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
Stoma care do's & don'ts
DO - ADD HUMIDITY
(For recommendations on Humidifiers, check Stoma Care - Equipment)
RULES CONCERNING HUMIDITY
Humidity is important to a laryngectomee but there limits to maintain. The relative humidty should stay between 30-55% except when in the shower. Remember that relative humidity is not the same as humidity. Relative humidity refers to the amount of water that air can hold at a certain temperature. Air temp at 75 degrees may have a cup of water in the air at 100% RH while at 40 degrees it may hold only a 1/4 cup at 100% RH.
Rules concerning humidity are simple:
1. Get a gauge that tells you the relative humidity. They can be found at Walmart and other places especially if they have garden centers.
2. Keep the range between 30-55% relative humidity. Below 30% the air becomes hard to breath and dry skin conditions, along with other problems, form. 60% and above constantly maintains an environment desired by mold.
3. If moisture forms on the inside windows you may have one or both problems of needing new windows and/or the humidity level is to high.
4. If you still have breathing problems at 55% you need to talk to your doctor about breathing therapy.
5. If you have a central air heating and cooling system find a good HVAC company to install a humidifier for you. If you don't have one of those systems, then carefully look into of the shelf tabletop/tvstand units.
Frank O, Croydon, Pa
I live in Minnesota and have found anything over 30% humidity is within my comfort zone. I only use a humidifier during the winter months. I keep it in the 30 something % range on my homes main floor which results in the 40 something % range on the second floor where my bedroom is located. Theoretically my attic will be in the 50 something % range as the moisture seems to rise. This should keep any mold from forming in my attic as that is supposed to happen around 60 - 65%. I have a humidifier in my office that I use during the day. I have several gauges in my home so I can monitor the % and adjust as necessary.
Wild Bill, - MN
WAYS TO HUMIDIFY
In my one-bedroom apartment I have a humidifier in the living room, another in my bedroom, and I keep a pot of water on low heat in my kitchen during the day, just to keep the place moist. I live right on Lake Erie but the winters tend to be dry and cold, and believe me, these help. Come summer, when the air conditioner is on, makes no sense for any of that: The AC has a de-humidifier built in and, with the Lake right outside, moisture a-plenty.
John S. - Ohio
WORKS WITH YOUR SHOWER
In the Cold weather, humidity control is important. I have used every kind of humidifier I could get my hands on. In my opinion, the Mr.Misty is the best. The principle of the units operation is the water pressure in your shower. You simply screw the shower head off and screw Mr.Misty on in it's place. You then screw the shower head on the Mr.Misty unit. When you turn your shower on, there is a very fine mist that comes out of the unit. When you are ready to shower all you have to do is push one button on the Unit and you have a regular shower. This unit puts more than enough moisture into the air with no filters or messy units to clean or replace. It is not automatic and you will need a meter to watch the humidity level. The moisture will naturally spread to every room. I purchased mine in my local drugstore and it works so simple and good I am amazed any time I turn it on. I am just over my first year and believe my life get easier and better every day that the good Lord gives me. If you have any questions you can reach me by e-mail in sunny but cold Florida. Ron Momeyer
(Note from Editor. I was not able to find these online)
HUMIDITY - INTERNAL & EXTERNAL
I would hate have beat the big "C", for as long as I have, then die from coughing. The ideal objective for lary mucus is to have a continuous flow of watery, almost clear mucus. Like mucus elsewhere in your body, that which is produced in the respiratory system protects the tissues of the trachea (stoma hole and tube down to the lungs) and lungs which are exposed to the dirtier, colder, and drier air (since the upper part of our respiratory system became bypassed by the laryngectomy surgery.) In addition to providing a protection of the tissues to prevent drying and the invasion of bacteria and viruses, the upward mobility of the mucus carries any impurities which are breathed in up so we can cough them out. Managing the amount of mucus used to be an automatic process before we became larys, but now we must play a more active part. Things we have to actively do to get and maintain a good consistency and flow of mucus (basic):
1. Hydrate yourself. Do not just drink water when you are thirsty, but drink enough water and other liquids during the day because water from your body is the building material for the formation of protective mucus.
2. Keep the humidity in the spaces you control at about 50% relative humidity (certainly no higher than 55%). If you have an automatic whole house humidifier, your job is easy. You just set the humidity level like you set the temperature with your thermostat. The rest of us have portable humidifiers and humidity gauges to check it. You can buy portable humidifiers which have an automatic on and off function when they reach the set humidity, but they are not inexpensive.
