"My Voice"

Order a paperback or Kindle Edition or e-book of "My Voice: A Physician's Personal Experience with Throat Cancer," the complete 282 page story of Dr. Brook's diagnosis, treatment, and recovery from throat cancer.

Order a paperback or Kindle Edition or e-book of "The Laryngectomee Guide," the 170 page practical guide for laryngectomees.

Obtain and/or view a video presentation, instructive manual and a slide presentation how to ventilate laryngectomees and neck breathers (free).

To obtain suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.

Saturday, January 25, 2020

Coronavirus outbreak and how laryngectomee and neck breathers can prevent getting the infection:

Watch the video "How laryngectomees can cope with the COVID-19 pandemic"

There has been a deadly outbreak of a novel strain of coronavirus in China causing severe respiratory illness and death. The virus has been spreading arround the world causing pandemic. The causative virus has been identified and its genome sequenced, which will allow confirmation of cases and development of a vaccine, though most likely not for about a year. As of today the CDC has recommended travelers avoid all nonessential travel to areas where the virus is prevalent. The virus is most likely spread by droplets. Those traveling to high risk areas should practice certain health precautions like avoiding contact with people with respiratory disease symptoms and careful hand-washing. Wearing a surgical mask is helpful, but it's more effective when worn by those with the disease. 

Human coronaviruses most commonly transmit from an infected person to others via: 

  • The air by coughing and sneezing and rarely, fecal contamination
  • Close personal contact, such as touching or shaking hands
  • Touching an object or surface with the virus on it, then touching the mouth, nose, eyes or stoma (in neck breathers) before washing hands

   Coronaviruses are usually transmitted from animals, particularly bats, camels, and even snakes to humans. The first 4 cases were all workers in the Huanan Seafood Wholesale Market, which sells live poultry, aquatic animals, bats, and snakes to the public. Unfortunately, the virus has mutated to cause human to human transmission. 

Symptoms can range from those of a mild cold to severe respiratory distress and death. The first signs and symptoms are a fever, cough, and initially mild respiratory distress that often worsens due to development of pulmonary edema ("water on the lungs"). All deaths to date have been in Wuhan City. The incubation latent periods are not certain. 

The virus is likely to spread throughout the world because of international travel and precautions may be needed to implemented everywhere. Head and neck cancer may be more vulnerable to respiratory infections and should exercise caution to prevent getting infected.

As the epidemic of corona virus is spreading throughout the world it is important for laryngectomees to protect themselves. Most laryngectomees experience less “colds” than non laryngectmees. This is believed to be because respiratory viruses generally first infect the nose and move to other body sites (including the lungs). Because laryngectomees do not inhale through their noses this mode of getting infected does not exist.

However, respiratory viruses can also access the body through the mouth, and conjunctiva. In laryngectomees the virus can access the lungs directly through the stoma. Although the exact mode of infection transmission of Corona virus is yet unknown, it is prudent to assume that it would behave in a similar fashion. 

It is not yet known if laryngectomees are more susceptible to COVID -19. It is therefore prudent to be extra careful. There are several risk factors that places laryngectomees in increased risk to get infected.

Once laryngectomees get infected they may be more likely to develop a serious pneumonia because their airway are compromised.  Many have chronically dry  and irritated trachea and bronchi, and they often have reduced lung capacity and lower lobes athelectasis.
This is why it is wise that laryngectomees are careful and follow the Health Departments direction.

laryngectomees and neck breathers can protect themselves by:
  • Wearing HME 24/7 especially when being around other people. HME with greater filtering ability would work better in reducing the risk of inhaling the virus ( i.e., Provox Micron TM, Atos Medical's XtraMoist). Provox Micron, has an electrostatic filter and 99.9% filtration rate and it’s cover prevents direct finger contact of the stoma. Wearing it protects other individuals from becoming  infected when the laryngectomee is infected.  Provox HME Cassette Adaptor enables the use of a Provox HME Cassette to any tracheostomy tube with a 15 mm ISO connector. Those with tracheostomy can protect themselves by using ProTrach XtraCare HME.
  • Wearing hands free tracheostoma valve because it does not require touching when speaking)
  • Those who use a regular HME should wash their hands before touching their HME.
  • Wearing a face mask ( preferable N95 respirator) over the stoma. A facemask with four strings can be modified to fit over the stoma. One of the strings can be extended with extra string; and the lower pair of strings can be tied behind the back. (see pictures)
  • Wearing face mask or respirator over the nose and mouth, and protective glasses. (see picture below) This can prevent the virus from entering the body through these sites or spread to other people when infected. Men should shave their facial hair prior to wearing facemask or respirator. 
  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
  • Avoid touching your stoma, eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Staying at least 6 feet from other who don't live with you.
  • Clean and disinfect frequently touched objects and surfaces.

To prevent the spread to others stay home when you are sick, and cover your cough or sneeze with a tissue, then throw the tissue in the trash. 
If worn properly, a face mask can help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria). Face masks may also help reduce exposure of the wearer’s respiratory secretions to others.
While a face mask may be effective in blocking splashes and large-particle droplets, it does not filter or block very small particles in the air that may be transmitted by coughs, and sneezes. Face masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the skin over the stoma.
Some face masks (i.e., N95) offer greater filtering abilities of germs and small dust particles. However, neck breathers and people with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their healthcare provider before using a N95 face mask because it can make it more difficult for the wearer to breathe.

It is prudent that laryngectomees follow the government and local health authorities’ instructions and avoid exposure to the virus by strictly isolating themselves.

To obtain more suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.

Technique to place a facemask over the stoma in a laryngectomee

Wearing a facemask over the nose and mouth and protective glasses

Message from the Japanese Head and Neck Support Society. (in Japanese and English)

Message from the Singapore Cancer Society

Message from Nu Voice ( University of Southern California)  Los Angeles.

Click for further reading about protection of laryngectomees (International Achieves of Otorhinolaryngology)  

No comments:

Post a Comment