Simon says "Wiggle your toes".

Hearing is integral to communication. How we hear things as well as how we interpret what we hear can have a significant effect on our response and where the conversation goes from there.

Perhaps 11 years ago, I was doing some work on our house and had borrowed a neighbour's jigsaw and after I was finished with the jigsaw, I put it and all the attachments back in the case in which it came. My boys had been "helping" me with this project and wanted to continue to be helpful. I asked the two older boys to take the box across the street, deliver it to the neighbour and thank him for its use. My oldest son was five and his brother four at the time. Ours was a quiet neighbourhood and a dead end street but still as a responsible and concerned parent I sat in my living room at my piano and began to play while I had the chance while keeping an eye on the boys crossing the street. . A few moments later I heard a blood curdling scream and saw the younger of my two boys running across the street with a horrified look on his face with tears streaming. My heart may have skipped several beats as I jumped up and ran outside to see what had happened.

In haste, my oldest son, Sammy had run across the road spilling the contents of the jigsaw case while tripping and falling down. When Sammy tried to stand back up he snagged a blade in the bottom of his foot causing the blade to go through the bottom of his foot vertically.

In the emergency room the physician examined the bottom of the foot  while Sammy lay on his stomach. The concern was that the blade may have interfered with a nerve or significant blood vessel. The doctor asked Sammy, my five year old son, "Do you think you can wiggle your toe?"  Sammy, after giving the question careful consideration replied "I don't think so". The physician looked a little worried. After checking the foot out thoroughly, he decided to wait a little before removing the blade. Some time later the doctor returned, checked the foot and asked again about the ability to wiggle the toe, and again the answer was "I don't think so". The doctor was somewhat concerned but decided to remove the blade carefully. With the area in question locally anesthetized, he excised the blade without consequence upon which he cleaned and bandaged the wound.

With the concern for the ability to move his big toe still primary Sammy was moved onto his back with his foot propped up. The question was whether the ability to wiggle that toe had yet returned. Once the anesthetic was thought to have worn off the doctor returned and asked Sammy again "Ok, now do you think you can wiggle your toe?" Sammy replied "I...........I will try."   At this point this five year old proceeded to sit up and while getting a hold of his big toe between his thumb and fore finger began to "wiggle" his toe back and forth. Indeed he could "wiggle his toe". The very serious doctor couldn't hide a mild chuckle and the very relieved father couldn't help but understand his child's literal interpretation of the request in question.

This story is a wonderful lesson in the art of communication. The person initiating conversation asking questions may think that their question is well understood while in reality the person interpreting the question may have come to a completely different understanding. The hearing impaired individual experiences added complexity in communication given that their hearing loss causes the speech signal to be inherently compromised.

I recently had one of my staff call a patient to book their annual hearing test, my patient responded by saying they would be happy to come in for their annual urine test. Hmmmmm.........   Choose your words carefully.

Isolated and Alone

With the holiday season upon us, we  will inevitably find ourselves in challenging listening situations;  parties, dinners, church services, concerts etc….perhaps it is at times like these that we wonder why a loved one seems to avoid the very gatherings they previously enjoyed.

Are you perplexed by this unexplained change?  While there are many potential explanations for this change there is one that is readily understood and has the potential for a happy ending, so to speak.

Given that this article is dealing with hearing and issues related to hearing, I am obviously suggesting that hearing loss can lead to social withdrawal. I talk to people every day that have come to this understanding.  It stands to reason to say that we avoid situations that are difficult or challenging.  Why go to that party if the background noise is so loud that you can’t follow the conversations?  Why be in a listening situation that makes you feel like you are less than competent?  The resulting avoidance and ultimate withdrawal may not be sudden but perhaps a slow and insidious process which, nonetheless, will take root over time to such a degree that those around will start to take notice of this change in social interaction.

If one is inherently a social being and find themselves withdrawing from social settings the end result may be to miss those interactions to the point of depression.  I have heard patients rationalize this withdrawal suggesting that this is the way they prefer life. Typically, it is the family member that disagree in this regard.

It is one of the more amazing experiences to watch a patient re-engage with the world as their hearing is brought back through the use of prescribed amplification.  I have story after story related to me of the life altering changes that occur when one can communicate effectively.  To be able to connect with each other in social and other settings can be one of life’s great joys and when that is taken away, through the loss of hearing, the results can certainly be life altering, even devastating.

Perhaps it is time to find that happy ending.

Best Wishes for a Merry Christmas and a Happy New Year!!

To Clean or Not To Clean...

A common discussion point with my patients is the issue of ear wax and ear wax removal.  There seems to be a great deal of uncertainty as to what, if anything, needs to be done to keep ones ears clean.  

