FINIS

Its been a while. Time to close this blog.

The jury is still out.

The battery is still working.

Envoy Esteem has changed its business plan.

Not getting the adjustment help I need. The Esteem is still OK but not any better or worse than a hearing aid.  Still have word recognition issues and the noisy places are still noisy.  Hope the journey portions of this blog have been helpful to anyone making a decision for Esteem.

Adjustments--My Processor and Envoy Medical

Five months ago, I discussed the WPA, a "work in progress".  Like the economic recovery, the work continues.  I had a June appointment to tweak the sound processor, the Envoy Esteem implant.  The technician I was to meet in Tampa advised she had to attend a surgery in Atlanta so we put it off.  I called the Envoy rep. in early August to reschedule but was advised there had been some changes.

I wrote about the Envoy Medical business plan on January 11 and 12, 2012 and a possible IPO.  Apparently that plan was not working.  I was informed that I will no longer set my adjustment appointments through Envoy but through my physician.  Apparently the Spearmans are out and a new executive team is in place.  I and all other patients received a letter from Barb Cederberg, the new President of Envoy Medical advising of the business model change and clearly written by the legal team.  The letter advised that the surgeon and audiologist will now handle all followup and long term issues.

I was contacted a day later by Dr. Marzo's office in Chicago that they would be doing adjustments and made an appointment for Monday, August 27.  We sold our home in Chicagoland in early August but my wife was flying up that weekend for our youngest daughter's wedding shower so I booked a flight for Sunday August 26 so we could fly back together after my appointment.  Hey, what's another $500.  I stopped by the RNC Convention to check out doings before flying north as I was afflicted with a political virus in 1952 when I was glued to the Taft/Eisenhower battle for the nomination. I was a political science major and ran for state office in Ohio in 1972 and have always been involved even to this day serving on my Town Board, serving on the Chamber of Commerce Government Affairs Committee and active on some local campaigns.

I digress as I tend to do but Judy and I headed down to Dr. Marzo's office and met with the audiologist who has been involved with all of his Envoy Esteem patients and has 19 Envy Esteem post-FDA study patients.  She had been up to the Minnesota headquarters that weekend for training and meetings and was very encouraged with the change.  The medical device industry can choose to market their product to the public or through physicians.  Apparently their marketing to the public choice was not as effective as they expected.  I believe I will have have more confidence in the surgeon's audiologist who has been trained on the Envy Esteem sound processor than the technicians hired and traind by the company.

She did an hour and a half of tests and listened carefully to my concerns.  I was getting volume but having word recognition issues in normal settings.  In restaurants and parties, there was reduction of noise when I reset the device but it also reduced the sound of the people I was listening to.  There was just no sound separation in any setting.  Adjustments were made to the programs and Dr. Marzo reviewed this and checked out the surgery and answered a few questions and we determined we had done all that we can for this visit.

Sounds are a lttle better but hearing will never be optimum.  I had the occasion to attend the Hearing Loss Association of America Convention in Providence in June and spent a morning listening to four research otologists from Johns Hopkins and learned about neuron damage and why such damage causes the loss of the ability to process and separate sounds.  All sound is noise for me and I have to keep trying to discriminate the best that I can.

I will continue to review the business plan and, in fact, gave some tips to the MedCity News reporter who works the medical device beat.  He was unaware of the changes at Envoy and he is digging in and had interviews scheduled with Barb Cederberg and some patients,  I am anxious to see what he finds--we can only hope the investors with deep pockets stay with this.

WPA

The Works Progress Administration (WPA) was the largest stimulus program in our nation’s history in terms of success.  Coming out of the depression, FDR’s “New Deal” program employed millions of unskilled workers to carry out public works projects including the construction of public buildings and roads, and operating large arts, drama, media, and literacy projects.




 Almost every community in the United States had a park, bridge or school constructed by the agency. At its peak in 1938 it provided paid jobs for three million unemployed and women.



Many of my friends and guys at the golf course know of my Esteem journey.  Rather than say, “Hi, how are you?” (which even if you the flu, a hangover or surgery recovery, you say “fine”),  they say, “How’s the hearing coming?”   I at first went into a dissertation of the Envoy Esteem, its settings, my audiogram, word recognition and the oscillar chain. Now I say “great but a work in progress” or WPA for short.



