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Tracheostomy anyone?
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Tim M Offline

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Post: #1
Tracheostomy anyone?
Has anyone had a tracheostomy for Apnea? How difficult was the recovery and life afterward? How is you Apnea now?
10-05-2013 11:58 PM
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Peter_C Offline

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Post: #2
RE: Tracheostomy anyone?
TG - not yet. I miss Mr. Flappy though. It was described to me many years ago by my DR (as a possible what if). That's the surgery with the button on your throat/press to talk/etc?? Me and terminology is rather bad.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-06-2013 12:41 PM
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Tim M Offline

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Post: #3
RE: Tracheostomy anyone?
(10-06-2013 12:41 PM)Peter_C Wrote:  TG - not yet. I miss Mr. Flappy though. It was described to me many years ago by my DR (as a possible what if). That's the surgery with the button on your throat/press to talk/etc?? Me and terminology is rather bad.

I'm not sure about the button. It's been a while since I met with the doctor on this. He guaranteed that I would have no apnea after this surgery.
(This post was last modified: 10-06-2013 01:24 PM by Tim M.)
10-06-2013 01:22 PM
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me50 Offline

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Post: #4
RE: Tracheostomy anyone?
(10-05-2013 11:58 PM)Tim M Wrote:  Has anyone had a tracheostomy for Apnea? How difficult was the recovery and life afterward? How is you Apnea now?

I haven't and for me, I wouldn't even consider it unless it was to save my life. For apnea, I would not want a hole in my throat. I have a friend that her husband had a trach for several years after a heart attack. There is a lot of work to keep it clean so the patient doesn't get an infection. It requires cleaning twice per day. I can't swear to this but it seems that the relaxation of all that relaxes when those with apnea goes to sleep would still do that even with a trach. Let's see if Doc Wils sees this and can explain better.

I am basically expressing why I would not do this unless I had to in order to continue to live.

Hopefully, someone else can give you a more detailed answer.
10-06-2013 01:42 PM
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Peter_C Offline

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Post: #5
RE: Tracheostomy anyone?
Well, my discussion was like 7-8yrs ago - I was concerned with 'what-ifs', as in what if the throat surgery I did have didn't help, what if my pressure needs continued to rise, etc..

My weekly AHIs average 10-15 per night, and it's called good. AIs are down to 1-3 a night. My long-term sleep apnea has caused heart issues (now much better) but only after both nose and throat surgery - so I was concerned if it wasn't enough? So my Doc proceeded to (scare) tell me about a complete guarantee surgery that bypasses then entire mouth/nose breathing issues, where my CPAP/BI-PAP would connect low down on my neck, basically a hole with a skin flap that I could manually close when I wanted to talk. Sounded (back then) like a lot of work (cleanliness, gross, etc) - but as a very effective way to deal with life-threatening sleep apnea.

I would imagine that fast-forward to today, the surgery is more refined, and the care of the area much easier/better, and also the equipment much better than back then. Are you thinking of having it done? What kind of numbers do you have currently?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
10-06-2013 01:44 PM
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Tim M Offline

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Post: #6
RE: Tracheostomy anyone?
My AHI was 6.6 on my last study but I am symptomatic. I am thinking of having either MMA or tracheostomy. I'd hate to go through MMA and not have it work, it's so invasive. Trach on the other hand is no picnic either and then there is having a hole in my throat but the payoff is supposed to be that 100%, it will cure apnea. At least that's what the surgeon says and he really is an apena expert.
10-06-2013 03:30 PM
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me50 Offline

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Post: #7
RE: Tracheostomy anyone?
(10-06-2013 03:30 PM)Tim M Wrote:  My AHI was 6.6 on my last study but I am symptomatic. I am thinking of having either MMA or tracheostomy. I'd hate to go through MMA and not have it work, it's so invasive. Trach on the other hand is no picnic either and then there is having a hole in my throat but the payoff is supposed to be that 100%, it will cure apnea. At least that's what the surgeon says and he really is an apena expert.

I would be so surprised if any surgeon can guarantee that a tracheotomy or any other surgery would sure anything especially Apnes 100 percent. as I said I am no doctor or nurse or medical personnel but you would still have the same issues that happen that causes cessation of breathing I would certainly be skeptical of any medical personnel that guarantees any surgery would cure apnea 100 percent there are Many on this forum that have had surgery of some sort and said that that's still have to use their machine
10-06-2013 03:53 PM
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Don in Austin Offline

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Post: #8
RE: Tracheostomy anyone?
(10-06-2013 01:44 PM)Peter_C Wrote:  Well, my discussion was like 7-8yrs ago - I was concerned with 'what-ifs', as in what if the throat surgery I did have didn't help, what if my pressure needs continued to rise, etc..

