Mucus production and increasing air
humidity
Prior to becoming a laryngectomee, the
inhaled air is warmed to body temperature, humidified and cleansed of organisms
and dust particles by the filtration capacity of the upper part of the
respiratory system. Since these functions do not occur following laryngectomy,
it is important to restore the lost functions previously provided by upper part
of the respiratory system. These practices should be continued during the
COVID-19 pandemic.
When the inhaled air humidity is too low
the trachea can dry out, crack, and produce some bleeding. If the bleeding is
significant or does not respond to an increase in humidity, a physician should
be consulted. In addition, if the amount
or color of the mucus is concerning, one should contact a physician.
Tracheal dryness, irritation and
overproduction of mucus can lead to the development of mucus plugs. These plugs
can cause airway obstruction that can lead to collapse of sections
(atelectasis) of the lungs. An irritated trachea may be more susceptible to
COVID-19 and other respiratory tract viruses.
Steps to achieve better humidification
and healthier mucus production include:
• Wearing
an heat and moisture exchanger (HME) filter 24/7 which keeps the tracheal
moisture higher and preserves the heat inside the trachea and lungs
• Wetting
the soma cover (or bib) to breathe moist air (in those who wear a stoma cover).
Although less effective than an HME, dampening the foam filter or stoma cover
with clean plain water can also assist in increasing humidification.
• Drinking
enough fluid to keep well hydrated
• Inserting
3-5 cc saline (preferably using saline "Bullets") into the stoma 3 to
5 times a day (see below how to prepare saline)
Saline "Bullets"
• Using
a humidifier in the house to achieve about 40-50% humidity and getting a
hygrometer to monitor the humidity. This is important both in the summer when
air conditioning is used, and in the winter when heating is used
Humidifier
• Using
nebulizing bottle twice daily
• Breathing
steam generated by boiling water or a hot shower
.
More information about treatment of these
conditions can be obtained in The Laryngectomee Guide and in My Voice
Respiratory rehabilitation
After a laryngectomy the inhaled air
bypasses the upper part of the respiratory system and enters the trachea and
lungs directly through the stoma. The change effects the efforts needed to
breathe and potential lung functions. This requires adjustment and retraining.
Breathing is actually easier for laryngectomees because there is less airflow resistance
when the air bypasses the nose and mouth. Because it is easier to get air into
the lungs, laryngectomees no longer need to inflate and deflate their lungs as
completely as they did before. It is therefore common for laryngectomees to
develop reduced lung capacity and breathing capabilities. This may eventually
lead to collapse of portions of the base of the lower lobs of the lungs
(atelectasis). Atelectasis of portions of the lungs may increase the risk of
acquiring respiratory virus infection and make it more difficult to adequately
ventilate them.
There are several measures available to
laryngectomees that can preserve and increase their lung capacity:
• The
use of a heat and moisture exchanger filter (HME) can create resistance to air
exchange. This forces the individual to fully inflate their lungs to get the
needed amount of oxygen.
• Regular
breathing exercises under medical supervision and guidance of a respiratory
therapist. This can get the lungs to fully inflate and improve individuals' heart
and breathing capacities. One way to
improve breathing capacity is by using a modified incentive spirometer (a
device that make the ball rise to the indicated range). One can mark their
progress with a siding pointer. (Picture X) The spirometer can be modified for
laryngectomee use by replacing the mouthpiece with a large diameter baby bottle
nipple that fits over stoma. Another way
to expand the lungs is to take 2 to 3 deep breaths, hold, and slowly let the air
out.
• Using
diaphragmatic breathing. This method of breathing allows for greater
utilization of the lung capacity. This can breathing method can be used when
resting or exercising (e.g., walking, biking).(see below)
More information about treatment of these
conditions can be obtained in The Laryngectomee Guide at
and in My Voice
Incentive spirometer
Keeping fit and eating adequate nutrition
during the COVID-19 pandemic
Keeping up with fitness and exercise
during the COVID-19 pandemic can be difficult. As people self-isolate and
practice social distancing, many gyms are closed. At the same time, it’s more important than
ever that laryngectomees keep exercising and staying as active as possible –
for both our mental and physical health. Performing fitness exercises and
riding stationary bikes can be can be done at home and provide an excellent
mode of keeping fit. Taking walks outside home while keeping social distance
and wearing protective mask and HME can also be helpful.
People who eat a well-balanced diet tend
to be healthier with stronger immune systems and lower risk of chronic
illnesses and infectious diseases. Eating adequate diet is very important and
may be challenging for laryngectomees with swallowing difficulties. (click to read more ) Proper
nutrition and hydration are vital according to the World Health Organization
(WHO). Their nutrition advice for adults
during the COVID-19 outbreak is to eat a variety of fresh and unprocessed foods
every day to get the vitamins, minerals, dietary fiber, protein and
antioxidants the body needs. Drinking enough water is also important. The WHO
recommends avoiding sugar, fat and salt to significantly lower the risk of
overweight, obesity, heart disease, stroke, diabetes and certain types of cancer.
Indoor bikes
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