laryngectomee Stoma Care
- Stoma Care - Basics
- Stoma Care - Do's & Don'ts
- Stoma Care - Equipment
- HME (Heat/Moisture Exchange)
- Stoma Covers and Patterns
- After Care - Mucus Problems
after care - mucus problems
MUCUS - MUCUS - MUCUS
We not only have a problem with thickened mucus in the stoma but often in the oral cavity. We have hints under Post Laryngectomy for humidification and irrigation and under Stoma Care for thinning mucus and what to do about dried mucus in the stoma. However, this surgery or radiation can create very thick saliva and mucus in the mouth and throat. This can make talking, eating, and swallowing difficult. Early after surgery, almost all of us carry water with us everywhere we go. This section will be for suggestions to help us with that continuing situation.
1. SOFTEN DRIED MUCUS FIRST I found out the hard way that you should first soften dried mucus which can accumulate around your stoma before trying to remove it with tweezers. You can really irritate your skin if you pull dried mucus from the stoma area without first softening and loosening it. If you shower or bathe in the morning, let the water vapor or steam soften dried mucus before removing it with your tweezers. Warm water on a dampened washcloth will also do the trick. For those who have the TEP prosthesis, the tweezers are also handy to use along with a tiny brush and modified hypodermic style syringe/pipet to keep the prosthesis clean.
2. ANOTHER WAY TO SOFTEN DRIED MUCUS When you first get up in the morning wet your stoma bib. By the time you take a shower, that moisture will have softened the mucus you see, plus loosened some you couldn't see so you get a productive cough and start the day right. You may not need to use tweezers since thinned mucus coughs or wipes out
3. PICK UP MUCUS WITH TEP BRUSH I'm sure everyone is familiar with trying to remove wet mucus from around or just inside the stoma, stuff that is not deep enough in the trachea to cough out. Tweezers are fine for dried gunk but, at least in my case, just pulls the wet stuff out in strings, it lets go and springs back. It's an unending chore. In the meantime I gurgle as I breath. I take the TEP prosthesis brush and roll it around in the wet mucus. It winds up like spaghetti on a fork. Three or four windups and the mucus is gone. I rarely use the tweezers anymore. To make the twirling between my thumb and forefinger easier, I removed the handle from the end of the brush. Good luck, Bob Power
4. COTTON SWABS
Cotton swabs can be used to clean mucus around the stoma. There are two types of cotton swabs and the ones that you should use are the medical type which are longer and have a swab only at one end. These type do not leave lint. Caution should be used as they can be harsh on the delicate tissue of the stoma and can cause bleeding, so use they are best used on the outside or entrance of he stoma.
5. GUAIFENESIN Used for keeping mucus thin. From the Internet >>>Guaifenesin is an expectorant, a medication that promotes elimination of mucus from the lungs. The expectorant effects of guaifenesin promote elimination of mucus by thinning the mucus and lubricating the irritated respiratory tract. Guaifenesin is an ingredient in many over-the-counter cough and cold products. Guaifenesin was first approved by the FDA in 1952.<<< Some laryngectomees take this on a regular basis and in varying amounts. Most everyone takes it when they have a "cold" in one cough syrup or another. Please take it with enough water to make it effective. It's purpose of liquefying mucus needs the water and you may find that less medication with water works better than a lot of medication without extra water. Robitussin or Tussin (Most drugstore chains have their own brands, Read the label.), is a non-prescription liquid cough syrup and is 100mg guaifenesin per teaspoon. You want the one that is all guaifenesin, nothing else added. It should be marked something like Robitussin PLAIN, not the CF or DM which have other ingredients. Humibid, Humibid LA, Fenesin and other prescription guaifenesin is in tablet forms. 200mg, 300mg and 600mg. See your doctor. If you can't swallow the large pills, and they have a 300mg capsule that can be opened and sprinkled...BUT I haven't been able to find it or order it, so I keep some Plain Robitussin liquid to use if I feel I need some help with thinning mucus. First, I try extra water alone. Surprising how much help that is and how seldom we think of it! Pat Sanders
6. MORE GUAIFENESIN
Something that I do on occasion when I know that I will be in very dry air, i.e. airplane, long car ride, etc. I take Guaifenesin to help keep things lubricated and thin. It seems to work for me. This way I'm on top of things, a little preventive medication. Rita Burfitt
7. CLUB SODA USE - Use The Bubbly Kind
My doctor recommended sipping club soda for cutting loose the mucus from the throat and making the mouth and throat feel less dry. He suggested you buy it in small bottles so it doesn't go flat because the carbonation is part of what works so well.
