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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 Mary Z on
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Dr. Mack can clear this up for us about the trach. I understand it is used as a last resort if all else fails,even though it is a reversible procedure. Compliments of Web MD
: "Why It Is Done
A tracheostomy is done only if you have severe sleep apnea, other treatments have failed, and other forms of surgery for the condition are not appropriate."
So you have to jump through hoops to get one done.
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Permalink Reply by RockRpsgt on
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Dr. Mack went with the trach because all other options had failed him. He went through all of the surgeries (except the MMA) only to see his AHI increase. His final option was either the trach or the MMA. Only one was a sure cure. We see more trach pts than I ever would have suspected coming into this field.
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.
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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Permalink Reply by sleepycarol on
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That is surprising as I thought they were in a very, very small portion of the patients. I mean like non-existent in other words.
Rock what are some of the reasons people give for having it done?
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it is still a very small group. It is just a bigger group than one might expect. In 2 years of doing studies at least 20 of them have had to do with a trach. That is almost 1 month of pts out of 24. The reasons vary. Most just can't do PAP.
sleepycarol said:That is surprising as I thought they were in a very, very small portion of the patients. I mean like non-existent in other words.
Rock what are some of the reasons people give for having it done?
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But that is a bigger percentage than I would have expected Rock.
Okay here is a dumb question probably -- if a child had a major disability and refused to wear a cpap would this be a viable option?
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Permalink Reply by Matt on
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Rock Hinkle said:it is still a very small group. It is just a bigger group than one might expect. In 2 years of doing studies at least 20 of them have had to do with a trach. That is almost 1 month of pts out of 24. The reasons vary. Most just can't do PAP
That's almost 1 a month. With the prevalence of MRSA these days, I'm surprised. What's your observation with these patients, regarding Central apneas, is it still a problem?
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Permalink Reply by Banyon on
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Matt said: .... With the prevalence of MRSA these days, ....
As an aside, it looks like the high prevalence of nosocomial (hospital acquired) infections has been caused by government programs (Medicare and Medicaid). Historically these programs continued to pay hospitals and doctors for treating patients infections obtained while in the medical facilities. So there was no financial incentive for hospitals to prevent the infections.
Now that these programs have started to discontinue paying for treatment of nosocomial infections, hospitals have the proper financial incentive to prevent the infections. It is all about medical professionals hand washing. A company has developed a soap dispenser which is able to detect whether the professional has properly washed his hands. It gives either an all-clear signal or an alarm. One hospital in Florida has started using it and their infection rate has fallen to zero. (If anyone has a link to that story, please post it.)
Give the free market a chance to work and it solves problems that government has created.
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Carol-That is a great question. I do not know the answer. I know that Dr. Mack and others out there have had good experiences with the trach. Working at an inner city hospital I have not. Most of the pts that I have seen have not taken very good care of the trach. Out of the 20 I do not believe one pt brought a plug with them. They are not fun to clean out when they have not been taken care of. For this reason I do not know if this would be a good option for a child. Personally I could not give up water sports.
Matt-Most of the pts that I have seen have been on those that have had the trach for sometime. I could not talk of the residual centrals that come with the surgery. I can say that on the studies that I have done that I have more fingers and toes then they had events.
Banyon-That is a good perspective on MRSA and superbugs. I like it! Your pretty good for an unlicensed guy.
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Rock said: Out of the 20 I do not believe one pt brought a plug with them.
Do you mean they are breathing through the trach all day long!!? Are you talking about trachs for sleep apnea or other problems?
Is it a correct assumption that they have traditional trachs and not skin-lined trachs like Dr. Jones?
Rock said: Your pretty good for an unlicensed guy.
I do have a state driver's license. Better wear your seat belts and practice defensive driving!!
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They had to have been breathing through it all day. All but one had the procedure done due to apnea. I do have to retract those numbers though. I was just reminded that 2 of them did come in with plugs. The rest either myself or another tech had to go find one. I have yet to see the skin lined trach. That I know of anyways. Honestly short of learning how to clean them I had not paid them to much attention until reading Dr. Mack's book along with a few other studies. I went a whole year without seeing one before coming to the hospital. Prior to taking my test my mind was on other studies. Recently I have had some more free time to look into some of the things that i had put to the side.
I always wear my seatbelt;)
Banyon said:Rock said: Out of the 20 I do not believe one pt brought a plug with them.
Do you mean they are breathing through the trach all day long!!? Are you talking about trachs for sleep apnea or other problems?
Is it a correct assumption that they have traditional trachs and not skin-lined trachs like Dr. Jones?
Rock said: Your pretty good for an unlicensed guy.
I do have a state driver's license. Better wear your seat belts and practice defensive driving!!
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Ha, that doesn't apply to the VA...Banyon said:Matt said: .... With the prevalence of MRSA these days, ....
As an aside, it looks like the high prevalence of nosocomial (hospital acquired) infections has been caused by government programs (Medicare and Medicaid). Historically these programs continued to pay hospitals and doctors for treating patients infections obtained while in the medical facilities. So there was no financial incentive for hospitals to prevent the infections.
Now that these programs have started to discontinue paying for treatment of nosocomial infections, hospitals have the proper financial incentive to prevent the infections. It is all about medical professionals hand washing. A company has developed a soap dispenser which is able to detect whether the professional has properly washed his hands. It gives either an all-clear signal or an alarm. One hospital in Florida has started using it and their infection rate has fallen to zero. (If anyone has a link to that story, please post it.)
Give the free market a chance to work and it solves problems that government has created.
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Banyon, do you have a source for that info you posted about MRSA?
Thanks,
Matt
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