This morning’s meeting was a bit of a mixed bag. We were afraid that we would be told that there was nothing that could be done. That was not so.
There are a range of options, the simplest is to use a balloon dilation to try and push the tissue growth out of the way, squashing it to a size where it does not interfere so much with his breathing. Next was the possibility of fiddling with the size and length of the trachy, which is what we have done in the past, and which does work, but past experience shows that this is only a temporary solution as eventually either a granuloma forms at the end of his trachy or he has tracheal collapse beyond the tube if it is too short. Another option is to surgically remove the offending object. The possible problem with that is that it may be part of the tracheal wall, being pushed in by the tumour, and if it is removed, that would obviously pose problems later on when/if the tumour regresses.
If push comes to shove, they could operate to remove the tumour that is around his trachea, leaving behind the majority of the tumour in his neck, but relieving the immediate threat to his airway. This option carries with it very severe risks. The assessment between the (4) consultants involved was that this procedure would carry a 50:50 chance of Max dying on the operating table. Further, even if he survived there is every chance that some of the nerves that control swallowing and the diaphragm, which pass close to the trachea, might be damaged. Given that it is unlikely he will be able to swallow anyway, that is less of a concern, however if the nerves that control his diaphragm are damaged, then he would never be able to breathe without the assistance of a ventilator.
Similar to last week, we briefly discussed the quality of life for Max going forward from any of the possible procedures that may need to be done. To help in any decisions that need to be made, a neurologist will come and assess Max (although, given that he is totally sedated and paralysed, I am not sure what they would be able to ascertain).
It transpired later in the day that there are very few people who can carry out a balloon dilation in the airway, and those that can do it are out of the country at the moment. It has therefore been decided that they will concentrate on treating Max’s infection, and try and bolster his immune system – get him to a stage where he can more ably cope with a dose of steroids which has proven successful in the past at helping him turn the corner in situations like this. Also, to get him to a stage where he can cope with a general anasthetic so that a) his hickman line can be replaced so he can continue to be given his original cocktail of chemo drugs, and b) so that a balloon dilation can be carried out next week if it is still felt that that would be useful.
It is hoped that a combination of more of the same and steroids will allow Max to come off the ventilator, as his current situation, whilst stable, is quite precarious.