8. MORE CLUB SODA - Freshening Mouth After Brushing
Way back when...I knew about club soda to help with mucus problems. I do not have a TEP so I can't gargle. When I brush my teeth, I never really feel fresh, always feeling a residual toothpaste, bubbles, etc., in the back of my mouth and throat. The other day, I remembered the club soda and decided to try rinsing with it after brushing my teeth. Wow! Feel much better. Thought this might be a good tip to add to our list.
Rita in NJ
THE TISSUE ISSUE - ADVICE FROM OUR MEMBERS
Puffs are available plain or with aloe cream in them and they seem to shed less than others. Some of the harder finish store brands also shed less. Try several brands and see what works best for you. An environmentally friendly solution to our need to catch a cough or to clean our stomas is to purchase a quantity of low lint cloth handkerchiefs or soft, thin, washcloths. Wash several times to get rid of the lint or dye odors before using.
See below for suggestions from our list:
(1) The only time I use Kleenex is when I am not glued up, and my stoma area is fairly clean (no glue residue); normally, I use a cotton handkerchief, with NO starch. I have used paper towels, toilet paper, catalog pages, old newspapers, and leaves, when in need. None of these do I recommend other than in an emergency. I think paper towels are too rough and like something that is soft, but that will not fall apart. That's why God invented cotton handkerchiefs.
(2) After one of our returns from our friendly ENT, we had an abundance of NUGauze General-Use Sponges. They are made by Johnson & Johnson and are 4"X4" and 4 ply. They are available at any medical supply store and come in Qty. of 200. We use these exclusively for stoma care, wash them out with any anti bacterial soap and are reusable for sometimes up to a week. It's great because they are soft on my Hubby's skin and everyone knows how tender the area can get. They also don't create any residue or dust like tissue does.
(Maria--caregiver of William)
(3) I started out with one of the well known paper towel brands until they changed their consistency and were much coarser and not soft at all. Then, I then switched to Bounty Select-a-Size and have been using them for many years now with no problems.
(Jean & Donald Blaisdell)
(4) By now you should have figured out that the biggest part of getting on top of this laryngectomy thing is simply mucus management. That stuff just shouldn't be running down your neck/splattering your mirror or keeping you from enjoying a good breath of fresh air. The former is unsightly and the latter is downright uncomfortable. Most likely, the first thing your friendly ENT or nurse gave you to remedy this situation was a facial tissue and there is very good chance that your are still using them for that purpose. Wrong! Those things are designed for some lady to remove her facepaint or for you to blow your tender, sensitive, formally useful nose. Actually, you may encounter a couple of very real problems using facial tissues for stoma cleaning. First, they are just too light and flimsy making them a fair candidate for inadvertent aspiration. A damp tissue in the stoma? I doubt anyone would want to go there! If that were not bad enough, there is another, equally undesirable, reason for not using facial tissue. Go to a strongly sunlit window and shake your facial tissue. See that little dust-like stuff being ejected into the air by the tissue? Those things are tiny, irritating wood fibers. Every time you place a tissue near your stoma, you give your windpipe a good dose of that. Care to guess what they produce on the vulnerable mucous membranes of your respiratory system? You got it. More protective mucus! You may wish to consider using something a little more substantial like paper napkins or paper towels. I take my wife’s select-a size paper towels, cut them in half and keep about 50-75 in a square, 5 cup sized, Rubbermaid ® serving-saver container that seems to be designed for that very purpose. It doesn't matter what you use, but you really do need to put those facial tissues down.
(5) My two cents worth goes as follows. You are all right and all wrong. I have used tissue, paper towels, wash cloths, handkerchiefs, napkins, and the same 4x4 gauze pads from the hospital. They all work just fine, as to how much lint is involved, I don't know. I have settled on the 4x4's and napkins, Yes plain ole dinner napkins. I feel very secure and safe using these. This brings me to my point, whatever makes you feel the best about yourself is what you should be using. There will never be a universal cure-all solution for all of us, so never be afraid to try something new, TRY them all and go with your heart.
