Tracheal Resection Scar Healing Process — Time Lapse Photo

I made a “time lapse” photo of my tracheal resection scar to show how it has healed  The image on the left is from May 26th, three weeks after my resection. The images on the right are from Sept 25th.  Originally I wasn’t going to get the resection because I didn’t want huge scar on my neck.  (Guys can’t wear scarves to hide it like most ladies can!) I finally had to get the resection in May becau…se after three dilations in six months I kept re-stenosing and a resection was the only option.  I am so glad I did it and turns out the scarring was very minimal.  My doctors (Dr Melissa Statham & Dr Adam Klein at Emory University Hospital) did a great job with not only the resection but the wound care after the procedure.

"time lapse" photo of my tracheal resection scar to show how it has healed

Here are the products I used for those of you worried about scarring from a resection:

  1. Do not expose the site to sunlight for at least six months. Use sunscreen on it. I use SPF 14.
  2. Palmer’s Advanced Scar Serum with cocoa butter. http://www.palmers.com/product/detail.php?ID=1995
  3. Mederma Advanced Scar Gel http://mederma.com/products/gel

Breathing treatments, inhalers, nebulizers, humidifiers ?

During the past 6 months dealing with tracheal stenosis, I have done many types of breathing treatments.   I’m going to list out the ones I’ve tried and the results I got.   I’d love to hear from others about what they find works best and what doesn’t.

Nebulizer Treatments with Sodium Bicarbonate 3x day ..works pretty good at night before bed to help cough up mucous…especially in the days after my trachea resection surgery.

Inhalers: Flovent, Combivent, Advair, Albuterol, Primatime Mist….all of these serve to open up my airways when I am under respitory distress. Side effect is they make you gittery, pulse races, cardiac effects. I only use these in emergencies. Noteworthy: Primatime Mist is no longer available as a HFA inhaler, but you can get a mini-nebulizer (battery powered) kit at CVS or local drug store for about $40.  The epinephrine treatment packets come in a box of 50 for about $25. They now call it ASTHMANEFRIN.  This stuff really works quick and will help you breathe if your having immediate issues, but it is like crack cocaine and makes my pulse race and heart beat fast, so only use it when you need to.  Final note on inhalers,  I noticed the prescription Flovent can cause a bothersome oral infection called thrush…so avoid it.

Humidifiers:
I generally sleep better..but not sure if they actually help healing process after having tracheal resection surgery or a baloon dilation.

Whitney Bryan’s Story – An Emory University Voice Center Success Story

Ms. Bryan shared her story with me and it gave me such hope and inspiration, I feel compelled to share with my readers. Especially those who live in the Southeast and Atlanta area.

My name is Whitney Bryan. I’m 29 years old and am now a Registered Respiratory Therapist, this is my story. On January 6 of 2007, I was in a very bad car accident involving myself getting hit by 2 cars, t-boned by the first who ran a red-light and hit again by the second. Both of these were trucks and I was in my brand new Mazda 6. A pregnant woman who was training to be a CNA at the time (who I have become friends with and is now a RN) witnessed the first strike of the t-bone and stopped to try to help until emergency responders arrived. That’s when the second truck hit me and pushed my car over the woman and catching her hair in the tires and dragging her several feet, her and the baby both survived God bless them.

Once the responders arrived, I was cut from the car using the “jaws of life” and life flighted to the nearest trauma center in Gainsville, Florida Shands at the University of Florida about 50 miles away. On top of several internal injuries of a lacerated liver, kidney, bladder, and spleen, shattered pelvis and 3 broken ribs, I also had a collapsed lung so was intubated and put on a ventilator. After about a week or week and a half they gave several unsuccessful attempts at weaning me off the ventilator, they decided to give me a tracheostomy to continue ventilation. I came off the ventilator within the next week. After some more therapy and follow-ups on that and my other injuries, the trach was removed and allowed to heal and close on it’s own. After 5 weeks in the hospital and 2 weeks in rehab, I finally returned home mid February in a wheelchair which I was out of after about 3 months of physical therapy and healing.

