A Salute to Two Generous Souls

Two retirements were announced in the past few weeks by two gifted SLPs whose reach extends far beyond their own caseload.  These women started blogging early on and shared countless ideas and resources, free to anyone who could use them.  I have always admired their generous spirit and creativity;  to me, they represent the best of our profession.

screen-shot-2017-02-10-at-3-33-49-pmCindy Meester’s Blog, “Speech Therapy with a Twist,” is a delightful compendium of ideas for making every aspect of school-based therapy fun, functional, and motivating.  Cindy knocks herself out with amazingly creative theme units.  The photos of her room decorations, the way she incorporates technology and literacy, and the many ways in which she builds multiple therapy lessons into a single theme are nothing short of inspiring!  Just look at her posts!  How could her students and teachers not love Cindy’s “twist” on therapy?  I’m not sure how long Cindy has been blogging, but it seems to me that she was one of the pioneers who has been around at least as long my site.  To maintain this high level of energy and enthusiasm for so many years — that should be the goal of all SLPs.  Cindy has set a wonderful example for all of us and, through her blog, has left a detailed roadmap of inspiration for SLPs to follow into the future.  Cindy will be retiring at the end of this school year, but will be maintaining some part-time involvement in private practice.  This seems a wise move for Cindy;  I can’t imagine this energetic SLP going cold turkey into retirement.

screen-shot-2017-02-10-at-4-21-25-pmRuth Morgan is another pioneer in blogging.  On her blog, “Chapel Hill Snippets,” Ruth describes herself as “a mentor, speech pathologist, mom, wife, and technology junkie.” But that hardly says it all.  Ruth has dedicated her energies to students who have significant disabilities.  In post after post, year after year, Ruth has created and generously shared visual materials to support even the most challenged students in communicating and engaging in literacy activities.  In addition, Ruth has shared lots of ideas on using the iPad in therapy, created easy-to-follow tech tutorials and data forms, and much more. While she has a great fondness for using books in therapy, she also sees potential lessons in everyday life, such as the social skills lesson she built around this funny political ad.  As Ruth prepared herself for retirement, which took place about 2 weeks ago, she wrote a post for her replacement, but the message is one that we all should heed:  Helpful Tips for Teaching a Language Group for Students with Severe Communication Challenges — outstanding advice to read and share.  Those tips give us a glimpse of the insight, compassion, and dedication that Ruth brought to school each day.  Like Cindy, Ruth is more “easing out” than cutting ties abruptly.  After a vacation in Florida, she’ll join the board of New Voices Foundation and promises to keep blogging and creating.

Cindy and Ruth, I am sure I speak for countless SLPs when I thank you sincerely for your outstanding contributions to our field!  You’ve certainly earned a very long and happy retirement.  Congratulations on your wonderful careers.  You are leaving a legacy of creativity and generosity that will continue into the future.

With best wishes,

Pat Mervine

 

 

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The Power of Persistence

In November 2015, my assignment was changed from part-time SLP/part-time assistive tech consultant to full-time assistive tech.  In this role, I support augmentative communication needs in two school districts, one residential facility, one specialized day school, and two vo-tech schools. That has caused a distinctive shift in the age of the students I am supporting.  Suddenly, I have a long list of students in the 17-20 age bracket who are using district-owned AAC devices or who don’t have a device but could use one. Given their age, the goal is to obtain their own device funded by their medical insurance so they can continue to communicate effectively when they exit the public school system at age 21. For students who use a “standard” speech-generating device (SGD), such as a NovaChat (Saltillo), Accent 1000 (Prentke-Romich), or T-10 (Tobii/Dynavox), obtaining funding through medical insurance is generally not a problem.  Yes, it takes a lot of time and paperwork (AAC eval report, parents’ assignment of benefits form, physician’s statement of medical necessity and prescription), but commercial and state Medicaid insurance programs are increasingly likely to cover the cost of these devices. Students who use these devices happen to be in the minority in the schools that I now support.  The majority of the students use iPads with AAC apps, primarily TouchChat HD with Word Power, ProLoQuo2Go, and GoTalk Now.  One district is heavily leaning toward CoughDrop, so that app is now in the mix, too.

