"please keep me updated about oximeters "
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BARRETT CRAIG
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- Arlington, VA
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Comment Wall (6 comments)
- At 11:36am on October 20, 2009,
Mack D Jones, MD, SAAN said…
- You may have to use a slightly longer trach tube until you heal. It's a small price to pay to get to the Montgomery.
- At 11:14pm on October 12, 2009,
- I was in the hospital for 3 days, went home and returned in 6 weeks for followup.
It takes 6 weeks to heal. So you shouldn't try to go back to work while the surgical site is in the process of healing. I don't understand why you cannot have your job back after your surgery. If your problem is resolved, then you should be good to go. This should hold true even if you were a truck driver or an airline pilot.
There is no guarantee that your will immediately get your faculties back following the procedure, but it is a good bet that you will, if not right away, then eventually.
- At 10:50pm on October 12, 2009,
- Barrett,
Check out http://www.bosmed.com/airway-management/montgomeryr-cannula-system.html
It is the Montgomery tracheal cannula that I use. There is a flange on the inside that helps keep it from popping out. It sits at a 27degree angle so that the it slants downward from the outer surface to the inner flange. It doesn't protrude down inside the trachea, it goes no further than the inner wall. You can customize it on the outside by cutting it to whatever length you wish. It depends on how thick you neck is as to how long the stent needs to be. Mine is 1.25 inches long from the longest part of the slanted flange and 0.75 inches long from the shortest part. It is actually about 0.25 inches longer overall than it needs to be, but I haven't bothered with it because I decided to wait for the next replacement and make the change then. When I have that 0.25 inches cut off, the stent will protrude about 0.25 inches, which is almost flush with the surface. There has to be a little play or extra length to have some freedom of movement.
If you have a very thick neck it could possibly change the entire picture in your case. I would have my ENT consult with Dr Mickelson in Atlanta for his input. He has been using the Montgomery stent for sometime and should be able to give some invaluable advice.
By the way, I'm in Pensacola from time to time. If you would like we could meet for a cup of coffee and talk about it. I'm ok for most any day of the week except Thurs. and Fri. when I go to school. Even better might be my going with you to visit your ENT. I can show him my stent and how successful it has worked for me.
- At 1:10pm on October 4, 2009,
- Barrett, feel free to give me a call if you have any questions about the trach. I am not an expert on the subject, but I can give you my own thoughts from personal experience. I recommend Dr. Sam Mickelson because he had done an average of two or more tracheostomies/month over the previous 16 years when I had mine in 2005. His ENT specialty is limited to sleep disorders surgery. You will have a hard time finding a better man for the procedure. jonesmd3@gmail.com
- At 10:28am on October 4, 2009,
sleepycarol said…
- Welcome to the forum.
Here you will find caring patients and professionals that care about your health. Sleep apnea can be deadly and with the help and support of this group, I have been able to be 100% compliant and improve my health.
Please feel free to join in the discussions, add a discussion, or just lurk. We are glad you are here
- At 12:22pm on October 3, 2009,
- At 9:18am on October 3, 2009, Mack D Jones, MD, SAAN said…
Barrett, Sounds like you and I have a lot in common. I can't help but wonder if you might have a few of those "axonal lesions" (see example on the front of my book) as a cause of continued symptoms, as I suspect I have. Of course, regardless of whether you have them or not, the treatment is the same, i.e., either PAP or trach. Here's the way I look at it. You have to find out if your machine is or is not keeping your airway open. You cannot go by your symptoms because the presumed "lesions" are responsible for symptoms which are expected to be very slow (or not at all) to respond to treatment. If the machine is keeping your airway open, then you don't need a trach. If it is not maintaining an open airway, then a trach is the way to go. It is better to find that out now rather than going ahead with the trach and then start wondering if your machine was actually working before and you didn't actually need the trach in the first place. The trach is reversible, of course, but why go through all that when it wasn't necessary. If you already know the machine is simply not maintaining an open airway, then the trach is the way to go.
You probably know my opinion regarding the other surgical procedures that are available to open the airway, but they should be considered after the trach, not before. My ENT surgeon is Dr Sam Mickelson in Atlanta. He has his own special technique for the so called "permanent skin-lined" tracheostomy. It is constructed with a 27 degree downward slant from outside to inside and the floor or bottom is fashioned from the inner lining of the the trach. There are some advantages to his technique, including ease of maintenance and reduced risk of infection. You can have your stents customized to your preference.
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