Michael remains well.  He is still slowly getting used to the PMV valve (speaking valve).  He doesn't like it and does not tolerate it for longer than 15 minutes but it's all me monitoring and putting it on unless I ask them to do it.  The response is usually "Oh, he has an order for that?" which becomes frustrating after 1000 times and that is why I had my favorite RT's teach me how to do it since they are only there once or twice a week.  Another thing is him beginning to use Stimulators.  I'm gathering data on which to use first and asking others in the facility who use them on their loved ones and what their experiences have been.  Every body is different but researching which may be best to start off is now clear and I will be purchasing that soon.