The use of a wax removal implement, such as a ‘Q-tip’, is one of the major points of discussion that comes up.  I can almost always tell when my patients’ have used ‘Q-Tips’ to clean their ears.  Typically, I see wax pushed down in the canal and impacted, often appearing hard and dry.  Ear wax, in dry form, is hard and can adhere to the canal wall.  Certainly one may find some wax on the end of the tip but the majority is pushed further down and or caked against the side of the ear canal.  I liken the use of a ‘Q-Tip’ to a rod used to load a musket; this doesn’t remove gunpowder but pushes it down and packs it into a solid wall barrier. Just like the musket rod the ‘Q-Tip’ pushes the ear wax down the canal and packs it into a solid barrier which can become an impediment to hearing - often causing discomfort as well as hearing loss.

The question that then arises is how do we keep our ears clean and prevent wax impaction?  The truth is – for the most part – ears are self cleaning.  A healthy ear canal is lined with tiny hair and hair cells that move debris out of the ear canal rather spontaneously.  The use of a wax removal implement such as a ‘Q-Tip’ actually compromises the ears ability to remove ear wax.

For those that have difficulty with wax buildup it can often be due to the ear canal being too dry. A drop or two of mineral oil, applied once a week before bed, can help keep the wax soften, allowing the ear to self clean.

So, when it comes to keeping your ears clean perhaps the less you do the better.

Life and Death Decisions

A long time ago I had to make a decision as to the profession that would occupy my future. Being an immigrant meant that my parents had a focus on improving our lives with the focal point being education. My parents themselves are well educated but they wanted more for my brother and I. The educational destiny chosen for me was that of a Medical Doctor. As the reality of this choice confronted me as a young undergrad I was faced with the reality that this professional choice would mean that the decisions I made could impact life and death. I could not bring myself at that time choose to pursue a profession that carried with it that kind of responsibility or burden. My heart didn't feel capable of dealing with patients where life and death was in the balance knowing my propensity for emotional attachment. In my naivety, I chose a profession that I thought was immune to such matters of the heart.

In the last couple of weeks, I have seen the passing of several patients who have also been my friends. Oscar was a man that bounded into my clinic about 6 years ago. Oscar was a man full of energy with a story to tell. Actually Oscar had many stories to tell. I can say with certainty that the vast majority of the time Oscar spent in my clinic was spent talking and sharing. Sometimes we talked about his families history of escaping slavery through the "underground railroad", sometimes we talked of his tough teenage years and dealing with the consequences, sometimes we talked about how a black man ended up in a town where he was the exception. Oscar shared real stories of real struggles but always with the theme being that of overcoming. When Oscar fell ill and had to have a lung removed, the story he told was one of overcoming. When Oscar found trouble in his relationships, the stories he told were of overcoming. The man chose happiness over despair. It was always with a smile on his face and a step always just a fraction away from dancing that Oscar chose to live his life. Two years ago Oscar was given the news that the Cancer was back, Oscar was ready to fight.  We have an amazing event that raises money for Cancer treatment in our community called the "Relay for Life". I was attending this event two years ago when I saw Oscar in marching with the cancer survivors in a ceremony of celebration and remembrance. When the group made their second round, I joined my friend Oscar and walked and talked. Just a few months ago we were attending the same event a year later and Oscar was there. As I joined Oscar in our walk of celebration and remembrance Oscar shared that he had actually temporarily checked himself out of the hospital where he had been for the week just to support this cause. Oscar had changed, his body had diminished but his spirit had grown. It was with deep sorrow that I walked with this man who showed nothing but joy. As I hugged him and sent him on his way  back to the hospital, sorrow was a feeling that I just couldn't shake.

Oscar passed away last week.

As an adult, I have come to realize that the profession that I have chosen is one in which I can not avoid the issues of life and death. I can not isolate myself from the kind of human contact that makes you feel deeply. Over the years, I have seen many a patient pass away, people that I have grown to know and love. While it is rare that the decisions I make on their behalf rarely have connotations of life and death, it is still undeniable that the impact that we have on each other through our time together has significant implications. I avoided a profession that involved emotional attatchment only to realize that it is sometimes the ability to feel for one another and be affected by one another that allows us to make professional decisions that are valued and appreciated. Getting to know my patient, understanding my patient, makes me a better Audiologist but more importantly, a better person, whose life is enriched by his patients.

TINNITUS

Do your ears ring, buzz, hum, roar, etc?  This manifestation is known as tinnitus.  Tinnitus can be a mild aggravation or, in some cases, debilitating.  Over the years I have encountered thousands of patients with tinnitus and quite a number of those have found it to be debilitating to varying degrees.  The vast majority of tinnitus sufferers however, find it to be an annoyance or inconvenience.

