site and browse for moreinformation.

Dutch's Bits, Buts, &Bytes "IAL 2004 in Anaheim - How to Navigate the IALWeb Site"

OK ... you've pretty much decided to go, but now needsome more information on the programs, the hotel, the hotelreservation and meeting registration processes, etc. Well,by far the best place to go is to the Anaheim section of theIAL web site. It can be accessed from the main IAL HomePage or directly via the IAL 2004 Anaheim Home Page at: http://www.larynxlink.com/Anaheim/Anaheim1.htm.

(1) To check out the Annual Meeting AND the VoiceInstitute programs, simply scroll down the above Anaheimpage to the red-bordered white "box" and click on the LINKthat says: "AM/VI Schedule of Events". This will take you tothe Schedule of Events page. The schedules are nowprobably 90% firm but will undoubtedly be updated manytimes between now and July of 2004. If you want moredetails about the Voice Institute, just scroll to the bottom ofthe "Events" page and click on the LINK that says, "VoiceInstitute". This page contains a current course descriptionwritten by Dr. Ed Stone, the VI's Director.OK ... now you have some details and now you want toregister with the IAL to attend EITHER the Annual Meeting orthe Voice Institute.

http://www.larynxlink.com/Anaheim/Anaheim1.htm



the Voice Institute.

(2) At the bottom of the above pages, and on others, thereis a LINK that says, "AM/VI Registration Pages". Click onthat LINK to reach the Main Registration Information Page. The upper half of this page provides AM/VI information thatyou need to know. The lower half of this page providesyour LINKS to the specific AM Registration Page or the VIRegistration Page you will need to access to properlyregister with the IAL. For both the AM and the VI, you havetwo choices ... (1) a LINK to Dual Registration FORM that youcan print out and then mail in or (2) a LINK to a secureelectronic Registration Page which you can complete, usingyour VISA, MasterCard, or Discover card, and then send itoff electronically to the IAL. There is also Hotel Informationat the bottom of this Main Registration Page ... but we'llcover THAT later.

(3) So, for IAL Registration you have two choices ... amail-in form you can print out OR and electronic form youcan complete and send in. The mail-in form is self-explanatory, but the electronic form is easy, too. From theMain Registration Page, simply click on the LINK to theregistration form you desire, either for the AM or the VI. When you get to the secure form page, you will notice asmall "lock icon" in the lower right hand corner of yourcomputer screen. This indicates that you are logged into a"secure page" and can feel confident about entering thepersonal and credit card data that is requested. Once youhave filled in the blanks or checked the little "boxes" withthe correct information, just double-check them foraccuracy, and then click on "Submit Form". It may take afew seconds for the information to transmit but when it doesyou will get a new "Thank You" page, acknowledging yourregistration. And, BINGO ... you are now REGISTERED.

(4) OK ... you are now registered for the IAL meeting, butnow need the Hotel Reservations. You can reach the "HotelReservation Instructions and Information" Page via a LINKfrom the Anaheim Home Page, from any of the other pagesabove, AND from the Registration Acknowledgement Pagethat you got back immediately after registering. Once ONthe Hotel page, scroll to the bottom to the black-bordered



white "box". Therein is ALL the information you need tomake your hotel reservations ... by PHONE or by FAX. Justfollow those simple instructions and you are DONE! (I,myself, being lazy, just FAX'ed them a letter with myreservations request ... and, surprisingly, I received anEmail confirmation from the hotel within just a few shorthours.) By the way, just below the little white informationbox is a LINK to a Sheraton-sponsored page that covers themany attractions in the Anaheim area ... certainly worth yourvisit!!

(5) Finally, are you interested in pursuing an IAL BattenScholarship to help you attend the Voice Institute? If so,just go back to the IAL 2004 Anaheim Home Page, scrolldown again to the LINKS and click on the one that says,"2004 Batten Scholarship Applications (VI Only)". This willtake you to the form which you can print out, complete, andthen mail in for IAL review and approval. Piece of cake!!

I hope the above "tutorial" will help you navigate the IALsite so that your registration and reservation experienceswill be good ones ... user-friendly and successful. Hope tosee MANY of you in Anaheim in July of 2004!