3. Wearing an HME (Heat/Moisture Exchange) filter raises the humidity and heat of the air you breathe by temporarily storing both in the filter when you exhale, and returning it to the lungs when you inhale again. The filters are also excellent at filtering out the impurities found in the air around us we breathe.
4. While we disagree about whether it should be a daily ritual or only used occasionally or as used, squirting some sterile saline into your stomas can help loosen by thick mucus and help you cough it up. A product like Simple Saline or the pink saline bullets serve this purpose.
5. You can also add additional humidity at the stoma level by dampening a cloth (the double lined ones like the Gennel are particularly good) or foam stoma patch. When you travel in your car, or otherwise, you can carry a small spray bottle containing water to redampen your stoma cover. Whenever I fly, I bring or ask for a bottle of water and use that to keep the stoma cover wet. Doing so also improves the covers ability to filter impurities from the air.
6. You can also get some temporary relief from dryness when you take a steamy shower, breathe in the steam from a boiling teapot (don't get close enough to get burned), or use a nebulizer.
David B. - VA
MOTHER NATURE USUALLY GETS THINGS RIGHT
Prior to the laryngectomy surgery the air which reached our lungs was almost always filtered completely clean, was 98.6 degrees Fahrenheit, and 100% relative humidity (think fog). The laryngectomy surgery bypassed the upper part of the airway which accomplished this conditioning of our incoming air and what we began to breath was dirtier, cooler, and drier. Too little humidity is unhealthy, as is too much. At either extreme the environment is ideal for the growth of respiratory infections, bacteria, dust mites, fungi, viruses and the like. There is an article on the ideal humidity levels for larys in this issue of the WW monthly publication: http://www.webwhispers.org/news/dec2000.htm We can adjust to dirtier, cooler and drier air, but if you believe that Mother Nature tends to get things right, doing what we can to approximate our respiratory environment prior to becoming larys seems like the better idea.
David B. - VA
TOO MUCH OF A GOOD THING
Too much of a good thing? 50% relative humidity is about the maximum before the disadvantages overwhelm the advantages of additional humidity. There is an article, "Ideal Humidity Level," with a chart which shows why too dry air or too wet is not healthy in this issue of the WW monthly publication: http://www.webwhispers.org/news/dec2000.htm As you mentioned, an excellent investment is a digital battery powered humidity gauge (hygrometer) (great holiday gift for a lary!) available from Wal-Mart for under $10. However, during the winter months I find that I still must add more humidity at the stoma level by dampening my stoma cover with water or I will still dry out. It is less of a problem in the summer months.
David B. - VA
BUY OR MAKE SALINE SOLUTION
1. Make your own by boiling one cup of water and adding 1/8 teaspoon of Kosher or canning salt. Table salt contains an anti-caking agent and Iodine, neither of which do you want in your lungs. Put it in a suitable closed container. If you don't use it within a week, toss it and make a fresh batch. Apply with an eye dropper, syringe or spray. This solution can be used for cleaning the stoma, irrigation of the stoma, and flushing out the nasal passages. Adding 1/8 teaspoon baking soda adjusts the pH balance of the solution. Use it warm and it is good for getting rid of sticky mucus. (Put together from suggestions sent to the WW list. The hint about the type of salt was sent in by Mark Finfrock)
2. A saline solution for irrigation is easy to make. To make an isotonic solution (one similar to the salt content of your bodily fluids), mix 1/4-teaspoon salt in an 8-ounce glass of warm water and add a pinch (1/4-tsp.) of baking soda. Discard any unused solution. You may chose to use filtered or distilled water if your water contains a lot of chemicals. Table salt can be used, but many prefer to use non-iodized canning or pickling salt. Using baking soda improves the mucus-solvent properties of the solution.
3. You can purchase sterile saline at your local pharmacy in large bottles to fill your own bottles or sprays. You can find it in small nasal spray bottles or in the contact lens care section of the store. Several manufacturers sell saline in a can for misting and you can purchase saline bullets. All of these things contain the same product. Amazon has an amazing selection including the pick bullets, 100 to a box for about $20.
4. I was in WalMart and discovered Wound Wash Saline. I went to another isle and found a can of Simply Saline and compared the two. They are both made from the same company, BLAIREX, and have the same exact contents. Simply Saline is 1.5 oz and Wound wash is 7.1 oz for $3.00; the only difference is the nozzle, it's not as fine as Simply Saline but it's a little more direct and a more powerful spray. I like it better. The price is definitely right. Dennis D.
