Topic: Cochlear Implant Advocate and Patient Support Manager.

HH/Beck: Hi Nathan, thanks for taking the time to speak with me today.

Schepker: Hi Doug, nice to get together with you again!

HH/Beck: Nathan, I know we covered your history and background in the interview last year, but can you just briefly review it for the new readers?

Schepker: Sure No problem at all. I graduated in 2000 with a my college degree in International Business from Mary Washington College in Virginia. Between my junior and senior years of college, I started working at MED-EL. I served as an intern at MED-EL and I went around the country to trade shows, state meetings and exhibitions addressing cochlear implant issues and speaking with people about my implant experience. When I finished college, I came back to work here full-time, and I've been here ever since.

HH/Beck: Nathan, please tell what it means to be a Patient Support Manager?

Schepker: Basically, I provide programs for cochlear implant candidates and for people using the MED-EL cochlear implant to connect the dots and provide a support network for people. I correspond with, and coordinate the information flow between MED-EL, the cochlear implant candidates and the implanted patients. I try to help people understand what an implant is, what its all about, what they can expect and whatever else they need. Sometimes I put candidates and their families together with cochlear implant users. That's a really gratifying thing to so! We also have the Hearing Companions program, which is a network of volunteer MED-EL users, and they're available to help people get through the process and share their stories. We're sometimes able to match up people who are actually quite local to each other, and that's always a nice thing too. These are really important services.

HH/Beck: Do you also get involved with the acquisition of cochlear implants between the candidates, their insurance and the implant centers?

Schepker: Yes, sometimes I do. Sometimes people are looking for local audiologists or surgeons, and I help direct them to the appropriate professionals. Sometimes there are groups of cochlear implant patients that like to get together and talk about their experiences, problems and solutions. I try to help bring these people together. I also help individuals-both candidates and implantees- locate community resources available for them in their area.

HH/Beck: Nathan, I know that you too, are a cochlear implant patient. Can you tell us a little about your personal cochlear implant?

Schepker: Sure. I was born with hearing loss and they thought it was probably moderate-to-severe at birth. My hearing loss wasnt detected until I was almost two years old, and that only came about because there was a question as to my speech development, which is why they started to investigate my hearing! Anyway, by the time my hearing loss was detected, it was a profound hearing loss. I was fitted with hearing aids and I wore hearing aids throughout my education. I went to a preschool and kindergarten for the deaf and I learned to sign there. I was mainstreamed in first grade with an oral interpreter and I stayed mainstreamed throughout college. By the time I graduated I had had oral interpreters, note-takers, FM systems and a lot of support from speech therapy too.

HH/Beck: Nathan, how old were you when you received your cochlear implant?

Schepker: I was 20 years old when I was implanted. It was between my sophomore and junior years of college. My implant was in 1998.

HH/Beck: I probably should point out to the readers that you are in North Carolina and I am in Texas, and were communicating over the telephone, virtually without repeats or problems while wearing your implant.

Schepker: Yes, I use the phone all the time every day! In fact, using the telephone is one of the best things for me, regarding using a cochlear implant. The fact that I can use the phone is amazing it really opens up the world to me.

HH/Beck: What has been the biggest surprise for you regarding your implant?

Schepker: Thats really a difficult questionif I had to pick one thing, I would just say sound in general. Now what I define as a sound is clear and easy to listen to. But, when I was first hooked-up, I wasnt really able to identify sound as sound. Early on, it was just a sensation in my head. I knew what sound was or at least I thought I did, and that sensation through the cochlear implant wasnt sound. I had a 110 dB loss, which is way past profoundly deaf, so maybe the sounds I was used to werent quite right either. Anyway, as a week or two became three and four weeks, the sound started to make sense, very slowly at first. But eventually my brain started to recognize the sensations the cochlear implant was providing as sound, and it was amazing to start identifying sounds as related to a certain object or event. I never heard high frequencies until I got my cochlear implant, and at first, the high frequencies kind of overrode all of the sounds I was hearing, everything sounded high pitched and it was very hard to listen to the sound easily. It was pretty confusing. In fact, it was almost like I was hearing two versions of each sound at the same time- the high pitched and the low pitched. But eventually, the high-frequencies and the low frequencies began to blend together into a whole and complete sound that began to make sense.

HH/Beck: What was the approximate time frame from the time your cochlear implant was activated, until sounds started to normalize ?

Schepker: Actually associating sounds with basic sound sources took about 3 to 4 weeks, but it took longer for speech sounds to make sense and to be clearly understood. It was probably about three months before I could understand speech without lip-reading. Music took a while too. I love music and I used to listen to it with my hearing aids, but with the cochlear implant I am better able to get the harmonics and sometimes I get the melody too. I just started playing guitar a few months ago, and I can now tune the guitar and play a few chords by ear while wearing my cochlear implant. So it gets better all the time, and I always work on my listening skills to become a better listener.

HH/Beck: Nathan, what can you tell me about the aural rehabilitation process, as someone who has gone through it?

Schepker: The most important thing is to have reasonable expectations. Some people expect that as soon as they get their cochlear implant activated, everything will be great. That happens sometimes, though rarely, and more often, it takes time and practice. If the expectations are too high, that sets up the individual for failure. Everyone reacts differently to a cochlear implant and no two experiences are alike. Its best not to compare your experience with others, but to compare to how you were performing before you got the implant. Thats a better indication of how you, personally, are doing. It is also important not to set a time frame for certain achievements, such as, I want to hear on the phone in 6 months. You cant be rushed or timed in this manner, because thats simply not how the brain adapts.

HH/Beck: Supposing someone wants to get in touch with you, whats the best way to do that?

Schepker: They can write to me at my email address, nschepker@medelus.com, and Ill be happy to get in touch with them.

HH/Beck: Thanks Nathan. I appreciate your time.

Schepker: Thank you too, Doug. Its been fun.

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