Through this whole process all of my Dr.s kept saying how they couldn’t believe how quickly and well I was recovering. By April or May ’07 I would say, I started having trouble with my breathing so I scheduled a visit with my pulmonologist from my accident. He set up a bronchoscopy and when he did it he found excessive granulation(scar) tissue where my trach healed up causing tracheal stenosis(narrowing of the airway). He told me I had what was called hypertrophic scarring, which means my body produces lots of excess scar tissue. He said he performed a dilatation(dilation) where they stretch your throat open with a balloon making your airway larger and applied and antibiotic which should help suppress the growth. Well that didn’t hold very long and after a few more of those procedures he scheduled a tissue removal that would be performed by himself and ENT colleagues. That was towards the end of ’07 and I believe I had 1 more dilatation in the beginning of ’08, but it held well after that.

I had minimal difficulty with my breathing unless strenuous exertion but my breathing was more audible than others even at rest though I didn’t have difficulty with it, until the beginning of 2012. Building up to that point, I had started going to school in Fall 2008. I started with the basic prereqs knowing I wanted to do something in the medical field after having had received so much help myself from my accident, but not sure of what so started researching programs at my school. That’s when I came across the perfect choice for me given all my previous issues, Respiratory Therapy. The catalog said it was offered at a nearby school and that they were in partnership with it. I knew right then that was the one for me. I finished my prereqs and transferred to my new school for my program in Fall 2009, and graduated in May of 2011. I passed my national boards shortly after that and am now a Registered Respiratory Therapist just approaching completion of my first 2 years of employment in October.

Back to 2012, after starting work in October 2011, by the beginning of ’12 I began noticing having difficulty breathing again so I contacted my Pulmonologist who set up another scope and confirmed the tissue was back. After him telling me the hospital’s CO2 laser was currently down, and 3 dilatations between February and September, in October I could tell there was something very wrong. I contacted him and after yet another scope, he proceeded to tell me the many dilatations have now lead to malacia (floppiness) of 2-3 tracheal cartilage rings; meaning that when I inhale, that negative pressure sucks my throat shut, and that I would need a tracheal resection surgery to remove the damaged part of my throat and he would be consulting with colleagues to find someone with expertise because that type of surgery is not common. In the mean time, I found a group for people with tracheal stenosis on Facebook. I met several people on there and we traded stories, and after sharing with one lady in particular, Mrs. Jean Martin Bowles, and telling her my Dr was researching she gave me the name of her Dr. She told me he was the best in the Southeast, which I later found out was true, Dr. William Grist at Emory Hospital in Atlanta, Ga.

She gave me the info and I forwarded it to my Pulmonologist and the rest was history. He said he would be happy to send me there and he thought that Atlanta would have been the closest place that would have any expertise anyway because he was finding nothing here in Florida. I was scheduled a consultation with Dr. Grist on November 5, 2012. After seeing me, he said with my case being so severe and me driving 5 hours just to get there, he would admit me and perform the surgery the next day. He performed the surgery on the 6th, removing 3cm of my trachea, and kept me for follow-up/observation. On Thursday the 29th it was so bad I couldn’t sleep, I finally sent him an email at 4am Friday morning letting him know my problems and concerns. At 7am he emailed me back asking if I could I make it there today and how soon, I said yes and was there by 3:30ish. He performed an emergency scope and surgery where he performed tissue removal along with dilatation and antibiotic and steroid injection. He said my body had rejected the sutures where sewn shut and my trachea split, not enough for and air leak, but enough for that granulation tissue to grow. That was on Friday November 30, he kept me for the weekend so he could rescope and follow-up the following Tuesday and I wouldn’t have to make the drive again. I stayed the weekend and come Monday, 2 of my Dr.’s residents along with another Dr. entered my room and proceeded to tell me my Dr. had been in an accident and this Dr would be doing my follow-up scope this coming Wednesday instead of Tuesday. He performed the scope and said everything looked good and discharged me.

