Mike Day 81: Success

May 10, 2011

Family, Health, Mike

Yesterday proved to be a success on many fronts. I arrived at the hospital and the first stop was in the office of the care manager.. she is appropriately titled. And wonderful. She assured me that my schedule ideas could be readily implemented. On the subject of trach removal she wanted respiratory involved. Off we went to find Cory, a great respiratory therapist and all around great guy. I have high respect for him.

He listed all the reasons why not to do the decannulization…prudent, cautious reasons. But reasons, in my opinion, that were remote possibilities. Ultimately he deferred to the doc. Susan got the doc on the horn and up in the conference room. We all discussed both feeding tube and trach removal.

Downsides to trach removal are incremental lack of oxygen during sleep apnea episodes if not compliant with the cpap. I think he will more easily adapt to that than ever to the trach…and bottom line, while capped in the hospital (all day) he should wear his cpap while napping but nobody has been worried about that and he’s no worse for the wear. The next issue is that if he is unable to clear his airway of secretions he could end up with pneumonia, in respiratory distress and with a new trach. I maintain he has a good cough. Cory maintains he has a lot of secretions lately. I agree but think he will clear them. Bottom line, we establish that he is not going to go into sudden cardiac arrest as a result of having been decannulated so if the kids and I agree that’s the risk is ok it can come out today. Along with the feeding tube. The kids and I agreed. Last night Cory suggested he sleep with the trach capped. I agreed. It’s like not having a trach.

I went to find Mike. He was resting and when I asked how he was he allowed as how he was “better now”. I told him I spoke to Melanie and she would visit today. I asked if he knew who Mel was and he replied “my sister”. I asked who I was…and he said “robin”. Going for the gold I asked our kids names and he named them. It was a great day. Later in the evening he asked why we had not played air hockey. He said he enjoyed it and I had to promise to play tonight.

By bedtime he was having some trouble coughing. Cory gave him a breathing treatment and he began trying to clear his throat. With the knowledge of the ramifications of taking the trach out in my pocket and able to step back from the decision making, I uncapped his trach. His breathing became easier and the coughing stopped. I thought it might be something psychosomatic…so I let him uncapped until he slept. I slipped the cap back on. The more difficult breathing and coughing began in his sleep.

This made no sense. He breathes through the trach…which is below his larynx. When you cap the trach he breathes through upper airway…but is having trouble. I did some anatomy research. Seemed to me something might be awry physiologically between trachea and mouth/nose. I uncapped him and waited for Tina, the night shift therapist, to make her rounds.

I discussed my observations with her. I showed her by capping the trach. She, too, could hear and see the difference. She asked if there had been an ENT consult and I said there hadn’t. She wondered if something might be funny in larynx or vocal cords and an ENT scope would prove or rule out anything physiologically wrong in the upper airwa and give us data to make an informed decision. I’ve decided to hold off on decannulizaton until an ENT looks at him to see if there is any reason not to decannulate.

Stay tuned!!! Meanwhile, huge kudos to the staff at Good Shepherd Rehab. Without exception they are pretty great.

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