Life With a Tracheostomy: What Can William Rehnquist Expect?
Apart from his thyroid cancer and the underlying need for the tracheotomy, in a best-case recuperation scenario, Rehnquist's tracheotomy opening -- known as a "stoma" -- will heal in about a week.
After a tracheotomy, however, normal physiology is altered. Typically, cough is weakened. Speech is changed, and because air is not passing through the vocal chords normally, it is difficult to speak normally. Speaking requires plugging the tracheostomy hole, or using a cap to cover the "stoma" or opening, a process which many experts say can require three days to a week to properly learn. Swallowing can also become difficult because of the presence of the tube, and patients need to learn how to properly swallow food and drinks without aspirating.
Early complications of tracheotomy include air leak, pneumothorax, accidental dislodging of the tube (known as decannulation), airway obstruction, and hemorrhage. Later on, the risk of accidental decannulation continues, as well as airway obstruction, infection, hemorrhage, and damage to the trachea. The patient may need ongoing suctioning in order to clear secretions that cannot be cleared by coughing. (Source: Perspectives on Nursing: Focus on Tracheostomy)
Given this situation -- as well as his underlying thyroid cancer, which as noted, some experts are speculating may an advanced or inoperable cancer -- a key question is whether Rehnquist will be able to return to the bench as early as this Monday November 1, as the Court has indicated.
About Thyroid Cancer
In 2004, it's estimated that there will be 23,600 new cases of thyroid cancer in the U.S. Of these, 17,640 will be in women, and 5,960 in men. About 1,460 people (840 women, 620 men) are expected to die of thyroid cancer in 2004. According to the Thyroid Cancer Survivor's Association, thyroid cancer is one of the few cancers that becoming more common in the past several years, with a growth rate of 3% per 100,000 people each year. Normally, thyroid cancer is considered an easily cured form of cancer, with surgery and radioactive iodine treatment eliminating the condition in the majority of cases.
The butterfly-shaped thyroid gland, located in the neck, is the master gland of metabolism, and produces hormones that help regulate the body’s use of energy.
There are four types of thyroid cancer: Papillary, Follicular, Medullary, and Anaplastic.
Treatment for
Papillary cancer is the most common type of cancer, and mostly involves one side of the thyroid and sometimes spreads into the lymph nodes. The cure rate is very high.
Follicular cancer, the second most common type of thyroid cancer, is somewhat more malignant than papillary. Follicular cancer is more common in older people. Again, the long-term survival rate is high.
Medullary thyroid cancer is the third most common type of thyroid cancer. It spreads to the lymph nodes earlier than papillary or follicular cancers. This type of cancer can run in families, and also has a good cure rate.
Anaplastic is the rarest and most serious thyroid cancer. It can spread early to lymph nodes, thus usually the cause for a visit to the doctor is a mass in the neck. It also is the form of thyroid cancer most likely to spread to other organs beyond the thyroid or lymph nodes. This type of thyroid cancer is more common in those over 65 and in men. Long-term survival rates are far less than for the other three types of cancer.
