Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a
doctor or a nurse in Intensive Care!
This is another episode of "YOUR QUESTIONS ANSWERED" and in last week’s episode I answered another question from our readers and the question was
My Wife Had A Brain Death Test In The ICU. Why Did They Do That Without My Consent?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Kaye as part of my 1:1 consulting and advocacy service! Kaye’s husband had a
cardiac bypass surgery and tracheostomized in the ICU. He is now in LTACH and Kaye is asking if decannulation is risky for him?
My Tracheostomized Husband is in the ICU, now in LTACH. Will They Remove His Tracheostomy Soon?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Kaye here.”
PART 1
PART 2
PART 3
PART 4
Patrik: Oh yeah.
Kaye: We have so much complications, you know.
Patrik: Yeah.
Kaye: I’m telling you, my husband took me for a ride, I’ll be honest with you.
Patrik: He did? He completely sure did.
What happened, I know when we last spoke and there was still the talk about getting him to a nursing facility. Why did he go to LTACH and not nursing? What happened there?
Kaye: Oh. You don’t know. I crafted all doctors, so this is a joke. I met with doctor at the meeting, board meeting, and I told them I was convincing them that … I don’t honestly think that my husband is ready to go to the nursing home with his trache.
Patrik: Yeah good.
Kaye: And they all agreed. No. No. So why did corporate appeal? I did a corporate appeal together with the doctors, and all that paperwork, all doctors on the board with me would be petition and everything.
Patrik: That’s really good.
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Kaye: And the medical insurance ask me to drop their appeal.
Patrik: That’s good.
Kaye: And they said if you do that, we’ll send your husband to LTACH, and my doctor told him, who’s fantastic doctor, he said, no, let them heal first and after that we will
drop it. And this is what happened actually.
Patrik: That’s really good. And that’s Medicare?
Kaye: Medicare and medicaid, we have two.
Patrik: Yup that’s good. Well I’m very-
Kaye: And also we have private insurance, so he pretty much has three of them.
Patrik: I see. So the combination of those insurances has probably helped, but it’s also-
Kaye: Yeah, yeah, yeah.
Patrik: But it’s also you’re … You’ve been very firm with them, and it sounds like the surgeon has been really supportive of all of this, hasn’t he?
Kaye: Oh yes, yes, the surgeon he’s my client, the nature of this is I’m his financial advisor, and I deal with a lot of hospitals and doctors. So, when I was speaking to the doctor, he’s actually my client.
Patrik: Oh I see.
Kaye: So pretty much the doctors who I worked with, they are all doing their financial case for them, planning for their hospitals.
Patrik: Ah.
Kaye: So this has definitely helped.
Patrik: Right.
Kaye: This definitely helped, and the doctors being my clients and he really, really respects them and that is why he was like a family. And he still is. He was doing everything, to everything possible to put him onto trach I promise you that and we did
that.
Patrik: That’s really good.
Kaye: Yeah so, so aside from this medical, we have like a personal relationship before the surgery-
Patrik: I see, that probably helped as well.
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Kaye: Sure. It sure helped. I’m not gonna lie, yeah, this is definitely … That is why doctor pretty much were … They know me, and that is why pretty much were helping me here.
Patrik: I’m very pleased to hear that. But it’s really good news that everything seems to be moving in the right direction, that’s such good news.
Kaye: So far-
Patrik: Yeah so far.
Kaye: Yeah … Only one thing of course we’re struggling is for him to get off of trach to start walking and I’m not dreaming, and I understand it’s gonna take a while for him to actually walk.
Patrik: But I mean he’s made steady progress, so there’s no reason why he can’t continue making progress.
Kaye: I hope so if he’s very active and he is trying hard, he’s trying hard to exercise his muscles even lying in bed. He’s trying to touch his moving arms up, and all that good stuff, and this might be who I hired, she’s actually good. A couple of things to improve in, and she will. But I will have a conversation with her about it. And yeah, so far, I think we’re in the right direction.
Patrik: I’m so pleased to hear that. Very pleased to hear that.
Kaye: Yeah. Now that’s it, I have a serious question.
Patrik: Yeah sure, of course.
Kaye: Do you think there is chances, and you probably already know what I’m going to ask, do you think there is chances for that…if you start getting liquid water in his lungs, he might relapse and go back?
Patrik: Not if they’ve done a proper assessment. Not if they-
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Kaye: I’m sorry one more time?
Patrik: Not if they have done the proper assessment. Yes there is a risk, a remaining risk, but if they have done the proper assessments, he should not aspirate. And with aspiration I mean getting water into his lungs.
Kaye: Yeah.
Patrik: Have you seen the tests yourself? Were you there when the speech pathologist did the tests? Have you seen it yourself?
Kaye: Respiration?
Patrik: No. Have you seen the speech therapist doing the test? Have you seen this?
Kaye: Well yeah I was there, yes. And so when they will be doing the barium I will be there as well, when they’re doing that time.
Patrik: Right. Look, there is a remaining risk, but, you know, if they’ve done their tests appropriately, then he should be okay.
You know what is important, especially in the beginning, when your husband is taking water, or has something to eat even, what’s important, he needs to sit up as much as he can.
