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The Trach.............Dr Mack!
I understand that the trach is the only current 100% cure for obstructive apnea. What about cases of complex apnea. What effect would it or could it have on CSA? Is a trach even an option for complex patients?
I just recently read Dr. Mack's book. It was amazing. Not your typical repitition of Apnea mantra. I am looking to reading Dr. Parks next.
Views: 68
Replies to This Discussion
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Permalink Reply by Mack D Jones, MD, SAAN on
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Good question, Rock. I haven't read anything regarding this issue. I would have to ask the guys who deal with this problem on a daily basis to get their take on it.
My first guess is that the trach would eliminate OSA, as you would expect, but would have no effect on the CSAs (i.e., you would have to have a ventilator backup to take care of the centrals).
However, I doubt that it is that simple because there are a number of different causes of CSAs and their treatment will vary depending on the underlying pathology.
Thanks for the compliment re. my book.
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Permalink Reply by Matt on
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That's a big part of why my doctors hesitate to give me a tracheostomy. My most recent sleep study shows 60/40 Central versus obstructive apneas. They say - and from what I've read, I would agree - that there is a good possibility that my Central apneas will increase. And I don't think this is specifically because of my spinal cord injury. The autonomic mechanism that triggers one to breathe would be even further compromised, from my understanding. But hey, I'm just a layman.
Good discussion, Rock, thanks. Thank you too, Dr. Mack.
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Permalink Reply by RockRpsgt on
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So technically a trach in such a case would probably not eliminate the need for some type of PAP therapy?
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Roger that, and like I say, I don't think it would be limited to someone with my disability. But hey, I'm just a layman... though my doctors seem to concur.
Rock Hinkle said:So technically a trach in such a case would probably not eliminate the need for some type of PAP therapy?
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No, Rock, my diaphragm is strong. However, from my understanding, damage to the brain stem has a likelihood to cause central apneas. Also, the meds I take for spasticity and pain are neuro-depressive (Baclofen, Valium and gabapentin). Also, limited to sleeping on my back is a contributor (to obstructive apneas).
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I'll expand more later as to why I think this applies to able-bodied people, also - got to get some sleep now.
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Permalink Reply by Banyon on
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Someone (forgot whom) has stated that a trach in a patient who has only obstructive apnea will sometimes cause centrals but the centrals will go away in just a few days as the body and brain adjust.
Isn't an MMA intended to be another cure? Maybe Dr. Jones can comment on why he chose a trach over a MMA.
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Ah yes, that's what I remembered reading, about the trach causing centrals, thanks.
Banyon said:Someone (forgot whom) has stated that a trach in a patient who has only obstructive apnea will sometimes cause centrals but the centrals will go away in just a few days as the body and brain adjust.
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What about complex apnea? OSA + CSA? A trach is the only 100% cure for obstructive apnea. My curiousity was what would it do for a person with complex apnea? Would it even be an option? What if any improvement might this procedure bring to the table for these pts?
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Permalink Reply by Mary Z on
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Banyon, I was curious about this, too. I don't why Dr. Jones chose a trach. A good reason would be the MMA requires quite a lot of presurgical dental work. There is lots of moving of teeth, perhaps even losing some teeth, or needing a root canal for some reason. If you have crowns or implants, I don't know if they move like regular teeth. I can visualize the crown part moving by itself and then needing to have those teeth pulled, and implants at a later date. It sounded time consuming, the presurgical part, as well as afterwards to make sure your bite is correct. There were lots of photos showing people in heavy duty braces.It definitely sounded like a big commitment, though worth it if you did not need a lot of orthodontic work before hand. And if it worked as a cure.
Banyon said:Someone (forgot whom) has stated that a trach in a patient who has only obstructive apnea will sometimes cause centrals but the centrals will go away in just a few days as the body and brain adjust.
Isn't an MMA intended to be another cure? Maybe Dr. Jones can comment on why he chose a trach over a MMA.
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Mary Z said:Banyon, I was curious about this, too. I don't why Dr. Jones chose a trach. A good reason would be the MMA requires quite a lot of presurgical dental work. There is lots of moving of teeth, perhaps even losing some teeth, or needing a root canal for some reason. If you have crowns or implants, I don't know if they move like regular teeth. I can visualize the crown part moving by itself and then needing to have those teeth pulled, and implants at a later date. It sounded time consuming, the presurgical part, as well as afterwards to make sure your bite is correct. There were lots of photos showing people in heavy duty braces.It definitely sounded like a big commitment, though worth it if you did not need a lot of orthodontic work before hand. And if it worked as a cure
Mary, In other words, the MMA surgery and recovery is brutal and the trach surgery and recovery is much easier.
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