Six Years Later

Six years ago today is when I got my tracheostomy tube.  February 24, 2007 I was back in hospital for the 3rd time with worsening respiratory condition from high CO2 buildup.  I was intubated in emergency and then on February 28th I had surgery to put in my trach tube.  I have blogged about this before around the anniversary.   Now six years later I am quite used to the trach and continue to use a ventilator at night.  At first I got the trach tube changed every 4 weeks, and now every 6 weeks and have had this done over 50 times now so it is getting quite routine.

In the picture above, cuddling new granddaughter Li'l E, you can see the connection to my trach tube with a heat and moisture exchanger (HME)  and oxygen tubing.  The HME is also known as a "Swedish nose"  apparently since the inventor was Swedish and it has the same function as your nose with filtering the air and retaining humidity.  When I go out I wear a speaking valve with a scarf over it but at home it is more comfortable with the "Swedish nose."
         
Last week I had an appointment with the ear, nose and throat (ENT) specialist who examined around and below my trach tube with his bronchoscope.     This was a follow up appointment after being in hospital in November.  He was very happy with how well healed everything looks in my trachea and the stoma opening for the trach tube. 

As I think back to how I was 6 years ago, I thank God for His goodness and for the health He has given me each day.

High Tech Breathing

I have been using a respiratory ventilator at night for over 5 years since I was in hospital in 2007.   I had respiratory failure from high CO2 buildup in my blood.  I have had several blog posts about this, and have been using the same model of ventilator at home each night since I was in the hospital.  

For the last 5 years I have used a Phillips Respironics PLV-100  ventilator set for respiratory volume assist/control.   This ventilator model is out of date and no longer supported by the manufacturer.  It is a simple and reliable machine, sometimes with a few clunks, honks and rattles, but it just keeps puffing along.   The family says I sound like a steam engine.  It is a pretty rugged machine and I told the respiratory therapist it looks like it was designed to mount in the back of an army truck.

Then earlier this year we got the news that the provincial health department  had approved the purchase of new ventilators.  Mine came yesterday and the respiratory therapist was here to get me going using it.

 The new machine is a Covidien Puritan Bennett 560  ventilator which is the latest technology.   I used it for the first time last night.  I woke up after sleeping one hour and then had some trouble getting used to the new machine before sleeping and waking several more times.  After being used to the feel and sound of the old machine it takes some getting used to sleeping with the new one. 

The old ventilator we called a "steam engine" with the sound of a large piston  cycling back and forth with each breath.  The new machine has  a variable speed micro turbine that has a varying higher pitched whirring  sound with each breath.  The feel of the breathing cycle is different as well.  Hopefully tonight will be better as I get used to it.

One big advantage of the new ventilator  is that it is much lighter to take with us when we travel.  It just has a zippered soft  case with a shoulder strap for carrying.  The old one had a large heavy steel framed shipping case.  Not having to take the old heavy ventilator in and out when we travel will make Elaine very happy.  We will get to try out the new ventilator when we go away for the upcoming long weekend.
 

  

Trach Examination

I had an appointment at the hospital yesterday for an examination related to my trach  by my ear, nose and throat (ENT) specialist.  I had a problem with a trach tube and it had to be replaced two weeks ago, and now to order new customized trach tubes for me the respiratory therapy department at the hospital needed a prescription from the ENT specialist.  I was to have an appointment at 4 PM yesterday, and at 6:30 we were still in the waiting room.    The doctor came out and talked to us to explain the delay that some of his equipment had not been sterilized since it had been used and he was waiting for that.  He is a very nice man and the staff at  the hospital keep telling us that as well.    When we were called into a hospital room and the nurse heard which doctor we would be seeing she said "He is a very nice man!".  We said "Yes we know that."    The nurse told us this ENT doctor did her 6 year old daughter's tonsillectomy.  Her daughter was afraid but the doctor was so nice talking to the girl about the surgery,  and now her daughter thinks the doctor is pretty well her new boyfriend.  

Finally the doctor came to do his examination and he had the bronchoscope with him.  He has done examinations in my airways with a bronchoscope several times before.  I posted on my blog back in 2008 that it was like having a microscope up my nose.  This time he did not go up my nose and around the sinuses and back down to the trachea with his scope.  He pulled out my trach tube and put the scope into the trachea through the stoma (the opening in my neck for the trach tube) and pushed the scope's fibre optic tube down my airway.

