I just spent the last hour searching for posts on tracheostomies and I can't find any info on those with a "permanent" trach!

Mom, who is in a very good LTAC at Emory, is 12 weeks into post-surgery. She has been "buttoned" 3x but they can't keep her o2 stats above 90 when she doesn't have oxygen. She also has a lot of secretions. Her surgeon looked at her yesterday and said that they should not assume a permanent trach as her airway is clear and her neck is completely healed from her surgery.

So my question is: should I suggest more agressive respiratory care? Is there anyone here who has had a permanent trach?

We REALLY have challenges finding a rehab/nursing home who accepts trach patients. I have read a few posts tho where pts/caregivers find machines and the like to suction at home. Is this an option?

I will answer your questions here and also on your previous post as well. The suction machines you are talking about are used on patients that do not have a trach. Its something several members have used during their recovery from radiation treatments. After going thru radiation first a patient will experience extreme amounts of mucous in their mouths. This mucous is very thick and difficult to get out of your mouth. Ive felt like I was choking to death on a few occasions! I could actually pull the mucous out of my mouth with both of my hands, it was thick and like a rope. Then one day the mucous secretions disappear and turn into dry mouth.

When I had a trach, my nurses would use a suction machine to clean my trach and get all the gunk out of my throat. I have had radiation so it could be different for someone who has not had radiation. I would think that a suction machine could be used at home as well as in a facility. I havent seen any posts by people who have done this themselves. I know of one member who would do his own care and he would have probably used a suction machine. Sadly he has passed away so we cant check with him. He is one who had a permanent trach, there arent many others with one. Try a search by typing the word trach in the box, many posts come up.

In my opinion since your mother is having issues with her oxygen, would she be well enough to be at home? I know the operation was a difficult one and recovery can be very long with this type of surgery. Best wishes for her continued recovery!

I would go with the more agressive respiratory care - if she's clear then there is no reason that her SATS should drop. Unless there's a build upnof secretions.
Good luck.

They make portable suction machines that can be used at home or when you travel and there are stationary machines, big suckers, that you can also rent. I always found it almost impossible to suction myself but had home health care to help me after my surgery. I found sleeping with a good humidifier next to my bed helped thin my secretions. If at all possible, I would avoid a permanent trach.

Since her airway is clear, I would address the cause of the low O2 levels. What are they doing to alleviate this?

Take care,
Eileen

Hey Trish - I am a speech pathologist who works with Pt's who are trach/vent dependent. 12 weeks is not a long enough time to make a determination as to whether or not this is yet to be "permanent" - especially since she has tolerated being buttoned a few times- even though it resulted in a drop in O2 sats- it sounds like she was able to breathe just not as effectively as she should to maintain high sats.

Respiratory therapists can be a little conservative - and it's understandle - they've likely seen pt's prematurely de-cannulated (trach removed) with bad results - and the definition of a "bad result" when it comes to complications breathing is really quite bad! RT's and pulmonologists are very focused on decreasing the risk of aspiration - when you have a trach (cuffed) your risk is VERY low - they like that - when you uncuff, cap or remove a trach you're increasing the risk of aspiration and pneumonia to a degree that might not be comfortable - it's a hard line to walk - risk and benefit - but it sounds like your Mom has a little more time to really figure out a final outcome for her. The degree of her secretions may be making them a little nervous too - is there a speech pathologist there that's working with her too? They might be able to assist with the swallow and saliva management to improve your Mom's chances to tolerate a longer time buttoned and her overall potential to be decannulated.

I think you're right on point to suggest more aggressive RT - that the surgeon backs this is very good news and it is a very good indicator that it's not yet a certainty that your Mom's going to end up with a life-long trach. Best of luck to you and your Mom - I truly hope she has the potential to improve!

Hi all-thanks everyone for good advice. Mom has been in a rehab facility for 3 1/2 weeks now and her progressive has been great. She wants normally and steadily and is strong for her age. I think ironically that she is given less attention here then at the LTAC and therefore isn't being babied.

There has been no progress on her trach, though. She still has secretions, although not as significant. Her voice is weak/non-existent and she wasn't deemed a candidate for speech therapy. It has been 4 1/2 months since her surgery. We did not seek radiation tx although it is still a viable option.

So my questions are..

1)Should I consider a barium swallow test?
2) Is it her advanced age that's making her N & T so weak?
3) Are her lungs weak? There were spots during her last scan 7 mos ago..should we order another scan?

Thanks for all y'alls advice...they are gospel to me!

Well all I know is that Ron came home with his trach and that suction machine, it was a portable one he took everywhere with him while he had the trach in and they delivered the sucky part with the medical supplies to stick down the tube that I was shown how to do it and did it a couple times for him to help clear him out, but he actually did it himself...but he didn't have it that long. I hated that thing as did he, he is still scared of getting that this week, he says he can't breath with it in and got mad that he says he couldn't breath but his sats were fine in the hospital. Good Luck!

What happens to her voice when she closes her trach and speaks?

Funny that you ask that-her surgeon took one look at the trach, put his finger over the trach, and asked what her name was. After she gave him a duh look and then said her name, she spoke it pretty clearly! Her surgeon said she has no blockages and is not in need of a trach.

Update--Mom has been "buttoned" for 5 days now. Her cough sounds hoarse and she still has secretions. Voice is not very strong and I have to tell her to shout to be able to hear clarity.

That's awesome news Trish!! She hasn't been using her lungs to their full capacity for a long while - the more she moves around, sits up, walks around (if she's able) the deeper she'll breathe and the stonger her lungs will become which will help her better manage her secretions AND build a stronger voice.

You've been a great advocate for your Mom - good job!