Throat Blog — Woah, we’re half way there

Ok, the doctor went in with the intention of cutting out some suspect tissue for biopsy, and to evaluate for trach tube removal. But, when he scoped me, he couldn't find any suspect tissue. So, not nearly as sore as I had anticipated (just a contusion under my tongue from where my mouth was wedged open). I did wake up with the trach tube still in place…but the plan is to keep it fully plugged overnight and make sure my O2 stays good, then take it out tomorrow morning and monitor me for a few hours before sending me home.

So, stuck in a room for another 20 hours or so, but getting a few work tasks (and blog updates) done. I hear the dinner bell ringing…gotta go eat, now.

Throat Blog — No More Neck Snot

Ok, the ENT team came in at 6:30 AM and pulled the tube out of my neck, covered it with dressing, and left me breathing from my mouth. All the backpressure is gone with the tube out (as long as I don't cough or try to talk). The first dressing was too loose…regular breaths were still going in/out of the hole. I think it was because my neck was not cleaned before the first dressing was put on, so it didn't stick very well. So, floor nurse helped to re-dress it and we sealed it better. I do need to hold it tight with my hand when I talk or cough, but all my normal breathing is now going in and out of my mouth and nose.

And, my need to cough almost immediately went away, too. Something about installing a foreign object in your throat must irritate things. Of course, when I needed that to have an airway, it was worth putting up with. But, glad that part is over.

I am now released from the hospital (just waiting for my ride to get here). Still have the tube in my stomach…it takes a release from several specialists (nutritionist, speech/swallow therapist, maybe others) and then the controlling doctor. I haven't figured out who the controlling doctor is, yet. I have so many it is difficult to know, sometimes, who to ask what. But, I can probably get this out of the way in the next week or so. It doesn't really affect my day-to-day, but is a bit of an annoyance I could do without.

Ok, back to the salt mines, tomorrow. Actually got quite a bit of work done this morning. But, with all the night-time interruptions the hospital provides for free, plus the early wake-up call by the ENTs, I suspect I'm going to be ready for a bit of a nap by the time I make it back to my house. Or maybe a snack, first (lunch at the hospital was an uninspired burger that was just a patty on buns…most of the food here is quite good but the burger wasn't so delicious).

Throat Blog — What to Expect after Trach Tube Comes Out

Ok, I believe I've finally had an experience that is "typical." My cancer treatment was atypical for several reasons, but mostly because one week in, I got the blood clot in my small intestine. This caused me to miss one chemo and have to double-up some days on radiation to make up for missed doses while I was down. So, not sure how much of what happened to me would necessarily translate into what would happen to someone else. Certainly, some things would be similar, but … I dunno.

However, post-decannulation (removal of the tracheostomy tube) seems to be progressing as normally as you could expect for such an abnormal condition.

Before the tube was removed, if I blocked the tube (which I was routinely doing in the weeks leading up to removal), breathing became more difficult. Not bad if I was sitting, driving, or doing nothing much. But, if I took the stairs or did much of anything that would increase my oxygen load, I had to unblock for a few minutes so that I could breath fast/deep enough to get enough air.

So, despite desperately wanting the damn thing out of my neck, it was with some trepidation I approached the removal itself. A team of doctors (this is a teaching hospital, so nearly every doctor's visit included a few doctors or doctors-in-training) came in at around 6:30AM. Removal was a complicated process that consisted of…releasing the Velcro holding the strap around my neck and pulling the tube out. They then quickly pressed a medicated dressing and then taped a gauze pad over the hole in my neck.

The first thing I noticed was that I was able to breath with absolute no restriction in my airway. My slight fear that without the tube in breathing would be laborious completely dissipated. Breathing was great.

Then, one of the doctors said "When you talk or cough, press your finger here" and proceed to poke me way to hard directly in the stoma. Ouch! The area was not especially tender, but, man, he pressed in a bit aggressively. Twice. I actually batted his hand away (sorry about that) and rasped "Dude!" (sorry about that, too). They all watched me breath for a minute, then booked it out of the room. I must have had a look on my face, or something.

Ok, so as I said breathing was great. Let me modify that. Breathing was great if I was breathing from my mouth. If I breathed through my nose, there was enough back pressure that a lot of air went in/out of the stoma. I really thought that the stoma should be sealed off better, so that afternoon, I had the nurse re-dress the hole. She used basically the same method as the doctors, but used a lot more tape to hold things down and somewhat seal things better.

I left the hospital the same day that the tube was removed. The only instructions I got were "Be sure to block the hole with your finger when you talk, cough, or laugh, until it heals…which will take a week or two." I also got a bunch of information on stopping smoking (I've never smoked) and similar irrelevant advice, as well as things to watch for that might require a trip to the ER. A bunch of pages of stuff, and I foolishly assumed that taking care of the stoma itself would be covered. The entirety of that part was:

  • Keep trach site covered with occlusive dressing.
  • Apply pressure to the dressing when speaking or coughing to avoid air escaping from the hole
>

So, I supplemented with Dr. Google. Found a credible source (MD Anderson). Fold a 4×4 gauze twice and tape over the stoma. Then, cover with a waterproof wound dressing. Change daily.

Ok, this worked much better. If I was lax in covering the hole in my neck when I talked (or if a cough snuck up on me), air would inflate the dressing a bit, then the air would go back into my neck to deflate. This was the case for about a week. Then, my neck became a one-way valve. When I coughed or talked without fully sealing my neck with my finger, the air would inflate the dressing. But, I'd have to press down on the dressing to "burp" the air out around the edge…the air would no longer go back into my neck. Around Day 10, my trachea was healed enough that no air came out at all. I replaced the gauze and wound dressing with a smaller (about 2 x 3) clear waterproof bandage and no gauze.

For my next adventure…my PEG (stomach feeding tube) comes out on Wednesday. It has been hanging unused from my stomach for over 6 weeks now. Meanwhile a crust has to be cleaned away every day from around the exit wound. So far, my only instructions are to be there at 9:30 AM Wednesday and to stop taking my baby aspirin until after the procedure. I might have a few more questions before I leave after this procedure, if the printed followup instructions are as skimpy as they were for the trach tube.

Throat Blog — No News is No News

I’ve been pretty lazy as far as the blog goes, lately. No posts for a long time…which means that nothing of note has really happened (throat related, anyway). I did get the stomach tube removed. Unremarkable…the doctor deflated the balloon then yanked it out, slapped a gauze on it, taped it down, and said not to eat for a few hours. That was basically it. I’ve got another ugly scar on my stomach, but I’ve started collecting them, so that is OK. I should think about getting a tatoo to theme them all together. Where the tube is could make a pretty decent eye without much ink. Not sure about the footlong vertical scar through my belly button, though.

All my vitals have been normal. The only bad thing that has happened has been a case of food poisoning from eating out last Thursday that I am still recovering from. Other than the 20 hours of agony from the clot in my small intestine, I’ve not felt this bad in years. Certainly the chemo/radiation never had me feeling this bad (tired, run down, but not nauseous). Couldn’t eat on Friday. Eating, now, but very carefully. Trying to stay hydrated as the badness works itself all the way through my digestive tract. It has lodged somewhere south of the navel and sounds like two squirrels arguing with a gorilla.

Anyway, next up will be a CT scan on May Day. Hoping I can stay lazy.