I Got "Looped" Last Night

December 19, 2011

Judy and I went with another couple to see the Irish Tenors last night.  Our local performance art theatre, Van Wezel, was recently looped.  I am a member of the Hearing Loss Association of Sarasota (HLAS) which has been advocating looping. Only western Michigan under the impetus of Professor Myers at Hope College has been as successful as Sarasota has been (http://www.hearingloop.org/).

This was the first time attending Van Wezel this season (Frankie Valli and Seinfeld on the docket next month for us) so I switched to my T-Coil setting.  The microphone and speaker are OFF--no outside noise--and loop transmits stage sound system in an FM like manner right to my inner ear--plenty loud and clear--misses a little richness and similar to a good transistor radio. I can now enjoy plays and the spoken word again—even though deaf in one year as I labor through the eight week “gestation” period for activation of the Envoy Esteem implant in the left ear.  Interesting in that when audience claps (I can't hear that—no hearing aid microphone), the three guys speak to each other and I can hear the comments BUT the audience cannot!

I quote from the newspaper account on looping of the Van Wezel Performing Arts Center



“The "induction loop" system magnetically transmits sound to hearing aids and cochlear implants with telecoils (T-coils). The hearing loop system transmits performers’ voices from the stage microphone directly into a hearing aid or cochlear implant equipped with telecoils for clear sound, allowing wearers to use hearing aids as wireless loudspeakers.

The copper wire of the Van Wezel’s hearing loop is placed at floor height of the hall. A loop driver drives the electromagnetic field, which allows a hearing aid or cochlear implant’s T-coil to function as an antenna directly linking the listener to the Van Wezel’s sound system. This system complements the hall’s existing infrared hearing system.”

I sure hope the copper thieves don’t figure a way to steal the loop!

More good news.  HLAS obtained a grant last month from a local foundation to loop 13 theatres in our area.  One of the reasons we chose Sarasota over Naples or Tampa as our Florida home was the dedication to the arts in the community.  There are five Actor’s Equity stages and eight community and special event stages.

More quotes from the HLAS press release:

“The hearing loop is the only system that sends clear, clean and interference-free sound from the stage’s microphone directly into the hearing aids or cochlear implants of the hearing impaired in the audience.

The 10 theatres includes 13 stages, which will receive the grant: Asolo Theatre, Florida Studio Theatre (Keating), Florida Studio Theatre (Gompretz), Manatee Player’s Theatre, Neel Performing Arts Center (Main), Neel Performing Arts Center (Pinkerton), Sarasota Opera, Sarasota Orchestra, The Player’s Theatre, Venice Community Center, Venice Theatre (Main), Venice Theatre (Pinkerton) and the Westcoast Black Theatre Troupe.

Each stage will receive a hearing loop system that transmits the sounds of the performance through an amplifier and induction loop to any hearing aid or cochlear with a T-coil, which is a tiny wireless receiver. Virtually all new hearing aids, and some 75% in use today, are equipped with a T-coil. Each theatre will also receive a box office loop system and 5 loop receivers that hearing loss individuals without T-coils or hearing aids can use to access the loop system”.

Huh? "Hard of Hearing" Not Defined

December 18, 2011

Pleased to report all is well.  No pain, playing golf (won $107 Friday)—just kind of quiet.

The onset of loss of hearing was late in my career.  In 1995, speaking to a group of 180 police chiefs and attorneys at the Boston Marriott, I could not hear the questions from the rear and recognized a problem.  In my classes at Northwestern and University of North Florida, I became Phil Donahue, rushing up the aisle to listen to and address the question.  At City Council, Civil Service hearings, and Zoning meetings, the FM speaker system was a blessing as an earpiece brought the sound in loud and clear.  Most of my court work was motions and arguments so I could manage there. One day in Federal Court, a big room with a very high ceiling, I was arguing a point and the Judge apparently had instructed me to stop—only when the Marshall approached at the direction of the Judge did I realize the problem.  I obtained my first hearing aids shortly after that, around 1997

“Hard of Hearing” is a phrase that identifies those with varying levels of hearing loss.  “Deaf” is arguably the total loss of hearing but many at profound levels of loss refer to themselves as “deaf”.  I have no expertise on the appropriate scientific language and find little formal levels of description in audiology journals.