From the school district perspective, there are advantages to using iPads as AAC devices:

  1.  An iPad with an AAC app and protective case is much less expensive than standard SGDs.
  2.  AAC apps offer robust, easy-to-program vocabulary, comparable to the software on standard SGDs.  Indeed, TouchChat HD with Word Power is nearly identical to the software in the NovaChat, and Word Power can be added to Accent devices.
  3.  When the iPad needs repair, the districts now keep a stock of loaner iPads that can be immediately provided to the student so there is no break in communication and no issue with non-compliance with the IEP.
  4.  When an iPad with an AAC app is recommended at the conclusion of the SETT framework, districts can generally provide this device to the student within days or a few weeks.  Obtaining a recommended SGD through insurance can take months.
  5.  So many middle schools and high schools in our area are providing tablets to their students as part of their curriculum, so using an iPad for communication doesn’t make our students look different from their peers who are carrying around the same device, albeit for other purposes.
  6.  Some students in preschool and early elementary programs would benefit from having AAC support in their younger years, but will eventually outgrow the need for them as their speech and language skills develop.  In these instances, it makes more sense to provide iPad-based AAC support than to obtain insurance funding for an expensive SGD that may only be used for a few years.

That said, there certainly remains a great need for standard SGDs for some students.  Like everything else in special education, the decision to go with one device or another is highly individualized and should be made with careful consideration of many factors.

Of course, as in most things in life, with every upside often comes a downside. The downsides for my secondary students of using an iPad for communication:

  1.  The district owns the device and will take it back when the student graduates.
  2.  iPads for communication are less likely to be funded by some insurance companies.  This is especially true for a particular state Medicaid insurance company in Pennsylvania which has held to a “no way, no how” policy against iPads for communication.  And there begins our story…..

A nineteen-year-old student with Angelman Syndrome (I’ll call her “Linda”) had been exposed to many AAC systems over the years:  PECS, static communication boards, photographs posted around the house, low-tech devices such as the GoTalk and talking switches, and sign language. For a variety of reasons, none of these adequately met Linda’s expressive communication needs.  The SETT process was initiated and I was called in to see what other options could be explored.  A brief trial with a NovaChat was unsuccessful, primarily because Linda didn’t respond well to the abstract symbols.  In addition, due to her overall clumsiness and tendency toward drop seizures, the team felt the case wouldn’t offer adequate protection.  We then tried an iPad with several AAC apps.  Linda’s response to GoTalk Now was great!  Set up with realistic drawings that come with the program, plus photographs from Linda’s environment, on boards of 4-12 symbols, Linda was able to ask to use the bathroom; participate in classroom activities, such as morning meeting, art, and cooking;  make choices throughout the day; and terminate or refuse appropriately.  Of course, this took a lot of modeling and engineering of the environment to provide opportunities for all of these functions of communication, but within a short time, Linda was seeking the device, and her normally fleeting visual attention improved.  Data collected during the device trials clearly indicated that the iPad with GoTalk Now was the device for Linda.  Also important, the iPad could be housed in a thick foam case.

screen-shot-2017-01-02-at-6-20-02-pmAlready well aware that insurance companies won’t fund an off-the-shelf iPad, we opted for a “dedicated” or “locked” iPad-based device, the ACCI Choice Communicator by Augmentative Communication Consultants, Inc., in which all features not related to the communication app have been disabled.  This configuration of a dedicated iPad-based device meets the Medicaid/Medicare definition of Durable Medical Equipment (DME). The AAC eval report was written very carefully to specify what had been tried in the past, and to detail the positive feature/match of the dedicated device and GoTalk Now to Linda’s very specific needs. Stressed in the report were the advantages of the software (realistic drawings, simple layout, ease of programming for parents, plus Linda’s positive response to it) and the durability provided by the thick foam case.

