Laryngectomy

Some people think having a tracheostomy is the worst thing that can happen. This is ironic; most times a trach is placed to 'preserve the vocal cords' from damage from contact with the breathing tube for intubations that are expected to last over three weeks.

the little circle on the right is where I put the breathing tube

Anesthesia for a patient with an indwelling trach ('in-situ') are easy. You just hook up your circuit to the special connector that is shared like an accordion, connect to the trach, dial up the gas and give i.v. paralytic. The Respiratory Therapist will have told you the vent settings already. You just dial them in to the anesthesia machine. Typically these patients come down from ICU and have a lot of monitoring lines. So most of the case I untangle the lines and make sure they are not missing any doses of medicine that are due by checking the chart. That is, if blood pressure is stable. If it isn't , I work, and I work hard.

the anesthesia breathing circuit connect to the blue plastic

Putting in a trach if someone is intubated is sort of the same thing. But once the surgeon gets close, he or she asks me to deflate the balloon cuff, and pull back about four centimeters. Then he pops the new trach in. I hand the circuit over the drapes, and we make sure the new trach passes air properly. This is demonstrated by the presence of end-tidal carbon dioxide on the monitor. When we see the waveform, I pull out the tube and throw it away. If it doesn't , I advance my old tube, reinflate the cuff, and let the surgeon try again to fix it.

Sometimes for complex head and neck cancer, the ENT will put a trach in first. They use a long armored tube that is flexible, and they sew it to the chest so it won't come out. I have to watch closely to my monitors for signs of that happening too throughout the rest of the case.

Dr. Passey invented a device that is called the Passey-Muir valve. With it, a trach patient can talk!
They sound just like themselves. I always encourage the family to ask for it later when the patient is better.

And many times, after the trach is not needed, they keep putting smaller and smaller ETT unttil it can close completely. There is also a device called a 'button' that is a little plastic plug that can hold the trach hole open in case it is needed later, but the patient can breathe on their own in the meantime.

This is a 'button'. A Passey-Muir valve looks similar.

The scary ones are the Laryngectomy patients, some people get cancer there, and it has to come out. For that procedure, the surgeon makes a hole very low in the neck, inserts an armored tube, and does the procedure. But if the patient already had that and is coming to the OR for something else, like a knee? I use a special Laryngectomy tube that is short and bent funny. Once the patient is asleep I stick it in the hole, connect to the circuit, and tape like mad. It always wants to fall out. The anesthesia gas also leaks out around it, and I get creative trying to make sure only the patient goes to sleep, and not myself by breathing that stuff! I use wet gauze or Vaseline gauze for an air tight seal. At the end of the case I take everything out.

This is a laryngectomy tube for anesthesia 

The people with a Laryngectomy talk.

I am serious. They use this device, the Electro Larynx. This short video shows the old style and the new one together. The only one I have ever heard before was the monotone one:

I am surprised at what angry people the patients tend to be. (This Tony guy is very nice by comparison!) Most of the ones I have seen always want to give you a 'piece of their mind!'

 But as they hold the device to their neck and rant away, something is 'lost in the translation'. That device is a monotone. The whole picture of patient holding thing to neck and cursing but sounding like Donald Duck gone techno just cracks me up. So I smile, take a deep breath, and do what is reasonable to soothe the patient to help them calm down.

Why am I writing about this?

Because I have a passion to share that which I know. A lot of medicine is very 'exclusive'. It takes a while to learn it, but I look at the vocal cords daily and I think it is really cool. I hope you do too.

Birds do not have a larynx. They have something similar but it is called a syrinx. The very best ones at mimicry are the African Greys. I want one.

These amazing creatures display empathy, according to their owners. They will also call over the dog to the cage, stick their tail out, and say 'Poop!'. They will mimic the microwave, the telephone, the door bell, and even the voice of your spouse just to play tricks with you. My personality is more of a cockatoo one, however. These shy and reserved African Greys do not warm up to me. I am happy enough with my pet Goffin's, Harry Bird.

