Awake Trach Procedure - Quite An Experience - Experiencing A New Phase Of H&N

wbcgaruss

I am writing to give you an update on my health situation.

I have been having difficulty breathing on and off now for several months or more.

I was usually better as the day went on, and in the evening till I went to bed, I was breathing fine.

But in the morning, when I woke up, breathing was difficult.

Finally on Monday November 10th I got up in the morning and was working hard to breathe and I said to the wife I can't live like this anymore and called my ENT at their Satellite office from the main hospital and was put on the line with a nurse and after asking me a few questions, she told me to go to the emergency room at Hershey Medical right away.

I got checked in, bloodwork done, scans done, and was scoped by an ENT.

You see, I had a trach 5 years ago after an operation at this hospital, but 4-5 months out I could breathe ok without it, though I would run short of breath and had to pace myself.

My years of a couple of big cancer treatments, 2012 and 2019, radiation twice, and my aging all play in as factors here, and it caught up with me.

Tuesday, my ENT met with me and, considering that my vocal cords were paralyzed and the opening in my vocal cords so small that I got air through that, they were going to operate that day and scheduled me for an opening in the operating room and were going to operate as soon as they had an opening. And my ENT at the hospital said he considered it an emergency situation because it was possible that if just the right thing happened, I could not breathe and would die, and they would not put it off another day.

I cannot be intubated to be operated on anymore because of the small opening they have to go through. Any attempt to intubate me, if it failed, could cause death, so what the doctors did was called an awake tracheostomy procedure.

Awake Tracheostomy Explained- Emergency Airway in OR!

https://www.youtube.com/watch?v=njE3Qlkh044&t=3s

They numb the area of the trach insertion and give you medications to relax you but not put you to sleep and they cut the opening for the trach and when they have the opening for the trach cut you notice how it is suddenly so easy to breathe but then you start coughing a lot at which point the anesthesiologist gives you medication to put you to sleep. The trach is stitched in place for a few days so it doesn't move and inhibit healing, and whatever other wrap-up they had to do after the operation, and I woke up in the recovery room.

I had some discomfort but no pain during the procedure.

There were plenty of people in the operating room, and I was feeling confident in the team of care I had. There were at least 10 people there for the procedure, maybe more, but I had good coverage of professional medical people.

I was released from the hospital on Friday, November 14th, and was glad to go home.

So I only had to spend 4 days there.

I am thankful.

And again I give God the Glory and Honor for seeing me through this time of trouble once again, Praise God.

I certainly didn't want a trach, but at least I can breathe now.

And since I had one before, it is not all new to me.

I will be checking out Life With A Vent Channel Videos to get the best information on how to do the needed maintenance, etc.

I will now be using a YouTube channel that I am familiar with, but it is now relevant to my situation and offers good knowledge involving trachs and other helpful topics, even a ventilator for anyone needing one of these. I highly recommend this channel for anyone with a trach or ventilator.

The channel is “Life with a Vent”

https://www.youtube.com/c/LifewithaVent/featured

NEGU (Never Ever Give Up)

Wishing you all a Blessed and Happy Thanksgiving

Take Care, God Bless

Russ

Do What You Can….

Logan51

Bill

Car accident when I was 13 resulted in a "crushed windpipe at the larynx" and my having a trach for 26 months while Stanton Friedberg solved my problem @ Rush in Chicago- one of 3 Hospitals in the US, at the time, we were told had a Dr./Drs. who could deal with my injury. Back then they were made of sterling silver (Doc let me keep one and I have in a sealed jar). I took care of it for just shy of 2 years in my early-teens, as fixing my issue required an Op.(s) every 2 months. Not difficult.

Doc Friedberg, by the way, was awarded the James Newcomb Award in 1981 that's given to one Otolaryngologist/Rhinologist in the world per year in recognition of lifetime achievement in that field of medicine.

Sorry to hear your post-tx journey has taken you here, but I can tell you breathing was never easier than those 26 months with a trach.

wbcgaruss

Thank you, Logan, for your input.

You have the experience with my situation and certainly can relate to my situation of having a trach.

You certainly went through quite an ordeal yourself at a young age.

I am glad that you had an excellent Doctor in Stanton Friedberg who could solve your problem.

Take Care, God Bless

Russ

SASH

I have a single paralyzed vocal cord and the other has limited mobility. At times they swell blocking the small area for breathing even smaller. They reduce the swelling using a weeks worth of steroids. This helps short term. The ENT Specialist for vocal cord issues said he has 4 options to deal the the issue.

1. Use the steroids for a short term resolve. So far I've had to do this twice within the year.
2. Use Botox injections to see if that would help with the vocal cords.
3. A quick out patient procedure to trim the vocal cord to increasing the space for air flow.
4. Do a trache to bypass the blocked vocal cord area to allow me to properly breathe.

So far the steroids are working in my situation.

Maybe bring up these options with the doctor to get their opinion if that would work in your individual situation before going to the extreme of the trache.

wbcgaruss

SASH Thanks For Your Input

The points you covered are certainly something to consider for everyone in this situation.
In my situation, I had radiation and chemo in 2013 for throat cancer in the neck area.
Five years later, I had a spot on my tongue removed with clear margins, and this was not too difficult.
About a year to a year and a half after this, I got lymph node cancer on the left side of my neck, which was not encapsulated and had spread in the neck area, which caused a lot of tissue to be removed and damaged nerves, part of which was my vocal cords and my Chyle Valve. I then had numerous complications, which kept me in the hospital for 36 days, and then I was released to a Hospital Rehab for 10 days before going home.
On release from the hospital, I was told I should get follow-up radiation because I was warned that if not, this kind of cancer may come back.
So I was radiated a second time locally by my original radiation doc, who planned out my radiation carefully in coordination with the hospital where I was operated on to spare my swallowing ability and cause as little collateral damage as possible.
This second course of radiation was done with the Cyberknife.
At this point, considering my aging, I am now 72, and as you get older, your skin and body in general don't get smoother and more supple; they do the opposite.
So my neck is somewhat deformed on the left side from all of this, and very stiff and somewhat hard to the touch.
I still have pretty good movement, though.

I have said all this to say this.

The only thing that wasn't really considered or not considered as an option in my case was the Botox injections.

I had been taking the steroids course for over 10 days a few times already, and over the span of 2-3 years, and it certainly helped.
But as soon as they were stopped, my breathing deteriorated.

I had also been presented with a procedure to trim the vocal cords to increase the space for air flow.
I saw a doctor for a consultation at the same teaching hospital as my operation.
John P. Gniady, MD, FACS
https://www.pennstatehealth.org/doctors/john-p-gniady-md-facs

I did not opt for that because there was no guarantee it would work.
I was told that when they trim the vocal cord, it then needs to heal, which can create scar tissue, and you may not gain anything.
The only way is to go through the procedure and in the end see where you are at.
This needs to be done 3 times, and I would have a trach for 9 months.
So basically, there is no guarantee of success. I did not do it.
Also, I did not want a trach at the time.

Since I now have a trach, I may well see the doctor again for a refresher and consider it—still a tough decision, more operations.

The tightness of my neck, scarring from the major lymph cancer operation, aging, and radiation damage from being radiated twice, I believe, had finally caught up with me.
I could no longer be intubated safely, and my airway was almost closed.
My ENT said that with just the right circumstances, my air could be cut off, and that would be it.

Considering all things, I pushed this to the limit for my H&N situation.

Again, SASH, thanks for your input and mentioning all the other options. People should know about these for consideration in their personal cases to consider before getting a Trach.

Wishing You The Best

NEGU (Never Ever Give Up)
Take Care, God Bless
Russ