Bronchoscope inserted in the stoma (opening in neck for trach tube) to examine the trachea 

He had first sprayed anesthetic to freeze the area so I would not cough from the scope.  He was looking for any granulation  which would be scar tissue or sore areas caused by the trach tube. He was very happy that the trachea looked very good.    Then he got Elaine to look in the scope while he moved it to show inside my trachea.  He said "See how good it looks."   Everything has healed up well and the trach tube is not causing any soreness or scar tissue.   This confirms the respiratory department should order trach tubes of the same type and size for me.    Overall I felt very good about the results of the examination. 

When we were leaving the doctor asked if I would be willing to talk to some of his other patients that will likely need a tracheostomy.  I remember how uncertain I was 4 years ago not really understanding what it is or how it would affect me.  I have done this before for another specialist who asked me to talk to some of his patients.   I said I would be glad to do this.  He said he will call me when he has something arranged to have me visit someone who is in hospital now needing a tracheostomy.   I hope my experience can be an encouragement to someone else.  

    

Birthday Balloons

We just got home yesterday evening after being away 4 days visiting Elaine's parents and other family at the farm.   We had a great time there and a good trip home.   Yesterday was my birthday but we were mostly just traveling and had already celebrated my birthday early.   While traveling I started having problems with my trach tube.  It has an inflatable cuff (the light blue balloon that is down inside my trachea) that I deflate during the day and inflate at night to connect to the ventilator.   As shown in the pictures below there is a tube with filler valve (dark blue) that sticks out that I use to inflate and deflate the balloon cuff using a syringe. 

While traveling I would take air out of the cuff with a syringe and a few minutes later the air would leak back in restricting my breathing.  At night when I inflated the cuff to connect to the ventilator it would not stay inflated, the equivalent of a flat tire in my trachea.  I was not able to use the ventilator to assist my breathing for the night and got very little sleep.  So first thing in the morning I phoned the respiratory therapist (RT) to arrange a  trach tube change.  Usually I have trach changes at ambulatory care (out patient rooms)  at the hospital every 6 weeks.  Rather than arrange this at the hospital on short notice, the RT phoned back and said he will be right over to my house to do the trach change.   He was at my house in 20 minutes with new trach tubes and all his supplies and had the procedure done in short order.  Now that is real health care service.

   

Trach Anniversary

It is 4 years now since I was in hospital with respiratory failure from high CO2 retention.    It was February 24 2007 when I was back in the hospital for the third time and in critical condition in intensive care.   I was intubated to help my breathing with a ventilator and then on February 28th I had surgery to put in a trach tube.  I have continued to use a  ventilator at night which has helped to stabilize my CO2 level. 

I recently had my 35th trach change which is hard to believe. At first I was back for a appointment to get my trach tube changed every 4 weeks.  Then it was lengthened to every 6 weeks.   It is done at ambulatory care by a respiratory therapist (RT).  Elaine has assisted with every one of those trach changes  including at the beginning when it was done by a ENT specialist.  Once the doctor got Elaine to do the trach change herself but she would prefer to assist.   After 35 times they are becoming fairly routine but I am a difficult customer due to the extreme bend in my trachea caused by kyphoscoliosis.  I have custom Bivona silicon hyperflex trach tube that can follow the curvature of my trachea.  

I also recently had a checkup with a respiratory specialist and he was quite pleased that my lung condition is remaining stable.   So I have a lot to be thankful for.    Again I thank God for his goodness and everyone for their prayers.

Custom Office Chair

In 2005 I had an ergonomic assessment by an occupational therapist at my office where I work.  Ergonomics means the science of designing the job, equipment, and workplace to fit the worker. As an office worker up to 70% or more of my time is spent at my desk using a computer. The occupational therapist examined how my body size and shape fit the chair and desk while using the computer keyboard and mouse, and the viewing angle for looking at the computer screen. As a result of this assessment she provided a report with several recommendations.

After having polio at about 18 months in 1955 I developed kyphoscoliosis of my back starting at about age 7 and progressing as I grew. The kyphoscoliosis is an outward curvature of the right side of my back in addition to a double S-shaped lateral curvature. I am thankful that over the years I have not had as much back pain as many people with back conditions. However in about 2004 I started to have a lot of pain in my lower and upper back and right shoulder. I tried unsuccessfully to use additional cushions with my chair. But a standard chair does not fit my body shape or provide proper support. In the ergonomic assessment the occupational therapist recommended that I get a chair that is more adjustable than the standard office chair and investigate getting a custom made back cushion to fit my back.

