Yes, it sounds like another atrocity is about to occur to your body but be assured – it isn’t! Your stoma, (hole, new nostril, breathing tube or whatever else you deem to name it) has simply started to close up-hence narrow/constrict. Now this can cause multiple problems and the owner is quite often unaware that actual breathing has become more intense/harder to do, and that is because our bodies are marvellous things as they adjust and accomodate all variations to what is considered the norm.
Think about it for a minute: when first undergoing the full laryngectomy the nose and mouth were shut off as means of breathing yet the body soon adjusted itself to the hole in your neck for its air supply. OK, it was a hell of a shock and it took a few days to adjust but you soon got there – and life carried on!
Sometimes we don’t notice that our breathing is becoming more laboured, or that the hole (stoma) is narrowing and sometimes our newly exposed airway starts to narrow as well. If you feel any anxiety about your breathing get yourself back to your consultant immediately-you cannot afford to mess about with such situations for fear of causing too much stress to the body.
So, to the ‘stomaplasty’ itself. It is a delicate, relatively simple but lengthy process whereby the stoma is reopened in several directions, skin/tissue removed and then the enlarged hole is gently stitched (here, there & everywhere) so that a much larger hole (stoma) is created. One of the major problems confronting your surgeon will be interior scarring and whatever damage has been caused by radiotherapy prior to your initial surgery. The biggest shock to the patient is the fact, that upon waking up from surgery, breathing is a damned sight easier than it was when you (the patient) went to sleep! In actual fact, it is a marvellous feeling (forget the little bit of soreness) just to lay there and take in deep breaths of air with ease.
OK, so it looks fairly gruesome but the benefits are manyfold!
You may be required to ‘wear’ a “lary-tube”, which is similar to a ‘trache-tubs’ but wider, far more pliable and easy to remove for cleaning etc. Because ‘stenosis‘ has occurred (narrowing of the airway), it is imperative that the airway is ‘stented’ (kept open) by another means until it has re-adjusted itself to remain adequately open by itself.
55mm Lary Tube (Stenting an airway)
Yes, I hear you, it is an awesome task the first couple of times you try and change the tube yourself but trust me, you will feel so much better once you have mastered this art! One problem you may have is ‘blowing the tube out’ for although it is held in place by a nice, soft velco adjustable strap around the neck, you would be surprised at just how much pressure your lungs still manage to summon when coughing profusely. This is why, after expert tuition, you are advised to master the art of changing cleaning & replacing your lary tube asap.
The other beauty of this ‘lary-tube’ is the fact that the exposed end has been made to accept stoma buttons-a must for reducing secretions. You may find that your secretions become much thicker (below) but by using a “Suction Machine” you can usually foretell when that appliance is needed.
Portable suction machine
One very important thing to remember however is that after all this treatment/change etc, you may well find that your secretions have suddenly become much thicker and actually defy the suction machines attempts to keep you clear. Do not panic-whip the lary-tube out, breathe deeply, ensure you are feeling tickety-boo again and simply rinse the lary-tube out under clean, running water and pop ‘him’ back in. Problem solved. It is always useful to carry a spare ‘lary bib’ around with you for emergencies as they can cover the exposed stoma quite adequately until such time as you can ‘repair yourself’.
The most important thing of all, although it is scary, is:
“DON’T PANIC CAPT MAINWARING!”