Tinnitus can be brought on by an increase in neural activity often specific to the auditory system.  Hearing deterioration, loss or damage can be a major contributor to tinnitus as can certain medications, musculoskeletal problems or even high levels of stress, as well as an array of other possibilities.  The vast majority of those that suffer from tinnitus are experiencing some degree of hearing loss.

While there may be a thousand potential reasons for tinnitus it is known that hearing loss is a major contributing factor causing this extra neural activity that presents as tinnitus.  The solution to tinnitus is dependent on the cause of it.  If tinnitus is linked to medication or other medical disorder then one needs to consult their physician.  If however, as in most cases, it is related to the hearing and the health of the auditory pathway then a hearing test is the place to start.  

A key point to keep in mind is that there is also a psychological component to tinnitus in that the more you think about it the worse it can seem.  One can find themselves crippled by tinnitus as a result of becoming focused on it.

There are a lot of assertions made regarding cures for tinnitus ranging from drugs, both natural and engineered, as well as devices marketed on mass.  As an audiologist I focus on evidence based findings born out through good research.  The current research based knowledge points to the use of sound generation to suppress neural activity coupled with appropriate counseling as the most effective approach to tinnitus management.  I have found that the use of amplification or sound generation, when correctly prescribed, can have a life changing effect on my patients.

As mentioned earlier, there can be a thousand causes for tinnitus so the solution can be different for each individual.  A hearing test with a qualified audiologist is a great place to start.

Using Your Brain To Hear

As I have grown a little older, I have often found myself stalling as I try to think of someone’s name, embarrassingly this might be someone familiar to me.  Sometimes it is a word that I try to remember that is illusive.  As my frustration rises at the inefficiency of my mind, I wonder what might be causing this seeming change.  Recently I was fortunate enough to hear a presentation on some research out of the University of Western Ontario that shed some light on this type of frustrating inefficiency.

MCI, minimal cognitive impairment, is a reality that many face as they grow older where our brains do not want to work as efficiently as we would like.  Yes, they do have a name for what we intuitively know happens over time.  The point of the study was that MCI, in combination with hearing impairment, adds another wrinkle to the ability to communicate effectively.  Functioning with a hearing impairment means that one is constantly putting 2 and 2 together, trying to fill in the blanks in attempt to make reasonable sense of what is being said.  Even minor changes in word recall that we encounter can create an increased difficulty in quickly and efficiently communicating.

So yes, when you didn’t quite catch what someone said it may indeed be your hearing, or the ability of the brain to process information effectively or maybe a bit of both.

Hearing Loss Unavoidable?

The Ear Company

“Everything related to hearing.”

It is absolutely unavoidable. No matter what we think, no matter how hard we try to prevent it from happening, it happens. Our hearing will change whether we like it or not. Certainly it is important to do all we can to protect our hearing but change is inevitable. Our hearing deteriorates for a variety or reasons, noise exposure plays an undeniable role but so does genetics and the process of deterioration that takes place over time.  

The complication with time-based deterioration is that this is typically a slow process that creeps up on us. Most often it is others that recognize the changes in our ability to hear before we do. I am of the opinion that we base normal upon ourselves and this is one of the reasons that we are not the best judge of our own hearing ability. 

Some of the signs of hearing loss are, difficulty hearing in a background of noise, loss of clarity more than volume, speech sounding more and more like a mumble, and television being turned louder but never getting clearer. These are just some of the signs of hearing loss. Rather than being the last to know that your hearing is changing it is wise to have that hearing test, be informed, know where you stand and have the ability to recognize change and deal with it sooner rather than later. The longer one waits to do something about poor hearing the poorer their outcomes are. 

Take it upon yourself to be the first to know and understand your hearing needs rather than waiting for others to point you in the right direction. Have your hearing tested, be educated, and make decisions for yourself based on an accurate understanding of what your needs are rather than misunderstanding, misinterpreting and feeling less than effective while engaged in the process of communication.

By Sanjeev Sukumaran Au.D.

May is Better Speech and Hearing Month

May is Better Speech and Hearing month, a time to consider the importance of the ability to communicate effectively.  Hearing is a key component of communication. Without being able to hear, we are just talking. When we are able to hear and respond appropriately, we are interacting and communicating.  The effects of hearing loss may not be as readily understood as some of the other disabilities.  Hearing loss may not be visibly identified and therefore is an invisible disability. 

What I know to be true with my patients is that reduced hearing has a significant adverse effect on understanding speech. When one struggles with understanding, they become self-conscious in environments where they have to communicate interactively. The bright and brilliant can loose self-confidence simply because they are not receiving a clear message. It is understood that for those with a hearing loss it can be fatiguing to simply follow a conversation over a period of time. This is true because these individuals are using a lot more of their intellectual resources to make sense of a conversation with missing pieces.  When you add a background of noise for these people a tough listening situation can get to be impossible. 