I researched available chairs, visited office furniture dealers, and tried out three different ergonomic office chairs available at that time; Herman Miller Aeron, Teknion Contessa, and Steelcase Leap. The recommended features from the ergonomic assessment included: seat adjustable depth, back material either customized, or somewhat flexible material, adjustable seat and back height with back height to support shoulder blades, height adjustable armrests, with 5 prong swivel pedestal base. I evaluated a Steelcase Leap chair for a week in my office and concluded it was the most suitable for my particular needs.

I was referred to an assessment by a team including a physiotherapist, occupational therapist and seating technician. They concluded it would be feasible to customize a seat back cushion to fit and support my back, and install it on the ergonomic office chair. At a later appointment they had fitted a plastic bag arrangement on a modified chair back frame. As I sat in the chair, the seating technician poured liquid foam material into the plastic bag to fill the area around and behind my back. This then solidified into a cushion the shape of my back. They later upholstered the moulded chair back cushion to match the seating material. The finished chair is shown in my office in the pictures, where I have been using it for the last 5 years.

There were number of other recommendations in the ergonomic assessment in 2005 that were implemented and quite helpful.   I got a flat screen monitor that could be moved farther back and lowered down to give a better viewing angle.  A  keyboard shelf was made for my desk to give the right height.  And I switched to using the mouse with my left hand as seen in the picture.  I am right handed but using the mouse was aggravating the pain in my right shoulder.  Switching to the left hand also allows the mouse to be closer to the keyboard since the numeric keypad is on the right.  For 5 years now I have been using the mouse with my left hand at work and my right hand at home.   It came quite naturally and I do it now without thinking about it.

I am now writing an article about the ergonomic assessment and my custom office chair for a newsletter of the polio organization I am involved in.  So last week I took some pictures of the chair and someone took pictures of me sitting in it.   It is pretty unique and I hope it will be of interest to others.
 

No Place Like Home

Today April 13 is a memorable date for me since it was exactly 3 years ago today that I was able to come home from hospital after being there for 7 weeks.  In January and February 2007 I had already been in hospital twice for 10 days and for 7 days.  Then I was back in critical condition with complete respiratory failure at the end of February and was there until April 13 recovering.   I can't really express how happy and thankful I was to be able to go home.  I was very well cared for in hospital but as I titled this post there is "No Place Like Home!"  

Today I had another trach change. One trach tube is removed and the other one which I have cleaned and sterilized is inserted.  I have posted previous updates with the label Health about my trach and using a ventilator at night.  Today's trach change was the 28th time since I was home from the hospital. (But who's counting?)  They used to be every 4 weeks and now they are extended to every 6 to 7 weeks.  I like the respiratory therapist who does them now.  The procedure is becoming fairly routine and I am usually only at the hospital for about a half hour.    

As I mentioned in my previous post I saw the respiratory specialist doctor last week.  He very happy about how I am doing and said I can come back in 2 years to see him again. Another indicator of my respiratory condition is that I used 1/2 the amount of oxygen in the last year than I was previously using. All in all I thank God for His goodness and all the people praying for me.  

Three Years Breathing Easier

On February 24, 2007 I was in hospital in critical condition with respiratory failure and then on February 28, three years ago today,  I had my tracheostomy to help me breathe easier.    I posted updates  one year and two years  after this and other reports on my health.     Now I have had a trach and been using my ventilator at night for three years.   And my respiratory condition is stable.  In fact in the last year I have reduced in half the amount of extra oxygen I use.    So to mark this third anniversary I want to thank everyone once again for their prayers and thank God for his goodness.

H1N1 Flu Shot

I went and got my H1N1 flu shot today.   I posted some information about the H1N1 vaccine last month when I got my seasonal flu shot.   The H1N1 flu shots were being made available in stages  to groups the health department considered higher risk, starting with children and pregnant women.  This week it opened up for people under 65 with chronic health conditions.  

The health department had taken over a building which was a former high school for the H1N1 vaccinations. Since I saw on the news that there had been long line ups at that location I was planning to wait until later in the month when flu shots may be given at the building where I work.   Then this afternoon a woman that I work with phoned me on her cell that she had just gotten her flu shot and there was no line up.  So I went straight down there.  Sure enough there were enough people on duty to handle hundreds of people and I was able to walk right in and get my flu shot with no line up.        

Everything You (Didn't?) Want To Know About Flu Shots

I got my seasonal flu shot last Thursday as I have done for many years.   This is for the typical varieties of influenza that go around each year, not the new H1N1 influenza which will have a separate vaccination.  Some previous years I felt some soreness afterward but none this time. 