It is nearly four months since the surgery and the jury is still out but perhaps taking the last ballot. I had my first follow-up appointment since the January activation this past week on March 21. I felt I was doing well and advised Allison that I was ready for more volume.  We did some audiogram testing and a word recognition test.  I was sure I flunked as I could hear but not understand the words.  The result was 80% so I guess that is progress. I got a boost in volume which is good but it still sounds a bit “tinny”.  There are three banks of sound, one (A) for normal situations with 5 levels; a second one (B) for meetings, lectures, theater with 5 levels; the third (C) is for noisy settings such as parties, restaurants and sports events with the 5 levels.



In the past 4 days I have been actively testing all of these settings at a school fundraiser with a sound system, candidate cocktail party, a homeowner meeting, Rays baseball game (with irritating loud speaker system with music for every between inning), a farcical play, Tony Bennett (I saw him with wife 45 years ago and a few times in between), Hearing Loss Association state meeting with loop system, HLA cocktail party, three rounds of golf (winning money each time) with loud 19^th hole and three noisy restaurants. Yes, I try to stay involved and not retreat due to hearing loss. 



It was a great opportunity to test the programs except I forgot the Programmer at the school event and had two hours of static!  I had success at the noisy restaurants and cocktail party by bringing the level down (to 2) and still hearing the person(s) talking with minimal background noise.  I am working on watching TV (news and sports is about it) without captions to learn to hear well.  This should improve my word recognition but this is weak right now.



“Work in progress” will be my answer for a while and I will check back in with another report in a month or two.

Inside Baseball

“Inside baseball” is a metaphor for a discussion of science, technology, entertainment, politics, or related subjects of which the public has some general knowledge, but whose inner workings could be totally boring or TMI for those outside baseball or the subject at hand.

I love to keep my mind going at a baseball game—hit or bunt with man on first and one out; steal with two out and the one slot at bat—if out, one slot leads off next inning; bring in the lefty or leave the control pitching right-handed reliever in; tag up from second on a long fly ball; and so on.

Quality of piezoelectric (love that word) transmitted sound vis a vis Bluetooth could be that type of  “inside” and probably boring discussion

It has been three weeks since activation of the Envoy Esteem and I thought I should do an update but the information will not be of interest to my friends and relatives who check out this blog.  It may be of some interest to Esteem patients so I will be brief.

There is an A, B and C setting.  I know that two settings are some kind of volume settings and one settings are for noisy places--just not sure which is which.  I started at A-3 and had no issues—no feedback, no static.  I progressed easily to A-5 and had comfort but some difficulty since it is set below my audiogram maximum.  I moved on to B-2 and B-3 but had difficulty in restaurant settings.  Total static at a loud bar—and that was before the house band started up.  Went to C-4 and liked that until I went to a Big East basketball game with the 100 decibel announcer and seats adjacent to the 60 member pep band—OUCH!  Other than that, it was comfortable and I thought it was more volume than the A band.  I have been at C-4 and C-5 the past few days for every day use but still have problems hearing soft spoken folks.  I found the word recognition of the TV was better with the C settings than the A settings, but still weak.

OK, enough of that.  I will try B-4 tomorrow for an 8 AM meeting and golf match later and see how it goes.  [I wrote that last night—had the meeting today--in the online edition of paper already.  That is me on the left—bored]. 

Envoy Medical’s technician, Allison is in Tampa March 19 so I set an appointment for that day and will keep a daily log for her review.  I hope she can program more richness and base into the B settings.

Pitchers and catchers report this week and the Pittsburgh Pirates and Baltimore Orioles are both 15 minutes from the house and my Rays are a half hour away (Manager Joe Madden, to the left, with Ozzie, signed a 3 year contract today).    Time to start hanging by the bullpen and the benches and picking up inside baseball from the guys who do  it for a living. Just maybe I can actually HEAR what they are saying.

Envoy Esteem Activation

My post of January 4 discussed the anticipation of activation of the Envoy Esteem implant.  It seems that hearing with one ear has become progressively worse over the past seven plus weeks so activation cannot come too soon.

