Kung Hee Fat Choy!

Happy Chinese New Year everyone! Here's some notes from the past few days:

Cory came by Friday to look at Peggy's trach. Someone had taken the blue cap off the end of the balloon and replaced it with tape. She has put a new one on. PLEASE DO NOT take the blue cap off the end. You do not need to take it off to put air in and out of the trach - BUT NO ONE EXCEPT THOSE WHO ARE TRAINED TO should be taking air in or out and manipulating the cuff. If Peggy feels like the trach is leaking - you can check to see if the blue cap is screwed on tight enough, but don't take it off.

The gurgling at Peggy's neck does not necessarily mean that her trach is leaking. Peggy has "tracheal malasia" which means that there is a loss of integrity of the muscle surrounding the trach (inside her throat as well as around the trach site) - this will mean that no matter what it will always be somewhat positional to avoid that gurgling noise. If Peggy is gurgling but the balloon is taut and firm then it is most likely positional. Now, that being said, if she is gurgling and the balloon is soft and pillowy then this could indeed indicate a leak.

It is important to note that manipulating the cuff repeatedly and/or putting too much air in the cuff could cause problems down the line. Adding more air is not a quick fix solution to the problem of gurgling. Unfortunately, tracheal malasia is just part of the problem for long term trach patients. This is not to say that we should disregard Peggy's concerns about the gurgling or leaking - we need to address these issues with sensitivity and understanding so that we can help Peggy to be comfortable and have peace of mind.

Peggy wanted to me to add a couple reminders to the blog. First she says, "Please don't cover my right ear because I'm totally deaf in my left". This is, as we mentioned before, because her eustation tube has closed on that side due to lack of use of her jaw. She'll be going to the ear doc soon to have a stint put in to open it back up.

She also says, "During the day, put only a small drop of the Refresh Liguigel at a time. Follow it up with an 'up-blink'." If you don't know what an "up-blink" is, have someone show you this blink technique where you blink her by pushing from under her eyes.

Peggy would also like to request that her arms and legs be moved more often. We know its hard to get everything done in a shift and remember everything, so Peg agreed that she will try to remind us when she needs movement.