There has been a lot of discussion in the news and at work about the potential H1N1 influenza pandemic and the vaccinations for it.   A recent survey reported on the news said that 50% of Canadians are not going to get the H1N1 flu shot due to various concerns.

One of the concerns about the new H1N1 flu shot is that it has an extra additive called an adjuvant that the seasonal flu shot does not have.  An adjuvant is an additive that helps stimulate the immune response and increases the effectiveness of the vaccine. The adjuvant in the H1N1 vaccine to be used in Canada contains squalene oil, vitamin E and an emulsifier.   Squalene is a natural substance in every plant and animal, and in our bodies it is manufactured by the liver and circulates in our blood stream.  If you Google squalene you will get many many hits from the scientific to the conspiracy theorists.    One controversy is a claim that it was the cause of Gulf War Syndrome among soldiers given flu shots is in the 1970s.  Others are concerned because it is something new and unfamiliar.  Reports by the World Health Organization about squalene adjuvants say they have been used safely in vaccines in Europe for many years. 

The tests with the the new H1N1 vaccine with squalene adjuvant show it can give more chance of soreness or pain in the arm where it is injected.   Other serious reactions are very rare as with other flu shots.  But more importantly has been observed to be more effective than the standard flu shots.

Another concern is that the flu shots contain thimerosal  a preservative containing mercury.   But the amount of mercury is less than the approved safe level for one can of tuna.  The new H1N1 flu shots have less mercury than the regular seasonal flu shots.

The US is using a different H1N1 flu shot than Canada with no adjuvant.  Their rationale is that without the new ingredient it could go through testing sooner and start production.  If the H1N1 influenza turns out to be less severe they feel the higher effectiveness of an adjuvant will not be needed.  However if the H1N1 virus mutates and becomes more dangerous they have some adjuvant available to add to the vaccinations.  The same as Canada the US vaccine is made from killed virus material.  However the US also has weakened live virus nasal spray vaccinations for healthy adults.   You could get influenza from the nasal spray but not from the flu shots with killed virus.     

I am someone who likes to be knowledgeable about whatever medication I am taking.  And I am basically an inquisitive fellow so I researched the ingredients of the new flu shots.   Even with some of the uncertainties I am still planning to get the H1N1 flu shot when it becomes available.  But I am still trusting God as the primary protection for my health.

A Very Nice Man

Last night Elaine and I were visiting at the hospital again. When I was in the lobby, waiting while Elaine parked the car, my Ear Nose and Throat (ENT) specialist saw me and came over with a big smile on his face. I used to see him regularly for trach changes and other examinations, but in the last year things have been going very well with my trach and I haven't had to see the ENT specialist.

When the doctor came up to me last night he said "I haven't seen you for a long time." I told him that I have been doing well with no trach problems. He said "But I have missed you." He did not remember Elaine's name and said "And how is Mrs?" He is very friendly person, originally from South Africa, and always has a smile and makes you feel good just talking to him.

In the past when I have gone to the hospital for an appointment with him, when I said which doctor I was there to see the woman at admitting said "Oh he is such a nice man." And the nurses also said to me that he is a very nice man. And when he was examining me he took the time to explain everything to Elaine and I, as well as showing nurses who are in training. No wonder the staff at the hospital like this doctor so much. Some specialists are just short and "crusty" when they talk to the patients or staff. But this specialist is so good. Last night as the ENT specialist was leaving he told me to call him any time and he will meet me if I need a trach change and my regular RT is away.

Each time when I have visited at the hospital I have seen nurses who remember me from being in hospital in 2007. Last night I talked to one of these nurses who was so happy to see how I am doing. They are so glad that I am just there as a visitor and not a patient. And so am I.

Good Air In - Bad Air Out

It has been exactly two years now since I was first in hospital due to respiratory problems with high CO2. The lungs taking in oxygen is critical to life. But just as critical, or maybe more so, is to get rid of the CO2. High CO2 can lead to the blood becoming more and more acidic causing organ shut down and death.

I had an appointment today at the hospital for a checkup with a respiratory specialist. While there I had an arterial blood gas test. It had been a year since my last test. This is different than a normal blood test which takes blood from a vein. The blood from an artery (in my wrist) is analyzed to determine oxygen and CO2 content and PH (acidity level.) Basically the results are that my CO2 is still under control. In fact he said my oxygen level is too high! He told me to cut in half the amount of supplemental oxygen I am using. If oxygen is too high the lungs think they don't need to get rid of the CO2. I don't need to go back for another test for a year.