I am familiar with the facility near the Tampa Airport where this will occur and head out at 8 AM for the 9:30 AM appointment with Allison, the Envoy Esteem technician.  An easy drive over the Sunshine Skyway Bridge and a beautiful morning.  It always feels better in Florida when there is cold and snow up north and they had a good dusting over the weekend.

We arrived early and Allison was set up and ready to go.

I have been on an Envoy Esteem Patient Facebook group for some time and the experiences of the other patient activations prepared me for the process and the sounds I would hear.  The peer support has been both enlightening and uplifting.

Would it turn on?  Would it have feedback?  Zap, beep and bingo – sound!  As expected, my voice was strange at first as well as a number of sounds I had not heard for some time.  Some audiogram tests were done to set the sound below optimum level as the levels are to be increased by increment over the next few weeks as I learn to hear again.  No feedback issues occurred.  Everything worked well.

We did some sound level instruction on the personal programmer and the process went efficiently and exactly as expected.

Judy and I  then went shopping  next door at the International Mall.  We went to the Apple Store as I am now addicted to my IPAD2.  I offered to buy Judy some $30,000 ear rings at Tiffany’s since this would make our ear costs even but she declined (if you believe that one, I have some Florida properties to offer you).  We had a light lunch and I experienced the expected chewing sounds but actually heard the server for a change.

Driving back, I could listen to talk radio.  This has been difficult since road sounds are so loud with hearing aids that I cannot get enough volume to hear over the highway noise if I have a passenger (volume is no problem if I am driving alone but the car vibrates due to the level of sound I set it at).   I listened to Envoy Esteem’s #1 benefactor of advertising revenue talk about the Florida Primary this week. I am not a happy camper with Republican choices so I will write in Gov. Mitch Daniels as my little protest and encourage others to do so.  Nonetheless, off to a big Republican event tonight, a short rally with Newt tomorrow and more political events this week.  At least I will hear what they are saying.

The follow up appointment for adjustment will be in early April and I will keep copious notes of my hearing experiences but so far, so good.

Envoy Medical, Story of American Capitalism[Part 2]

January 12, 2012 

Envoy Medical Business Plan

I have always supported local businesses and have been a local Chamber of Commerce member wherever I have worked or served..  Whether it is a medical practice, an ice cream store or a print shop, I think about their business plan, their market, their appearance, their attitude, their advertising and their product.  When Bank of America announced debit card fees last year, I watched the papers for the small banks to run ads of no fees or to post banner signs—nothing!  Eventually B of A dropped the fees but it was a missed opportunity for the small banks to gain new customers.  Our community recently opened a 22 field soccer and lacrosse complex in the middle of nowhere (The NFL Combine and the US Soccer Women’s Olympic team are both there this month).  One strip mall with a pizza shop is the only retail within a mile.  Over 78 teams from 20 states as well as France, Turkey and Brazil were here for a competition last month.  Did the pizza guy bring in extra supplies and help? Did he distribute coupons and deals to the thousands attending?  I hope so as I want every entrepreneur to do well, big and small.

I investigated my consumer investment in Envoy Medical’s product for 18 months prior to paying the $30,000, I wanted to be sure they were well financed and would be around if problems occurred and I investigated their business plan.

It is estimated that 31.5 million people in the United States have at least some hearing loss. Of those people, more than 90 percent suffer from sensorineural hearing loss which results from problems that originate in the inner ear, the auditory nerve (which runs from the inner ear to the brain) or in the brain itself.

Envoy Medical’s target market comprises people with moderate to severe sensorineural hearing loss—about 18.5 million people, or more than half of all people with sensorineural hearing loss.

At the time of submission to the FDA in December, 2009, Envoy Medical has spent over $150,000,000!  I was shocked to read that the Rush Limbaugh airtime is billed out at $250,000 a month.   Fine for me but how do they reach my liberal friends.  I hear their commercials with talk hosts Glen Beck and Laura Ingraham as well.  I guess they figure the folks with $30,000 to spend are conservatives.