Those with hearing loss can compensate in many different ways, some might overcompensate by dominating a conversation not allowing others to define the direction of the communication. The majority of others, however tend to withdraw from social or difficult listening situations because they feel inadequate. The potential to feel a sense of loss and isolation is significant. It is difficult at best when a naturally social individual withdraws from taking part in one of life’s joys.

I have seen first hand the effects of better hearing allowing my patients to reconnect with family and friends. I have had patients and their families talk about how better hearing and improved communication can be life changing in a positive way. In the context of my elderly patients I often talk to them about the importance of conversation in their lives. We may have limitations to do physically what we once did but we can still have life changing and positive interactions with family and friends simply by having a conversation. May is better Speech and hearing month perhaps it is a good time to consider how well you really hear.

The Gift

I have written in the past of how our interactions can change lives even through the simple things. The interesting thing is that sometimes by seeing our effect on others we too are forever changed. 

Over the last few years I have been a spectator to the suffering of a couple of people in our community that have suffered with ALS. "Amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) is a fatal neurodegenerative disease. People living with the disease become progressively paralyzed due to degeneration of the upper and lower motor neurons in the brain and spinal cord. Eighty per cent of people with ALS die within two to five years of diagnosis– unable to breathe or swallow. Ten per cent of those affected may live for 10 years or longer."( http://www.als.ca/)

I can't really say this was an arms length experience in both cases because a close personal friend was very close to one of the situations and fairly close to another. The point I make is that ALS has been a disease that has been part of my consciousness for some time. The rapid deterioration against impossible odds has been stunning to me. The fact that there is no recovery from this disease is frightening.

Yesterday I got a desperate phone call at my office from the husband of an ALS patient, his wife had lost her hearing suddenly and as a result she was unable to communicate effectively. I have to interject that the ability to communicate with patients suffering from ALS can often be the one positive thing that remains in a body that is deteriorating rapidly. I was called over by one of my staff to see if I could find time in my jam packed day to see this lady. Providentially I had just had a cancellation and I was able to see her that afternoon. 

As these folks came into my office I was moved by the knowledge that the two others there, the husband and the worker were caring for a woman that was dying before their eyes. I don't know how long this woman had been suffering with ALS but she was confined to a motorized wheelchair having lost much of her motor control including limited speech production capability. I could not help but feel a sense of deep sadness for someone I had only encountered seconds ago. I wanted desperately to be able to do something for this woman and her family. I was already thinking that if she had lost her hearing suddenly due to neurological deterioration I could probably loan the family some sort of earphone based amplification system in order to converse with her in her last days. Prescribing a hearing aid would have been taking advantage of a desperate situation. I was ready to take this logical and ethical course of action. As always I chatted for awhile with the patient as well as the accompanying members of her party and could hear their frustrations. 

As I did an Otoscopic examination of the ears I was overjoyed to see that it appeared as though both ears were impacted with wax. With great hope I went about removing the wax from the ears and as one ear cleared there was an expression from the patient that moved me deeply. As simple as this rather benign procedure was the return of hearing to this woman brought her immense joy. By the time I unplugged the other ear her joy had spread to the others and they were all chatting away with big smiles on their faces. I too could barely contain my own happiness. You see with ALS nothing ever gets better, only worse. I suppose the joy in the room was incongruous with the typical response of someone that had their hearing return because of the nature of the disorder and the lack of hope that accompanies ALS. 

As I held my patient's hand while she squeezed it and smiled and communicated joy and thanks I was moved by a mixture of joy and sadness. My job is one that avoids decisions of life and death. I am not involved in life saving procedures but you know what? Even the little things we do in life through our every day interactions can have a profound effect on others and in return we are also changed forever. 

Why Do You Work?

Why do you do what you do? What I mean is, what is the core reason you work in your chosen profession? For the most part, I love my job. I love being an Audiologist. I take great pride in my work. The question as asked however is getting much further to the core of motivation.

About a month ago, I was in Scottsdale, Arizona for a business development conference. Our keynote speaker was from the sports world, Michael (Pinball) Clemons. Pinball, as he is known played football and was electrifying on the field as he amassed the most all purpose yards of any football player in any league over his career. Pinball upon retirement became a coach winning accolades and excelling even there. 

Mr. Clemons moved to the front office some time ago. During his talk to us, he asked us the  question that I asked to open this article. Initially, I thought I had lots of answers to the question but as he went on I realized that he was not referring to the "why" on a peripheral level but the "why" that was core to the question.   In the end he shared with us his "why" and how his "why" defined the career decisions that he made. Pinball revealed to us that his basic core "why" was his family. This man did what he did for his family. Mr. Clemons also shared that he had made a conscious decision along the way to remind himself of this core "why" as he made career decisions. Michael revealed to us that he stepped away from certain roles and career decisions because they were counter to his core "why". When career decisions removed him further from his family he knew that they would not be his choice. It was interesting to hear of his making a conscious effort to keep this value at the forefront in his decision making process. It was interesting to hear how he would leave his cell phone off each day as he drove his children to school to make room for conversation, interesting to hear how he chose to change his career path to keep him closer to home.

