Just when you think youve encountered every side effect that severe asthma can possibly throw at you

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It throws a new one at you.

This time its “tracheal stenosis”, or more specifically in my case, “posterior glottic stenosis”, which is basically a narrowing of the windpipe near the vocal cords, usually caused by multiple or prolonged intubations. And talk about scary, everything happened so fast. Nothing says youre gonna need a tracheostomy like Tracheal stenosis does. Here’s the story leading to the diagnosis and miracle treatment that saved me. This blog post is dedicated to the skilled and caring HEENT surgeons and specialist at UCSF.

Thinking back on it now, the condition was probably a long time in the making, but the symptoms didn’t surface until just recently. I think the first hint that something wasn’t quite right was that I never fully recovered from my last hospitalization back in Oct. Usually after a bad flare or hospitalization, Im fully recovered with in a few weeks, a month tops, but that didn’t happen this time around. For some reason my breathing never really settled down completely. I felt weak all the time and couldn’t get my stamina back up. Then about two weeks ago I noticed that when I exerted myself, even slightly, or took a deep breath in, that it was noisy and stridor sounding, not like a regular wheeze. Usually with asthma it’s difficult to exhale, but now it was also difficult to inhale. As the days went by it became increasing more difficult to pull air in without added effort. Also, my voice would always cut out when I would talk. I felt like my upper airway was obstructed, but I couldn’t pinpoint exactly where. Finally it bothered me enough that I texted my pulmonologist asking him if he could move my appt with him up to this coming week so that he check my symptoms out.

A few days later in his office, still having inspiratory stridor and now my asthma acting up, he thought I might be having some vocal cord issues , which can sometimes happen with severe asthma. So he sent me across the hall for quick spirometry to check out my flow volume loop. This can sometimes how patterns that are common for VCD ( vocal cord dysfunction). Nothing really stood out on the spirometry loop, so just to be safe he ordered some stat CT scans of my neck and lungs. Fortunately, we were about to get a same day CT appt over at the Mt Zion a couple miles away.

The CT scans took all but 10 minutes and thinking that it would take a day or two to get the results back, we headed back home. Then just just as we’re about to exit off the freeway, I get call from my lung doc. Nothing more nerve racking then receiving a call from your doctor when your driving. He said not to be alarmed, but the radiologist who read my scan was alarmed by what he saw and that I needed to head back to the hospital and directly to ER where an ENT doctor (Ears, Nose and Throat) would come to talk with about what they found. Obviously, receiving from your doctor while your driving can be a little alarming, but he told not worry and just drive slow back…..oh and don’t eat anything.

Well after a quick shower and changing of close, we head back to city. And in true bay area style during rush-hour it took us 2 hours to drive the 30 mile distance to the hospital. Poor Douglas, he was so tired of driving back and forth all day. We made it to the UCFS ER at 8 pm.

They were obviously expecting me, because when I went to register something popped up on the computer screen and the triage nurse took me right into a room. A few minutes later one of the ER docs came in and said, you have severe glottic stenosis that blocking your airway and because of your history of severe asthma and the frequent need for intubation, we think its wise for you to get a tracheostomy now before my asthma get worse. The fear being that because my airway was so narrow they would be able to get an endo tracheal tube in if I crashed with my asthma. I said WFT?? If you put a trach me how long do I have to keep it in? They said, well it might be permanent, or at least until they find a way to repair the stenosis. Wow, talk about that sinking feeling. It felt like I was being handed out an ultimatum of life with a tracheostomy or possible suffocation if I refused.

A few minutes later one of the ENT docs stopped and told me what they found on the CT scans and that she would like to take quick look at my airway and cord, which she did with a small fiber optic scope that she inserted through my nose. She had me do a series of quick sniff and E sound, and swallowing. Within a minute she was done and news wasn’t good. The stenosis was worse then they thought. There was at least a 50% occlusion and one of my vocal seemed to tethered to some scar tissue underneath. The only way to fix this is by dilation surgery , which usually required tracheostomy before the procedure can be done. Again, I asked , will the trach be permanent? The response again was, we don’t know. She said that because my asthma was also acting up that they would admit me to the ICU for observation overnight and would brainstorm with her collogues and would stop to see in the morning.

So this is the part of the story that I consider miraculous . The following morning Dr Russel and his team arrived at my bedside and unveiled there plan of action. Describing in great detail with illustrations and an actual video of my airway, of what was going on with vocal cords and glottis, and knowing my feelings about tracheostomy, they told be about an innovative technique that one of their Otolaryngology docs had invented that would allow them to work on my throat without needing a tracheotomy. Because the type of stenosis I had was significant, but in the early stages, that I would probably be a good candidate. Not only that, but that I would be only the 2nd person to ever have the surgery done using this new technique.
Well, of course I said. Lets do it!

But here is the amazing part and probably best example of teamwork and communication I’ve ever witnessed. When I asked when’s the soonest we could do this, the head surgeon said, we’re a little worried about your current asthma status ( I was on continuous nebs at the time), but we’ll call your pulmo and if he thinks you’re stable enough, well do the surgery today, how’s that? Its a deal I said. I swear, within 3 hours of that conversation I was on the OR and the surgery was finish. After a short recovery period ( and a brief episode of psychosis which always happens to me when I’m steroids and anesthetics at the time), I was back in my ICU bed breathing deeply and effortlessly again. I cant tell you how good it felt.

The fact that they were able to pull off this procedure without a hitch is nothing short of amazing to me. Then again, UCSF has a lot of smart and innovative people working for them so I guess its not that surprising. The particular procedure they performed on me ( posterior sub glottic dilation using the teardrop method) has only been one on one other patient. Lucky for me I was at the right place at the right. Had I waited much longer to get this problem checked out, I might have a hole in my neck or not be around at all. They found that 75% of my airway was occluded. It was literally the size of a baby straw.

Before leaving hospital they scoped my airway one more to make sure everything looked ok. Here’s actual VIDEO

Finally, a picture of me breathing in normal again after the surgery.

It’s now my first day out of the hospital and second day since the surgery, and other than a mild sore throat and achy tongue and mouth, Im doing great. My asthma is not back to baseline yet, but at least I can inhale easily now. Going forward I have to be rescoped every few months to make sure there is no more scar tissue developing, but hopefully it will stay gone.

(Here’s a good illustration of the anatomy of the human airway to give some perspective.)

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