Kaye: He needs to what?
Patrik: Sit up, like sitting up in a chair.
Kaye: Oh okay, okay. That’s it, if I will lose you, I’m in elevator going upstairs.
Patrik: I’ll call you back if that’s happening, but I can hear you, I can hear you.
So-
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Kaye: Okay.
Patrik: It’ll be important that if he takes any water or if he has something to eat, he needs to be sitting up upright, you know?
Kaye: Okay.
Patrik: Because if he’s lying down, or doesn’t sit up properly, the risk-
Kaye: No they set him like that, but last time he was under influence of the narcotic and I didn’t know that, this is something they don’t say, they don’t believe in that.
Patrik: No. They shouldn’t.
Kaye: When I told them and they all know right now, it’s a big no.
Patrik: Right.
Kaye: Can you hear me Patrik?
Patrik: I can hear you, I can hear you.
Kaye: I didn’t lose you, good.
And this is something we will never be taking unless it’s absolutely necessary. But, at the technician and they are stages that he is currently ill, there’s no drugs the administrating for him, perhaps except Tylenol if he has that agitation or anything like that.
Patrik: Right right.
Kaye: So, yeah. I’m very very … I’m being protective, he is my husband.
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Patrik: Right, right.
Kaye: So he’s sleeping right now. I’m looking at his oxygen level right now, 98.
Patrik: Oh that’s…
Kaye: 98.
Patrik: That’s fantastic.
Kaye: Yeah.
Patrik: So, yeah. Look the risk is there, the risk is higher compared to other people of course. But as I said, it’s important that he … Especially in the first few days, that he only has fluid intake or eats when he’s properly sitting in a chair rather than lying in bed, that’s going to be really important.
Kaye: Well yeah, this is what we’re trying and even he’s getting tired, I will only insist that. You have to sit down, we have to sit down. And you know what? He understands us right now. And he’s trying so hard to sit down, I noticed when he’s awake, and he wants to lay down more, but even when he lays down, I keep him elevated at 45 angle, so to make sure that he is … Even he doesn’t like it, I say like it or not like it, take it or leave it,
just call it what it is.
Patrik: This is almost like, especially in the next few days, you got to be mindful of that.
Kaye: Now what kind of questions do you think ask them after he will be… would you say decannulated?
Patrik: No no. Decannulated.
Kaye: Once he will be decannulated, what do you think I should ask them?
Patrik: So number one, what’s their plan in terms of … Normally what happens is, he will probably be nothing by mouth for the next 24 hours right? So they don’t want to give him any water for the next 24 hours. He can have feed through his tube, but usually give patients meal by mouth for about 24 hours.
Kaye: Okay.
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Patrik: Okay?
So and then when he starts eating and drinking, then the question is, how do they monitor, whether he can swallow properly or not, how would they go about that.
But that’s pretty much it. Once he’s gutted out, he’s gutted out. What’s the situation in terms of … Is he in a single room, or what sort of the set up there?
Kaye: He is in a private room.
Patrik: Okay. And how far away is the nurse, how often do they see him, what’s the sort of situation around that?
Kaye: You know what, I’ll be honest with you, since we’re here, they give us very special…of the special attention I’ll be honest with you. It’s not have approximately three, four patients, which is not bad.
Patrik: No that’s not bad.
Kaye: Because of them our patients, I know that they are not banned, they don’t allowed to move, and they noticed some of the patients are like my husband … But I noticed a couple of patients are not asking about that I noticed that. And I will talk to the nurse and pretty much I’m in a very good relationship with the nurses here, too.
Yes, like yesterday going home, actually this customer he loves this facility because he worked here before and he had this relationship they’re not overloading the facility with patients. So pretty much they can hear others say to check on my husband that will be every forty-five to one hour becomes over time, and since his blood pressure, I insisted to bring the monitor and monitoring his blood pressure and heart rate, and they brought it in. They did. They have
it. So I said because you guys here … And the important thing they have those monitors up front, and I always keep them sitting upfront there’s always nurses or someone sitting up front.
Patrik: Okay.
Kaye: So that tells me they see their … what you call it … They see his results on the monitor.
Patrik: That’s good, that’s good-
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Kaye: Now Patrik, to remove the … Just a very simple question, right? I’m asking right now I feel, I’m not familiar with that system, because I know a couple of people whoever you like, just the way how they treat my husband, it’s a procedure, should they wait for the person I’m feeling comfortable with?
Patrik: Look, if you can find the person that you are comfortable with, obviously that’s always preferred, but in terms of procedure itself, an experienced nurse should be able to do that procedure, it’s not … You know the removal, and they should put a dressing on top of it and that’s it right? So yeah of course it always helps if you have somebody there that you feel more comfortable with, but generally speaking, it’s a simple procedure. It is a
simple procedure.
Kaye: Okay. Because they will be meeting in five minutes with the doctors here. And they will meet on Monday. And I’m going to meet a particular person. And I really like to … I never met this person respiratory person, I don’t even know who’s that. So we have a board and they invited a board who’s assisting us today, and they are writing and the board takes the blood pressure work last time they gave him medication, last time he was turned,
last time his skin, blood pressure, everything is here, so I really like that. They write it down for me everything here yeah.