As a father of six boys who runs his own business, this line of thinking really spoke to me. As a private practice Audiologist,  why do I do what I do? What are the core values of my business decisions? I can relate to family being the reason that I do what I do. The unfortunate reality of private practice is that vacation time is difficult to schedule into the demands of the profession, yet family is core to the reason I work as I do. Hmmm......   An interesting correlate to having a strong value based motivation for doing what we do is that it tends to influence our businesses in a very positive way. When my patients walk into my office, they see walls covered in pictures of my family, they hear me relate to them personal experiences from family life pertinent to their visit. From this foundation, I have built a business that makes the values that are valuable core to the success of the practice.  If my family is core, I am motivated to make integrity core to my dealings with others because after all, I represent more than myself. If what I do is because I love my family then I need to make compassion a core value in my interactions. You can see where I am going with this.

Preaching values has become a key component in the business world as of late especially in light of the basis of the economic crisis being born out of ruthless self interest and deceit in big business. We hear the terminology so often yet we fail to really consider what values really mean to us in the context of what we do and why we do it.  It would probably be wise for all of us to question our core motivations on a regular and ongoing basis.

Making a difference

Some time ago, I was out of the country attending some industry meetings when I received an interesting phone call. There is nothing that out of the ordinary to say I received a telephone call. What is out of the ordinary was that it was my teenage son. I was not sure up to that point whether or not my children knew that cell phones had the ability to allow one to communicate by live voice one to another. I was sure they thought that the only communication a cell phone was capable of was texting. Even I have fallen into the trap of communicating with my children in my own house through text messaging, I might tell them to turn off the television and go to bed, I might tell them to politely get rid of the neighbourhood kids before I come down and tell them to leave (out loud). I think you get my point.  So when I got an actual phone call from my son I was surprised to say the least. My oldest son Sammy was calling to tell me that he had been on a school trip for one of his classes and was visiting a community agency that helped people find work. While this was interesting the prime reason for the call was to relate to me that he had met one of the staff members that recognized him and that he was my son. This wonderful lady engaged Sammy and shared with him her experience bringing her son into my clinic where I had assessed her child relative to some of the difficulties he was facing at school. The point that she made to Sammy was  that her visit to the clinic had changed her child's life for the positive and also hers as a result. Sammy was obviously moved enough by this experience to call me and relate this fact to me with something akin to pride in his voice.

As I thought about the implications of this experience for my son, it became apparent to me that perhaps Sammy did not really understand that each of us has the ability to affect positive change in the lives of those around us. Sure a teenager has heard the rhetoric but have they really seen the effect of lives changed by their influence. The message I took upon myself to share with Sammy upon my return was that each of us is responsible for our interactions with those around us in every context, work, school, social etc.  Each of us has the power to be a positive influence for change in the lives of those we come in contact with. 

As it happened, this same woman brought her son in to see me with impacted wax in his ears a few weeks later and we were able have a discussion about Sammy's experience and how her willingness to share this positive experience could influence a teenager's view of social responsibility.  I was hopeful that Sammy could learn an important life lesson about how our interactions can influence positive change. What surprised me was that in my discussions this woman volunteered that the class that came in on this field trip was somewhat unruly and disrespectful yet she was impressed by how well behaved Sammy was and how he was respectful in his interaction and engaging while in conversation.  I was obviously trying to teach a lesson that perhaps was already understood on some level by my child.

Normal Is Me

This is a concept that I address often in the context of hearing impairment, but not only in this context. Each of us sees the world through our own eyes, hears through our own ears, feels through our own hearts and intellectualizes through our own brains. Each individual's reality is their very own. I use myself as the basis of normal. When it comes to hearing loss, it may not be a great idea to use ourselves as a measuring stick of normal. The fact is that hearing loss is insidious, creeping up so incrementally that the person with the loss is often the last to be aware of it. It is often explained away or rationalized. I certainly hear these rationalizations verbalized by my patients. I hear consistently that "I don't have a hearing loss it is just that people mumble now" or "People just don't open their mouths when they speak or anunciate anymore."

On a much more universal basis the fact is that each individual has a very self centered sense of normal and a very specific interpretation of the events surrounding their lives. Sometimes I find myself in a disagreement with someone with a very different view than I have. I think that the premise people function on is that "I am right and you are wrong."   I heard a quip on American Idol the other day when Steven Tyler disagreed with Randy Jackson regarding the performance of one of the singers, Steven Tyler in disagreeing with Randy said " If I agreed with you, we would both be wrong." This is to say that there are absolute correct opinions and absolute incorrect opinions. I have learned to tell myself in circumstances where I might disagree with someone that this may be their absolute conviction, that this is perhaps their reality. I may not share the view of another but the reality that they percieve is no less real to them than is my own.  This little reminder to myself  has often helped to defuse situations that might otherwise have proven volatile.