(Note: When you do register, for the AM or the VI, pleasesend me an Email letting me know ... giving me the namesand the home towns of those in your party, so that you arecorrectly listed on our Anaheim Attendees Page on our website. In this way, all WW members can know, at a glance,which other members will be attending. Thanks much!!)

ListServ "Flame Warriors"

Terms of Importanceflame 1. n. A hostile, often unprovoked, message directed at a participant of an internetdiscussion forum. The content of the message typically disparages the intelligence,sanity, behavior, knowledge, character, or ancestry of the recipient. 2. v. The act of sending a hostile message on the internet.

http://www.webwhispers.org/secure/WWinAnaheim.htm



2. v. The act of sending a hostile message on the internet.

flame warrior 1. n. One who actively flames, or willingly participates in a flame war ... (AnotherExample Below) ...

THE BLOWHARD

Blowhard feels the need to present his credentials before entering the fray - even if they are irrelevant to the discussion. For example, in a movie forum

conflict he might attempt to settle the matter by saying, "As a Ph. D. candidatein particle physics I believe I can say with some authority that the 'Beavis and

Butthead'movie represents the emergence of a new cultural paradigm." Huh?

Above courtesy of Mike ReedSee more of his work at: http://www.winternet.com/~mikelr/flame1.html

Welcome To Our New Members:I would like to welcome all new laryngectomees, caregivers and professionals

http://www.winternet.com/~mikelr/flame1.html



I would like to welcome all new laryngectomees, caregivers and professionalsto WebWhispers! There is much information to be gained from the site andfrom suggestions submitted by our members on the Email lists. If you haveany questions or constructive criticism please contact Pat or Dutch [email protected]. Take care and stay well! Murray Allan, WWPresident

We welcome the 25 new members who joined us during December 2003:

Lee & Diane(caregiver) Allard

Kirkwood, NYMargaret AttridgeHomosassa, FL

George BechardWaterloo, Ont., Canada

Sarah Brinklow - CaregiverBrockport, NY

Stephanie BuckGloucester, MA

Riley CaudillLexington, KY

Walter CrosbyAnn Arbor, MI

Ian CurrieTauranga, New Zealand

Robert DlouhyRiverside, CA

Claude DuhamelLafayette, GA

Vicky (caregiver) & GeraldKaufman

Camby, INIan Kurka

Titusville, FL

Betty LamppaWyoming, MN

Vicki Leslie - CaregiverHercules, CA

Clarence LewisBeaumont, TX

Sharon LickmanElsie, MI

Sid MillerFort Myers, FL

Clarence MitsdarfferEvansville, IN

Alan ShafranTarpon Springs, FL

Robert SheltonHampton, VA

Roger SilbermanSan Francisco, CA

Marshella UngererSt. Joseph, MO

Sue Ward - CaregiverGreenville, VA

mailto:[email protected]



Happy New Year 2004!!

WebWhispers is an Internet-based laryngectomee support group. It is a member of the International Association of Laryngectomees. The current officers are: Murray Allan..............................President Pat Sanders............V.P.-Web Information Terry Duga.........V.P.-Finance and Admin. Libby Fitzgerald.....V.P.-Member Services Dutch Helms...........................Webmaster

WebWhispers welcomes all those diagnosed with cancer of the larynx or who have lost their voices for other reasons, their caregivers, friends and medical personnel. For complete information on membership or for questions about this publication, contact Dutch Helms at: [email protected]

Disclaimer:The information offered via the WebWhispers Nu-Voice Club and in

http://www.webwhispers.org is not intended as a substitute for professional medical help or advice but is to be used only as an aid in

understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition.

As a charitable organization, as described in IRS § 501(c)(3), the WebWhispers Nu-Voice Clubis eligible to receive tax-deductible contributions in accordance with IRS § 170.

? 2004 WebWhispersReprinting/Copying Instructions

can be found on ourWotW/Journal Page.

http://www.webwhispers.org/pages/Journal.htm

whispers on the web - january 2004

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