tracheotomy, tracheostomy benefits?

[ill13632]

I got a tracheotomy for severe sleep apnea but I don't feel much better and after the operation I was even more exhausted and light-headed and don't sleep well.
I have moderate asthma FEV1 70 and desat to 70% during sleep.  hopefully it should help my asthma and sleep apnea but I have a shiley 6 which makes it difficult to breathe



This discussion is related to tracheotomy.

[ill13632]

I think prednisone seems to help a lot with my asthma too but there are side effects.
I also take singulair and combivent on the nebulizer

[ill13632]

he said it was medically inappropriate for a larger size than 8 since there are complications

you could try symbicort which is one of the latest combo inhalers, prednisone does have a lot of side effects....so you have sleep apnea too? the trach hasn't cured it but one doctor told me that it takes 8 months and you have central apneas in the beginning while your brain adjusts to your new breathing

[jjswartz_1]

I am completely empathetic about your situation.  I mean I am a respiratory therapist and I developed asthma.  However I never sounded wheezy on auscultation.  So when I tried getting ventolin and a corticosteroid my doctor didn't believe I had asthma.  He keeped saying I had anxiety.  Of course I looked anxious.....I had trouble BREATHING!!!!.
I ended up stealing the vetoiln from the depatment.  The ventolin helped but I really need a corticosteroid for the inflammation.  It was so chronic and I could not even sleep on my back.  Then I finally got a prescriptiion for the ventolin and Flovent.  I had worsening asthma will the Flovent which can happen with any med, so I went back but the doctor did not believe me again.  It was so bad that I went to the emergency doc where i worked and begged him for 10 day course of prednisone.  I felt the difference with the first pill.  However after the prednisone was done my inflammation came back.  I went into a burn -out after 2 months of this.  Finally I got pulmicort which worked after a few weeks of regular use.

So yes I know that doctors can be idiots....they are human.  I work as an Anesthesia Assistant so I would with different Anesthesiologist everyday.  Some are amazing and others are well.....lets just say I would not let them touch me.

Its been only 3 weeks...give yourself some time to heal.  Don't get depressed like I did.  I can imagine how frustrated you are.  You can always get a second opinion later on down the road.

So what exactly DID the doc say when you said you feel like it is to small?

[ill13632]

you see I'm convinced that empirically even doctors don't always make the right decisions because of their theoretical distance

[ill13632]

it's not dangerous you just take the whole outer cannula out.  I payed this surgeon all of this money he should have at least followed my wishes

[ill13632]

I think the sizing is all wrong, I'm a large male and shouldn't be on a shiley 6, I know women who are on 10s.  and I have lower airway resistance and can't exhale because of asthma after I took azithromycin for 6 weeks

[ill13632]

thanks very much!!!!!!  I am still exhausted and lightheaded post op 3 weeks.  I have an uncuffed trach and it's fenestrated with holes so I think I can get air passing through my mouth.  you know nothing else worked for me even the asv so I had to have this surgery.  I just hope I wasn't brain damaged by the Percocet they gave me because sleep apnea does cause brain damage on DTI MRI's

I've heard people do recover their cognitive function on trach after some months.  this awful surgeon wouldn't cut the stoma to a 10 and switched me down to a 6 from an 8.
  I take the whole outer cannula out at least once a day and scrub the mucus thoroughly with a brush, soak it in H202 and rinse it with tap water  

[jjswartz_1]

Be careful leaving the inner cannula out.  If you plug up with an inner cannula then you can relieve the obstuction by taking the inner cannula out.  however if you take the cannula out and plug up severly then it can be very serious.  Especially if you are alone at the time.

I understand that taking the inner cannula out creates a larger diameter and less resistance but leaving it out can be dangerous.

We breath 21 % oxygen in our air.  The rest is nitrogen and some trace gases.   The 21% oxygen usually produces about 100 mmHg (PaO2) in our arterial circulation that feeds our body.  At 100mmHg our Oxygen saturation will be 100%.  If our  PaO2 drops to 60mmHg we will still have an oxygen saturation of about 90% which is enough to feed your whole body.  So you see we do have a reserve of oxygen, so NO I do not think that the size 6 Shiley will lower your O2.

However your dyspnea/Shortness of Breath will be increased which effects greatly your quality of life.

By the way is your trach cuffed or uncuffed?  Meaning is air passing only through your trach or does the air also pass through your nose and mouth?

I AM A REGISTERED RESPIRATORY THERAPIST

I worked the last 8 years in Anesthesia but I did work before in Respiratory Therapy.

[ill13632]

I'm never going to have a normal life because my body has been ruined by these diseases

[ill13632]

thanks very much for your help!!! my life was ruined by sleep apnea, I couldn't learn new sentences or read or do math.  I didn't get immediate relief from trach for my sleep apnea, but I'm starting to sleep more after trach 21 days ago.  I was exhausted after the operation even more than w/o trach.  The shiley 6 is too small and gets clogged with blood and mucus and I don't use the inner cannula so I can get more air.  I'm a large person and already can't exhale well because of asthma.  is a size 6 going to lower my O2??
trach does reduce breathing effort and improve blood gas exchange?  but I was still light-headed and tired for weeks.  
I spoke to my doctor but he isn't that helpful, I'm getting a custom trach ordered in size 8.  I also have a hernia

[jjswartz_1]

Obstructive Sleep Apnea is when the tongue and soft tissue relax and cause an upper airway obstruction.  The tracheostomy should help with the OSA but the asthma will not improve. The mouth and nose adds humidity to the inhaled air which is bypassed by the tracheostomy.  Also dust particles and allergens get trapped by your nose preventing entry into your lungs.  Therefore a tracheostomy might not make the asthma worse but it is not gonna make it better.

Asthma is a disease that cause inflammation to the walls of your lungs.  It also causes small muscles around the airways to tighten that further decreases the size of airways and creates increased resistance to air flow.

Therefore the tracheostomy should have no effect on your asthma.  It shouldn't have any impact on the asthma part.

A shily 6 is a small diameter trach.  The smaller the size the greater the resistance will be.  Are you a small person?  

How long ago didi you have your surgery?
Have you spoken to your doctor about your concerns?
What specialist follows you?