Investor Glen Taylor has admitted that the implant is expensive but said: “We have to learn how to drive down costs.” CEO Patrick Spearman said two years ago that in order to hold costs down, “We brought everything in house that we could to keep costs down, quality up, and ensure product availability,”   Envoy Medical manufactures the device at its White Bear Lake headquarters, where it employs 50 people. (Rhetorical Query—do the OWS alleged 99% hire and employ folks)


To help overcome the lack of insurance coverage, Envoy Medical offers its own financing.  Investor Roger Lucas was quoted as saying, “Just last week, I got a call from a waitress making less than $40,000 a year-- when she found out we’d finance it and what the payment would be, she said, ‘That’s my car payment. I’ll just hang onto my car a while longer.’”

I found it interesting that they have forged ahead with little expectation of insurance coverage for the implant happening anytime soon.  Their materials and agreements clearly lower this expectation.  I have submitted a claim for reimbursement as a “medical necessity” which it is as I can no longer function at meetings and events due to my severe hearing loss.  I did not send in the agreements with my claim as there was so much pessimism for insurance.





I do like the fact that Envoy Medical will not deal with insurance companies in setting arbitrary rates.  They will let the market, the folks that can afford the implant, decide if it is a good medical investment for them.  Med City News quoted Patrick Spearman last year saying, “The patient will decide whether this works or not, not the medical community.” Envoy will not even bother to apply for reimbursement.



Last year, Spearman estimated Envoy Medical’s 2010 revenue at $10 million and 2011 revenue at $50 million. As of yet, no other company has started to develop a technology to compete with Esteem.



Competition may change, too. “It’s inevitable that we will get competition, because this development is profound,” the late Ken Dahlberg (founder of Miracle Ear) said in 2010. He added, “It is an absolute threat to the hearing aid industry”.  Normally, medical device companies market their technology to doctors, with hopes they will recommend them to patients. However, Envoy will take its message directly to the consumer through mass radio and TV ads.



It was reported last year that about 90-to-100 surgeons are training to implant the device, including doctors from Mayo Clinic, Harvard University and Yale University,   To my knowledge, my doctor has always met the four hour goal (based on the fact I am online with half of his patients) as the patient is under anesthesia. Just like I told my kids, “nothing good happens after midnight”, nothing good happens after four hours of anesthesia either.  I have heard of many cases with other physicians running from 6 to 9 hours.  I know that Envoy Medical will not continue to approve of doctors who consistently exceed that time frame.

In Medical Device Daily, April, 2009 some insight to the business plan was given by CEO Patrick Spearman., he said, "We have a lot of money and keep putting in money ourselves...To raise $25 million to $30 million should be a slam-dunk. We have such a high value, it makes raising money easy. We believe the company can be sold, after FDA approval of Esteem”.  The goal, he has said, is to go public and then create a surgical franchise.

"It takes a skilled surgeon to implant the Esteem and we want to make sure they are properly trained and we want control of it all," he said. "There's a steep learning curve. Our marketing strategy will be completely different. We're not going to hospitals and doctors. We're going to launch our own surgical centers and use direct-to-consumer advertising. If you use a hospital, the cost of surgery is $30 to $40 a minute. If you have your own center, it's $6 to $10 per minute, like a plastic surgeon."

Spearman has been further quoted as saying, "Initially, there are enough people who can afford this...we're not going to be at the beck and call of the medical community on what we can charge. When they see the success, they'll come to us. The public will sell this product. If a pacemaker is put in, how can you tell if it's working? Only the doctor can tell. With our device, the patient can tell if it works or not. This product is a public interest story and we're going to devote tens of millions to advertising."  He believes the volume of sales will reduce the overall cost of Esteem.

It appears the Envoy Medical is on course to an IPO.  They filed with the SEC for a $20,000,000 security offering on November 17, 2011.  The FDA approval, the trained physicians and word of mouth of successfully implanted patients may make this another successful American story of reinvestment, the essence of capitalism. 

[Attribution and Disclaimer-- Sources used for this post were: Twin Cities Business, Hearing Aid Home, Med City News, Forbes, Medical Device Daily, Fox 26 Houston. The information herein is from reliable sources and deemed to be accurate. If any information is believed to be inaccurate, please notify and corrections will be made]

Envoy Esteem, Story of American Capitalism [Part 1]

January 11, 2012

Perhaps this post should be titled, “Bob Dylan, Occupy Wall Street and the Envoy Medical Business Plan”.  It is a story of smalltown Americans whose efforts to achieve success and help others are on the road to success.