All in all I am very thankful to God for my health today compared to two years ago.

Trach Change # 17

I just had a trach change for the 17th time (but who's keeping track?) since I was in the hospital early last year. At first I was having trach changes once a month, but now we have extended it to 6 weeks. I really like the Respiratory Therapist who does it now. The process to take one tube out and put the other one in only takes a few minutes. It doesn't usually hurt but does cause quite a bit of coughing.

I am still reusing the same 2 trach tubes. I clean the one that comes out, and have it ready for use next time. I just soak it in soapy water and then put it into boiling water to sanitize it. The trach tube is a Bivona Hyperflex Aire-cuf made of silicon with wire reinforcement to keep the tube from kinking when it bends. It is 11mm OD and 8mm ID and 95mm long.

These are two pictures of the trach tube that just came out. One with the cuff deflated like I have it during the day, and one with the cuff inflated like I have at night. During the day air can go around the outside of the tube through my vocal cords, and through my mouth and nose. With the cuff inflated at night the trachea is sealed off so the air from the ventilator goes directly to my lungs, and none escapes through my mouth and nose. Then I can only talk with a whisper. But I talk anyhow and make Elaine guess what I am saying.

All in all there are some inconveniences and irritation from having a trach tube, but there is no question it is helping me breathe better.

The Breath of Life

Genesis 2:7 "And the LORD God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a living soul."

Breathing is fundamental to life. If we do not take in sufficient oxygen or get rid of CO2 it affects every part of our body. For this reason I have been using a ventilator at night to keep a proper balance of oxygen and CO2 in my system.

There are types of ventilators that give Positive Airway Pressure support, called CPAP and BIPAP. I used a BIPAP machine for a while in January/ February 2007 but my condition continued to worsen and I need the extra support of a volume ventilator.

The ventilator I use is called a Respironics PLV 100. It is called a volume ventilator because it gives a measured volume of air on each breath. At night it is connected through a hose to my trach tube. It is set to give me 0.37 liters of air on each breath for a minimum of 10 breaths per minute. Room air is about 20% oxygen, but extra oxygen is added to the ventilator air to bring it up to 30%. The machine I have on a bedside table looks like this picture:

I found a video of what the ventilator looks like internally. I have always been fascinated by how things work. There is a microprocessor that controls a motor driven piston to give a measured volume of air on each breath. In the video you can hear the rhythmic breathing sound similar to what I have while I use it at night. After about 20 months of using it every night I have gotten quite used to the sound and feel of it. Elaine has also gotten used to it and can pretty well sleep through it. And I am thankful that each night it helps me get a sufficient level of the "breath of life."

Nasty Bugs

Today I was at the hospital for an examination and a trach change by the Ear, Nose and Throat (ENT) specialist. Usually I have been having a trach change about every 6 weeks by a Respiratory Therapist. But I had an examination by the ENT specialist about 4 months ago, and he wanted to check how I am doing.

On my previous examination, the ENT specialist said I had some pseudomonas around the opening in my neck for the trach tube. This is a type of bacteria that naturally occurs in the soil, in water, and on plants, and is normal to have on your skin. But it is a very nasty bug if it gets into your lungs because it is very resistant to antibiotics. And the risk with a trach is the direct opening into the lungs where it could get in.

At my examination 4 months ago the ENT specialist prescribed that I use 3% acetic acid drops (vinegar is 5% acetic acid) on the neck area around my trach tube. This is supposed to get rid of the pseudomonas. This is not pleasant but preferable to the nasty bugs deciding to move down into my lungs.

Elaine has been using drops of oil in her ears. Janny told me not to get my vinegar mixed up with the oil or I will end up with salad dressing on my trach. I get no sympathy.

But the good news is that today the ENT specialist said that the area around the neck opening for the trach tube looks very good. No sign of nasty bugs. However I will still use the acetic acid drops once in a while to prevent any deciding to take up residence again.

Another Trach Examination

Today I had another examination by the Ear, Nose and Throat (ENT) specialist including having my trach tube changed. My last trach change was 6 weeks ago in early May. When the ENT specialist examined me at the end of March (which I referred to as having a Microscope up my Nose) I had been having a lot of pain in my neck area around the trach. I am thankful that pain is completely gone. The ENT specialist says that area looks quite good now. The surgery that was scheduled has been cancelled.

