Deb - I know how you must be feeling. My son lost his voice, too and said it was too painful to talk. We used a lot of improvised sign language (thumbs up, down, shoulder shrugs, etc.) so much so that his daughter started using it with me, as well. It was almost comical sometimes when Paul would get angry with me for not understanding him. He would try so hard to express anger and it just wasn't working! For some reason his frustrated attempt at expressing anger kind of struck me funny but I was very careful not to even smile because I knew he was so serious. I would try to just use yes or no questions or give him choices where he could hold up 1, 2, or 3 fingers. It can be so frustrating for both patient and caregiver. It does get better, though.