My husband, Chip, had his surgery on Aug. 26 at Sloan Kettering. 12 hour marathon. Segmental mandibulectomy with reconstruction using fibula free flap. Modified neck dissection. The surgeons seemed pleased and said they got good margins and did not have to cut corners.

Chip came through the surgery well despite his diabetes and was even sitting up in a chair for a few hours yesterday (less than 24 hours after surgery) although quite groggy and in some pain even with morphine, etc. Still, better than I expected. Last night, however, he had a big problem with the trach. I'm still not certain exactly what happened or why except that he couldn't breathe, lost a lot of blood (but didn't require a transfusion), the doctors and nurses came running and had it all under control by the time I arrived in the morning. Just wondering if others have encountered similar problems with the trach?

They ended up changing his room this morning so that he would be directly across from the nurses' station and I have arranged for an aide to be with him all night for the next few nights so that she can watch him for any changes/issues since he cannot talk with his jaw wired shut. Any other ideas or thoughts?

This trach problem scared the wits out of him. He wrote this morning that he thought he was a goner - and that's from one of the toughest guys I've ever met.

Since he can't talk, I would get him a large, loud bell to ring for attention just in case nurses don't notice call light or night nurse has to goes to the bathroom. I'd also get an erase slate so he can write notes easily. Having a new trach is very scary and the bell just might make him feel safer. I used one when I got home to page my husband when he was in another room or floor of the house.

Take care,
Eileen

Karen- Having someone sit with him is a great idea. My husband was in the same situation with the trach. He hated every minute of it but when I ask him now, almost 1 year later, he doesn't remember it. I brought him a clipbaord and some paper but most of the time he was so doped up he wasn't legible. He thought he'd been in an accident and that's why there were so many bells and alarms going off. Just when we thought he was getting better, 2 days before going home, he pulled out his ng tube(it was stiched in,ouch). He also tried to get up and wander away so they had to restrain him. Needless to say, he has a bad reaction to sedation. It almost has the opposite effect. Just be sure to keep your eyes on him when you are there.

You'll be amazed at how well he'll heal after such a traumatic operation. My husband looked great just a few days after the surgery. People couldn't believe the extent of what was done. You'll feel better also when the pain subside for him. I know how you must feel seeing him so helpless but I'm sure he is in the best hands at Sloan. I can't say enough about the staff there.

Sue

Thanks both to Eileen and Sue for your suggestions. I had already given him the whiteboard after reading about it on this website. That's certainly helpful. And, I think the aide is like an extra alarm. She'll run get the nurse if he's in a jam. And, I have the perfect bell at home. Problem is that if he's out of it or really unable to breath, he can't find the call button easily. Last night if his roomate's wife had not heard him thrashing about and choking at 1 am, I don't know what would have happened. She's the one who ran to get the nurse. But, that's yesterday and today was better than that. Gotta luck forward!

Hi

This must be very stressful to have to worry about this happening. I must say this concerns me as I am about to have surgery on Sept 8 and the trach is the one item I am extremely nervous and leary about. Has anyone suggested any reason as to why there was so much trouble with the trach? What could have caused the trouble?

I am extremely happy to hear the situation is much better and your husband is ok. I am thinking this would be a good question for my doctor unless there is a logical answer or something to watch out for. I was under the impression that after sugery one is in ICU for a couple of days. I apologize if this is too personal but it is important to me.

Dianne

Diane,
I'm still not sure exactly why my husband had difficulty with the trach but I do know they fixed it quickly and that it seems to be okay now. It may be that he pulled at it without realizing it or that it got a bit clogged. Also, I think he could't find the call button at the time. That's why I have a nurse's aide with him tonight.

The good news (and there is some) is that he is actually doing far better than I ever would have expected at this stage. He was kept in the special recovery area overnight following his surgery, as is done with all head/neck surgical patients at Sloan Kettering. After that he was in his own room with nurses in and out all the time checking his vitals, the trach, his blood sugar levels, the drains, etc. In less than 18 hours after surgery he was sitting up in a chair! They've already cut his morphine in half and he's already begging for crutches, which they won't give him just yet. So, while the trach thing was unnerving, it seems not to have interfered with his overall progress after surgery. I just hope he keeps it up at this pace and that your own surgery will be less difficult than you think.

Karen

I was a little unsure about replying to this one as I did not want to cause any more worry to either of you. I guess it helps to hear all the information and in my case I went in to this whole thing not knowing anything except what I was told at my initial and only meeting with the team. I did not take a lot of that in either.
In my case the tracheotomy was one of the more difficult things to deal with for around the first 3 days or so in intensive care.
There was a lot of mucus build up and I needed that to be suctioned out quite often. From memory this was more of a problem during the late night/early morning shift for the nursing staff. I had the buzzer and did have 1 nurse get quite annoyed with me and telling me I would have to wait. I though I was going to choke to death. As a lot of people in the ICU are sleeping some of the nursing staff on this shift is able to take it a little easier and I guess I was spoiling it for this one.
In any case I was very upset and felt very helpless as I could not even talk. I could cry however (that is tears just rolling down my cheeks) and I also wrote on a children�s white board.
Fortunately I was close to the doctor�s station and he came over to tell me that it would not happen again and to use the buzzer whenever I needed to. Thankfully I did not see this nurse again.
After around 3 to 4 days 1 of my favourite nurse�s on the day shift showed my how I could do the interim suctions for myself. Got quite a shock when a few days later I saw how much gunk there was in the large bottle behind me.
All the best Diane with your upcoming surgery and Karen I am sure your husband will get better as each day passes.

Hi Karen

There is a chance that your husbands trache blocked up.

I had to have a trache twice and was scared stiff. You definitely need to have something to get the nurses attention if you need it. I had a bell, but I also had for any emergencies an alarm pinned to my hospital gown that once I pulled the cord sent the nurses running in.

Which unfortunately I needed during my first operation - because the trache blocked up with bits of gunk- the doctors and nurses called it clots. Even though they were continually suctioning it - it did block up. Thankfully the nurse came running in and I was trying to explain that it was blocked and that is all I remember until I woke up after being 'brought back' by the cardiac machine and being surrounded by doctors and nurses.

I was moved to ICU where they kept me under close surveilance. My family were advised and were told that that is the first time they have heard of that happening IN 9 YEARS and following that they actually took that trache out and put a bigger one in so as it had a much lesser chance of blocking again.

Having told you the worse case scenario, the second time that I had a trache again for about 12 days I had no dramas. The hospital was well aware of what happened to me last time and this time they put the larger trache in.

Hopefully everything has gone really well, the swelling goes down quickly and he will be able to get the trache taken out asap.

Karen

Thank you both, Gabe and Karen. What Gabe describes is exactly what Chip described so it doesn't frighten me. Rather, everyone's replies help me tremendously.

Fortunately, Chip had a reasonably quiet night last night with no more problems with the trach. And I was able to sleep knowing that someone was watching him every minute. I am bringing a bell to the hospital today and will ask about an alarm (thanks Karen for the idea). And, I would imagine that they will be showing Chip how to suction his trach in a a few days, probably when the splint and bandages on his leg come off and he is entirely weaned off the morphine.

Today is another day and let's just hope it's a good one. The aide told me that he's stronger this morning than he was last night. Thank you again for taking the time to write me.

Karen

Thanks for the info and the heads up...I am really not sure what I am up against and I guess everything is coming to a head so to speak. I am kinda like a timid dear jumping at every little thing I think I am gonna have to talk to the drs office about a few more concerns. The hospital I am going to is a teaching hospital and is very very good. I am sure that they will take good care of me. At least I know a little more....

Dianne