Our state board for assistance is entitled “Florida Coordinating Council for the Deaf and Hard of Hearing” so I guess there is no specific word for those who have moderate to severe loss of hearing other than “hard of hearing”.  One would think the audiology community would have more defined descriptors.  In reading about the use of the terms, I have found that one’s use of "deaf" or "hard of hearing" is a sociological choice, whether to identify with the deaf community or not.

You have all seen the ads in the health sections of the newspapers with a range of day to day activity that could be signs of hearing loss.  All of this to sell a product that simply amplifies sound—of all kinds—and drills them into your ear.  Works fine for this severe loss guy in one on ones but as the number of persons rise or the room reflects sound, “fagetabadit.”.  The hope with the Envoy Esteem is that the natural ear with increased stapes vibration but not amplified sound will separate the distant from close and discriminate and locate sound sources.  Our spouses know not to talk if the dishwasher, vacuum, disposal or even the TV is on—just can’t break down the sound—and the background sounds are loud!

One of the fears of hearing loss for me is social isolation which is a common downside to those with hearing loss. I try to challenge this and not permit it to happen.  At work, social conversations were difficult to follow; restaurants and cocktail parties, a given failure; meetings—I must situate myself at an optimum point; theaters, tough, but more on this in the next post.  Many avoid social situations, I will not—I just don’t ask as many questions because I may not hear the answer.  My “Type A” is now “Type A-“.  Perhaps it is this battle that caused me to invest in the Envoy Esteem.  Still in my 60’s, I figure at least 20 more good years and I want the best quality of life.  For the price of a Chevy, less than a Volt :), I have pursued that opportunity.

Heading Home to Sunny Florida

December 5, 2011

Saturday and Sunday were rough.  Slept in 20 minute intervals at night. I did get over to my daughter Wendy’s house for da’ Bears game.  I grew up a Browns fan, came to Chicagoland in 1973 and got into the Bears in that great 1985 season.  Now a Tampa Bay Bucs fan but frankly, I go with the frontrunner of these three each year.  All disappointed this year and am now a Tebow fan having watched him at Florida for those great years. I get a kick out of the secular liberals trying to put him down.

I have not felt like eating since the surgery and some ginger ale and a few crackers is it.  The surgery limits the ability to open the mouth very far and the effects of anesthesia must kill the hunger brain cells. I regret missing Wendy's birthday party Saturday night--just too much pain--but am glad Judy could make it.

Today is Monday and it is still cold, dark and drizzly.  We have a 2:00 flight back to Florida, thank God.  A follow-up with Dr. Marzo at 10 AM and 20 minute ride to O’Hare from there is on the schedule first.  We arrive an hour early and I am prepared to wait but Eileen, his great R.N., calls us in at 9:05. I explain my pain and they both tell me not to fight the pain but take the pain pills.  I recall Rush Limbaugh getting addicted to pain pills after his cochlear surgery so I have tried to avoid them as much as possible.  They explain body has to work to heal and can’t do that when fighting pain—“Oh”.

Dr. Marzo advises everything is coming along fine and adjusts the pain medications. Feeling better already.

We get over to O’Hare and hangout at the C Concourse food court.  I did classes and seminars in all 50 states for Northwestern University, University of North Florida, ABA, and other groups for 28 years and flew somewhere once or twice a week.  It could be Billings, Phoenix, SFO, Meriden, Ct., Waterville, Me., Paducah, Westminster, Co., Bismark, Bellevue, Wa, Plano, Tx., Charleston, Jacksonville or Honolulu to name a few.  I went non-stop from O’Hare to all of them but ran such a tight schedule with my day job (city attorney) that I rarely had time to graze at an airport.  I tried some eggrolls and Snapple and it felt good to finally eat.

The flight was uneventful.  I refuse to pay for bags or seats on principal so I was relegated to rear scrunchy seats (I am 6”3” and no longer slim) but got lucky.  It was not a full flight and I had a whole row to myself.

We arrived to a beautiful sunset and 78 degrees.  I am looking forward to recuperation by my pool overlooking a golf green across a small lake with a bird and eagle estuary beyond.