After about a week I started having difficulty breathing again and contacted one of the residents by email, she responded and told me my Dr was still out and gave me the info for the Dr who would be taking over my case, Dr. Johns, a colleague of Dr. Grist. I contacted him n he made me an office visit where he just used the laryngoscope there in his office to see if there was tissue which indeed there was. He set up an out patient surgery for December 18 where he scoped me and performed tissue removal, steroid and antibiotic injection to help suppress the growth of the tissue. He told me the body’s full healing process usually takes from 6-8 months on average so it’s possible the tissue will continue to grow back until fully healed and scheduled another out patient scope in the OR in 4 weeks and he also started me one prednisone(steroids), antibiotics, and antacids. 4 weeks was just enough for the first time because I’m not sure if I would have made it much longer. I could tell the tissue was back though not quite as bad as the first time. So in January he did the same procedures and continued scheduling me every 4 weeks though February and March. Meanwhile between visits I would monitor myself with my peak flow meter which measures how much air you can blow out in on big breath to help me keep tabs on when the tissue was starting to grow back. Each time I went he showed me the pictures he’d taken while in my throat so I could see the progression and said it was getting better and better each time. In March he said it looked much better so let’s do one last time of 8 weeks this time and if everything looked good maybe that would be it. I was so happy to hear that after struggling with these types of problems for 6 years! So my last visit on May 7 of this year, I went to see him for hopefully would be one last time. I felt like this was it, I hadn’t had any problems and my peak flows were just as good as they were right after surgeries, I had even started working out at the gym, but I was still very nervous and anxious. They took me back and put me out, when I came to they told me I had only been back in the OR for a total of 8 minutes or so and he was only in my throat for about 3. They said he put the scope in, said everything looked great and he wasn’t going to touch it, and pulled it back out and sent me to recovery. After waking from a nap in recovery, the Dr came and told me that everything looked great, no tissue at all. He said everything had calcified and though that does make my airway about 50% of what it should be, since I told him

I have been going to the gym and such that he knows it will not be debilitating or affect my quality of life and to contact him if I ever have any more problems, but he hopes not to see me again and well wishes. Truly one of the happiest days of my life!!! My struggle after 6 years is finally over! I know there are always possibilities in any circumstance, and if I come to that path I will cross it because I am a strong woman and have already overcome so much, but I hope that day never comes. Now I love my new career as a RRT working in the hospital taking care of patients and have so much compassion for them since I have been through so much myself! I hope this story has helped and touched many of you and I hope to continue to do so. I think there should be more awareness made of TS because it is becoming more and more common these days and there is not much expertise. I will continue to share and do anything I can to assist in this, and hope the public becomes more aware of this condition and people struggling with it.

Post resection complications

post-op complications after tracheal resectionI am back in the hospital only three weeks after my trachea resection.  Things were going fine until two days ago when I noticed stridor sounds and increased coughing.  Uh oh…was my first thought.  This thing is re-stenosing and I was going to have to get another dilation or worse yet, a re-resection.
image

So here I am in the ICU at Emory University Hospital Midtown and am being administered strong IV steroids and breathing treatments.  They say I may have a shot of getting discharged tomorrow depending on how it looks when they scope me in the morning. 

UPDATE *** I have a 50% narrowing of my trachea already…the resection failed. I am being admitted to the ICU and they’ve scheduled a dialiton for the morning.

I am actually more scared now than I was before I had the big tracheal resection surgery three weeks ago.  Those doctors at Emory University Otolaryngology assured me a 98% success rate and said patients rarely exhibit re-stenosis.

I followed all my aftercare instructions so I don’t know why this is happening to me. If anyone has any experience like this, please comment. Thanks.

Tracheal Stenosis – What is it?

Laryngotracheal stenosis (Laryngo-: Glottic Stenosis; Subglottic Stenosis; Tracheal: narrowings at different levels of the windpipe) is a more accurate description for this condition when compared, for example to subglottic stenosis which technically only refers to narrowing just below vocal folds or tracheal stenosis. In babies and young children however, the subglottis is the narrowest part of the airway and most stenoses do in fact occur at this level. Subglottic stenosis is often therefore used to describe central airway narrowing in children, and laryngotracheal stenosis is more often used in adults.

Surgical Treatment of Laryngeal and Tracheal Stenosis

The Laryngologists of the Emory Voice Center perform cutting edge procedures to restore breathing in patients with laryngeal and tracheal stenosis.  This includes the full range of interventions from minimally invasive procedures such as endoscopic balloon tracheoplasty to major open airway surgeries such as tracheal and cricotracheal resections.

The Emory Voice Center also offers comprehensive evaluation, preventive care, and intervention for vocal professionals.