Bob Dylan

Hibbing Minnesota, a city of less than 20,000 along the Mesabi Iron Range in northern Minnesota is most famous for being the hometown of Robert Zimmerman, better known as Bob Dylan.  I had Hibbing business acquaintances from The Ryan Companies They built 15 million square feet of Targets, Best Buys, Kohl’s and others including a 12,000 seat arena, the Sears Centre, in the city I represented for 35 years.  They still have summer homes there.  Hibbing athletes?  How about Roger Maris and Kevin McHale!

McHale married his high school sweetheart, Lynn Spearman.  Lynn’s brother, Patrick Spearman,  is the CEO of Envoy Medical. Another brother Michael is CEO of Ototronix and an investor in Envoy Medical.  Ototronix is another non-microphone hearing system and the home office is in the Woodlands in Houston.  Not surprisingly, Envoy Medical has established “the premier international center for the implantation of the Esteem hearing restoration technology” in the Woodlands.

Patrick, Michael, and a third brother Daniel had $5.25 million invested in the company as reported a year ago. The Spearmans are veteran entrepreneurs who sold their first company, filter maker Porous Media, to Minneapolis-based Pentair for $225 million in 2007. Their second, Lexion Medical, has 100 employees and shares a building with Envoy Medical, the more universal-sounding name that St. Croix Medical assumed in 2006.

Houston media says: “The Spearman brothers work to bring the world of sound to those who have difficulty hearing, using remarkable technology that exists no where else in the world.”

They said when McHale was named coach of the Houston Rockets: “It seems Hibbing, Minn. has a habit of producing one-of-a kind individuals, whether it is legendary musician Bob Dylan or Kevin McHale, a tremendous big man who made it all the way to the Naismith Hall of Fame...the move to Houston to begin his new job as head coach of the Rockets will be a little like coming home away from home for he and his wife Lynn.”

It is reported that the Spearman families split time between Minnesota and Houston. I would bet Houston is the home of all during the winter.


Occupy Wall Street



The folks down at Zucotti Park decry the 1% and espouse redistribution of wealth.  Most millionaires in this country, the one percent, were not born into wealth.  They worked hard and took risks.  Some fail but those who succeed receive great rewards due in part to a tax system that does not penalize success.  We would not have Envoy Esteem but for a system that rewards entrepreneurship. The Envoy Medical story is a continuing one—a lot of capital is invested and rewards have not yet come to them but the investors believe they will.  The investors would not invest unless they were assured they could keep a fair amount of return for the risk taken.

Before the Spearmans, there was Roger Lucas.  Lucas is currently Chairman of the Board of Directors of Envoy Esteem. He is also currently Vice Chairman and Chief Scientific Advisor to the Board of Techne Corp. (NASDAQ:TECH and  a Forbes top 100 mid-cap), a biotechnology company that he co-founded in 1985 and developed into one of the world’s largest suppliers of genetically engineered immuno-modulatory molecules. The story goes (from Twin Cities Business) that Lucas, “stumbled across the company and its technology while looking for something else. In November 1995, he was chatting with an independent technology broker working for the University of Minnesota. That discussion was interrupted by an incoming call that Lucas needed to take. The next day, when Lucas called to continue the conversation, the broker mentioned he had just returned from showing office space to Ted Adams and Bruce Brillhart, two former Medtronic employees who had founded a new company called St. Croix Medical. Adams and Brillhart told the broker they owned a technology that could restore hearing.


Intrigued, Lucas got in touch with the start-up’s founders. ‘They had this device, and they drew it out on the back of the proverbial napkin,” he recalls. Lucas was impressed and says that he ‘kept falling more and more in love with the company.” He kept pouring more and more money into it. Today, he owns about 18 percent of the company,”

Other investors include Minnesota Timberwolves owner and billionaire Glen Taylor with 15 percent of Envoy; former Medtronic Inc. vice chairman Glen Nelson, a prolific investor, owns a little under 1 percent. The late Ken Dahlberg, founder of Miracle Ear and inventor of the first in-the-ear hearing aids was an early investor with 3%. Dahlberg said “I think [this technology] will replace a substantial share of the hearing aid market, but it will be gradual...once people buy this, they are off the hearing aid market forever”. It has been reported that Starkey Laboratories have invested $10,000,000 last year and that Allen Lensmeier, former Vice Chairman of Best Buy has also made a substantial investment. in this hearing aid alternative. Patrick, Michael, and Daniel Spearman have, at last report, 34%.. Cofounder Adamshas cashed out, while Brillhart retains a small stake.

