"Was I scared? Heck yeah! I didn't want to cut myself."
Steve Wilder, 55, may not have wanted to take a knife to his own throat, but his do-it-yourself tracheotomy probably saved his life.
Wilder, a truck driver from Omaha, Neb., was asleep in his basement two weeks ago and awoke when he found himself unable to breathe. Afraid that the rescue squad would not get to his home in time, Wilder ran into his kitchen, grabbed a steak knife and made a slit through his throat so that his windpipe could get air, unobstructed.
This was the second time Wilder had taken matters into his own hands. Wilder performed a self-tracheotomy in 2006 under similar circumstances, when he felt he could not breathe.
"I did what I did the first time. I took a knife and opened it up," Wilder said, in his high-pitched, broken voice. "I did it to save my life."
A Breath of Air
The problem began after Wilder had throat cancer and underwent radiation therapy four years ago.
"Radiation actually cooked his muscles," said Cora Wilder, his wife. "If you feel his neck and my neck, his neck is hard and my neck is soft."
Paul Sherrerd, Wilder's doctor, said that he had more inflammation from the radiation treatments than was normal and that it had not gone away completely. He suspects that Wilder's inability to breathe sometimes may be due to seasonal allergies.
Wilder said that both times his throat has swollen to the point where he felt he could not breathe have been in the spring.
"Something has to set off the swelling," said Sherrerd, an ear, nose and throat doctor at Immanuel Medical Center in Omaha. "It could be allergy, which I think is probably what happens with him."
But Wilder and his wife are not convinced his problem is related to an allergy. Aside from some occasional difficulty breathing, Wilder does not experience other symptoms that are typical to an allergic reaction, such as itchy, watery eyes or a runny nose.
Cora Wilder said her husband never had a history of allergies or illness.
"All this happened since the cancer," she said. "He never was sick before."
A Cut Above
But Wilder's medical history puts him at risk for serious breathing problems. Because of the radiation treatments, his vocal cords have narrowed in his throat above his trachea to about a five-millimeter gap, according to Sherrerd. By comparison, a healthy person has about one centimeter of breathing room. For Wilder, even a mild allergic reaction or a small amount of swelling could spell disaster.
"It doesn't take very much to get [Wilder] into trouble in a hurry," Sherrerd said.
A tracheotomy can be a delicate procedure. A slit is made at the base of the throat; the thyroid gland, which sits in front of the trachea, is cut; and the trachea is slit and a breathing tube is inserted so that air can reach the lungs. The carotid artery is also in the vicinity and even a nick could release a lot of blood.
But Wilder may have had an easier time with a self-tracheotomy than the average person. His thyroid was already out of the way from previous tracheotomies, and because of the radiation treatments, there was nothing but skin and some subcutaneous tissue to cut through to get to the trachea. He also had a scar from previous tracheotomies as a guide.
"I knew where the [trachea] was and I knew that's where I could breathe," Wilder said.
Wilder recovered quickly from his self-administered operation, and is back at work.
Sherrerd has placed a permanent tube in Wilder's throat to help him breathe when he needs it, but said that Wilder only needs to be monitored occasionally and that he is doing well.
"As crazy as it sounds, it probably wasn't the craziest thing to do," Sherrerd said.