BehindTheMedspeak: U.S. Supreme Court Chief Justice William H. Rehnquist's 'October Surprise'

The United States Supreme Court sprang it on Monday, when it issued the following terse press release.
___________________

Chief Justice William H. Rehnquist was admitted to Bethesda Naval Hospital on Friday, October 22 and underwent a tracheotomy on Saturday in connection with a recent diagnosis of thyroid cancer.

He is expected to be on the Bench when the Court reconvenes on Monday, November 1.
___________________

Don't count on it.

This news exploded like the bombshell it is when became public Monday.

I'll leave the bloviating to the grand panjandrums of punditry (Spiro T. Agnew, where are you when we really need you? But I digress).

Here we'll go behind the what and take a look at the why, the specialty of this exclusive bookofjoe feature.

First, a brief anatomy lesson.

The thyroid gland straddles the trachea [also known as the larynx or windpipe].

It's the largest gland in the neck, and regulates the body's metabolism.

If an enlarged thyroid - whether from goiter or cancer - starts to press on the trachea immediately adjacent to it, breathing difficulty can ensue as the lumen of the trachea shrinks.

Thyroid enlargement can result in thyroid tissue eroding the trachea, and lead to its collapse.

Justice Rehnquist's tracheotomy [also called tracheostomy] was prophylactic: that is, it was done to prevent a catastrophic tracheal narrowing and/or collapse which could result in respiratory arrest, cardiac arrest, and death.

What is a tracheotomy?

It's a surgical procedure, often performed under local anesthesia with the patient awake (very likely the case with Rehnquist) in which an incision is made in the front of the neck, enlarged down to the trachea, and then continued through the front wall of the windpipe.

A breathing tube - called a tracheostomy, or trach - tube is then inserted through the opening.

The tube can be left open to the air for the patient to breathe on his own, or connected to a source of oxygen for assisted or controlled ventilation with a ventilator.

In general, thyroid cancer, of which about 23,000 new cases a year are diagnosed in the U.S., does not result in breathing or airway compromise or difficulty.

Therefore, I must conclude that Rehnquist's disease had progressed to the point of physical impairment beyond the cancer itself, which makes it far more serious and potentially life-threatening.

Rehnquist is 80 years old and a longtime smoker, two big strikes against him.

Dr. Yosef Krespi, chairman of otolaryngology at St. Luke's-Roosevel Hospital in New York, was quoted in yesterday's Wall Street Journal as saying, "It has to be the aggressive type or complicated thyroid cancer for someone to have a tracheotomy."

Dr. Paul Wallner of the National Cancer Institute was quoted in the same article as saying a tracheotomy might be done for two reasons: "Simply in anticipation of routine thyroid surgery or... because he was having breathing difficulty."

I have to go with Dr. Krespi's assessment.

No one has a tracheotomy for routine thyroid surgery.

Why?

Because cutting a hole in the larynx and putting a foreign body through it into the windpipe is not a trivial thing.

Obstruction, infection, bleeding, a whole host of potential complications are introduced which are otherwise not present.

No, this is serious stuff.

Which is why there is no way Rehnquist will be on the Bench next Monday morning, November 1, when the Court reconvenes.

Dr. Krespi said he would not recommend a cancer patient who needs a tracheotomy return to work so quickly.

As I said, not to worry; ain't gonna happen.