Confident that all bases were covered, and secure in the knowledge that this particular Medicaid insurance provider had already approved, as both primary and secondary coverage, the same device for several of my other students, we sent off the funding packet in April and anticipated receipt of the device by May.  Instead, we received a rejection letter that stated as reasons for denial:

  1.  The device was an iPad which could be used by anyone without a medical need.
  2.  The provider is out-of-network.

The insurance company never questioned medical necessity for Linda, but they didn’t recognize that the dedicated iPad is useless for anyone who doesn’t have a significant communication disability.  Instead, they recommended that I request a “standard” device from two AAC companies, which they named.  Those devices cost between $4000-$7000+ and were already proven in our trials to be too sophisticated for Linda.  The device we were requesting costs $1550.  In effect, the insurance company was willing to pay for a Cadillac that Linda couldn’t drive, but denied her the Volkswagon that she could.

I called the insurance company to explain we were asking for a dedicated, locked iPad, and that it was from a sole provider (which is an exception for Medicaid coverage), but got nowhere.  I was told to follow the appeal options listed in the denial letter.  So I did….

  1.  I requested a “peer-to-peer conversation” but was told the insurance company’s “peer” would only speak to another physician.  When I explained that the physician was a very busy pediatrician and that I, with 25 years’ experience in AAC, could better explain the rationale for requesting this device, I was told, “no, our physician will not speak with you.  He will, however, speak with the pediatrician’s office manager or nurse, if the pediatrician can’t participate in the call.”   ARRGHH!!
  2. I filed a written complaint with the insurance company and the Department of Human Services.  The insurance company reviewed it and issued an identical denial.
  3. I requested a telephone appeal.  This was granted, and again we received the same denial.
  4. I filed a second level complaint.  As a result, I had to travel 40 miles to appear before a 3-person panel:  a physician and an employee of the insurance company, plus a non-employee who participated by phone.  I presented charts and graphs, written testimony full of footnotes that cited relevant Medicaid regulations and case law, and demonstrated the various devices and apps. Linda’s mother participated by phone and spoke to the improvement in her daughter’s attention and independence when using the trial device.  Again, we received the same denial — literally word-for-word. The insurance company would not recognize that a dedicated iPad meets the same DME criteria as a “standard” device.”  They would not acknowledge that ALL of the 10″ dynamic display devices are built on one tablet or another, or that ALL can be unlocked if the parents choose to purchase the “key” once they have the device in hand.  They would not acknowledge that Medicaid regulations allow for funding through an out-of-network provider if that is the only source of the needed equipment or service.
  5. As is my right according to the denial letters, I wrote TWICE to request a copy of the Medicaid and/or insurance company policy on which the denial was based.  I wanted to see where it is written that either Medicaid or this specific insurance company will not fund a dedicated iPad for communication.  I never received a response.
  6. I filed for a hearing before an adminstrative law judge.  Prior to the hearing, I mailed to the judge a thick packet of all documents related to this case:  the initial eval packet, every denial letter, and every letter and written testimony that I had provided along the way.  Linda, her family, and I traveled 30 miles to appear before the judge in a courtroom, where I presented the bulk of the testimony to justify the specific iPad-based device (basically a repeat performance of the second level complaint meeting) and had to cross-examine the insurance company’s lawyer and their medical director, who participated by phone. Linda’s mother and grandmother, a retired special education teacher, testified to the improvement they saw in Linda at home.  After an exhausting two hours, we left the courtroom, knowing that we had done our best.  To aid in her deliberations, the judge ordered that I provide photocopies of the symbol sets from GoTalk Now and two other “standard” devices, and also a statement from Linda’s teacher as to improvement noted in school.  The judge ordered the insurance company lawyer to provide the written policy on which the denial was based, the same policy I had requested twice, and also ordered that a copy be sent to me.  We had two weeks to comply.
  7. I immediately provided the requested information with a cover letter to the judge and also sent a copy to the insurance company lawyer.  I never received anything from him.  That meant two written requests and a judge’s order failed to produce a regulation or policy document that specifically prohibits funding of a dedicated iPad.
  8. I requested through the Department of Human Services an external review of this case.  The outcome of that is still pending.