Back in the world of Audiology I have made it my role to assess and educate my patients, to try to give them an understanding that reshapes and questions their perception of normal, of their reality. I will not prescribe help for someone that doesn't believe they have a problem. I have had severely hearing impaired people in my office that think they hear normally. While I know they need help I can do no more than educate them to the fact that they have a hearing loss and wait for them to have a perception of need. It is futile to force help on those that do not think they need it.

Perhaps the lesson here is that each of us tries to keep an open mind, that we allow for the possibility that we might be wrong or that the view of others rises out of true conviction much like our own. Perhaps what we consider to be absolute truths are not so to others.

Playing Poker CAN Promote Better Hearing...

So does Poker really promote better hearing? Well, it really depends on how you look at it. I have never really spent much time playing cards. Oh sure, I played penny poker in high school and a variety of card games over the years. I have also been accused of being a sports fanatic willing to watch anything that shows up on sports stations. In this vein I have watched a few poker tournaments over the years. I never really focused on the details of the game but found myself wishing I had. 

This last weekend I was privileged and proud to be invited to a charity event hosted by the Pros for Africa organization (http://prosforafrica.com) as well as the Starkey hearing foundation (http://www.starkeyhearingfoundation.org). The Pros for Africa organization consists primarily of NFL players that are involved in raising money and becoming involved on a first hand basis drilling wells improving living conditions as well as other humanitarian endeavors on the African continent.  The Starkey Hearing Foundation is one dear to my heart where the gift of hearing is delivered to children around the world by the tens of thousands each year by hearing professionals under the leadership of the Foundation. I have several close friends that regularly travel to distant parts of the world to fit hearing aids on children that may otherwise never hear.  These two charitable organizations decided to put together a charity poker event to bring better hearing to Africa.

The Raise your Hand for Africa charity poker tournament was held this last weekend at the Golden Nugget Casino in Las Vegas and as I said earlier I was privileged to be invited to be there and take part in this tournament. It was quite something to see the celebrities and athletes arrive to the throngs of fans behind the security ropes, while photographers snapped away from the press area. Being on the inside things were also chaotic with autograph seekers and photo opportunities. As I watched these athletes, these young men with a social conscience I could not help but be impressed to see that these were blessed and gifted individuals that still had a profound sense of social responsibility. 

I was especially drawn to watch Roy Williams, a hard-hitting free safety and six time NFL pro-bowler. What drew me to him was his natural ability to interact with people to make them feel welcome, to do the little things like sell raffle tickets, but most of all to hear him speak with passion for the cause he was there to support. To be authentic and genuine is something each of us should strive for in our interactions and this young man seemed to have it.

One of my good friends, knowing that this was obviously a famous athlete, came up to Roy Williams and jokingly pronounced “I don’t know who the @#$% you are but can I take my picture with you?" She quickly also added that she was off next week to Kenya on a Starkey foundation mission to fit hearing aids on children. It was at this point that Roy Williams, six time Pro-bowl safety turned to her as said,  “No but can I have my picture taken with you?" Wow, now that is the kind of thing that helps adjust your idea of what is important in life.

(This is the picture that was taken)

Playing poker for a good cause turned out to be a wonderful event. With a little advice from my poker playing friends and a whole lot of luck I was able to survive the cut from 50 tables and several hundred players down to the last 24 players. Beginners luck really does exist.

Events like this continue to remind me that each of us, whether we are football players or Audiologists have a responsibility to give back, especially to those who need it most. The real heroes in life are those that make sacrifices in their lives for others.

http://www.starkeyhearingfoundation.org/

http://www.cardplayer.com/poker-news/10760-raise-your-hand-for-africa-charity-poker-event-takes-place-saturday-at-golden-nugget

http://icydk.com/2011/02/20/celebrities-gather-for-raise-your-hand-for-africa-charity-poker-tournament/

I sure wish I had ADD!

Have any of you heard this one? "Well, your child may be diagnosed with Attention Deficit Disorder and here are your medication based options." The implication can sometimes feel like a death sentence. Often the reaction of the parent is severe given the understanding that is prevalent regarding this variation in functionality. I call it a variation because we are all different, we each see the world through our own eyes, hear through or own ears. We can vary in how we approach problem solving, in how we integrate information, in how we learn. The issue is that while we may learn differently one from another, we are all taught the exact same way. We are taught to the middle so to speak. We are taught to the norm. So many brilliant children fall outside of this area. These can be the minds that think faster, that are far more visual and  kinesthetic when it comes to taking in information, these are children that can work at lightning speed, these are the Einsteins of the world the Davincis and  the Edisons. Those that harness this ability rise to the top they become corporate heads, owners of their own companies, emergency room Doctors, elite athletes. There is actually a fair amount of documentation showing these professions to be populated with a a statistaically significant concentration of those with "ADD".  

