Scar serves as a show-and-tell les­son

The News-Times - - ADVICE / GAMES - Keith Roach, M.D.

Dear Dr. Roach: For 58 years, I’ve been walk­ing around with a vis­i­ble tra­cheostomy scar on my throat, lead­ing the cu­ri­ous to ask: “Yuck. What hap­pened there?” My an­swers have changed over the years, but were usu­ally some­thing like: “I was 4. A doc­tor had to cut my throat open so I could breathe.” But now, I don’t wait for the ques­tion. Lately, my scar has helped me do some show-and-tell about what causes this near-fa­tal clos­ing of the wind­pipe and why doc­tors don’t see kids dy­ing from Hae­mophilus in­fluen­zae any­more. Could you elab­o­rate?

M.A.P.

An­swer: Hae­mophilus in­fluen­zae (of­ten called H. flu or Hib), de­spite its name, is not the cause of in­fluenza (the “flu” is caused by a virus). H. flu is a species of bac­te­ria that can cause menin­gi­tis, pneu­mo­nia and the con­di­tion you had, epiglot­ti­tis — an in­flam­ma­tion of the epiglot­tis, the struc­ture that closes your tra­chea when you swal­low.

Be­fore the vac­cine for Hib be­came avail­able, epiglot­ti­tis was a feared and not un­com­mon prob­lem. Back then, doc­tors were ex­haus­tively taught how to rapidly rec­og­nize the life-threat­en­ing H. flu epiglot­ti­tis so that chil­dren could be treated quickly, which some­times meant an emer­gency tra­cheostomy (a di­rect hole through the throat into the wind­pipe to al­low breath­ing). That is the pro­ce­dure that caused the scar on your neck. De­spite treat­ment, 3 to 6% of cases of in­va­sive H. flu were fa­tal.

Dur­ing the time I was in med­i­cal school, rou­tine vac­ci­na­tion for H. flu be­came wide­spread, and the dis­ease es­sen­tially went away. His­tory records a 99% drop in this in­fec­tion. I’ve only ever seen one case. Es­sen­tially the only peo­ple at risk for this dis­ease now are those who are de­lib­er­ately un­vac­ci­nated.

Many peo­ple feel that the dis­eases we vac­ci­nate against are “no big deal,” but thou­sands of kids per year died of con­di­tions we thank­fully al­most never see to­day. With­out con­tin­ued vac­ci­na­tion, those days will come back.

Dear Dr. Roach: In 2008, I had a par­tial sig­moid colec­tomy. Since then, I have had no re­cur­rence of di­ver­ti­c­uli­tis. The sur­geon rec­om­mended that I not use lax­a­tives but rather take fiber gum­mies to keep things mov­ing eas­ily in ad­di­tion to drink­ing lots of flu­ids.

I am do­ing that, but my flat­u­lence could power all the homes in a small city. It is dif­fi­cult to con­trol out­bursts, which are nox­ious and em­bar­rass­ing in the ex­treme. Is there any other way to avoid hard stools, strain­ing and other gas­troin­testi­nal sit­u­a­tions?

J.S.

An­swer: I am sorry for your em­bar­rass­ment, but I agree with the sur­geon that get­ting fiber and plenty of wa­ter is the safest and best way to pre­vent prob­lems. How­ever, maybe it isn’t just the fiber, but your diet that is at least par­tially re­spon­si­ble for the in­creased gas. You could try re­duc­ing your in­take of foods in the cab­bage fam­ily, onions, beans, corn and other gas-pro­duc­ers. Avoid car­bon­ated bev­er­ages and any bev­er­age con­tain­ing ar­ti­fi­cial sweet­en­ers such as sor­bitol or xyl­i­tol. In some peo­ple, chang­ing the bac­te­ria that live in your gut (your mi­cro­biome) through pro­bi­otic sup­ple­ments and a change of diet can re­duce the amount of gas pro­duced.

There are other types of fiber sup­ple­ments be­sides fiber gum­mies that might be bet­ter tol­er­ated, or you can get fiber from food.

Read­ers may email ques­tions to: ToYourGood­[email protected] .cor­nell.edu or mail ques­tions to 628 Vir­ginia Dr., Or­lando, FL 32803.

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