The management of restenosis following segmental resection for postintubation tracheal injury

Why I chose Emory Voice Center for treatment of tracheal stenosis

The Emory Voice Center is dedicated to the diagnosis and treatment of voice disorders and voice problems, offering the latest innovations in voice therapies and effective management options for all conditions that affect the voice.

We serve laryngeal conditions of all types, including problems that affect the voice, swallowing, and airway.The Emory Voice Center's multidisciplinary staff

The Emory Voice Center was founded in 2003 with just two clinicians and has since expanded to include three fellowship trained laryngologists, six specialized speech-language pathologists, and one registered nurse. In 2009, Dr. Michael Johns and Dr. Adam M. Klein saw more than 3,200 patients and performed approximately 5000 surgeries. At The Emory Voice Center, we use a multidisciplinary approach to treating voice disorders. This means a variety of practitioners are all available under one roof, so our patients can get comprehensive voice care in one place.

We are dedicated to offering our patients the latest in voice treatment technology. Emory is one of only a few centers across the country, and the only center in the Southeast, that uses a cutting-edge new laser treatment to correct vocal disorders. Pulsed KTP laser treatment can correct problems of the vocal cords with minimal risk to the patient’s voice.

The Emory Voice Center lab is actively involved in research to better understand and treat voice disorders and voice problems. Current research includes:

  • Novel treatments for the aging voice
  • Outcomes of treatment for neurolaryngeal disease
  • Slow-release drug delivery systems for use in the larynx
  • Novel laryngeal pacing systems to restore vocal fold motion
  • Development of laryngeal surgical trainer
  • Voice treatment adherence
  • The benefits of early detection and tobacco cessation education to an at-risk population
  • Novel treatments in voice therapy

Locations & Directions to The Emory Voice Center

The Emory Voice Center is located in the Medical Office Tower at Emory University Hospital Midtown, on the 9th floor. This facility is equipped with the latest, state-of-the-art equipment in a pleasant, comfortable environment. Our office is conveniently located in Midtown Atlanta, easily accessible from the Downtown Connector (I-85/75) and all Atlanta’s major interstate systems. We are just one block from the North Avenue MARTA station, Atlanta’s mass transportation train system. Click here for map and directions. The Emory Voice Center Emory University Hospital Midtown Medical Office Tower, 9th Floor 550 Peachtree Street Atlanta, Georgia 30308 Tel: 404-686-1850

Physicians and Staff

The Emory Voice Center’s multidisciplinary staff is dedicated to the compassionate care of all patients with voice disorders. We also serve the special needs of vocal professionals.

