The main goals are to eliminate risk of death from choking (which is pretty high in the current state of things), eliminate the risk of aspiration pneumonia and eliminate the anxiety of multiple daily episodes of strangeling/choking, and to do this without creating the extra maintenance involved with traditional trachs. My husband has 100% loss of speech so there is no compelling reason to preserve airflow through the pharynx because he cannot articulate with the mouth muscles, so no oral or laryngeal speaking device or valve will work. By separating the swallowing part of the throat entirely from the trachea, he would have airway safety. Since he is still very mobile, they think we will have more time to travel, fewer hospitalizations with pneumonia, and will have drastically less anxiety every day. He has strangeling episodes all day long, on food or drink or just his own saliva. He has literally choked on food three times and I had to do the heimlich...a couple of episodes took several attempts before the food dislodged. It's very scary for us both, and painfuI - am not young and have arthritic back - he's had a couple of falls and has sore ribs. With the daily strangels (going down the wrong way but not requiring heimlich), he also has laryngeal spasms so he can't get a breath in nor can he cough anything out. That is also freightening. All of this adds up to a lot of anxiety for both of us. If my husband quit eating by mouth, he'd still strangel on saliva and still have the laryngel spasms. If they paralyze the larynex with botox injections, he'd not be able to eat or drink by mouth and would still have the trickle down of saliva and be at risk for aspiration pneumonia. The surgery sounds drastic but it seems like the best solution the way they talk about it. The Dr. in town who has done the most of this procedure has only done 11. He trained with the surgeon who developed the procedure. And we are in a big city - Seattle - so if there aren't many experts here, there just aren't many experts period! My husband is resistant though because he can still at least make grunting sounds to get my attention, and he would lose that and his sense of smell (which is a large part of enjoying eating - but how much longer would he be able to eat anyway). He also is concerned about having an open stoma, just a hole looking into his trachea. I don't know how either of us will feel about that.