5. Sea water is 3.5% salt (I looked this up). Normal saline is .91%. When you swim in the ocean, yes, you'll get the salt residue on your skin as you dry but the inside of your body is normally a bit salty--more like normal saline. When you shed tears, they are salty. If you need to flush out your eyes for any reason, plain water will sting. If you use normal saline, this will not sting (at least not as much). In the hospital, when they give IV's, it is
usually normal saline that they give you to be close to the saltiness of your
blood. Saline was used to flush wounds--get rid of whatever debris.
I don't think plain water will do any damage to any of the mucous areas of our bodies, just may sting a bit. As to the stoma, I think the normal saline will not be as irritating as plain water (sterile, distilled, tap, whatever). And I THINK, since the stoma is more INSIDE your body, it would also fall under this normal saline area. I am not totally up on the above, but I did train as a nurse and worked many years as one. Vicki Metz
6. Saljet small volume saline solution application licensed for wound care.
Packaged in four vials per strip, ten strips per carton, see video:
7. Pink Bullets! Normal saline solution dispenses by the drop in 3, 5, and 15 ml increments, or quickly for procedural efficiency in tracheal cleansing. Amazon has an amazing selection including the pick bullets, 100 to a box for about $20.
8. Saline Solution is used for eye wash, nasal irrigation, and stoma irrigation. Look under Google for Saline Solution, In Amazon? Find in Med supply places or our own vendors. Check your drug store and WalMart.. Read the labels and compare. Same or similar product, different packaging and pricing.
9. Make your own saline solution by adding 1/4 teaspoon of Kosher salt to one cup of boiling distilled water. I used this solution after surgery & still do, about once a week. I keep a nasal spray bottle with me at all times to mist my stoma when dry. My stoma stays spotless & I have very little coughing problems day or night.
Harvey G. - TN
10. I use bullets and always carry at least one saline 5 ml capsule in my pocket. When I start repeated coughing, I squirt 1/2 or all of it into my stoma. This seems to replenish the moisture in my lungs and the coughing stops. I keep these capsules in my jacket pockets, car glove compartments, my desk drawers at work and always one in my shirt pocket so they are always handy when I need them. I also start and end my days with 1/2 a capsule. I use 1/2 the capsule in the morning and the other 1/2 at night. These can be purchased without a prescription now due to some change in a Federal law. Wal-Mart and Target both carry them in the pharmacy and they are about $14.00 per box of 100 which to me makes them more cost effective than trying to mix up and package your own saline and the plastic container is also recyclable.
William C. - MN
11. I have been making my own for about 2 years now with no ill effects, using the recipe on WebWhispers. When I travel, I get a 16oz. bottle of PLAIN bottled water and use 2 packets of NeilMed Sinus Rinse. They contain only Sodium Chloride and Sodium Bicarbonate. I get them at Walgreens. I can't remember where I saw the idea, but it is easier than dealing with TSA.
Mike Cohn - 2010
12. Mike, I had never heard of the packets but am glad to know about them. I Googled for NeilMed, found http://www.drugstore.com. They have 50 packets for $10 or 100 for $13.
NeilMed • Preservative Free • pH balanced mixture. Each packet makes 8oz.
Also at any drug stores.
AWAY FROM HOME
IN THE HOSPITAL
In the orders your doctor gives the hospital should include that your chart says "laryngectomee. Total neck breather. If oxygen required, apply to neck only". If you use a TEP a note should also be attached to not remove it. The doctor's orders should also inform the respiratory service at the hospital that you will require humidified air supplied continually with a trach mask which fits loosely around your neck. Suction should also be hooked up and ready for you to use or the hospital staff should it be needed. A sign close to your bed repeating the "laryngectomee. Total neck breather, etc." would also be a good idea. And your chart should also read that you may not be able to speak. A placement close to the nurse's station is an especially good idea for larys. If the hospital has a way to remotely monitor your oxygen saturation level at any time you are sedated that is still another layer of protection since this would indicate if your stoma had become plugged with mucus.
David B. - VA
IN THE CAR
In most cars you may change the ventilation system from "fresh air intake" to "recirculation of the air." If you use the recirculation system, the humidity will increase immediately. If the windows mist up, the humidity will be near 100%, and it's time for getting fresh air intake again. May be you find the right balance just with a small opening of one window? No idea to bring a humidifier into a car!
Lorents G. - Norway
IN AN RV
We travel and live in our RV for about 4 months each winter. RV's traditionally use a propane furnace system for warmth and very frequently use a "cube" electric heater to supplement the RV furnace. Both of these heating devices take moisture from the air to well below an acceptable level of moisture. Last year we were introduced to a new space heater called the EdenPure. We were told it would not remove moisture from the air and would provide much more warmth than other heaters used to supplement the furnace. It is economical as well, using about half the electric of other supplemental heating devices.
