At 07:45 PM 2/24/98 +0100, you wrote:
> As you know I´m a doctor working in Intensive Care and also in Home
>Mechanical Ventilation. One of the things I´m very interested in is what
>you think about tracheostomy. I know there are many people that refuse
>trach. perhaps because they are not well informed about it. Dr. Bach from
>New Jersey (there are people here in this list that know him) thinks that
>trach. can be avoided by means of different types of noninvasive
>ventilatory support....
I had polio in 1955, age four. I've worn leg braces and used arm crutches
since then, but it was not until 1984 that breathing became a serious
problem for me. My symptoms included morning headaches, falling asleep at
my desk in the early afternoon, tremendous fatigue, and shortness of breath.
My primary care physician referred me to a respected teaching hospital,
where pulmonary specialists first prescribed supplementary oxygen at night,
which helped only a little. My breathing further deteriorated to the point
where in 1986 a trach was suggested.
A trach would have meant a severe lifestyle change for me, but it seemed
the only solution. Then, one of the doctors at the teaching hospital
referred me to Dr. Bart Celli, now of St. Elizabeth's Medical Center in
Boston. Dr. Celli was then in the early stages of his work on noninvasive
ventilation. I was hospitalized for a four-night trial using a nasal mask
and an LP-6 volume ventilator.
The results were amazing. Within minutes of first putting on the nasal
mask, I was sleeping better than I had in years. I loved it! The skin on my
face does not tolerate the standard nasal mask very well, but Dr. Celli had
already found a solution to that problem. He brought in a dental
reconstructive surgeon, who took a latex mold of my face and produced a
silicone-and-fiberglas mask custom-fitted for my face. Twelve years later,
I am still using that original mask. Approximately six years ago, the huge
LP-6 was replaced with a Respironics BiPAP, which is a much smaller and
more portable unit.
I use the vent only while sleeping. In fact, if I ever feel the need to
ventilate during the day, due to physical exertion or staying up too late
the night before, I usually fall asleep within a few minutes! It still
amazes me that the mask and vent can feel so completely comfortable and
natural. I believe a lot of the credit goes to the custom mask.
My experience may not be especially relevant to this discussion, since I
have never been trached. But noninvasive ventilation has certainly worked
wonders for me. I am extremely thankful that I was referred to Dr. Celli
and that he had a solution that did not require a trach. For some people,
noninvasive ventilation works, and works very well.
Regards,
Jeff DeTray
jeff(AT)detray.com
http://top.monad.net/~jdetray