I recognized early on that we were in for a fight, and that the issue was for more than just Linda.  The insurance company’s repeated denials would mean that many AAC users would be denied access to appropriate and affordable communication systems. This incensed me as an SLP first, but also as a taxpayer.  For the price of one $7000 “standard” device that they were willing to fund, four students could receive the $1550 device.  I also learned that another state Medicaid provider in a different part of the state was denying “standard” SGDs, instead recommending an iPad-based device — the complete opposite of what was happening in my part of the state!  Something is seriously wrong with this system!  I did some research into how Medicaid providers in other states address the dedicated iPad issue.  Massachusetts regulations have a line that basically says (and I’m paraphrasing here) “…and must be the most inexpensive option available that fully meets the users needs.”  That little line would certainly open the door to dedicated iPad-based SGDs for whom that is the most appropriate device.  Minnesota regulations spell it out explicitly:  a dedicated iPad for communication is covered as long as it meets the requirements for medical necessity.  It is quite possible that other states have similar wording, but finding these two was enough for me!  I am now working with two state representatives and a state senator from our area to see what changes can be made at the state level so no one else has to go through this battle, so no other AAC users are denied appropriate SGDs, and so taxpayers aren’t footing the bill for expensive SGDs that don’t match the users’ needs.   (Again, I want to emphatically state that there is certainly a need for these “standard” SGDs, and they are certainly the most appropriate choice for many users.  Indeed, I’ve recommended NovaChats, Accents, and other sophisticated devices for many students in my career and will continue to do so.  I just also want to have the option of using an iPad-based, dedicated SGD with students for whom that is most appropriate.  Ablenet’s Quick Talker Freestyle is another example of a dedicated, iPad-based SGD that, like the ACCI Choice Communicator, offers a choice of communication apps and cases.  The major difference is that the Quick Talker Freestyle comes with blue tooth switches for those who use scanning).

Well, very long story short….Linda’s device trials started in January 2016.  The funding packet for the iPad-based device was submitted in April.  On December 21, we received the judge’s decision — WE WON!!!  She said the insurance company’s “denial was wrong,” and went on to say that they were unable to prove that the more expensive devices they recommended would be more appropriate than the device we were requesting, and that they failed to provide written regulations or policy on which their denial was based.  She gave the insurance company five days to approve the funding.  They complied, and Linda received her device right after Christmas!  Woo woo!!

There were those along the way who suggested I just give up and go with a “standard” device.  My husband, definitely feeling my pain throughout this arduous process, offered to buy Linda the device, just to put an end to my frustration.  But he knew, and I knew, that the fight had to go on for the benefit of Linda and all students who come after her.  My message to you is – be prepared and don’t give up!

  1. Caution parents from the beginning that the process may be lengthy but remain optimistic.
  2. Decide with the IEP team and LEA what AAC system will be available to the student until a device is funded.
  3. Do plenty of research on how to write an effective AAC eval report for medical insurance (it’s different from a report you’d write for school). Proving medical necessity is key. Google “Lewis Golinker;” he’s an AAC attorney who has great resources worth exploring.
  4. Present solid evidence in your rationale for each requested device, software/app, and accessory using feature/match to the student’s specific needs, and contrast this with what has been tried and found to be unsuccessful. You have to prove definitively why the device you are asking for is the most appropriate.
  5. If you receive a denial, follow the steps in the appeal process that will be outlined in the denial letter and stay within their stated timelines. Keep your cool and maintain a professional attitude on the phone, in person, and in writing. Then go punch a pillow if you have to.

If you are fighting a similar battle and need additional information or encouragement, please contact me and I’ll be happy to do what I can to support your efforts.  I can’t guarantee your success, but I know you’ll never achieve it if you don’t try!

 

 

 

 

Update on Speaking of Speech.com

THANK YOU, THANK YOU, THANK YOU for all of your encouragement and offers of assistance in my challenge to save the Speaking of Speech.com website! Two months ago, I received word from GoDaddy that my website would have to be upgraded by September or it would be lost.  If SOS.com was a typical website, this would be a nuisance but wouldn’t have dire consequences.  But SOS.com is NOT typical.  The Materials Exchange contains thousands of free materials.  To upgrade the site, I have to download every document individually, then upload and link each one individually.  I had to do this once before, and it was sheer torture.  I vowed then I would never do it again.

