Top: Incision for inferior tracheotomy

Bottom: Tracheal anatomy and surrounding structures

In diphtheria patients with a significant formation of leathery pseudo-membrane, providing a way to breathe is paramount. Since the putrid pus that hardened into the membrane would be pushed into the bronchi if regular intubation was used, a technique that allowed air in below the upper pharynx (where most of the membrane formed) was needed. The concept of the tracheotomy has been around for hundreds of years, but it wasn’t until the 18th century that more than a handful of patients survived the procedure when it came to diphtheria and other membranous croups. Well, if you consider 25% to be “more than a handful”.

By the point a patient would need a tracheotomy, the procedure would need to be done quickly and accurately, but because of the relative size of veins, arteries, nerves, and tendons surrounding a child’s trachea, it would be incredibly difficult to do this successfully. However, once the medical schools began teaching this as a standard procedure in the mid-1800s, the success rate (meaning the survival of the patient, not just the procedure being done correctly) increased to around 45%. Given how sick someone with advanced pseudo-membranous laryngeal diphtheria is, that’s not bad at all.

Atlas and Epitome of Operative Surgery. Otto Zuckerkandel, translated by J. Chalmers DaCosta, 1902.

A Treatise on Diphtheria including Croup, Tracheotomy, and Intubation. Henry Z. Gill, 1887.


Dear Juliana,

I’m in the hospital right now.  I don’t like it here and can’t wait to get out.   Like you, I have a rare neuromuscular disease that has made me very weak my whole life.  When I was a young child, I was in the hospital all the time.  There are so many things about it that I don’t like.  I don’t like nurses sticking needles in my arms and hands.  I don’t like the painful physical therapy.  I don’t like them connecting me to tubes that are supposed to help me breathe better.

I’ve been in the hospital this time for seven weeks and I probably won’t be getting out for a while.  Something bad happened in my brain called a stroke.  And the next day, I actually died for four minutes until the doctors could bring me back to life.  I’m so happy they did because I love my life!

When I was born, doctors told my parents that I wouldn’t live past the age of 15.  But now I’m 51 years old!  I have always been weak and skinny with no muscle strength, but people are always amazed at what I’ve been able to do.  I have three kids who are ages 23, 21 and 18.  Despite the fact that I can barely move my arms, I can drive my van.  I travel around the country and the world, telling people about the fact that they have the inner strength to do anything they set their heart and mind on.  I have written three books and been on television a whole lot of times.  One time, over a million people saw a documentary film about my life. (I can send you a copy if you like.)

When I get out of the hospital this time, my life will be different.  Now I have to live with a little sack in my tummy and I get fed through a tube.  I will still be able to eat, but the tube will make sure I get enough food.  I also have a new hole in my neck called a tracheotomy which will help me breathe.  But I don’t mind these new problems.  As long as I get to live, laugh and love for many years to come, I will be happy.  I look forward to meeting you someday soon.

Greg Smith
“The Strength Coach”

PS. If you want to read more about my life, check out my website and Facebook page. and

Image Descriptions: 1) Greg in the mid-1970s riding a horse at MDA summer camp. A counselor sits behind him and holds Greg’s waist to keep him balanced. 2) Greg sits in his power wheelchair on stage in a business suit. His fist is raised as he gives a motivational speech to a large audience (not pictured). 3) Greg and his son, a college football player, are shown together on the football field. 4) Greg sits in his power wheelchair at his laptop while in his hospital room. He’s eating ice chips. His tracheotomy tube is visible and there are hospital monitors in the background. Greg has a bright smile on his face in all of the pictures.

A horse with a tracheotomy, a hole cut into the trachea to facilitate breathing. This particular horse had been bitten on the nose by a snake, resulting in severe swelling of his nostrils to the point that they were occluded. The snakebite also produced a coagulapathy where his blood didn’t clot effectively, causing intermittent bleeding. He made a full recovery.

Dear Julianna,

My name is Evald and I have had muscular dystrophy ever since I was born. It’s called Spinal Muscular Dystrophy II. Actually, the doctors didn’t think I would live to be more than four years old. Now I’m 71 years old.

A long time ago, in 1971, I founded the Danish Muscular Dystrophy Association, and except for a period of three years, I have been the chairman since then. I have a daughter and two grandchildren around your age.

When I look at the pictures of you, I see a girl full of life and energy. In my humble opinion, it’s way too early to talk about when you should go to heaven. I can see that you are a smart girl, and I bet that you are a big inspiration to all your friends.

I have never been able to walk, but when my friends were running around or climbing trees, I used my imagination. It didn’t matter that I only sat on the ground, in my imagination I did all the same stuff as they did.

Until I got my respirator (that thing where the doctors put a tube in my neck for breathing – it’s awesome) I had pneumonia a lot. Now I haven’t had pneumonia for years, and I have a lot more energy.

One thing is for sure, we all have to go to heaven someday. You don’t have to go there just yet. It is possible to live for many years, to have many friends, and to have a good time with your brother and your parents.

Before you go to heaven, I think you should give it a try, and get a respirator. I think you’ll like it.

Maybe you have heard people say “life is what you make it”. I think that’s true, and I believe that you can make it awesome and sparkly.

If you and your parents are interested in learning more about life with a respirator, please ask them to connect with me on facebook.

Best regards,

Evald Krog

PS: Check out my shoes… I have them in pink too.

Photo Description: Evald sits in his power wheelchair. He is wearing red pants and a red sweater. His shoes and shirt under his sweater have green in them. His trache is not visible.

Our very first guest blogger!

Everyone has the right to equality. Where is the equality when you’re refused a wheel trans to drop you just cause you didn’t get up at 7am? Where is equality when a person cannot get a education because our healthcare system thinks people who need tracheotomy or ventilators should be home bound after age 18? People with disabilities are treated like shit starting from our healthcare system to our education system to our transportation system.

I use a tracheotomy to breathe. In order for me to go university I need someone with me at all times. They have no issue with providing the service at school or shopping facility however they won’t provide it on Wheeltrans because of the risk of an accident. This would be understandable if the same rules applied to doctor appointments, but it doesn’t. the moment you need a health care professional on a bus the accident issue disappears. Why the difference? It all comes down to information, control and power. We live in systems that only want to grab our money and use us as guinea pigs…………i ain’t gonna stand for it are you?

- Anonymously written.

Watch on

Jasey, 1 month before her last surgery! which was september 21st 2011. the following month miss.Jasey will be having a sleep study conducted in order to determine whether or not she’s okay to have the trach removed. So far, things look promising!

It’s just part of my wanting to be all things to all people. I did a piece for Premiere magazine once on being a hyphenate. I’m a writer-director-actor, which I’ve always kind of enjoyed. I compared it to the Olympic biathlon. “Not only can he cross-country ski, but he’s a terrific marksman as well.” I want people to say, “You mean that writer performed a tracheotomy?” That’s right, I do everything.
—  Harold Ramis