This is our second winter using the EdenPure and I can tell you it does not remove moisture from the environment. In fact we are having to air out, even in this cold spell just to get dryer air in the RV. Cooking and showering produces more moisture than we need. We use it at home as well to heat our sun room, especially in the evenings after the sun has set.
I do not sell the product nor have any financial connections to the company.
DON'T - USE OINTMENTS
QUESTION: Dr. Peters, there was a big discussion recently in our WebWhispers online group about using ointments inside or around the stoma. What do you recommend in the use of antibiotic or antibacterial ointments
ANSWER: That's a very interesting question. I think that if the stoma has "matured" or completely healed that nothing is needed. If a raw area develops from say using your speech prosthesis then a short course of an antibacterial is indicated until the area heals. I would not recommend a routine daily use of such products when nothing is wrong with the stoma.
I can think of three reasons that routine use should be discouraged. The first thing that comes to mind is that most antibiotic ointments have a petrolatum (ie petroleum) base. If a big "glop" of that stuff gets aspirated and finds its way into the lungs then a lung abscess could result.
The second has to do with the fact that the main function of having petrolatum in a medicine is that it makes a seal on the surface. That is why we use it on a fresh wound cause it seals the bad guys out. The other thing it does though is to seal moisture and any surface bacteria IN as well. This will create a situation that is chronically "wet" and actually damage normal skin.
The last thing has to do with resistant bacteria. When bacteria are chronically exposed to an antibiotic they mutate in such a
fashion that they become immune or resistant to that drug. That is why antibiotics should always be used sparingly and only when truly indicated. The classic example of this is the horrible practice of prescribing antibiotics to treat a cold which is generally caused by a virus.
So, when you have to use an antibacterial medication to treat an area of irritation around your stoma, use it sparingly and use a water soluble CREAM that won't risk damaging the lungs.
Glenn E. Peters, M.D.
What is in Ponaris? AmericanRx.com describes it as follows:
INDICATIONS: Ponaris Nasal Emollient for relief of nasal congestion due to colds, nasal irritations, Atrophic Rhinitis (dry inflamed nasal passages), nasal mucosal encrustations, and allergy manifestations (Rose and Hay Fever). Ponaris is a compound of carefully selected mucosal lubricating and moisturizing botanical oils specially treated through the exclusive J-R Iodization process since 1931.
Exclusive Prescribed Therapy for: Colds (Sinusitis), Rhinitis (Acute, Chronic, Allergic), Post Nasal Drip, Epistaxis (Bloody Nose) = due to irritation of dried mucous membranes, Rebound sinus reaction from drugs and smog.
INGREDIENTS: Oil of pine, Eucalyptus, Peppermint, Cajeput, and cottonseed as specially prepared iodized organic oils. Total iodine 0.5% to 0.7%. Assimilable hence non-lipoid potential. Packing on sterile gauze.
DIRECTIONS: Instill half-dropperfuls in each nostril (fill to line on dropper) as needed, or as directed by a physician.
One ongoing concern for us all is the use of products designed and safety tested for one purpose being used by larys for another. Since we larys are so few in number it should not come as much of a surprise that there would not be many products specifically designed with us in mind or even safety-tested for our use. Many products which have been designed for use by non-larys to use by, for example, squirting into their noses, could be very unsafe to squirt into a stoma. The reason is our changed anatomies. For example, for a non-lary squirting a cold remedy product in their noses any excess is likely to end up in their stomachs and broken down by stomach acids and any waste products flushed out by the body's incredible waste disposal system. The lungs, on the other hand, have very limited ways to get rid of contaminants, and squirting the products into the stoma could be a health hazard.
One way the lungs get rid of contaminants is to cough things out. But we know that larys often must take some conscious steps to keep their respiratory systems functioning well with an adequate amount and flow of mucus moving upwards.
One troubling fact is that the respiratory cilia (microscopic hairs which line the trachea and bronchi) which carry mucus and whatever contaminants are suspended in it upwards and out stop functioning when the relative humidity level in the respiratory system drops to 30%. And indoor humidity can drop this low, particularly during the winter. The mucus becomes too thick to be moved at all by the cilia. So contaminants suspended in the mucus remain in the respiratory system too long, and some of these contaminants and immobile mucus are associated with several diseases including emphysema and worse.
Many of us (certainly including me) abused our lungs for decades by smoking and breathing in lots of other garbage. As a consequence, I am pretty leery of introducing anything into my lungs via the stoma other than water vapor from my humidifier and dampened stoma covers.
David Blevins, Va
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