The ENT specialist was also going to schedule me for a Cat Scan to examine the source of the pain in my neck area. So I studied up on the Cat Scan technology as shown in the diagram below. Since the pain is now gone it is probably just as well that examination is now cancelled.

Trach Change

I just had another trach change on Tuesday. I have two identical trach tubes. Every 4 to 5 weeks one is removed and the other one is put in. Then I clean and sterilize the one that was removed, ready for use next time.

I have been having the trach changes done each time by a Respiratory Therapist (RT). Except when there is a problem and the Ear, Nose and Throat (ENT) Specialist does it when he examines me, as in my previous post on having a microscope up my nose.

Ky was coming over for supper on Tuesday. I offered that if she came over early she could do my trach change. But she didn't come in time so I went down to the hospital and had the RT do it. Actually one time last year the ENT specialist got Elaine to do the trach change. He wanted her to have the feel for it in case there was an emergency with my trach being blocked. I was proud of how cool and calm she was.

I was experimenting with the web cam and made a little video showing the trach tube. The part of the tube that goes down my trachea is 9.5 cm long. It has a "cuff" at the lower end of the tube, shown as the light blue balloon part. At night I inflate the cuff and the trachea is sealed around the tube to only allow air through the tube. During the day I deflate the cuff and air can go up past my vocal cords and through my nose and mouth. All this is becoming quite routine to me since I have been doing this for over a year now.

Another Milestone

At the end of February I posted when it was One Year Later after being in hospital in critical condition. As of today, April 13, I have reached another milestone. It is now one year since I got out of the hospital after being there seven weeks.

I am very thankful to God for the measure of health I have had in the last year. And I am looking for further improvement.

Microscope up my Nose

I was examined by the Ear, Nose and Throat specialist this afternoon because I have been having pain in the area around my trach. He used a bronchoscope to examine me. I referred to it as having a "microscope up my nose"



The doctor started by shooting freezing spray up my nose, into my trach, and all around my neck area. The bronchoscope is like a microscope with a long thin fibreoptic tube. He was very thorough in examining with the scope into my trach all the way down my airway (trachea) to the connections to the lungs. Then came the "fun" part. He put the scope up my nose like in the picture. The tube went up through my sinuses around and down past and tonsils and through my vocal cords back down to the airway to my lungs.

There were two student nurses watching the doctor and they had to take turns looking into the scope as the doctor examined each part. Elaine had her turn too. I should have been charging admission! I surprised one of the nurses when I talked while she was looking at my vocal chords with the scope tube down between them. (By the way talking with frozen vocal chords is strange.)

The good news is the doctor did not find any serious problems. He said I have "peristoma granuloma and neuroma." In simple terms I have a sore spot with a bundle of nerve endings in my neck opening (stoma) that the trach tube rubs against. He wants to put me on a waiting list for surgery to repair this. He says it is not urgent so it could be 1 to 3 months. I am in no rush and I am trusting this will be healed up before any surgery is needed.

All in all having a microscope up my nose wasn't that bad. Doctors have a lot worse places they can put scopes.

One Year Later

It is now one year ago that I was in hospital in critical condition and an urgent prayer request went out on my behalf. I had been in hospital last year about 10 days in January, another 10 days in early February with worsening respiratory condition, and then back in hospital with respiratory failure later in February. My oxygen level dropped to 31% and my carbon dioxide level was 3 to 4 times the limit. High carbon dioxide leads to being incoherent, then unconscious, and then to death. I had been getting more incoherent over the previous weeks and was slipping into unconsciousness. While I was in critical condition a specialist was telling my wife how serious my condition was. She told him that many people were praying for me and the doctor said "That is what he needs." PRAISE GOD for he hears and answers prayer and breathed into me the breath of life. He also gave wisdom to the medical team and I ended up with a tracheostomy and on a ventilator to help keep my carbon dioxide level under control. I appreciate so much all the messages expressing your prayers for me as I was there recovering until mid April. I improved quite well and was able to go back to work part time by June. I still have a trach and use the ventilator at night to improve my breathing while I sleep. I recently had a test which showed that my carbon dioxide level is still under control. Praise the Lord for his goodness.

I still have some ongoing health conditions but thank God for the great measure of health improvement he has given. Philippians 1:6 (KJV Bible) "Being confident of this very thing, that he which hath begun a good work in you will perform it until the day of Jesus Christ." Praise God he has begun a good work and will complete the work through Jesus Christ. Glory to God.