(6) I'm sure I'm going to get into trouble for this reply, but I think all the discussion about paper towels, gauze pads, wash cloths, handkerchiefs and tissues is a tempest in a teapot. Granted, we are all different – and certainly entitled to our own opinion - but I've been using Kleenex for over 15 years and I'm wiping up mucus for heaven's sake which should trap most, if not all, of the lint they generate. I've not had a mucus plug since three days after surgery and not had serious mucus problems since I was at the hospital while my wife was getting a new heart valve and I had a full blown case of bronchitis. I see some lint on my "hands free" filter at the end of the day, but have no idea if its source is Kleenex, cats, or house dust. I suspect that there's more incidental dust in our lives than from a tissue.
(Carl Strand '93)
(7) Never thought we'd be having an ongoing conversation about tissues and gauze pads, but it does help to fill up the time between bowl games. Gauze pads were never suggested, and I didn't want to start laundering handkerchiefs, so I've been using the maligned tissues for 10 years. I don't inhale because that would defeat the purpose, and when I exhale I do it rather forcefully so any lingering lint should be blasted into outer space. That's my theory and I'm stuck with it.
(Mike Rosenkranz ’99)
(8) I'm afraid of tissue also. But one thing I have not seen mentioned is the inexpensive wash cloths. The ones that you can buy a stack of them for 5 dollars. They are great around the house and just throw them in the washer/dryer.
(9) Here is another possible alternative to the tissue/paper towel issue. Someone had recommended to me that "Puffs" has much less lint than other tissues and a lot less irritating than paper towels. I have been using Puffs ever since. Puffs come in home/office size boxes as well as pocket size packages.
(10) On searching for as close to a lint free paper towel as I can find I came across a brand called So Dri made by Georgia-Pacific. These have much less lint than Bounty or any other brand I have tried. They are not as soft as some but I use them for cleaning my Lary tube and am not worried about them being "user friendly" but just want something that soaks up the water and leaves as close to a lint free surface as I can get, so these do the job just fine for me.
(Wild Bill from Minnesota)
(11) For all those messy mucus, and other messes that need swabbing near the stoma, I have been using cut pieces of Good Paper towel, Bounty mostly in select-a-size, (learned from WebW on one of it's helpful pages) but it takes time to cut them, and convenience is everything these days. I have found that Charmin makes an Extra Strong variety that is almost as lint free as the bounty, but not quite. But it separates into one two or three sheet amounts without cutting, and fast, and accurately. The size is perfect for me. Dust and lint being slight, I believe they are a good back-up, or primary swab to carry with, or have around the house. I stack them up and put them in plastic bags, or just a pocket, or tray.
Mucus – Mucous
While my spelling is fairly decent and I have a pretty good eye for words, I did make the mistake early on of spelling mucus, that stuff we are all familiar with, as mucous, which is an adjective, as in, Mucous Membrane (a mucus-secreting membrane lining body cavities and canals connecting with the external air). Mucus, a noun, is the viscid watery secretion of the mucous membranes, that moistens and protects them.
I stumbled across the difference several years ago when I was looking for an exact meaning of mucus for an article I was writing, and did not change it in my usage because mucous seemed to be the more common spelling in use by everyone and, besides, it 'looked' right. Not to everyone, it seems, because I received a teasing note from a doctor friend on the Larynx-C email list. Seems he was a spelling champion in school and it has stuck with him. I answered his email that I love words and I know better than to mistreat them so I would immediately start spelling this correctly.
Thought I'd better explain my loss of the "o", because the next time I write about mucus, that "o" will be long gone! PWS
Thinning Mucus and Saliva
by Pat Wertz Sanders (From HeadLines 2000)
You are unlikely to be around a laryngectomee for 5 minutes without hearing the word mucus and if you get two or more of us together, we talk more about mucus than we do about our new voices.
Excess or thickened mucus is a problem for most of us. It is secreted by the mucus membranes for protection of the esophagus and the trachea. Too little and we are all dried up; too much and we cough it out from the stoma, cough it up from the throat, have trouble swallowing and have trouble talking through it with TEP or ES speech. The thicker it is, the worse our problems become but we can't be without it, so what do we do? We THIN it.