My weekly AHIs average 10-15 per night, and it's called good. AIs are down to 1-3 a night. My long-term sleep apnea has caused heart issues (now much better) but only after both nose and throat surgery - so I was concerned if it wasn't enough? So my Doc proceeded to (scare) tell me about a complete guarantee surgery that bypasses then entire mouth/nose breathing issues, where my CPAP/BI-PAP would connect low down on my neck, basically a hole with a skin flap that I could manually close when I wanted to talk. Sounded (back then) like a lot of work (cleanliness, gross, etc) - but as a very effective way to deal with life-threatening sleep apnea.

I would imagine that fast-forward to today, the surgery is more refined, and the care of the area much easier/better, and also the equipment much better than back then. Are you thinking of having it done? What kind of numbers do you have currently?

Not sure if there have been many advances as this operation is rarely done these days to my understanding.


(10-06-2013 03:53 PM)me50 Wrote:  
(10-06-2013 03:30 PM)Tim M Wrote:  My AHI was 6.6 on my last study but I am symptomatic. I am thinking of having either MMA or tracheostomy. I'd hate to go through MMA and not have it work, it's so invasive. Trach on the other hand is no picnic either and then there is having a hole in my throat but the payoff is supposed to be that 100%, it will cure apnea. At least that's what the surgeon says and he really is an apena expert.

I would be so surprised if any surgeon can guarantee that a tracheotomy or any other surgery would sure anything especially Apnes 100 percent. as I said I am no doctor or nurse or medical personnel but you would still have the same issues that happen that causes cessation of breathing I would certainly be skeptical of any medical personnel that guarantees any surgery would cure apnea 100 percent there are Many on this forum that have had surgery of some sort and said that that's still have to use their machine
The trach operation completely bypasses the area where obstruction occurs. Central apeas would still be possible.

Don in Austin
(This post was last modified: 10-06-2013 04:59 PM by Don in Austin.)
10-06-2013 04:58 PM
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me50 Offline

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Post: #9
RE: Tracheostomy anyone?
(10-06-2013 04:58 PM)Don in Austin Wrote:  
(10-06-2013 01:44 PM)Peter_C Wrote:  Well, my discussion was like 7-8yrs ago - I was concerned with 'what-ifs', as in what if the throat surgery I did have didn't help, what if my pressure needs continued to rise, etc..

My weekly AHIs average 10-15 per night, and it's called good. AIs are down to 1-3 a night. My long-term sleep apnea has caused heart issues (now much better) but only after both nose and throat surgery - so I was concerned if it wasn't enough? So my Doc proceeded to (scare) tell me about a complete guarantee surgery that bypasses then entire mouth/nose breathing issues, where my CPAP/BI-PAP would connect low down on my neck, basically a hole with a skin flap that I could manually close when I wanted to talk. Sounded (back then) like a lot of work (cleanliness, gross, etc) - but as a very effective way to deal with life-threatening sleep apnea.

I would imagine that fast-forward to today, the surgery is more refined, and the care of the area much easier/better, and also the equipment much better than back then. Are you thinking of having it done? What kind of numbers do you have currently?

Not sure if there have been many advances as this operation is rarely done these days to my understanding.


(10-06-2013 03:53 PM)me50 Wrote:  
(10-06-2013 03:30 PM)Tim M Wrote:  My AHI was 6.6 on my last study but I am symptomatic. I am thinking of having either MMA or tracheostomy. I'd hate to go through MMA and not have it work, it's so invasive. Trach on the other hand is no picnic either and then there is having a hole in my throat but the payoff is supposed to be that 100%, it will cure apnea. At least that's what the surgeon says and he really is an apena expert.

I would be so surprised if any surgeon can guarantee that a tracheotomy or any other surgery would sure anything especially Apnes 100 percent. as I said I am no doctor or nurse or medical personnel but you would still have the same issues that happen that causes cessation of breathing I would certainly be skeptical of any medical personnel that guarantees any surgery would cure apnea 100 percent there are Many on this forum that have had surgery of some sort and said that that's still have to use their machine
The trach operation completely bypasses the area where obstruction occurs. Central apeas would still be possible.

