Woof! A lot has happened since Betty had her surgery almost 2 weeks ago and since I last posted after her jail break from the hospital (just a mere 36 hours after her total laryngectomy, no less!).
For the first 5-6 days post-op, she was cared for by her primary ENT surgeon, Dr. Peter Belafsky, and his wife Angela. This was no small effort on their part, especially Angela, who took on the bulk of her care. She could not have been in more loving and expert hands, as Angela is both a live-long animal lover and a skilled ICU nurse.
What did her post-op care entail? Multiple daily trach changes, four daily tube feeds, plus lots of snuggles and even more supervision.
About the trach?
Post-total laryngectomy, Betty now breathes solely through a hole/opening in her neck, called a stoma, that was surgically created and from the moment she left the OR was both actively healing and trying to close. She has had a trach tube in place since surgery, held onto her neck by a "trach collar" - a soft, thin fabric collar that attaches to each side of the trach tube.
For humans post-laryngectomy, that stoma heals over time and ideally can be kept open and free from tubes for periods of time. In order for this to be true, the stoma has to be able to maintain its structure (i.e. remain open). The circular opening of the stoma needs to be rigid enough to allow easy passage of air, since after a laryngectomy, there is no other way to breathe.
In Betty's case, she needs a trach tube all of the time. Currently, that is at least partially due to the fact that her stoma is "immature" (still healing), however she is a dog with a long neck that has soft skin folds that jeopardize the structural integrity of her stoma. If her tube falls out, the stoma can immediately collapse causing her to be unable to breathe. In addition, because of how her neck moves and the fact that she rolls around on her back, bolts across the yard and jumps up and down far more than her typical human counterpart, it is hard for her trach collar to keep the tube in just the right place.
Betty and Angela discovered this the hard and anxiety-provoking way when Betty began obstructing (couldn't breathe) overnight while sleeping. Angela, acting fast, replaced the tube, but was alerted to the fact that Betty always needs company to prevent this from ever happening without someone available to re-establish her airway (let Betty breathe!).
The trach tube has popped out numerous times in the last week - both day and night. Each time that happens, Betty is promptly flipped on her back, her stoma is opened (by pulling down on the skin below it) to give her the opportunity to breathe and her trach tube is replaced. Fortunately, Betty is a champ and willingly flips on her back and she bestows numerous thankful licks on whoever the loving caregiver is that slips that tube back in. Interestingly, Betty also seems to understand that when that tube pops out she needs help, since she has on several occasions calmly walked over to Lauren or Angela, trach tube dislodged, silently asking for assistance (remember she is mute now!).
In addition to trach-watch-2022, Betty's stoma has required twice daily care to help ensure it is cleaned, healing well, and free of debris. The stoma care also includes cleaning the trach tube as things can collect inside of it making it a bit harder for dear Betty to breathe (this involves a trach tube exchange, take one out, insert a differet one, clean the original).
We are actively trying to problem-solve better ways for Betty's trach tube to stay in, so that she can have a bit more freedom, however the solution is not easy to find. We have been daydreaming innovative ways to adapt her trach such as Betty having some fashionable neck piercings to anchor her trach collar and prevent it from slipping, or finding some tech-savvy person to 3D print her a custom fit trach tube. We welcome all tips and ideas! In the meantime, Betty always has at least one person in her company who is ready and willing to come to her aid should she need it.
What about that feeding tube?
As you may recall, Betty had a feeding tube placed about 3 weeks prior to surgery to help prevent ongoing aspiration and allow her lungs to heal from aspiration pneumonia. Lauren was an amazing co-dog mom and godmother to Betty, helping to maintain her nutrition with tube feedings four times per day all the way up to her big surgery day.
Betty's tube feedings were restarted the day after her laryngectomy. True to form prior to her surgery, she required four daily feedings (each taking 20-30 minutes, hand-pushing dog food slop through a syringe) and this time Angela was the tube-feed guru. (Both Lauren and Angela will attribute future bouts of carpal tunnel to their devotion to Betty during this time)
The goal of Betty's laryngectomy was to prevent aspiration and endless bouts of pneumonia by rerouting her trachea away from her esophagus. Her ability to eat, however is still reliant on the muscles of her throat allowing to food to pass to her stomach without endless regurgitation and reflux. The myectomy performed as a part of the laryngectomy (removing her cricopharyngeus muscle at the top of her esophagus) was the only treatment that could give Betty a shot at eating by mouth like a normal pup.
The first week post-laryngectomy required Betty receiving her nutrition solely by g-tube (to allow her surgery sites to get a jumpstart on healing prior to introducing any food past her internal surgical incisions). Successfully eating by mouth was not a given. Her entire medical team and family eagerly awaited the morning when she would be given her first opportunity to eat some soft (mashed) dog food.
"Breakfast with Betty" happened last Tuesday, July 5th, at the home of the Belafsky's. Her humans had coffee and pastries on hand in anticipation of an eating-by-mouth celebration. Two of her surgeons, her trio of co-dog moms (Lauren, Angela, and myself!), her baby sister Dot, three additional human cheerleaders and three dog cheerleaders all watched with bated breath as she got her first meal and...she excitedly ate like a champ! First time in sweet Betty's life that she ate without choking. There wasn't a dry eye in the house. Cheers, hugs, tears, it was a whirlwind of emotion and Betty just sat and begged for more!
Since then, she has required no feeds by g-tube and she has successfully kept all of her by-mouth meals down (with the exception of regurgitating some food if she is excitedly interrupted, surprised or distracted when eating). If all goes as planned, she will get her feeding tube removed this coming Wednesday after having a repeat swallow study back at UC Davis.
Currently, Betty is getting her meals supplemented with cottage cheese and vanilla Ensure to make sure she gets as many calories as possible. She is trying to make up for lost time and we are trying to fatten her up!
The Healing Bottom Line
Betty's journey from total laryngectomy to her "rehab" stay at the Belafsky's and back to Reno with Lauren has proven that Betty 1) so many people have fallen in love with Betty and her amazing story and 2) that she is healing better than we could have expected (that's where the title "Pluripotent Betty" comes from).
Despite the roller-coaster ride and steep learning curve of her trach care, her stoma and the long, horizontal incision farther up on her neck has healed remarkably well (her stitches came out last Thursday). Her energy has come roaring back, she is as joyful as ever, and she is frequently chasing her doggy friends around the yard. She is still just as snuggly and seemingly grateful for her care team. We couldn't have asked for a better outcome!
Will fill in more details about Betty's first two weeks post-op in future posts, including her amazing visit to UC Davis Vet School for her grand rounds presentation, so stay tuned.
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