Non-CPAP Forum Posting

Posted by Scott on January 12, 2001 at 10:07:22:

In Reply to: Tracheostomy looks official posted by Dennis White on January 11, 2001 at 23:47:36:

Hi Dennis,

It looks like you have it bad.

I think my apnea RDI was a little higher than yours (160 something) but I don't think my desats were as bad. Anyway I have an inkling what you are going
through and you are considering the correct decision in my opinion. It takes great courage to take this step as a sort of preventative measure, I am the
only other person I know of who has done this in time. Most of the people I have talked with waited far to long or were trached while being unconscious or
near so, and now suffer more serious irreversible long term effects.

I will be glad to answer all your questions in order.

Will it be an inconvenience?

Yes! Waiting for soup to warm in a microwave is an inconvenience!
The real question is how convenient do you find OSA? Is it OK being chronically tired, working 2 or 3 hours and being exhausted? Balance, not being able
to think clearly, falling asleep while driving, and being frightened of going to sleep, against getting true healthful, rejuvenating rest. (chances are you
don't really remember what this is)

Is there a chance it won't help?

No, not really. It's usually considered a 100 percent fix for OSA. Some people can develop Central apnea from having a trach. I have not had time to
explore why this is but you should probably schedule a sleep study a few months after you are healed and comfortable with the trach, just to make sure.

What are the real life implications of tracheotomy as opposed to what the doctors tell you?

There are a few, but far and away the most significant are controllable by you and the choices you will make prior to surgery.

WHAT DOCTORS MAY TELL YOU: Tracheotomy will cure OSA

REALITY: There are right.

WHAT DOCTORS MAY TELL YOU: They always insert a 6mm Shiley in the initial surgery.

REALITY: 1. They or the hospital may have an agreement to do this for a special deal on Shiley trachs.

REALITY: 2. They learn surgery at the hands of another surgeon who passes his technique and surgical preferences on to the student thus guaranteeing
that unless you have a very progressive teacher and/or student(after graduation), you receive the best surgical technique medical science offered 20-30
years ago. (and this is a best case scenario, if you have a young doctor fresh out of college and his surgical instructor was fairly young and/or
progressive)

REALITY: 3. Many doctors simply do not want to try something new to them. From the perspective of maximizing their profit for a minimum in effort or
time, this makes perfect sense. Why reinvent the wheel? These sleds we are dragging around have been serving us for generations!!!

REALITY: 4. 6mm is large... for a drinking straw. It is however inadequate for a large adult to breath through. If there were never any mucus or colds
or infections or drainage then I would allow that some adults would be fine with a 6mm. Reality, however rears its ugly head here and we find out we do
not live under ideal laboratory conditions and a 6mm can turn into a 3mm faster than you can say "cough". Understanding that for the same effort your body
can oxygenate almost twice as well with an 8mm, near 3 times as good with a 10mm, and 4x with a 12mm, why then are not larger trachs installed at initial
surgery as a matter of course? See Reality 5.

REALITY: 5. A conventional tracheotomy tube is an exercise in compromise. You want a large enough air flow to keep the patient alive (we are not
talking of thriving here) and yet you want the patient to be able to pass enough air around the the tube in his trachea to allow for normal speech. To
complicate matters, the curved tube is not easily cleaned, so an inner and outer cannula approach is taken. This allows the outer portion to stay in the
stoma/trachea for a longer period of time between cleanings and the inner portion can be slid out and cleaned at will. The penalty for this inner/outer
cannula approach is the overall diameter of the trach tube must be increased for the same diameter breathing hole, thus giving less room to breath around
the tube for speech, fighting the primary objective of an adequate airway, etc. Is there anyway out of this engineering dilemma? Oh YES!!

WHAT DOCTORS MAY TELL YOU: I have performed over "400" tracheotomies like this and most ENT's use this procedure.

REALITY: The number of times a surgical METHOD is performed says nothing of the rightness, wisdom or efficacy of the surgery itself, only of increased
skill performing it. Likewise, it is a common logical fallacy that something is made right because more people condone it. Selah

WHAT DOCTORS MAY TELL YOU: All trach tubes are very similar and you can easily change later after the surgery.

REALITY: All tubes are not the same and do not only differ in size and lengths, but types and philosophies. There are trach tubes made out of at least a
half dozen different materials, and tubes that are designed to NOT OCCLUDE THE TRACHEA to any appreciable extent. ARE YOU LISTENING DENNIS? By not
occluding the trachea, the whole problem of tube diameter limitation in relation to trachea diameter is circumvented. The diameter of trach tube you
choose can be fairly independent of other factors involving the trachea. (very small women, children and accident victims may be excluded partially from
this generalization.) Choosy Trachers Choose Large!! This is not a win win situation. It is a win win win win win win scenario, as there are many benifits to a stoma
button and no negatives provided you do not need another kind of trach tube for other medical reasons.

The doctor who performed my operation made everything sound cut and dried, simple. I did not have the energy reserves or time to do a thorough study of
options, opinions and the like. I willingly choose to believe his version and was trached conventionally, the rest of my misery story appears elsewhere on this forum.

ENT's no matter how gifted and talented, no matter how empathetic and concerned, can have no clue of the frustration and prison of sorts it is to have a
conventional tracheotomy as opposed to a stoma button unless they have a tube hanging out of their neck. I thank God for my being trached and His leading me to an "accidental" discovery of the principle cause and reason for my apnea and the consequent treatment which is even now restoring me to my former self
and will soon allow for the removal of the tube with no need for subsequent CPAP, as restoration to God means FULL restoration. The key word here is
acromegaly but is a large posting all by itself (and I am tired Dennis). That's another story for another day.

Boston Medical would be happy to supply you and/or your doctor with all the research and info you could want on doing an initial surgery with a straight
stoma tube. They even sell the surgical instruments needed for making the tracheal incision. If you have any other questions and still want to ask, I'm
here Dennis.

Scott

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