When you think of it, there is logic to this possibility. Anyone who has visited an Emergency Room can understand that an ER Doctor is functioning at a frenetic pace assessing, concluding making decisions and moving on to do it all over again. The Corporate head will be talking to you while mentally being decisive and moving on to the several other things that need their atention. The elite athlete is an interesting one, this is an individual capable of doing things that only a small percentage of the population can do. Who can process the speed and trajectory of a 90mph fastball while deciding whether it is a ball or a strike and then co-ordinate body movements to intercept the path of the ball with a bat? The Hockey goalie is notoriously ADD, just watch them when the puck is not in their end of the ice, they are in constant motion keeping that synaptic response primed for reflexive movement to the possibility of a puck flying at high speeds from varying angles even with changes in direction involved. The point is that these are special people capable of so much more than the "ordinary" human. How  then do we clasify this exceptionality as a disorder in children when it is more often the system of education that is unable to meet nor understand their learning style rather than them having an inability to learn.

Here is a story I love to tell because it is probably the most vivid reminder to me of how wrong we can be about someone. I had a little girl come to my office for a Central Auditory Processing assessment a number of years ago. This child was 9 years old at the time and could not read, not even a little bit. To make things more complex she was adopted, and at that time her parents new little to nothing of her birth history or of family genetics. As a nine year old, all kinds of possible diagnosis had been sugested by the "professionals", some suggested Autism spectrum disorder, others severe Attention Deficit, Dyslexia, the list went on and on. The school system was not meetig this childs needs and they did not know what to do with her. When I saw her, she was slated to be moved into a "life skills" class which in and of itself was to give up on this child. Finally after much discussion,  her mom blurted out to me, "but she is not dumb!"  

This emotional outburst led to further discussion and the revelation that this child could go grocery shopping and calculate the contents of the cart, with tax! I was blown away! How could this child possibly be labeled in such a way that she would be categorized as "mentally limited".  We talked a long time and decided on a course of action. The long and short was  that with this exceptionality in mind further appropriate assessment was done and indeed it was found that when it came to language bases learning she was severely remedial but when it came to logical mathematical thinking she was off the charts brilliant.  The problem had been that she couldn't read the math problems to do them. The school system did not know what to think, what box did she fit in? Simply put and in the terms that were obvious, was this child smart or dumb ? Well, of course, she was brilliant. This exceptionality demanded that this child needed one on one attention emphasizing her strengths while strengthening her weaknesses. Long term she became a brilliant math student winning provincial math competitions annually.   In high school, she was taking University math courses. This young lady was one of the brightest and the best but remained a lousy reader. 

I happen to have a wife blessed with ADD.   This woman is capable of organizing events and people  at a blurring pace. I can watch with amazement the chaotic come together with purpose. I am sometimes woken in the middle of the night to hear of the racing of her mind creating  undertakings that the "mere mortal" would never consider possible. I recognize that my slow functioning mind is limited while hers is like a very fast sports car zipping around.  How can this be a "disorder"?  

My thinking is that we are all different with varying capabilities and strengths. The categorization of disorder is a necessity precipitated by a system of learning that is incapable of appropriately accommodating for variance amongst us. There is nothing "wrong" with the ADD child in a pathologic sense but we have to categorize this way due to our inability to adapt to their style of function. We reference "the box," some being in the box learners and some out of the box learners and thinkers. More and more, I am wishing to be capable of out of the box thinking because there is were excellence lies, there is where people stand out in society, these are the leaders in industry, the in the box thinkers remain ordinary. So yes "I wish I had ADD"!

What's the Hurry?

I have been blogging for a bit now and thought it was time to tackle a subject that is pertinent to me as a parent as well as a professional. As an Audiologist I do a test called a Central Auditory Processing evaluation. This test is simply put a listening test rather than a hearing test. I tell the kids that we adults like to use big words to say simple things sometimes. Typically children are sent to me by pediatricians or teachers when they are concerned with staying on task, task initiation and  task completion. Often language based learning dificulties aslo are reported. We do the Central Auditory Evaluation (CAP) to either rule out this possibility or include it as an element of the difficulty that the child is encountering. While I could go on and speak about CAP I would actually like to speak to a consistency that I have seen on an everyday basis.

