Travelling, driving & hospitalization as a laryngectomee

Traveling and driving as a laryngectomee can be challenging. The trip may expose the traveler to unfamiliar places away from their routine and comfortable settings. Laryngectomees may need to care for their airways at unfamiliar locations. Traveling usually requires planning ahead so that essential supplies are available during the trip. It is important to continue to care for one’s airway and other medical issues while travelling.

Driving a car as a laryngectomee

Driving a car can be challenging for a laryngectomee. Speaking may be difficult while driving because of the noise produced by the car and the traffic.

Holding the steering wheel with two hands is essential for safe driving. However, speaking using an electrolarynnx or voice prosthesis (with a non-hands free HME) requires the use of one’s hand. This leaves the driver with only a single hand to steer and operate their car. Using hands free Heat and Moisture Exchanger (HME) frees both hands to continue and operate the car.

Another potential problem is the need to cough or sneeze while driving.  The air inhaled when driving busy roads and highways is often polluted and may cause respiratory irritation and coughing. The sputum produced by coughing or sneezing can block the HME cassette and prevent breathing. Laryngectomees need to quickly remove the blocked HME to allow breathing. This requires using their hand(s) and creates a dangerous situation.

Safer driving can be enhanced by:

• Pulling over to the curb when experiencing coughing or sneezing, or when needing to speak (when using an electrolarynx or non-hands free HME)
• Do not use your cell phone (even a hands free one) while driving
• Stopping frequently to cough out one’s sputum
• Using Hands Free HME while driving
• Maintaining proper humidification is crucial, as cold, dry air from the car's air conditioning or heater can irritate the airway. Using HME or wetting the stoma cover can help
• Avoiding direct exposure to outside air while driving by using the car’s ventilation
• Making sure that the car’s safety belts do no impede breathing by covering your stoma
• Roll up the car windows, and use the air condition to reduce exposure to dust and irritants  

Laryngectomees using an electrolarynx should exercise caution if approached by a policeman, as the device could be misinterpreted as a weapon. It's recommended not to reach for it until there's an opportunity to clarify its purpose to the officer. Providing a written explanation can effectively communicate the necessity of the electrolarynx for speech.

Risk associated with deployment of inflatable airbag

Inflatable airbag can prevent serious injury and can save lives. The airbag provides the occupants a soft cushioning and restraint during a crash and prevents any impact injury with the interior of the vehicle. Unfortunately, in neck breathers including laryngectomees, the deployment of inflatable airbag may block air access to the stoma. Consideration should be given to measures that may preventing this occurrence.

These measures include having the laryngectomee sit in a rear seat, and measures that can provide an adequate distance between the driver and the steering wheel ( e.g., moving the seat rearward, inclining the seat back, adjusting a telescoping steering wheel toward the dashboard ). Information about these measures can be obtained from the National Mobility Dealers Association at 1-800-833-0427.  

Disconnecting the airbag all together should be discouraged as their benefit outweighs the potential risk. However, neck breathers should consult their physician about this option. 

Navigating Air Travel Challenges for Laryngectomees

Flying (especially long flights) poses unique hurdles for individuals who have undergone a laryngectomy, with concerns ranging from communication barriers to physiological challenges. The first challenge is going through airport security screening where additional clarification or documentation may be necessary for medical devices like electrolarynx, tweezers and respiratory supplies.

Several factors can lead to deep vein thrombosis (DVT). These include insufficient hydration (due to low humidity of the cabin air at high altitude), lower oxygen pressure inside the plane, and the passenger’s immobility. These factors, when combined, can cause a blood clot in the legs that, when dislodged, can circulate through the blood stream and reach the lungs where it can cause pulmonary embolism. This is a serious complication and a medical emergency.

 The, low air humidity can dry out the throat and trachea and the mucus can become thick, sticky, and dry; potentially clogging the stoma and airway leading to mucus plugs. Unfortunately, airline attendants are typically unfamiliar with the means of providing air to a laryngectomee (i.e., directing air to the stoma and not the nose).

Laryngectomees face several challenges when flying due to the dry air in the airplane cabin. Here are the key points:

Before flying:

• Booking a seat in an exit row, bulkhead, or aisle seat that allows greater leg room
• If in a higher risk category, asking one’s doctor whether to take aspirin before flying to inhibit blood clotting
• Placing medical supplies, including stoma care equipment and an electrolarynx (if used) in an accessible place in the carry-on luggage (It is allowed to bring durable medical equipment and supplies on board, even as an extra carry-on bag)

During flight:

• The elevated noise levels in the airport and during the flight may necessitate the use of alternative communication methods, such as such as writing, gesture, or electronic speech devices
• Drinking at least 8 ounces of water for every two hours on a plane, including ground time
• Avoiding alcohol and caffeine drinks, as they are dehydrating
• Wearing loose-fitting clothes
• Avoiding crossing one's legs while seating, as this can reduce blood flow in the legs
• Wearing compression socks
• Performing legs exercises and standing up or walking, whenever possible during the flight
• In case oxygen masks are needed, it should be placed over your stoma
• Prepare for potential in-flight emergencies by familiarizing yourself with the airplane's emergency procedures and communicate your needs to flight attendants if necessary.
• You may require special assistance from airline staff, particularly concerning communication or mobility issues. Advance notification to airlines about specific needs is advisable.
• Combating cabin dry air by wearing a heat and moisture exchanger (HME) filter or a damp cloth/foam cover over the stoma helps humidify the air. Staying hydrated and utilizing mobile humidifiers, inserting saline bullets into the stoma and moisturizing sprays can mitigate discomfort.
• Covering the stoma with a Heat and Moisture Exchanger (HME) that provides extra humidity (i.e., Provox XtraMoistandand and Provox Life – Home HME™,) or a moist cloth.
• Consider using an HME with protective abilities against microorganisms such as Provox Micron or Provox Life Protect HME to prevent getting infected with respiratory pathogens.