In August of 2010, Twin Cities Business reported that “in May 2000, McHale invested $200,000, then watched as the company faltered the next few years. “I thought, ‘There’s some good money that went bad,’” he recalls. “But I knew the technology was still good.”  He kept his shares. He and his immediate family now own about 1.5 percent of the company”. 



Glen Taylor was reported as saying: “It tickles my heart emotionally to hear the stories of people who have been helped by the technology...It is life-changing for people.”   Taylor also was impressed with the other investors: “The three Spearman brothers were nuts-and-bolts type of people. They watched expenses. They thought long-run, and there was a place and a need for someone like myself. I could help in the business practices.”

MedCity News reported in 2010 that Roger Lucas, said he believes Envoy will go public in two years and reach a $3 billion to $5 billion market cap.  As the Esteem reports more success and the economy improves, an IPO may be on the market this year or next.

Another Google or Apple?  No, but an endgame of three billion dollars would not have happened if our capitalistic system followed the European model to redistribute investor gains.  American capitalism is not political, it is American!

[Attribution and Disclaimer-- Sources used for this post were: Twin Cities Business, Hearing Aid Home, Med City News, Forbes, Medical Device Daily, Fox 26 Houston. The information herein is from reliable sources and deemed to be accurate.  If any information is believed to be inaccurate, please notify and corrections will be made]

Activation January 23--Life Changing Experience?

January 4, 2012

The folks at Envoy Esteem market the implant as a “life changing experience”. I buy into this to a point.  One published testimonial by Envoy Medical says “It’s like Jesus came down and touched my ear and said ‘be healed’”.   That may be a little over the top!  I was blessed with good hearing for my first 52 years.  Many patients have never heard well and their experience may be more exciting to them.  The device is intended for those with moderate to severe sensorineural hearing loss and not for the deaf or those suffering other sources of hearing loss.

Activation is a major step on the journey to hearing improvement.  I have been notified that the Envoy Medical technician, Allison, will meet with me on January 23 at 9 A.M. The technicians travel throughout the U.S. as well as Europe and South America.  A technician is always present during surgery to assure that the device is working properly. If I had remained in the post FDA approval testing group (see Dec. 1 blog), I would have gone to my surgeon’s office in Chicago for the activation.  Since this is not required, Allison will come from Atlanta to a Tampa medical office in the Outback Steakhouse home office building next to my wife’s favorite upscale mall, International Mall.  This could be an expensive trip.

I am in the fifth week of temporary total loss in the left ear and severe loss in the right ear.  My hearing aid has gone out a few times in reaction to loud sounds and I have an appointment to address this. When the lone hearing aid is off or removed, I literally cannot hear my razor, a blender five feet away or the vacuum.  A blessing sometimes as I removed the hearing aid a few times over the holidays when the grandchildren were roughhousing in the pool.

Due to fluid in the ear from the surgery, tests have shown that feedback problems occur if activation occurs too early.  Eight weeks is a prudent timeframe to limit such problems.  Earlier experience showed that the fluid could infiltrate the “wires” between the implanted Sound Processor and the incus and stapes bones. This has been corrected.  I have reviewed issues that occurred prior to the FDA approval and found that smokers have problems healing, that the batteries have improved, that the surgeon/technician teamwork is better, that surgeons who cannot meet the timeframes (time under anesthetic) have not been certified and other implant issues have been resolved.

Many persons interested in the Envoy Esteem implant have seen Sarah Churman’s activation appointment.  It is on YouTube at http://www.youtube.com/watch?v=LsOo3jzkhYA

She has been inspiring to the Envoy Esteem patients who share a Facebook group with her.  She keeps a blog which can be accessed at http://sarahchurman.blogspot.com/.