I’ll be honest….knowing what I was facing, I was on the verge of pulling the plug on the site when I posted a link on FB to a survey designed to find out just how valuable SOS.com is to the SLP community.  I knew it was an important resource 15 years ago when it was one of the very few pioneer SLP sites, but now it seems that every other SLP in ASHA has a site, blog, Pinterest page, Teachers Pay Teachers store, and/or Instagram account, which I would naturally assume would dilute the impact of my site.  Given that the site requires significant time and expense to maintain, I felt I couldn’t justify going through the torture of rebuilding it if it had run its course and wasn’t needed that much anymore.

Well, I was blown away by the response from SLPs around the world!  In the first three days that the survey went online, nearly 3000 responses were received, and over half of the respondents took time to leave dazzlingly kind words of encouragement, including suggestions about how to make the transition and offers to help with the effort.  I also received countless emails and messages on my blog and through Facebook.  Please believe me when I say that I was deeply touched by every one, and deeply regret that I cannot possibly answer every one individually!!  (Well, I guess I could, but then I’d never have time to redo the site!).  PLEASE share this post with your colleagues to help me send my heartfelt thanks to everyone who reached out in support!

The survey results provided me with some real surprises.  The first surprise is about how many SLPs still use the Materials Exchange:  92% report it is feature they use the most! (Gulp!) That response alone cleared up any doubt that the Materials Exchange would have to be preserved. In the comments section, SLPs begged, pleaded, and told me how the Materials Exchange got them through grad school and remains their go-to resource in their career.

The second surprise was how few SLPs use the message boards in the SLP Message Center! I was shocked to find that only 5% of respondents named the message boards as their favorite feature on the site and 68% said they NEVER use the message boards!!  Good grief, is this because users bookmarked the Materials Exchange and never get beyond that section???  Oh, if so, many SLPs don’t know what they are missing!!  I use the message boards every day and have learned SO MUCH from the conversations on the Help Line and other boards!  SLPs who do use the message boards routinely expressed over and over in the comments that they, too, expand their knowledge, skills, and techniques via the message boards, and many expressed that they appreciate being able to post anonymously (unlike the message boards on the ASHA site, for instance). This gives SLPs the freedom to seek support on caseload challenges, knowing their name, location, or students cannot be identified.  I hadn’t even considered that when I set up the boards, but this advantage was pointed out by a number of SLPs.  If you haven’t checked out the message boards, please do!  You’ll find them at the “SLP Message Center.”

After such an overwhelming response to the news that the site was in jeopardy, I had no choice but to try to save it.  I spent many hours on the phone with web developers, and actually started to recreate the site on 5 different web hosts to see which platform would be the most compatible with my needs.  Unfortunately, I ran into drawbacks with each one, so I went back to GoDaddy (unquestionably the best platform for my site’s features) and spent many more hours on the phone trying to figure out how to make the transfer as easy as possible.  The HUGE problem, of course, is the Materials Exchange. There is just no way around downloading, then uploading each and every page individually.  This is because of how the materials are stored on their server, soon to be obsolete.  The only good news is that I was able to purchase a second site that essentially provides me with “cloud” storage so that if I am ever faced with having to upgrade again, I won’t have to  go through rebuilding the Materials Exchange again.  At least, that’s what they told me, and I have no choice but to believe it!  GoDaddy has a “facelift” service which you can buy to do the site upgrade.  Although I was skeptical, I paid the $500 for this when the agent assured me that the Materials Exchange wouldn’t be a problem for the facelift team, then breathed a sigh of relief.  Unfortunately, a few days later, the facelift team took a look at the sheer volume of materials on the site and said “no way!”  I got my $500 back, but knew that meant I’d have to do it myself.  (To all SLPs who so very kindly offered their assistance in this task, and even offered their husbands and sons who are computer experts, I truly thank you all!  This really isn’t the kind of job that can be divided up.  Even if it was, it would take me a long time to write out the multi-step, often quirky, instructions, and I’d still have to go through the entire exchange to check for errors.  If errors are made –and they will be–better that they are mine, as then I’ll be able to figure out how to fix them!)

For the past 6 weeks, I have been chipping away at the transfer of the materials whenever I find some free time, and have declared nearly all of today through Monday as a marathon transfer session.  My dear husband is very understanding, but I did hear him refer to himself as a “website widower” and I know he’ll be relieved when the new site is up and running.  Me, too!