Don in Austin

Here is my concern about using a trach as not using a machine for apnea. If your muscles in your throat and tongue relax more than normal, will a trach stop that? I just don't know but I personally wouldn't want a trach as a permanent solution to apnea if a machine will control the apneas. To me, surgery of any kind would be a last resort. However, it is up to the individual to decide how drastic they want to go to control apnea. So many have said the surgery they had did not cure apnea so if the goal is to cure it, I am not sure surgery is the way to go unless it is a last resort. For me, I decided to tough it out and just deal with using a machine for the rest of my life as it beats the alternatives. As I said, this is what is right for me.

http://www.apneaboard.com/forums/Thread-...+for+apnea

I wish you the best in whatever you decide.
What Causes Sleep Apnea?

When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles relax, which narrows your throat.

Normally, this narrowing doesn’t prevent air from flowing into and out of your lungs. But if you have sleep apnea, your airway can become partially or fully blocked because:
•Your throat muscles and tongue relax more than normal.
•Your tongue and tonsils (tissue masses in the back of your mouth) are large compared with the opening into your windpipe.
•You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This narrows the inside of the windpipe, which makes it harder to keep open.
•The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
•The aging process limits your brain signals' ability to keep your throat muscles stiff during sleep. Thus, your airway is more likely to narrow or collapse.
(This post was last modified: 10-06-2013 05:54 PM by me50.)
10-06-2013 05:52 PM
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DocWils Offline

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Post: #10
RE: Tracheostomy anyone?
I cannot stress enough that having a tracheotomy is no trivial matter and should only be entered into after a long and concentrated effort for CPAP compliance has failed and no other non surgical techniques have proven successful.

When done correctly, a tracheotomy will bypass the area of collapse, if that is indeed the problem, but it opens itself up to any manner of other problems down the road and is open to infections and a variety of other problems. And, should the reason for your Apnoea not be based in the upper throat, as in CSA, it will have no effect at all.

This isn't a quick fix, and if the only reason for it is because you find the CPAP onerous, let me assure you that maintaining the opening after a tracheotomy will be far more onerous, and can be medically dangerous if you slack on the maintenance of it, unlike slacking on cleaning your CPAP.

Before you consider this, read up on all the side effects and the care and maintenance post-op, something you will have to do every day for the rest of your life. Twice daily, actually. I really would think long and hard about any form of surgical treatment for Apnoea, and even then only after it has proven impossible for you to get benefit from conservative therapies, like CPAP, either due to physical problems or to non compliance issues. And once you are old, it will lead to far more problems and infections than if you stuck with a PAP device.

But if it is simply because you hate the mask, trust me you will hate this even more. As for advancements in T-section techniques and post operative care, no, there is little advance to in now from my days in med school back when dinosaurs ruled the earth. We have better knives and some neat emergency T-section devices, but that is the extent of if. The basic technique is the same as 100 years ago.

About the "button" - that is probably a voder you are referring to, which is used when the vocal chords are damaged - to speak after a T-section, you have to close the hole, either by slipping a flap of skin over it by hand, or having a plug in the hole during the day. Some people can speak without need of closing the hole, depending on where the hole is made and other factors. The hole is prone to infection, and must be kept rigorously clean. Because the air intake bypasses much of the nose and throat, the air taken in is less humid and this can cause throat problems and lung infections, which can be even worse due to the fact that you are bypassing the body's first line of cleansing the air taken in, the mucous and hairs in the nose.

The operation itself isn't complicated, but easy enough to screw up in the wrong hands, and we have an emergency "punch" kit when doing it in the field, but that is a quick and dirty method for a temporary solution. The type of method used for longer term solutions, like you are looking at, requires considerably greater surgery, and sometimes painful post operative recovery, if the surgeon elects to create a skin flap to close the hole when speaking is needed.

Risks include the development of an oesophageal fistula, where a hole opens between your breathing tube and your eating tube, allowing fluids and foods to enter into your trachea and lungs, tracheoinnominate fistula, the generation of a a passage between the trachea and the innominate artery which can create life threatening bleeding, bacterial colonisation of the wound and tube insert, which can lead to pneumonia and other lung infections, some of them fatal, and a myriad of other types of infections, not to mention blockage of the tube itself due to excess mucous coughed up from the lungs because of the drier air you will be breathing.

Do this only if there is no other choice. If you can tolerate a PAP device and it works to alleviate your symptoms, then it is a far better, safer and more comfortable solution than ANY surgical solution. Period.

The only upside is that a tracheostomy can be closed up and healed, unlike a messed up MMA, so if you don't like it, or it threatens your life, you have an out, but you will have spent a great deal of money and have assaulted your body in a very non trivial way, and that will not give you good odds at prolonging your life.
10-06-2013 06:21 PM
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