Michael M. Johns IIIMichael M. Johns III, MD Director, The The Emory Voice Center Associate Professor, Emory University Department of Otolaryngology Dr. Johns is a graduate of Johns Hopkins School of Medicine. He completed his residency in Otolaryngology – Head and Neck Surgery at the University of Michigan, where he also trained as a research fellow through the National Institutes of Health program. He then pursued a fellowship in laryngology and care of the professional voice at the Vanderbilt Voice Center of Vanderbuilt University. Dr. Johns was awarded the highest honors during his academic career, including membership in Phi Beta Kappa and Alpha Omega Alpha medical honor society. He is a member of the Academy of Otolaryngology and the Voice Foundation and is involved in continuing research in his field, including a special interest in vocal fold paralysis and motion impairment.
Adam M. KleinAdam M. Klein, MD Laryngolgist, The The Emory Voice Center Assistant Professor, Emory University Department of Otolaryngology Dr. Klein is a graduate of the University of Connecticut School of Medicine. After completing his residency in otolaryngology at the University of Connecticut Health Center, he went on to do a fellowship to subspecialize in laryngology at Massachusetts General Hospital, Harvard University, under the direction of Dr. Steven Zeitels. He is board-certified with the American Board of Otolaryngology and is a member of the American Academy of Otolaryngology – Head and Neck Surgery. Dr. Klein’s clinical specialties include general otolaryngology, laryngeal disorders and the professional voice. His research interests include imaging of the human vocal folds using enhanced laryngeal imaging tools.
Melissa StathamMelissa Statham, MD Laryngologist, The Emory Voice Center Dr. Statham is a graduate of the University of Louisville School of Medicine. She completed her residency in Otolaryngology at the University of Cincinnati. She pursued two fellowships following residency. One was in laryngology and care of the professional voice at the University of Pittsburgh Voice Center and the other was in pediatric otolaryngology at Cincinnati Children’s Hospital Medical Center. Dr. Statham has expertise in treating pediatric and adult voice conditions and airway disorders. Her research interests focus on novel laryngeal electromyography techniques and outcomes from pediatric and adult major airway surgery.
Edie HapnerEdie Hapner, PhD, CCC-SLP Director of Speech-Language Pathology, The Emory Voice Center Assistant Professor, Emory University Department of Otolaryngology Dr. Hapner is a licensed speech-language pathologist and completed her doctoral work at Vanderbilt University in Speech and Hearing Science. She has over 25 years of experience in clinical work as a speech-language pathologist specializing in voice disorders. Her research interests include applying the principles of evidence-based medicine to the diagnosis and treatment of voice disorders, facilitating adherence to therapy, and the use of virtual reality in the comprehensive treatment of voice. Dr Hapner is a Scientific Fellow in the American Academy of Otolaryngology – Head and Neck Surgery and was appointed to the Clinical Scholars program through AAOHNS for 2005-2006. She is a steering committee member for the Voice and Voice Disorders Special Interest Division.
Marina GilmanMarina Gilman, MM, MA, SLP Ms. Gilman is a licensed speech-language pathologist with voice specialization, voice and speech teacher and a certified Feldenkrais Practitioner. Ms. Gilman has worked as the speech pathology voice specialist at the Bastian Voice Institute, Loyola University Voice Institute and as a singing voice consultant working primarily with singers, actors and other voice professionals for the University of Chicago Voice Center. Ms. Gilman offers techniques for effective voice therapy and on the application of the Feldenkrais Method for singers and voice professionals. Prior to earning her master’s degree in Speech and Language Pathology, Ms. Gilman was the coordinator and principal teacher in the Vocal Coaching Program at Cornell University and Chair of the Voice Department at Syracuse University.
Carissa MairaCarissa Maira, MS, CCC-SLP Ms. Maira is a licensed speech-language pathologist who was the first Emory Voice Center Clinical Fellow in Voice and Swallowing (2004-2005). She returned to the Emory Voice Center in 2010 after working as a voice specialist at the Evelyn Trammell Voice & Swallowing Center in Atlanta, GA. Her clinical and research interests include adherence to voice therapy and the psychosocial ramifications of voice disorders. She has presented at national and international conferences and has published several papers on the topic of adherence in professional journals. Ms. Maira completed her Master of Science degree at the University of North Carolina at Chapel Hill with a focus in voice disorders.
Meryl KaufmanMeryl Kaufman MEd, CCC-SLP Dysphagia/Head and Neck Cancer Specialist Ms. Kaufman is a licensed Speech Language Pathologist with over 14 years’ experience in swallowing disorders and head and neck cancer. She has worked within the departments of Otolaryngology at the Medical College of Georgia, the Medical University of South Carolina, and the University of Alabama-Birmingham. Ms. Kaufman held an adjunct faculty appointment in the College of Health Professions at the Medical University of South Carolina. She served as Clinical Supervisor and instructor at Georgia State University. Ms. Kaufman is currently president of the Georgia Chapter of the Yul Brynner Foundation/Alliance for Head and Neck Cancer.
Beth SeelingerBeth Seelinger MS, CCC-SLP Dysphagia/Head and Neck Cancer Specialist Ms. Seelinger is a licensed Speech Language Pathologist with over 8 years’ experience in swallowing disorders and head and neck cancer. She has worked within the departments of Otolaryngology at WakeMed Health and Hospitals in Raleigh, NC as well as the University of North Carolina at Chapel Hill. Ms. Seelinger held an adjunct faculty position in the Department of Communication Disorders at North Carolina State University.
Kelly CarrKelly D. Carr, RN Clinical Nurse Manager Ms. Carr is a CNOR-certified Clinical Nurse Manager and the Senior Manager of Clinical and Business Operations of Emory Voice Center and Emory Sinus, Nasal and Allergy Center. Ms. Carr has 19 years of nursing experience and 10 years’ experience in the operating room with emphasis in ENT, plastics and vascular surgery. Ms. Carr was instrumental in the development of the Allergy Program for Emory. She is an AORN member and the president of Atlanta Head and Neck Cancer Coalition, Inc.