What an exciting day we had! Today we put the voice valve on Lynn's trach. This is the next step towards eventually plugging and then getting rid of the trach. It allows the patient to inhale through the trach, but exhale through the mouth and nose. When we put it on, Lynn did great. When he went to cough, he was now making sounds. The new sounds were making him more alert. One of the times he coughed, he opened his eyes really wide and looked at me. I said "hi" and he said "hi"! I turned to the CNA that was there and said, "did that sound like hi to you? The CNA said, "Oh yeah, definitely". I tried to get him to do it again, and he would make sounds but you couldn't tell what he was saying like the first time. This is a huge step. Earlier in the day, he stuck his tongue out on command. It takes him a while to process what you are asking him to do, but he did it. He has a hard time repeating things because it takes so much of his energy to do the first thing. He was pretty alert for a large part of the day. Tomorrow could be good again, or we could have a quiet day or two. It seems to be the pattern. Let's hope for a good one!