Sunday, June 10, 2007

TRACHEOSTOMY DAYS

As was mentioned earlier in my previous blog that I was intubated 3 times and after the third intubation, doctors decided to perform Tracheostomy.

Tracheostomy is a surgical procedure, performed on the neck, to open a direct airway through an incision in the trachea (windpipe) to make breathing easier and it is usually done in the operating room under general anesthesia. However, as for me, it was being performed in the ICU. Normally it was done by the ENT but I was very fortunate to have experienced Respiratory doctors, Dr Loo and Dr Constance Lo, to attend to me. Their skills were so good that the scar would be neat after trachy being removed.

Just before this surgical procedure, I was apprehensive coz' I was fearful that I would never speak or sing again. Different nurses and Respiratory Therapist (RT) did a good job in explaining and assuring me. After this surgical procedure, I could not talk for more than a month but eventually I've learnt to talk by taking a deep breath and placing a finger over the stoma.

This is how it was performed:

After given the General anesthesia, the neck is cleaned and draped. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube to provide an airway and to remove secretions from the lungs. So instead of breathing through the nose and mouth, I will then breathe through the tracheostomy tube.










The tracheotomy tube consists of three parts: outer cannula, inner cannula, and obturator. The outer cannula is the outer tube that holds the tracheostomy open.




A neck plate extends from the sides of the outer tube (outer cannula) and has holes to attach cloth ties or velcro strap around the neck.




Here are the inner tubes (inner cannula)



The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator fits inside the tube to provide a smooth surface that guides the tracheotomy tube when it is being inserted.




This is how it looks when being locked in place.






Not many people has seen someone walking around with the trachy. Hence, you can imagine all the stares I get when I'm out in the public. Some would stares and stares and stares, some would ask what that is and why I need it etc. Some adviced to hide the trachy by using a scarf etc, but I've decided to reveal it so that people as well as myself would soon get use to it. It became a new fashion :-))))

However, with this trachy, sometimes it was rather difficult to talk when the secretion builds up and my breathing would become heavier and the sound would "scares" people around me ;-P

I remembered having steam boat at a friend's place and after that we played some card games. My breathing was rather heavy and that caused a friend of mine to look around "searching" where the sound came from. Initially, she thought it was her dog breathing very hard but soon confirmed it was not. Then she thought it could be the snore of a friend of ours who was sleeping coz' she was not well and again it was not. Then soon she realized it was me!!!!! Hahhahhahaha!!!!!






I was the mascot at Sentosa during Chinese New Year period. The job was tough and I was panting most of the time. Imagine having to stand besides the visitors and take pictures with them while panting heavily???? Hahaha.... they must be thinking where the "sound" comes from ;-P Of course I'd tried to hold my breath when I stood beside them.....it was ok if the "camera man" do it fast but some took ages to adjust the camera etc.....and you can beg I was desparately thinking...."QUICK!!!! I CAN"T BREATH!!!!!"




One afternoon at the Sentosa, I had to entertain some VIPs and as usual I was panting. It was ok if no one talks to me but one of the VIP did!!! I was panting so badly as I tried to answer all his questions but I guess he must be thinking to himself if I was ok.... hee, hee :o)))


The trach tube is sometimes sewn to the skin around the stoma but mine was another method in which the trachy is to be held in place with trach ties (tube holder).



However, instead of using the proper holder as was shown in the picture, I've tried to using the normal sewing thread :-O



It was so thin that sometimes I thought it might break!!! Hee, hee.... so daring hor!!! ;-P Take a look at these pictures and that was how it looks.



A gauze dressing was placed under my tracheotomy tube so as to absorb secretions as well as acting as a cushion between the tube and my neck. The gauze has to be changed when it becomes soiled.

Of course when I shower, I have to take extra care to prevent water from getting in. There were few occassions whereby water got in ..... choked, choked, choked......and cough, cough, cough!!!! scary!!!! Immediate suctioning was needed to help me breathe properly again.



My trach tubes have an inflatable cuff near the outer end to keep them from coming out and to prevent air from leaking around them. This is like a balloon, when inflated with air, I would not be able to talk at all. Usually during the day, it would be deflated so I can talk but in the night when I use the bipap, it has to be inflated. This would prevent the air from flowing upwards. This is important because if the air flows upwards, the air to the lung is minimized and I would feel extremely uncomfortable coz' my upper respiratory track would dry up so badly that it hurts.






As long as the trach is in place, I'll need to clean the inner cannula on a daily basis by scrubing it with a small brush so that it would not be clogged with mucus coz' if so, I'll be unable to breath.





Another way to prevent this clog was to do frequent suctioning. Suctioning was a must to get rid of the secretion out from the lung so as to prevent infection as well as to help me breathe better. However, this process was torturous!!! It was painful when the tube was being inserted into the lung and it works like the "vacuum machine", suction out all the secretion from the lung. Sometimes the tube would suction the lining of the trachea or lung that it started to bleed. Of course this was not new for me..... sob sob sob .... so painful lor!!!!



Here's the nurse getting ready to do suctioning for me
Ahhhhhhhhh!!!! "Tortouring Session" would soon begin!!!!!!!


HELP!!!!!
SOMEBODY OUT THERE .... HELP!!!!

A nurse once told me that my pain must be pretty bad that even in my sedated state, I struggled to grab hold onto the name tag of an ICU nurse who did suctioning for me and I tried so hard to focus my vision to see who that nurse was!!! Hahhaha .... that was shortly after being intubated that I was still in the state of confusion which I had no idea of what I did.


Take a look at this picture.... did you notice the bottle hanging on the wall? After suctioning, the secretion would be stored in that bottle. It was bloody isn't it? Sob sob sob .... that means it bled during suctioning!!!!




At home, I have to do suctioning myself. This is how the home suctioning machine looks like....



The suctioning tubes .......





And of course I have to wear sterile gloves before doing it ......


Take a look at these gadgets ..... they are humidifier, one with sponge and another with paper.



When my secretion is thick, it makes it difficult for me to breathe as well as very difficult to do suctioning. To ease the problem, I'll need to use nab or to use this gadget.



When assembled, this is how it looks....





The sponge or paper of this gadget is employed to captured the air (vapor) that I breathe out. This vapor is in turn being breathe in by me again and it acts to humidify the lung. After sometimes, the humidity builds up and the secretion would then be lossen.






Notice the two different kind of inner tubes as shown in the picture? The one with hole would allow me to talk whereas the other type without hole would not allow me to talk.



As for the outer tube, I used to use the kind with a hole as shown in this picture ....


However, I started to face another problem .... the granulation tissue started to grow into the tube through this hole!!!! Not only it has blocked the airway, it has also prevented the inner tube to be inserted. Without the inner tube inserted in place, I would not be able to use the bipap in the night. Because of this problem, I was rushed to ICU in two occassion for an emergency procedure and bronchoscopy. Eventually, the doctor decided to change it to the kind without hole. The one without hole means it would be rather difficult for me to talk. Initially I was miserable but was certainly glad that eventually I found my voice again.
Take a look at the following picture and note the red flesh on my neck. That's the granulation tissue growing outside the flesh. When the tube has been changed to the type without a hole, the space was limited and thus overflowed outwardly.



After more than a month upon discharged, the doctor decannulate (remove) the trachy tube and this tissue started to grow inwardly again. Doctor did bronchoscopy before decannulate as well as after two week of decannulation just to make sure that it was not growing any bigger.

Finally I was glad that life could return to normal again ...... meeting with friends ...... eat and eat ...... celebrate and celebrate =)))))


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