Out of the thousands of children I have seen over the years for this assesment the vast majority ( perhaps as much as 85%) of these children are born in the last quarter of the year. These are the children having a difficult time with staying on task, task initiation, task completion, and in general, language based learning. More specifically of this 85 % a majority of these children are boys. Should we be shocked? What do we expect in a province that change the kindergarten curriculum to include learning phonetics in Junior Kindergarten and expect early reading in senior Kindergarten. These children are starting school as three year olds and being expected to differentiate sounds phonetically. My Speech Pathologist friends have a lot to say about neuromaturation being insufficient at this point to make this expectation one that is reasonable for all. As a father of six boys I can definitely tell you that many a child is barely independent enough to be in school at three, some are barely potty trained, yet we expect them to learn phonetics and other basic skills that they are not ready for. What ever happened to Kindergarten being a time for social interaction and development , learning to share, learing the posturing that is required for the expectations of grade one.

As parents we are led to believe that the world is such a competitive place that our child needs every oportunity to step over  or on the competition to find the ability to stand out. We have learned to demand so much of our children and expect so much so early. The complication is that for those children that are not ready to integrate this learning, they simply miss it and are left with many blanks in the learning continuum. This point has been so obvious to me that when it came time for my child born in November to enroll for JK  I went to the principal and educated him as to why we were waiting till the next year to enoll our child in JK. Interestingly this was a point of discussion that was new to the principal. As might be expected those in the educational institutions take for granted that the curriculum development and age of entry requirements are well considered by those designing the educational process. In reality my wife and I were more concerned about social readiness as oposed to our childs ability to do the work required. We felt that from a confidence standpoint we would rather have our child feel like they were leading the pack rather than chasing it.

I can tell you that in this case our age of entry and understanding of neuromaturation is incongruous with the learning requirements of early education. It only makes sense that a child born in December for example is going to be at a very different stage of development than the child born in January. In junior Kindergarten this year of difference represents a significant percentage of the childs life. In the book "Freakanomics" an interesting anomaly was noted in terms that make this age predjudice understandable on a real practical level. The stat that I reference is one that found the NHL to be made up of players born primarily in the first few months of the year. Recently it was specified that 33% of all NHL players were born in the month of February. These stats point to the fact that maturationally these were kids that were bigger more co-ordinated and stood out in the tryout process as compared to those that were born later in the year. What it does not mean is that these were the more inherently talented kids. This parallels developmental readiness versus intellect.

The bottom line is that we as a society seem to be in such a hurry to get our children into school so that they can attain the educational goals set forth as they move towards excellence. Perhaps we need to slow down a little and not be in such a hurry to rush our children towards goals of success at the risk of frustrating them and destroying the self confidence of otherwise capable minds.

"Don't let Monkeys Inhibit Change"

The title of this posting is actually the title of a portion of a book written by Jeremy Gutsche, a sought after keynote speaker in business circles as well as the founder of trendhunter.com and host of Trend Hunter TV. I had the pleasure of hearing this awfully young, brilliant man speak and soon my age discrimination gave way to soaking in some of the frankly profound changes in thinking that Jeremy was suggesting in the context of business. I thought I would include this object lesson, story and share my interpretation relative to the practice of Audiology or really life for that matter.

"Long ago five menacing monkeys were placed in a cage. In that cage was a ladder that led to a ripe bunch of bananas. The catch was that a powerful water hose was connected to the ladder.

When the first monkey raced up the ladder to reach for a banana, the entire cage was drenched with water. Another curious monkey made an attempt. She rushed up the ladder, greedy to grasp the yellow bundle, but she too triggered a shower on the cage. At this point it became clear to the monkeys that if one of them reached for the bananas, they all would get soaked.

Each time one of the original monkeys was swapped out of the cage for a new monkey, the newcomer would immediately race toward the alluring fruit, but the group would beat him down before he made it up the ladder. This cycle repeated each time a new monkey was introduced to the cage .

Later the hose was removed, but it didn't matter. The monkeys already .had their lesson hardwired: don't reach for the bananas. One by one the monkeys were replaced until none of the original five were in the cage. The same behaviour persisted.

Why? Because that's the way we do things around here. "

I first considered this story from my own perspective especially in the context of how I do business. I tried to consider what walls I had put up that perhaps needed to come down. I also considered this from the perspective of the patient. There are those folks who fail to move towards making decisions that might mean an improvement in their lifestyle and functionality in communication environments, because they have heard "somewhere" that they may not succeed in this pursuit. We all have friends and family with hearing loss that we know to have put up the walls that inhibit not only the solving of problems but even the pursuit of solution. 

With this story in mind, I personally approach each patient in a way that hopefully helps them break down the walls  a little bit at a time taking little steps toward success. There are times when we need to leave our preconceptions aside and open our mind to current possibilities rather than dwell on past failures or the failure of others and find our successes where ever they are, even in places of previous failure.