This week at Shirley Ryan was focused on testing for trach removal. Various liquids were given to Marcus to monitor his reaction. Liquids have three classifications:
-Level 0 is a thin liquid. 
-Level 2 is nectar thick.
-Level 3/4 is a thin puree.

We learned a lot about Marcus’ epiglottis—a leaf-shaped flap in the throat that prevents food and water from entering the trachea and the lungs. It stays open during breathing, allowing air into the larynx. When a person swallows, it closes to prevent aspiration of food into the lungs, forcing the swallowed liquids or food to go along the esophagus toward the stomach.

What’s happening with Marcus is that with level 0 liquids, his epiglottis is not closing quickly enough on occasion. Therefore, the liquid goes down the wrong pipe, which is down toward the trachea near his vocal folds as he’s not feeling the sensation. The level zero liquid came back too fast and immediately split; half of it went down towards his airway, while the other half, he swallowed. He immediately sensed the problem and started coughing, which is good. He recognized he needed to cough.  

However, he is having a challenge with his sinus piriformis, which is a small pocket or recess located on either side of the laryngeal opening in the throat, essentially a depression in the hypo-pharynx. He does not feel that area, and it gets tricky sometimes when he swallows and some liquid comes back over, getting trapped by the epiglottis and going down the wrong pipe. Level 0 is the one where he’s not reacting quickly enough to correct the timing of the swallow; it’s too fast for him, and his timing is delayed. In addition to the delay, the parts are not moving in sync as they should be.   

Encouragingly, though, Marcus demonstrates a good handling of levels 2-4, indicating a positive aspect of his progress in this area.  

A comprehensive swallowing test, conducted using X-ray equipment, revealed a successful process of liquids entering his esophagus, frame by frame, which helps us feel confident about his progress.  

Rehab continued to go well towards the end of the week. There was some brief storming after they attempted to add calories to his diet to increase his weight, but the change upset his stomach.  

As of today (11/12) Marcus had his trach removed. The medical staff was well informed and prepared for this significant development. We are thankful and excited for this progress.
We remain increasingly grateful for all the prayers for Marcus and his continued recovery.