The new and improved Speaking of Speech.com will be up and running for the 2016-17 school year, with as much of the Materials Exchange as I can transfer (hopefully, all).  You’re going to love the new look of the site, and I hope you’ll enjoy the new features I’m adding.

Many thanks again to all of you SOS.com supporters!  Yes, I’m doing the work, but your encouragement is what is saving the site!

 

Tax Time — Maximizing Your Tx $$

Ah, it’s Spring!  That means daffodils and robins and income taxes.  I don’t know about you, but it’s often been a shock to add up the money I’ve spent on therapy materials each year.  Here are some ways I’ve found to ease the pain:

  1.  For the past several years, the IRS has allowed educators to take a $250 deduction for unreinmbursed teaching expenses.  Here are the details:  Educator Expense Deduction.
  2. I have been using Ebates as my starting point every time I shop online for goods, services, and travel. Then, when my Big Fat Check arrives, I put that $$ toward therapy supplies.  This is so easy to do, and it is amazing to see how many stores and other companies participate in this.
  3. I just learned of a new program that gives rebates for online shopping:  Giving Assistant.  Like Ebates, you earn cash back on your online purchases.  A bonus with Giving Assistant is this program’s social mission.  For every qualifying purchase you make, Giving Assistant will donate a meal to Feed America.  In addition, if you don’t need the rebate $$ for therapy supplies, you can designate all or a percentage of your rebate to be donated to the charity of your choice — a very easy way to provide ongoing support to worthy causes that are important to you.  Check out the “Thoughts” page of the site to read about lots of ways college students can earn cash back — I had no idea! giving_assistant_hero
  4. Once I have my rebate money in hand, I shop Zulily for therapy materials.  This can be hit or miss, as the participating businesses and their offers change frequently. A search of “education” or “toys” will usually turn up something useful and interesting but you’ll really hit the jackpot when “Super Duper Publications” is offering their materials at 45% off.
  5. Obviously, TeachersPayTeachers is a great source of inexpensive materials.
  6. And a creative SLP will never walk out of the dollar store empty-handed.

Taking Care….

We’ve all heard the directive on a plane:  “in case of a loss of cabin pressure, put the oxygen mask on yourself first.”  The reasoning is, of course, that if you don’t take care of yourself, you won’t be any good to anyone else.  Two incidents occurred in my own life that brought this message home in a big way.  What follows is not directly related to speech/language therapy, but it does speak to speech/language therapists, who are among the most selfless, caring people I know, people who routinely put the needs of family, students, clients, and colleagues ahead of their own.

Screen Shot 2016-01-31 at 4.45.52 PMSince February is Heart Month and February 5 is “Go Red for Women Day” to promote heart attack and stroke awareness and prevention, let’s start there.  Seven years ago, I had a heart attack.  To say this was a shock to everyone, including the doctors and nurses who took care of me, is an understatement.  I am very petite ( under 5 ft. tall and 100 lbs. soaking wet), have low blood pressure, excellent cholesterol numbers, no history of any heart problems, am scrupulous about healthy eating, and was not of the age where you’d expect heart problems to crop up.  In other words, I was about the last person you’d think this would happen to.  Well, long story short, testing revealed that I have an anomaly in one of the major arteries of the heart.  It kinked, and a heart attack was the result. No heart disease, no risk factors, just a hidden bit of off-kilter anatomy that decided to make itself known. An incredible stroke of luck (or are there no coincidences?), I had just watched Dr. Oz on Oprah two days before, describing the symptoms of a woman’s heart attack.  Had I not seen that show, I wouldn’t have recognized what was happening and would not have gotten to the ER as quickly as I did.  Even with the new knowledge from the show and the gut feeling that something very serious was going on, I  was still very conflicted on the way to the hospital and early in the ER:  Was I wrong? Was I overreacting to something as simple as indigestion? Was I wasting everyone’s time, when they really should be attending to someone who was really sick? It was only when I was rushed from the ER to the cardiac care unit that the reality sunk in.  The feeling that my body — my heart! — could betray me like this shook me to the core and, while I recovered physically in a short amount of time, it took significantly longer for me to recover emotionally.  I share this story with you because EVERY woman should know the symptoms of a heart attack and stroke and should take active steps to prevent both. In my case, there was no prevention, but awareness of the symptoms certainly saved my life.  You can learn more about women’s heart and stroke prevention here: https://www.goredforwomen.org/.  Take care….

