Greetings, everyone.
Unfortunately, this is the kind of place where we find ourselves meeting, but I suppose that’s just how life goes.
Here is the situation: my father has been diagnosed with a "malignant supraglottic neoplasm." He was born in 1955. On October 18th of this year, he underwent surgery for epiglottis carcinoma. However, due to a host of complications—which I assume include Ca epiglottitis T2N1Mo, lateral neck metastasis, aspiration pneumonia, sepsis, MRSE bacteremia, wound infection, COPD, and partial respiratory insufficiency—he wasn't able to transition to home care until just last week, December 16th. Below is a transcript of his discharge summary: "On October 18, 2011, the patient underwent a supraglottic laryngectomy, left RND, right SND, and a tracheostomy under general anesthesia. Postoperatively, he was kept in the ICU and transferred to the ENT department after two days. Five days later, the patient experienced breathing difficulties; a chest X-ray revealed bilateral inhomogeneous infiltrative shadows in the middle and lower lung fields, necessitating a transfer back to the ICU, where he remained from October 21 to November 15, 2011. He was evaluated by an infectious disease specialist and received targeted antibiotic therapy and antifungal prophylaxis. Tests returned HBsAg negative and Anti-HCV negative. There was improvement with the administered therapy, and regular lab work and tracheostomy swabs were performed. Further treatment with radiotherapy is recommended, and medical records are being forwarded to the oncology and radiation clinic at Mayo Clinic. The patient is afebrile, feeling well, and is being discharged for home care."
His current medication regimen includes Diflucan 200mg tablets, Nexium, Atrovent inhalers, Teotard tablets, Praxiten tablets, and Accupro.
Our biggest struggle right now is that he is still relying entirely on a feeding tube. The hospital staff told us he needs to "learn" how to swallow again, but he simply cannot do it. No matter what. No matter how hard he tries, or how much we assist him and try to guide him, everything just comes right back up through the tracheostomy tube. Another major issue is the constant coughing up of secretions through the tube, which is incredibly irritating for him.
I am asking for your help. If it is at all possible, please share any advice you may have. How can he attempt to swallow? Does anyone here have experience with this? Is there a way to improve this process? Additionally, is this constant expulsion of secretions normal, and how long does it typically last? We’ve also noticed occasional blood in the secretions. Generally speaking, how can we support him through this?
I would truly appreciate any response or guidance you can offer. We feel like we’ve hit a brick wall, and we don't have access to any specialized professional help in our area.
I also want to wish you all a happy and blessed Christmas and a successful, healthy 2012.
Thank you once again!
Unfortunately, this is the kind of place where we find ourselves meeting, but I suppose that’s just how life goes.
Here is the situation: my father has been diagnosed with a "malignant supraglottic neoplasm." He was born in 1955. On October 18th of this year, he underwent surgery for epiglottis carcinoma. However, due to a host of complications—which I assume include Ca epiglottitis T2N1Mo, lateral neck metastasis, aspiration pneumonia, sepsis, MRSE bacteremia, wound infection, COPD, and partial respiratory insufficiency—he wasn't able to transition to home care until just last week, December 16th. Below is a transcript of his discharge summary: "On October 18, 2011, the patient underwent a supraglottic laryngectomy, left RND, right SND, and a tracheostomy under general anesthesia. Postoperatively, he was kept in the ICU and transferred to the ENT department after two days. Five days later, the patient experienced breathing difficulties; a chest X-ray revealed bilateral inhomogeneous infiltrative shadows in the middle and lower lung fields, necessitating a transfer back to the ICU, where he remained from October 21 to November 15, 2011. He was evaluated by an infectious disease specialist and received targeted antibiotic therapy and antifungal prophylaxis. Tests returned HBsAg negative and Anti-HCV negative. There was improvement with the administered therapy, and regular lab work and tracheostomy swabs were performed. Further treatment with radiotherapy is recommended, and medical records are being forwarded to the oncology and radiation clinic at Mayo Clinic. The patient is afebrile, feeling well, and is being discharged for home care."
His current medication regimen includes Diflucan 200mg tablets, Nexium, Atrovent inhalers, Teotard tablets, Praxiten tablets, and Accupro.
Our biggest struggle right now is that he is still relying entirely on a feeding tube. The hospital staff told us he needs to "learn" how to swallow again, but he simply cannot do it. No matter what. No matter how hard he tries, or how much we assist him and try to guide him, everything just comes right back up through the tracheostomy tube. Another major issue is the constant coughing up of secretions through the tube, which is incredibly irritating for him.
I am asking for your help. If it is at all possible, please share any advice you may have. How can he attempt to swallow? Does anyone here have experience with this? Is there a way to improve this process? Additionally, is this constant expulsion of secretions normal, and how long does it typically last? We’ve also noticed occasional blood in the secretions. Generally speaking, how can we support him through this?
I would truly appreciate any response or guidance you can offer. We feel like we’ve hit a brick wall, and we don't have access to any specialized professional help in our area.
I also want to wish you all a happy and blessed Christmas and a successful, healthy 2012.
Thank you once again!