Surgery Today!

December 2, 2011

When I was on trial or heading to court for an appellate argument, I was always early.  I had thoroughly prepared and was “ready to rumble”.  I felt the same way about the Envoy Esteem mastoid surgery.  I had studied, I had reviewed, I had followed all the doctor’s orders, let’s go!

Judy and I left home at 5 AM for the 6 AM appointment.  A quiet morning with little traffic got us to the Oakbrook Terrace facility 15 minutes early.  We awaited staff to open the doors, filled out the forms and were escorted to a typical medical room.  Dr. Marzo stopped by, reviewed a few things and answered Judy’s questions.  A four hour surgery was expected—often extra time is needed to test the implant device to assure it is working as designed.  The anesthesiologist went through her explanations, a nurse of 40 years, Judy, followed up with down to earth expectations as well. In moments, I was asleep.

The nurses and my Judy were there as I awoke—where did the day go, 1:00 PM!  I had to stay for another hour or so as grogginess and pain continued.  Soon, prescriptions in hand, I was whisked away for the drive home.  Not feeling great and drifting in and out of sleep, Judy motored us home to the quiet Sun City farm town (endless corn fields are our back view).  The day was dark, cold, and drizzly.  I am thinking that this  is the first week of December and these Illinois people have nothing but colder and snowier to look forward to for the next three months—why did settlers settle here—why do retired folks stay here—no golf—no beaches—no fun!

I was resting for the rest of the day but a lot of pain limited my options.  Worse, we had turned off the cable and wi-fi when we left Illinois on Labor Day.  The cable company reported they could turn it on in five days—we will be outta here in four.  No basketball games, no football games, especially Michigan State/Wisconsin on Saturday, no politics, no surfing  the web.  I did have an ancient cell phone (18 months old) that could get me small screen e-mails and I could read my downloaded books on my I-Pad but this was truly roughing it.

Anyway, the surgery went well I am told, the pain will leave sometime and my two months of deafness in the left ear have begun.

Envoy Medical and the FDA Throw a Curve Ball

December 1, 2011

I had made an earlier trip to meet with Dr. Marzo at the Loyola University Center for Hearing in Oakbrook Terrace, IL in mid-October since I had planned to come up for the Northwestern Penn State game.  I am a huge Big Ten fan and had been adjunct faculty at Northwestern for 28 years (many of them 1-10 or 2-9 football years).

I grew up in Ohio as a Buckeye fan, have given lectures on the campuses of all of the original ten schools and paid tuition for a daughter at Illinois as well as attending every Big Ten basketball tournament game ever played. {Quiz—my wife and I both went to Ohio colleges where Woody Hayes was the coach and neither of us went to OSU].

I had studied the work of Dr. Shohet and Dr. Murray, the pioneers in Envoy Esteem, and felt comfortable going to either one.  Dr. Marzo started the Esteem implants after the March, 2010 FDA approval.  Envoy Medical representatives were complimentary, patients were finding success and his reputation and Loyola’s were good.  As in politics, character is important and the fact that he was an Evans Scholar (caddy scholarship program started by Chicago’s Chick Evans and a program well known to me) and the facility being in Chicagoland where I had a second home convinced me to meet with him. By that time, he had performed 30 implants and I was comfortable with this level of experience.

I met with Dr. Marzo on a crisp October morning and had my required CT scan in hand. He advised that I met the other criteria: 1) sensorineural loss, 2) healthy middle ear, 3) 40% plus speech discrimination, 4) hearing aid user more than 30 days--(10 plus years).  Dr. Marzo reviewed the CT scan and stated there was room in the mastoid to implant the device.  A new audiogram was prepared and appointments were made.

A battery replacement for the Envoy Esteem requires surgery with a local anesthetic and the cost is  $5000 to $7000.  The battery can last from 4.5 to 9 years based upon usage.  I had read the FDA finding and noted that a post-FDA study of 120 patients was required. I asked about this in the summer of 2010 and continued my inquiries.  Envoy Medical finally advised that a free battery replacement would be granted for participation.  It would require returns to the original surgery site about eight times over five years.  I was good with that and signed the papers.  Besides the freebie, I felt that the close monitoring would be beneficial to me and maximize my results as they would have a business interest in my success.

