Has Got All Clear To Remove Trach After Chemo Radiation Treatmnet, Swelling Has Gone. Should Pet Scan Be Done?

Posted on Tue, 18 Jun 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 18 Jun 2013 Answered on

Wed, 10 Jul 2013 Last reviewed on

Question : My husband has gotten an all clear to remove his trach after chemo radiation treatment. The swelling has gone down. They are are going to do this without a pet scan. should a pet scan be done?

Answered by Dr. Abhishek Sharma (50 minutes later)

Hello,

Thanks for the query.

Tracheostomy is a life saving procedure to protects the airway. However it should be removed as soon as the patient is able to breath normally and the airway is patent because if tracheostomy stays for long time then chances of complication grow up.

Now, whether or not to perform a PET scan before removal depends on when the chemoradiation was completed, physical findings of the local area and symptoms of the patient.
If you were to be my patient, I would suggest to remove tracheostomy now and get the PET scan done later.
But that is my view; your doctor would be the best judge her

'Hope I have answered your query".

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Abhishek Sharma (25 hours later)

my husband has the okay to remove trach and he will get a pet scan as per his radiation oncologist next week. He has attempted to ween of trach but he get very upset and has a fear that he will not continue breathing. He is afraid so it will be postpone until he can tolerate it. meanwhile he has developed a severe case of Lymphedema and fluid has swelled his neck really big and the track is pressed up tight against it. what can we do to make him comfortable enough to remove the trach?

Answered by Dr. Abhishek Sharma (23 hours later)

Hello,

Lymphedema can be because of radiation. In such condition do not try to remove the tracheostomy tube as it may cause respiratory difficulty.

For lymphedema you can try these after discussing with your doctor:
- Head end of the bed elevation
- Make him mobile i.e. ask him to move around
- Take mucolytic medications
- There are medicines like coumarin derivatives available which help remove edema faster. You can discuss with your doctor.

Most importantly you need to take care of the tracheostomy site. Proper nursing is required as the edematous skin gets traumatised easily by the tube.

Once the edema subsides, we may plan to remove the tracheostomy. I understand his apprehension. To make him comfortable, your doctors can replace the current tube with a smaller one so that he can breath from nose and from tracheostomy tube. Later the outside end of the tube can be closed by some attachments which are available. If he can close with a blocked tracheostomy tube, I think he will be able to gain the needed confidence. The tube can be removed with this set of actions once the edema has subsided.

Hope this helps. Let me know if you need clarifications.

Get well soon.

Regards

Above answer was peer-reviewed by : Dr. Prasad