Report from Respiratory Home Care

Ed from Respiratory came by for about an hour to check out Peggy's cuff issues. Here is what he said:

Peggy is at 15cc which he says is the absolute limit. He says that messing with the cuff/pillow more than once a day is a bad idea. He says that we need to montior the VTE, especially when Peggy is complaining of cuff problems or "gurgling". When she gurgles - look at the VTE on the vent. It is currently set at 650. It should not go 100 above or below 650. We checked the records and it seems like Peggy is pretty consistently at somewhere around 570. Also see if there is a correlation between her request for oxygen/SATs going down and the cuff complaints.

He told us that technically this is not a medically critical issue since her SATs are good and the vent readings are good. However, Peggy says that this issue is interfering with her sleep which is problem. And if she keeps having people manipulate the cuff, the problem will continue to worsen and potentially become a medically critical issue.

All of this stuff basically is due to the fact that Peggy has "tracheal malasia" which means that the tissue surrounding the trach balloon in her throat is stretched out causing air to leak around it. This is what happens to people who are on ventilators for long periods of time.

As Ed sees it, we have 3 options. The first is to move to a larger trach size. This is a bandaid fix for the problem, since eventually she will develop more tracheal malasia. Our second option is to switch to a different type of trach. There is one called the "Bivona" which has foam around it so it moves more with the patient. The third option is to switch to a longer trach tube so that the balloon inside is further down past the place where the tracheal malasia has developed.

I spoke with Cory today and shared all of this information with her. Her opinion is that the longer trach tube is the best option since she has heard that most adults find the Bivona uncomfortable. She will be calling Dr. Davis to discuss this along with Dr. Druger. From there, we will have to set up the procedure which would be done at Queen's.

FYI - Cory also told me that the Baza cream will be delivered today or tonight. She also told me that we're still waiting to hear about when we can get more Oxidose. In the meantime, Peggy should continue to take the Tylox.