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Thread: trach question

  1. #1
    Senior Member lunasicc42's Avatar
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    trach question

    I have a trach and I recently had the chance to take it out but I went to the hospital and took it out but it just felt too weird to me, having an open and exposed hole in my throat, but my Mom urged me that people walk around with open stomas all the time and she wants it out because it is just another foreign object in my body. But the doctor was hesitant to take it out in the first place for a few reasons. Like I have a very fragile airway in the first place. And that there is really no benefit beside the fact that it's another foreign object out of my body. But the trach has also caused several medical problems, like it rubbed a fistular stoma in the middle of my airway that had to be surgically repaired and my Mom believes that it will cut down suctioning but I don't even buy into that. What should I do?

  2. #2
    Well, I agree with your mom on this one. You have had a trach for 4 years???? Why?

    The trach itself creates much of the phlegm you need to be suctioned for. Without the trach, it is likely you would not need any suctioning.

    It will feel different to breathe again through your nose and mouth. You may be surprised to find that you get your sense of taste and smell back though.

    Without the trach you will be less at risk for both swallowing problems (dysphagia) and respiratory infections.

    Once the trach tube is removed, the trach should slowly close up on its own, and until then, you use a dressing to keep it closed. You should not anticipate needing to have a long term stoma unless you have upper airway problems like throat cancer.

    I would recommend you be seen in a pulmonary medicine clinic that specializes in artificial airway management and work with a specialist physician and nurse who can help you through this transition.

    (KLD)

  3. #3
    Senior Member lunasicc42's Avatar
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    Question

    but I can't let it close because I can't cough up the snot through my mouth. I guess my lungs aren't strong enough or something

  4. #4
    this is mom i have to comment on this tomorrow. he left out a couple of things.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  5. #5
    Why can't you cough up secretions? Do you know how to do quad coughing? Are you doing exercises for your diaphragm strength (ie, PFlex and or abdominal weights)?

    (KLD)

  6. #6
    This is mom again. Anthony has had the trach this long because of surgeries on and around the area and his ENT in Tampa would not go any further with us when we wanted him to do a scoping to see if it was all right to take it out. We had to set up an appt. with a willing ENT at the University of Miami and well it just took a long time. I'm so thankful I know these Drs. in Miami.

    Anthony left out that there was also another surgery due to the inominate fistula, remember the one that almost killed him. They couldn't say but I believe the trach rubbed through to it also. His airway is not fragile and is clear. And he has paralyzed vocal chords but they are in an open position not closed position allowing for air to go through smoothly.

    Anthony's stoma will never close due to the surgeries that he has had there. We would still have to suction him because he cannot cough up his phlegm. He only has shoulder movement. I always felt uncomfortable doing the quad cough because he has a baclofen pump and I didn't like pushing on it. I would like to learn more about the exercises you mention.

    He has agreed to try and take it out gradually. I took it out this morning for about an hour and everything was fine. Tommorow we will do it a little longer and he will have a meal with it out and so on.

    If there was some kind of button we could stick in the stoma I think it would make him more comfortable. I have seen some "stoma buttons". His Dr. said that those were used for people that their stomas would close so they put in those buttons to keep the stoma from closing so it didn't really apply to Anthony because his won't close. But why couldn't he use one anyway? I think our goal is to get him totally trachless and then see a speech therapist who knows about these stoma and speech buttons. Even though his vocal chords are paralyzed maybe we might get some sound out of him and if anything use one of the buttons so that he feels more comfortable. I don't know another learning experience here. Any thoughts?
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  7. #7
    It is well know that the main cause of inominate artery erosion is trach tubes and cuffs, which is a reason to get rid of the tube. I would discuss the use of an Olympic trach button with his physician. These create much less secretions than a normal trach, and are "capped" all the time except when suctioning is needed.

    http://www.natus.com/index.cfm?page=...&contentid=219

    Also, a good plastic surgeon together with a knowledgeable ENT should be consulted about the possibility of a surgical closure of his trach if secretion management can be improved through his mouth. A Cough Assist Machine could also be considered for this. This can also be used with the trach and often replaces suctioning.

    http://www.jhemerson.com

    Also, here is the PFlex. This is excellent for getting better diaphram strength for better inspiration, which then impacts better forced expiration (coughing).

    http://pflex.respironics.com/

    Quad coughing can be done with techniques other than just abdominal thrust. If you would like to have a handout on this, please PM me an e-mail address so that I can send a handout about these techniques.

    (KLD)

  8. #8
    thank you for these links. I have seen alot of these "stoma buttons" but am clueless on which one, if any would work for him. We will have to find a new ENT up here in our area that is versed with these. Do you know if speech therapists are knowledgeable with these devices. You think they would be.

    I totally forgot about the cough assist machine and actually had a person offer to give us one a long time ago. Will this machine work if he had the stoma button in and capped? or is it just for ppl with surgically closed stomas?

    The Pflex looks interesting. I searched the sight but could not find the instructions for it. I sent them an e-mail. The company is in the netherlands. It doesn't look like they sell to private ppl.

    Thanks again for the links.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  9. #9
    You can use the Cough Assist either through a trach connector or through a face mask.

    For the PFlex, you start with the largest hole (on the dial). It can be used either with a mouth piece or a trach connector. You connect and then simply breathe normally until you start to feel short of breath. You do this several times daily until you can do it for 10 minutes. Then you turn the dial to the next smaller hole, and repeat. Over a period of days and weeks the diaphragm gets stronger and stronger. Maintenance is using it on the smallest hole for 10 minutes twice daily. If you want to buy these, you may have to get a case.

    There are a lot of rehab and medical professionals who are not familiar with trach buttons, unfortunately. We actually used them more when I worked in brain injury rehab, so you might want to check for someone experienced with this population.

    (KLD)

  10. #10
    thanks for the instructions, sounds easy enough. gonna search more on net though to see if anyone sells separately and wait to see what Respironics says.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

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