Patrik: That’s good.
When your husband went into the LTACH, did you select the LTACH, or was that a decision that was-
Kaye: Select.
Patrik: You selected it?
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Kaye: No. Unfortunately. The place… insurance place being with us, so what’s happening, I already laid up a place for my husband, to my another client, Dr. Brian he said okay we’re gonna take him in. At that time, insurance didn’t approve. So, we did appeal, I called my doctor again within a couple days to go and to try again, and she said fine, and all of a sudden, insurance, and you know it was a labour day, all of a sudden, on Friday midnight,
they told me we have to move from Friday midnight to Sunday night to find facility and it was crazy holiday and weekend where can I find facility.
Patrik: Yeah yeah yeah.
Kaye: I tried to call my doctor he didn’t answer he was probably with a patient or something like that. So I called the director, it was a lady and she said “Oh my god we just got a new patient”. I said, “Are you kidding me?” She said, “Yeah.” I said, “Can we try and secure a place for my husband?” She said to me we don’t have enough med stuff, it’s full and I don’t want your husband, and she said, listen, let me recommend one facility and we’re
happy with, I worked with them till you will be retiring to your home.
I said, “Okay.” She provided me with this facility when I called it, it did not have a bed. She said, “No, no they have a bed let me arrange for you.” And she arranged it for me.
Patrik: Okay.
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Kaye: So when I called back, they said, “Okay what time you wanna come?” I said, “Now.” So they transferred my husband at 1 o’clock in the morning Friday.
So pretty much I’m glad that doctor didn’t help me with his facility, but they arranged me this facility, similar to that, to this. It’s a great facility-
Patrik: Okay.
Kaye: It’s a great facility. To me, I don’t care about the way how it looks, but it looks decent. It’s nothing what we see in the before when I had shock and I cried and I didn’t picture my husband to be. But… my husband woke up. But just … As I say, and I look forward to everybody and I will write a review. If you’re not involved with your loved one, you’re not gonna get proper care.
Patrik: No, no.
Kaye: Be always with your loved one. Because if you’re not here, if you don’t care, why should they? You know what I mean?
Patrik: Totally.
Kaye: You have to be involved, and I believe as often as you can, and be here, and talk to the doctor, and express your worries, and express your desires and wish regarding your loved ones, if you’re not gonna involve, pretty much you are done. This what I learned to all this experience here with my husband. I’m very … I’m the person that if I promise you I will do that. If I can do it I will probably straightforward, I can do that. And when
doctor telling me, nurses’ talk, I think the nurse is saying, yeah I will do it, and it’s not happening, this is making me angry. Don’t promise me something if you cannot do it.
Patrik: Yeah, yeah.
Kaye: So, at this point, we have to be involved. Of course you have to be involved. Anywhere. Even I see one-on-one you have to be involved.
Patrik: I agree. I agree.
So that’s really … You’ve gone a long long way. Long, long way.
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Kaye: We are, and as I said, I’m not even afraid to go back to ICU and Eric now he went on a conference to Mississippi, so he’s not here.
Patrik: Right.
Kaye: And here I am by myself and his mother came to help us with the dogs and everything because my schedule is crazy, working and hospital and going to the hospital and living with the doctors, I literally coming home around 11 at night and I’m crashing and I’m getting up at 5 o’clock and here we go again. Actually, yesterday I had a good day. I took time off to visit my husband while you’re gonna be sleeping, I went and I did my beauty things
and I just like to pass several hours to take care of myself a little bit. You know I decided to do that.
I’m not forgetting about myself Patrik.
Patrik: No, no. And it doesn’t sound like to me you have. I mean, you sound-
Kaye: It’s right. It was time, yes, I was devastated, it was time when nothing really mattered to me, and I’ll be honest with you. Because me and my husband we’re such a buddy. We have such a strong relationship. He is not only my husband, he’s my best friend. And this is what I didn’t want to lose him. Now he’s happy. He’s talking…
You see he’s talking really nice.
Patrik: Wow, wow that’s amazing.
Kaye: He’s talking very nice.
Patrik: That’s amazing.
Kaye: Very nice.
Patrik: I’m really pleased to hear.
Kaye: Thank you for helping us with all this tasks and going through, I know it’s not over yet, but we are in a right direction.
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Patrik: Absolutely.
Kaye: I will definitely keep you posted and I’m keeping my fingers crossed and hoping that we slowly will be improving, he’s a fighter, he’s a fighter.
Patrik: Absolutely. He’s a fighter. You are a fighter.
Kaye: Yes, yes, oh I don’t go down easy, no.
Patrik: No.
Kaye: I cannot afford, before I will say it’s over. No… no. Patrik, thank you very much for calling me. I have to go right now.
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Patrik: All the best.
Kaye: I don’t wanna-
Okay thank you thank you-
Patrik: You’re very welcome, have a good day.
Kaye: Bye bye.
Patrik: Bye bye.
Kaye: Bye bye Patrik goodnight.
Patrik: Good night.
The 1:1 consulting session will continue in next week’s episode.