Despite these challenges, many laryngectomees and other neck breathers successfully navigate air travel with meticulous planning and preparation. Seeking guidance from healthcare providers or laryngectomee support groups can offer invaluable insights for a safe and comfortable journey.

Supplies to carry when going out or travelling

When travelling it is useful to carry all one's airway management supplies and medication in a dedicated bag. The bag should not be checked in and access to it should be easy.

Suggested items to be included in the bag include: 

•  A summary of one's medication taken on a regular basis, one's medical diagnoses and allergies, the names and contact information of one's medical providers, a referral to a speech and language pathologist (SLP), and prescriptions for one's medication  

•  Proof of medical and dental insurance

•  A supply of the medications taken

•  Paper tissues

•  Tweezers, mirror, flash light (with extra batteries)

•  Blood pressure monitor ( for those who are hypertensive)

•  Saline bullets

•  Supplies for placing HME housing ( alcohol, Remove, Skin Tag, glue) 

•  Several HMEs and HME housings 

 •  Carrying an electrolarynx (with extra batteries). even by those using a voice prosthesis may be helpful in case one is unable to speak  

•  A voice amplifier ( if needed with extra batteries or a battery charger

 

•   A whistle or laryngectomee whistle (see Urgent Care Section) 

•   Hand sanitizer

•  Pen and paper

Individuals who use a voice prosthesis should also bring these items:

•  An extra hands free HME and an extra voice prosthesis

•  A brush and flushing bulb to clean one's voice prosthesis

•  A red Foley catheter (to place in the voice prosthesis' puncture in case the voice prosthesis is dislodged)

The quantity of supply items depends on the length of the trip. 

It can be useful to obtain contact information for SLP(s) and physicians at the area of travel.  

   


                                                       A medical supply bag

Preparing a kit with essential information and material when going to the hospital

Laryngectomees may need to receive emergency and non-emergency medical care at a hospital or other medical facility. Because of their difficulty in communicating with medical personnel and providing information, especially when in distress it is helpful to prepare a folder with this information. Additionally it is useful to carry a kit containing items and supplies needed to maintain their ability to communicate and care for their stoma. The kit should be kept in a place that is easily accessible in an emergency.

The kit should contain the following:

• An updated and current summary of the medical and surgical history, allergies and diagnoses

• An updated list of the medications taken and the results of all procedures, radiological examinations, scans and laboratory tests. These may be placed on a disc or USB flash drive

• Contact information and proof of medical insurance

• Information (phone, email, address) of the laryngectomee’s physician(s), speech and language pathologist, family members and friend(s)

•  A figure or drawing of a side view of the neck that explains the anatomy of the laryngectomee's upper airway and if relevant where the voice prosthesis is located

• A paper pad and pen

• An electrolarynx with extra batteries (even for those using a voice prosthesis)

• A box of paper tissues

• A supply of saline bullets, HME filters, HME housing, and supplies needed to apply and remove them ( e.g., alcohol, Remove, Skin Tag, glue) and to clean the voice prosthesis ( brush, flushing bulb)

• Tweezers, mirror, flash light (with extra batteries)

Having these items available when seeking emergency or regular care can be critically important.
It is also important to wearing a bracelet that identifies the laryngectomee as neck breathers.  When hospitalized the hospital patient ID wristband should be placed on the same hand that identifies them as neck breathers.

Bringing liquid or semi-liquid food items aboard a plane while traveling as a laryngectomee

Laryngectomees who experience swallowing problems may want to bring with them food items and liquids they are able to consume. Medically required liquids, such as medications, creams and breast milk, are permitted to be brought on board an aircraft. It is not necessary to place medically required liquids in a zip-top bag. However, travelers must tell the TSA officer at the beginning of the screening process that they wish to bring medically necessary liquids in excess of 3.4 ounces in their carry-on bag.  Liquids, gels and aerosols are typically screened by X-ray and medically necessary items in excess of 3.4 ounces will receive additional screening.

Travelers who bring medically necessary liquids in excess of 3.4 ounces or medical accessories such as freezer packs, IV bags, pumps and syringes to the checkpoint must inform the TSA officer at the beginning of the screening process. Transportation Security Administration (TSA) suggests, but does not require, medication be clearly labeled to facilitate the screening process. If a traveler does not want a medically necessary liquid to be X-rayed or opened for additional screening, the traveler must inform the officer before screening begins.

The TSA allows formula, breast milk and juice for infants or toddlers to be brought on board the aircraft. Although they do not specifically mention liquid food items (i.e., water, juice, yogurt, jelly) it has been my experience that they allow bringing these as long as they are medically indicated.

TSA officers may test medically necessary liquids for explosives or concealed prohibited items. If TSA officers are unable to use X-ray to clear these items, they may ask for the container to be opened and may also ask the traveler to transfer to a separate container or dispose of a small quantity of liquid, if feasible. If the medically necessary liquid cannot be X-ray screened or opened, officers may be required to take additional steps to clear it as well as conduct additional screening, which may include a pat-down of the traveler and screening of the remainder of the traveler’s accessible property.

For more details check the TSA website.