Birds with voices, anesthesiologists, humans with fake voices, and everything in between. All of it is Reiki for your brain cells. Now you have something to discuss at your Memorial Day events, perhaps?

Take care, and have a wonderful holiday weekend. I will not be writing for I have a conference to attend with Cobra. It begins tonight. I have waited for months for it to arrive! I feel like this!

I can't wait to go and be Galactic for a few days with other Like-Minded People. There is a big portal we are working together to open tonight; it is the very last one to open to usher in the New Golden Age. <3


Namaste, and Blessings from my heart to you,

Reiki Doc

P.S. Can anyone figure out why this song popped into my head this morning right before I woke up? It has symbolism, but I can't understand it.

Aloha and Mahalos

For My Colleagues

Native American Healing Product: note 'depression' is the most sought after remedy...

My esteemed colleagues:

You are my heroes, my mentors, the ones I emulate with every bit of my training in anesthesia. You are my colleagues and my friends. I have worked with you in surgery almost every day for twenty-years. Together we have saved the lives of many. Together we have laughed and we have cried. We have worried about our livelihood at times, with all the changes to health care as we have known it, being cast out as 'doctors' and recast as 'anesthesia providers' and 'healthcare providers' by the bean-counters in hospital administration and the insurance industry at large.

I was both excited and enthusiastic about the week that I just spent with you at conference. I enjoyed hearing what you had to say. I knew all those four one-hour lectures took much time to put together, from research to making the slides in your power point presentations.

My take-away from this conference is that you are willing and able to explore the possibility that 'as we were trained' and 'as  usual' management of patients might have some gaps in light of new information gathered from cutting edge research. You have forged bonds with your surgeons and your neonatologists, vital lifelines of communication branching out across the borders of 'hospital turf' for the better care of your patients. Your hearts were open, minds working actively in great focus--to put together what you know so that we may go home and take better care of our patients back home.

As I sat in my conference seat, turning pages of the syllabus as you spoke, and writing notes in the margins like I used to do at school...I both welcomed the familiarity and smiled inwardly at the irony of it all: what you can't see and what you can't measure is the coming trend in taking care of health.

Let me repeat: the unseen, which represents the ninety percent of the brain we do not 'use', is the Next Frontier of Medicine. Watching your Mastery over the ten percent 'that we can establish in a random-double-blinded study, or a meta-analysis' is both admirable and sad.

There is a beautiful world out there ahead of you to discover! I have learned, with pure delight:

• I get the big picture. 
• I talk with patients on a soul-level while they are asleep. 
• I am committed to the Highest Good that is obtainable in that Therapeutic Relationship.
• I work in partnership with Spirit, Intuition, and Light.
• I am a better person, a happier one, and a Healer instead of a 'technician' in my work.

Medicine right now is in the Dust Bowl of Oklahoma in the Great Depression in the 1930's. 

Medicine is headed for the lushest, most gorgeous tropical Utopia, right around the corner...

People have been hiding things from us. You know the part about 'half of everything you ever learned in Med School is antiquated by the time you graduate, but they do not know what half, so you have to learn it all while you are there?'--there are technologies that have far surpassed our Journals, that have been 'not shared' by the Illuminati and the Anunaki with the rest of the world. In fact, these 'groups' have been doing everything possible to keep us away from our own innate healing capability. It is going to shock you when you find out, when you are 'waking up'.

People everywhere are excited about a new tomorrow in Health. Note that I do not call it, 'the Health Care Industry'. This is going to start with an increase in the Level of Consciousness of the Collective Consciousness. Then it is going to get more 'experiential' with Energy Medicine. Just as acupuncture and yoga have become 'mainstream', 'auras' and 'chakras' and 'physical manifestation' are coming down the 'pipeline'. Patients are going to look to us for guidance and reassurance in their self-empowerment and new-found health. It is going to good for everyone, and you might find you have some time to enjoy your hobbies that you have given up in the taking care of patients all your adult life...