29852-pink-ribbon-cutoutAnd now the second incident.  Those who follow my newsletter know that I was diagnosed with breast cancer in September, had a lumpectomy in October, and radiation treatments every day in November.  I feel so blessed to have come through this so well, and know that the only reason my outcome is so positive is that I religiously get my annual mammograms as soon as the reminder postcard comes in the mail.  It was on an annual mammogram that it was detected:  stage 0 (very early, hadn’t spread) but grade 3 (fast growing and aggressive).  As my surgeon said, had I neglected to have the screening when I did or if my annual date had been months later, the outcome could have been very different.  Fortunately, that very early detection meant that I escaped without chemo therapy and/or more radical surgery, for which I am SOOO grateful.  When I shared this news in my October newsletter,(coincidentally, Breast Cancer Awareness Month), I was overwhelmed and so very deeply touched by the outpouring of support and encouragement from SLPs who visit Speaking of Speech.com regularly.  I was also moved to tears to learn how many of those SLPs have also faced this diagnosis.  Good heavens, we could form our own ASHA SIG!  I was frankly horrified when the American Cancer Society recently relaxed its guidelines regarding the age a woman should begin getting mammograms and how often they are needed.  My friends, please make this individual and very personal decision with your doctor. Know your risk factors and the symptoms, keep up with your self-examinations and GYN appointments, and don’t hesitate for a moment to speak up if you sense something is suspicious or flat-out wrong.  Nobody knows your body better than you!  Take care….

You may be thinking now that I’m a medical mess, but that is far from the truth!  I’m very actively involved with home and family, participate in many community organizations and events, work very hard on my job and my web site, and work equally hard to maintain a healthy balance of time for my hobbies and my friends. Indeed, I’m the picture of health! The one thing I wasn’t doing routinely was exercising.  ugh. Yes, I’ve done Curves and Jazzercise and yoga and Pilates. Yes, I joined a gym for 2 years (and hated every minute of it). Yes, I like to walk, but only in nice weather and only when I don’t have anything else to do….and I can ALWAYS find something else to do! I just don’t find any pleasure in exercising and prefer to delude myself that I get plenty of exercise on the job, running around to get students and lugging my laptop and school bags to and from the parking lot.  (My Fitbit proved that assumption wrong). While exercising probably wouldn’t have prevented the heart attack or breast cancer, I’ve come to the decision that I do need to take care of myself by adding an exercise regimen to my weekly routine. After all, I’m not getting any younger, and if these medical crises keep cropping up, I’d better be in great shape to fight back.   I was helped to this decision by a wonderful fitness and holistic health program offered to patients at my local hospital. At my 1-month post-radiation checkup at the end of December, the doctor said, “Congratulations! You’ve made it through your treatments. Now you qualify for this free program to get you back to full strength and keep you feeling well.”  The program consists of 10 weekly classes on fitness, nutrition, and mind-body wellness, 30+ workouts in the the gym that includes 4 sessions with a personal trainer, and 2 massages.  Since the timing of this program coincided with New Year’s Resolution time, I made the snap decision to sign up on the spot (knowing full well that if I thought about it too long, I could come up with a dozen reasons why I couldn’t possibly do it — too busy with other things, too cold out, too tired after work).

05-stock-illustration-13570049-gym-exercises-silhouettes-female-copy-2I’m now starting Week 4 and, much to my surprise, I’m actually able to handle the schedule and am feeling better and stronger.  Do I love it?  No, but I’m committed to seeing it through for the full 10 weeks.  By then, it will be spring when my exercise will be gardening, walking, and – yes, I do hope – continuing with regular trips to the gym.  Making this commitment, putting myself first for these 10 weeks, has been better than I expected.  Family and friends haven’t suffered, work hasn’t suffered, community involvement hasn’t suffered.  It’s getting easier to run home from work, quick change, and dash to the gym 3 days a week.  Taking care of one’s self feels good. Take it from me….

Take care,

Pat