My registrar immediately swapped case-loads of booty at the local off-licence, whose owner was even more fecund than him, for case-loads of booze...
So in the tradition of medical people, following my laryngo-pharyngo-oesophagectomy (even my spool-chucker recognises that word now...) I sent off letters to the people who deal in tracheostomy accessories.
The most impressive response was a phone-call from the medical director of one company who was extremely patient in conversing over the telephone with my weird Dalek like electronic-buzzer voice. Of course, they had never had a Medical Man as a specimen and would be delighted and most interested etc... Parcels of bits and pieces duly arrived from two suppliers, and I've embarked on a one-man uncontrolled eyes-wide-open trial.
For those not entirely au fait with tracheostomees (as we who have no larynx and live with a permanent tracheostomy are called) there are three problems raised by the absence of the physiology of the nose. Now I've always thought the nose a rather under-rated organ in the General Scheme of Things. It is frequently the butt of jokes; it behaves very inconveniently at awkward moments by running, sneezing and going bright red; and its various purposes seem sadly neglected.
But, in this context, it (1) heats the incoming air (2) humidifies it and (3) acts as a sort of restraining influence on air going into and out of the lungs.
So far, product number one (via a Dutch company, based in England, importing a Swedish-made product) is doing very well. It boasts a percentage moisturising figure and a percentage heating figure which seem to be bearing out in practice. So far, since the Big Operation some four months ago, I have worn a Buchanan Bib over the trachy. This is a nicely woven cotton number with foam filling, that ties round the neck and hangs over the stoma, absorbing heat and moisture on breathing out, returning at least some of both on the next breath in. In public I cover its effect of making me look like a bricklayer in a string vest by wearing a classy silk cravat. But it leaves a lot to be desired. It's either too tight or too loose: the interstices of the foam get bunged up with mucus; and sometimes it almost chokes off the airway when it gets too wet...
The neat little foam-filled 'button' which plugs into the sticky-backed-plastic fitting over the stoma tries to get round all these problems. Additionally, it deals with factor (3) above, by offering some resistance to exhalation in particular. Now we all remember, in the days of real 'blue bloaters' and 'pink puffers' that proper old-fashioned chronic bronchitics, (before they became COADs and COAPs...) in between puffs on their Players Senior Service, would purse their lips when breathing out, in order to increase the back-pressure in the remains of their alveoli to get the last fraction of a percent of oxygen out of the atmosphere.
But as well as this factor, I have the advantage of the marked decrease in 'dead space' - of air needing to be moved in the pipework before it can get down to the alveoli.
I must say that on the first day of use, I found myself quite noticeably more out of breath than previously. The manufacturers say this is to be expected. I'm waiting and breathing, and running up and down the stairs... I should be as fit and fast as a 'tubed' horse soon.
By the fifth day everything seemed to have stabilised. Much less in the way of secretions, much less of a morning cough, and very much easier breathing in the cold weather. My goode wyfe says that now, when I sigh, it sounds "...just like you used to." Sigh...
I then went back to the plain old Buchanan Bib for five days in what pukka medical trialists term a washout period, before trying the alternative product... from Yorkshire. This uses activated charcoal in a little cloth mesh filter capsule.
Again, noticeably more difficult breathing on the first day - exacerbated no doubt by a three mile walk out in the countryside in four degree autumn weather. We'll see how it goes. There are filters with three different degrees of resistance:ordinary day-to-day use, strenuous activity and night time use. Hmmm...
But I rapidly found that their adhesive patches were, er, not a patch on those of their rival. The adhesion was not as good, so that they separated from the skin at the first strenuous cough: they were much thicker and cosmetically more obtrusive, and I found the little filter capsules rattled annoyingly on each breath. With an exit to the atmosphere directed forwards, this could be covered by my cravat - unlike the first product where air entered and left round the periphery of a plastic disc which could be pushed in to block the trachy - when using a speech valve for instance. However, they had the same beneficial effect after the first day's use. But I decided that their disadvantages outweighed any little advantage (the capsules were smaller) so I went back to the originals for which I obtained a prescription from my long-suffering GP.
An interesting little trial. The trachy is now behaving immaculately and I completely forget its existence for much of the 24 hours. Excellent.
Dr Alan G. Gray