I couldn't educate you at conference. You were not ready. But in my clinical judgement, you are very, very close to the level of Compassionate Awareness that is right around the bend. I forsee that the future is bright for all of us.

Who ever really wants to be sick? Isn't it time we made strides away from disease and hardship?

I know that I used your names in a prior blog post. You are my heroes and I deeply respect you. But if you ever Google yourself, and find that post, it is my hope that you will soon come across this. I am waiting to help you rediscover that which you already know and have always felt at Truth about Medicine within your hearts. This new energy is going to steep in and invigorate health care as we know it today...

Namaste,

Reiki Doc

Meeting My Anesthesia Guide

I have always 'known' what size endotracheal tube to pick, even before looking in the chart, or meeting my patient. As I set up, I get this 'inner knowing' what size tube will be correct. (A rough estimate is the size of the patient's pinkie finger, or for an LMA, the size of the palm of their hand.)

How I 'know' this, I am not certain, but I have appreciated it ever since I was a resident.

In Psychic Development classes, I learned that there is always a Medical Guide with me. I have never known, seen, or 'spoken' with him. My friends say he is a man, about middle age.

Today, after a short day at work, I came home early, and was especially tired. I parked the station wagon in the garage, made my trip to hang up the keys, and came back with a kefir. I just sat on the back of the station wagon with the hatch up, enjoying the sun, and wincing at the Persian lady who just moved in from New York screaming in anger out the windows of her house at the top of her lungs.

Just then I sensed a spirit of a man, very mild mannered, average height and weight. He had a humble bow of sorts, and glasses. He was balding, and very very plain like someone from the Midwest. His energy was one of quiet strength, of reserve, of vast experience in the specialty.

G: You don't have to worry about that...it will turn out all right.
C: (I had been thinking about my crush, and what was going to happen. It is a long distance thing, and first meeting is in two weeks. The gentleness of this voice caught me off guard. Compassionate and kind.) Are you my Medicine Guide?
G: I am.
C: What is your specialty?
G: Anesthesia, just like you.
C: Are you one of the people that invented anesthesia?
G: No...I was much later.
C: (in my mind I see a picture of before I was born, but in modern times, not antique ones--30's, perhaps) Do I know you?
G: No. We have not met.
C: Thank you for all of your help. I really appreciate it. May I ask you a question? At the end of your career, what was it like? When you got to Heaven, looking back, what did you think?
G: (smiles) I signed back up, didn't I? (as sponsor for me). I picked you because you are the best at what you are about to do. I am Ralph Waters.
C: OMG! You ARE someone famous! (there are talks in his name, lectures, at the conferences, but I couldn't place the name or the face or the role in our specialty).
G: Go ahead, look it up.

I did.
You can see him for yourself.
I am so blessed to have a pioneer of the teaching of anesthesia as my guide! It is amazing!
This is like Montague Keen for Anesthesiology!
Here he is:
the video! He started with 'teaching films' to show intubation. Scroll down, it is on this page, the movie.
http://page2anesthesiology.org/2011/ralph-waters-the-man-who-invented-anesthesia-training/

I tried to lift a picture of him for up above. It didn't work. So I looked at this site:

1883 October 9: Ralph M. Waters is born. Dr. Waters' achievements during a long career at the University of Wisconsin make him the father of academic anesthesia in the United States . Dr. Waters died in 1979. For more information see Lucien E. Morris, Mark E. Schroeder, Mary E. Warner, eds. A Celebration of 75 Years Honoring Ralph Milton Waters, M.D., Mentor to a Profession. Wood Library-Museum of Anesthesiology, 2004 [Proceedings of the Ralph M. Waters Symposium on Professionalism in Anesthesiology, Madison ,Wisconsin , June 2002]

       
Ralph M. Waters, M.D. [1883-1979]

His Birthday is today, October 9, and he would have been 129 years old.

I have tears in my eyes at the generosity of this beautiful man.

It is my honor to serve you and my patients in whatever capacity I have.

Namaste, Namaste, Namaste,

Reiki Doc