Pre-op baseline testing was required and three hours were set aside with Loyola’s audiology team on Thursday, December 1 for this purpose.

Lo and behold, the test had a curve ball--the hearing aids had to be programmed to specified criteria to the audiogram (I think that is what they said as I don't hear well, duh!).  This had never been stated in the literature or the FDA documents. I get hearing aid feedback due to the necessary gain required and we (my Florida audiologist and I) set the program a little below max.  I could easily have had the hearing aids programmed to the required criteria for 30 days prior to the pre-op.

I was dismissed from the post-FDA study and left the facility after only a 20 minute test somewhat down—not a good mood to be in for the 6:00 A.M. surgery appointment tomorrow..

Chicago and the Piezoelectric Effect

November 30, 2011

Heading to Chicago with my supportive wife, Judy.  Beautiful drive over the Skyway Bridge to Tampa International on a clear Wednesday morning.  United was on time and O’Hare, well its O’Hare.

Chicago in November, such memories, cold, grey, drizzly!  Got together with friends before appointments and surgery the rest of the week.  Many of our friends have moved from Schaumburg/Hoffman Estates to Huntley where Del Webb has built a mega Sun City.

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We upsized to a new home in Florida and downsized our home in Illinois in 2005. The Illinois home (summer only!) is in Huntley, a farm town most famous for the annual Turkey Testicle Festival on the Wednesday before Thanksgiving—14 hours, 7 bands (http://www.parksidepubhuntley.com/ttf/).  Missed it this year but our friends at dinner updated us.

I enjoy talking about the Envoy Esteem and did so at dinner. I described the fact that no microphone or speaker is used and that the device in entirely implanted behind the ear.  I explained about the sound processor and that a sensor and driver are “glued” onto the tiny incus and stapes bones and vibrations are transmitted to emulate the function of the lost hair cells in the ear to produce natural, not amplified, sound using the natural ear. When I said that that the vibrations are created by a piezoelectric effect, one of our friends, a forty year chemistry teacher suddenly became attentive.  He explained that piezoelectric is like the old crystal radios and the effect is used in loudspeakers, guitar amplification and many sound related functions.

Dr, Marzo’s information said no liquids or food after midnight the day before surgery which is Friday.  Since this was Wednesday, I asked for separate checks so the others would not have to co-pay for my extravagant tastes and my traditionally celebratory drink(s), Glen Livet.

My daughter, son-in-law and two grandchildren live on the “family” side of Huntley so it will be good to spend time with them during this Illinois visit and I look forward to that.

The Envoy Esteem Journey Begins

11-29-11

Each session of the United States Supreme Court begins with the Marshall's announcement:
"Oyez! Oyez! Oyez! All persons having business before the Honorable, the Supreme Court of the United States, are admonished to draw near and give their attention, for the Court is now sitting. God save the United States and this Honorable Court!"

Then the fun begins. In my first oral argument in 1981, Chief Justice Warren Burger stated "You may commence argument Mr. Williams". For one hour, nine U. S. Supreme Court Justices fired questions from a high panel in front of me stretching 180 degrees. I heard every question and identified each Justice as I answered (O'Connor, Marshall, White, Stevens, Brennan, Blackmun, Rehnquist, Burger, Powell). A forty year legal career included two successful trips to that Court and over one hundred other appellate arguments.

That would be impossible today since even with hearing aids, my severe hearing loss, suffered late in my career, makes it impossible to identify the source of the sound or to fully understand the words.

Now, I need to hear "that's good" for a putt on the golf course, the voices of my grandchildren ranging in age from 3 to 17, dialogue in theatre plays, golf partners at lunch, friends at dinner and my wife, not so much (just kidding!). I can't use the phone, can't understand clerks, fail to return "Good Morning" greetings. Inconveniences, yes. I recognize the health burdens of so many others and my limitations pale in comparison.

I attended several Envoy Esteem seminars and studied every FDA submittal and transcript. I read medical journals and the Envoy Medical business plan. I found patient blogs to see if this could be the solution for my diminished quality of life.
I am convinced it is and am headed from my Florida home to my home from 1973-2007, Chicago, for meetings and surgery commencing November 30.