Saliva, another problem of - too much, too little, or too thick, is a clear, viscous, alkaline secretion from the salivary glands. It will normally decrease as we age and, as it lessens, the sense of taste is affected, speech can be more difficult, food is not digested as well, and overall dental health deteriorates. Saliva contains an enzyme that helps digest food, keeps the mouth moist, and eases swallowing, and it contains antimicrobial and antifungal agents. It is easy to see why we need saliva to stay healthy. In addition, we all know that having a dry mouth is a miserable feeling.
We who have had either chemotherapy and/or radiation, may precipitate these natural "old age" symptoms and our salivary glands might not work as well as they used to, if at all. The amount of damage depends on the type and quantity of chemotherapy or radiation and the fields included in radiation. Some medications, such as antihistamines, will reduce the flow of saliva so we should be careful how many and how often we take these.
We all know about humidifiers, dampened stoma covers, and irrigation, so, what else can we do to help the situation?
If someone told you about a product that is calorie-free, would keep your skin in a healthy condition, lower your risk of urinary cancers and perhaps colon cancer, hydrate your tissues, prevent kidney stones and, very important to laryngectomees, thin mucus and saliva, you would say, "I want some of that medicine. I don't care what it costs!" That medicine comes right out of your water tap and the cost, even if you prefer to buy bottled water, is one of the cheapest "medicines" around. Feeling tired? You may be dehydrated. Have a few glasses of water! If you wait for thirst, you may have already started to dehydrate.
The problem here is that hardly any of us drink enough water and the only way we can know for sure is to measure. Take a favorite glass and a measuring cup. Don't cheat. Fill the glass 'appropriately' and, pour it into the measuring cup to note how much it takes to fill it to that level. Then it will be easy to calculate how much you are drinking daily. Juice glasses are usually 4 to 6 oz. Tea and water glasses are probably 10oz or 12oz. How many of these do you need? For years we have heard that we should drink 8 glasses of water a day and they are talking about 8 oz glasses. That's 64 ounces or 1/2 gallon and doesn't sound so bad if you get to count coffee, tea, and colas, but you can't count that way. These other drinks are dehydrating so you have to drink more to come out even. Count these drink as about 2/3's of actual liquid content. A 6oz cup of tea would count as 4oz. Any noncaffeinated beverage counts as water. Foods have water content, but not enough to add much to your list. To make it even worse, Mayo Health says to divide your body weight by half and that's how many ounces you really need each day. That means the 1/2 gallon would only be enough if you weighed 128 pounds! So, if you weigh 200 pounds, drink 100oz of water a day. Think how important it is to a laryngectomee that water carries oxygen to your cells and helps to thin mucus.
Keep a jug in the refrigerator, carry a bottle around with you, and keep a glass at the kitchen sink. Drink a glass as soon as you get up in the morning and drink water with your meals. Swig a little extra when you take your medicines, especially vitamins, which need water to dissolve and be accessible to your body. Flavor it with lemon or lime or make a juice spritzer with carbonated water. Substitute some Gatorade but no more than a glass or two a day. It was meant for drinking after heavy exercise.
Any moisture that you can put "in", "on", or "around" your body will help to moisturize. Use your humidifier, dampen your stoma bib, hold your hot drink up so you are breathing in some of the rising steam, carry the water glass or bottle around with you and sip often. Water is an excellent expectorant and it may be that water alone is the medicine you need for thinning mucus.
There is a medication, an expectorant called guaifenesin, for thinning mucus. It has been approved by the FDA for almost 50 years and is sold both over the counter and by prescription for stronger dosages. It reduces the thickness and stickiness of mucus but must be taken with a full glass of water for it to be most effective.
You will have to read labels of cough syrups, but the one that has just guaifenesin is called Tussin or Robitussin Plain and is 100 mg per teaspoonful. Your doctor might have prescribed this for you, when you were having respiratory problems, under the name Humibid (600mg sustained release tablets usually prescribed 2 tablets in the morning and two at night) or under the generic name G-Bid. If you have trouble swallowing tablets, you might talk with your doctor about Humibid capsules (300mg) that are often called Sprinkles, because you can open the capsules and sprinkle these on your food or in liquid.
Unless your doctor has you on a water restricted diet, you will need to drink a lot of water with or without the medication. Talk with your pharmacist or physician about these suggestions.
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