I will NOT be taping my activation nor do I expect to be quite as emotional.  Nonetheless, after waiting eight weeks, one hopes it works.  Expectations are kept low as several post activation follow up appointments are required.

The device will be set with minimal gain as one begins to hear again.  A “personal programmer” remote device can move around tiers of settings to find comfort zones and optimal hearing situations. Many patients have found no reason to change settings once such a zone is identified.

I really have missed not being able to respond to my grandchildren who would repeat three times before I would have to give up—we made a game of it.   My golfing friends are veterans of elective surgery for knees and hips and have been understanding.  My wife somehow never raises her voice in frustration to my inability to understand (sometimes purposeful, shhh). At professional meetings, my input has been limited as I can nod to what has been said but since I am not sure what was said, I cannot contribute.

I look forward to this (drum roll please) life changing experience on January 23.

The Latin Beat

January 3, 2012

I like the Latin culture.  I have enjoyed time in Chile and have travelled to Peru, Columbia, Ecuador and South Beach.  For years, I did police seminars in Miami and Miami Beach and was a regular at the outdoor restaurants on Ocean Drive.  Seems to me the ambience for Latin culture is as great in South Beach as in Latin America. 

Unfortunately, today’s title reference is not to the great Latin culture but to the dead language, Latin. 

Some have asked what the blog title, OYEZ means.  It comes from the Latin word “audire” which in French became “oir” which both mean “hear”.  It became the call to public meetings and courts similar to “Hear Ye, Hear Ye”.  The U. S. Supreme Court continues the tradition with the “Oyez, Oyez” call that the Court is coming to order. 

In fact, the Chicago Kent Law School has compiled all oral arguments of the Supreme Court since recording at the Court began in 1955 in a project entitled, The Oyez Project.  My 1981 oral argument is found at http://www.oyez.org/cases/1980-1989/1981/1981_80_1681, a case we won unanimously. I wrote and defended an ordinance that effectively banned the retail sale of drug paraphernalia (even though the items themselves are legal) and the opinion effectively closed “head shops” in the USA.

 In a second case, my co-counsel argued for an expansion of the Federal Rules of Evidence to allow the conversations of a police officer involved in a shooting death to her psycho-therapist be privileged.  That argument is found at http://www.oyez.org/cases/1990-1999/1995/1995_95_266.  The Court ruled 7-2 in our favor and said that “those who serve and protect should be protected.”  

The other Latin term that has become my mantra is “pro bono”.  This is a Latin phrase more formally stated as “pro bono publico” and means professional services dispensed on a voluntary basis for the public good at no cost to the recipient.  Many state bar associations require attorneys to provide a minimum amount of free services. 

I have taken the “publico” literally and applied it to the greater public good..  In law school, students were required to work with Legal Aid to assist those in need.  Pro bono generally is thought of as assisting the needy. This is not my calling. 

Upon semi- retirement in 2008, I determined to provide free services for the public good and have never billed an hour or received a W-2 since then.  I have reported over 800 hours a year to the Florida Bar for pro bono services.  Most of the hours were spent in the effort to incorporate our region of about 20,000 residents as a municipality.  It required meeting twice a week and evening citizen meetings for 27 months, but more than that, tremendous hours of research in drafting and debating charter provisions, meeting with state and local elected officials, dealing with lobbyists and putting together a campaign.

The work was a great retirement transition.  Ultimately the citizens preferred the comfort of the way things are to forging forward with a “contract city” as we envisioned. See:  http://www.lwrincorporation.com/documents.html 

 I now serve, with pay waived, as an elected “Supervisor” for our local taxing district and also work with the Chamber of Commerce to promote local businesses. I was a Political Science major and had run for state office in Ohio in 1972 and worked for many campaigns since then.  I remain active in political matters and assist some of the local campaigns. I am becoming more active in Hearing Loss Association endeavors and hope to contribute my skills as needed.  I serve on several 501 (c) 3 Boards as well as law enforcement related Boards of Directors. 

I love my golf and family but the need to offer pro bono service is something I cannot give up despite the hearing modifications necessary to do this.

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.

. 

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.