VATICAN CITY – Pope John Paul II's (search) condition is improving, the Vatican spokesman said Tuesday, as the pontiff has begun speech and respiratory therapy following last week's surgery to ease his latest breathing crisis.
"He is well, his condition is improving," said papal spokesman Joaquin Navarro-Valls, speaking to reporters at Rome's Gemelli Polyclinic hospital. Navarro did not elaborate.
Throat specialists, including one who attended the pope's operation last Thursday to cut a breathing hole into his windpipe, said patients like John Paul should be able to speak normally again, although not as loudly.
But even as Monday's medical bulletin from the Vatican — the first issued since Friday — insisted the pontiff's recovery was proceeding uneventfully on his fifth day at Rome's Gemelli Polyclinic hospital, Parkinson's specialists said the debilitating neurological disease may well figure in more breathing crises for the 84-year-old pontiff.
"We are in a stage where it's evident that the patient is fragile because of progression of a disease with a 15, 20-year history," said Giovanni Fabbrini, a neurologist at Rome's Umberto I Polyclinic and a member of Sapienza's University (search) neurological sciences department.
"He's over the average age of 78" and he's "vulnerable" to more such respiratory problems, said Dr. Fabbrini, stressing that he hasn't examined John Paul.
For the second time in less than a month, John Paul was rushed to Gemelli on Feb. 24 with breathing problems that the Vatican (search) said were caused by a narrowing of the larynx.
"The Holy Father's postoperative phase is taking place without complications" and his general condition good, the Vatican communique said Monday. "The Holy Father is eating regularly, spends some hours in an armchair and has begun exercises to rehabilitate breathing and phonation."
The brief statement didn't describe the therapy.
Enrico Decampora, an ear, nose and throat specialist from the University of Florence who attended the tracheotomy, said speech therapy would consist of "elementary rehabilitation."
One approach is to insert a different tube with a smaller diameter into the hole created during the surgery to allow air some to reach the vocal cords.
Stressing that he was talking about patients in general who have a tracheotomy and not about the pope, Decampora said the voice will be normal although "the volume will be a little lower" because not that much air passes through to set the vocal cords vibrating.
"With that system you can breathe, talk and even eat," Decampora said.
The Vatican hasn't said if the initial tube inserted during the tracheotomy would be removed.
Leaving in the tube would give John Paul "a security valve," Fabrizio Ottaviani, a throat specialist in Rome, told Associated Press Television News. "The moment he starts having problems all he has to do is take off the top, and the pope can breathe again through the tube."
But another throat specialist, Marco Berlucchi, said if the tube's sole purpose was to ease the pope's breathing crisis, "the sooner you remove it, the better" to avoid possible injury to the trachea.
Usually, if the tube is inserted to help remove phlegm the patient can't cough up himself, it is removed in 10 to 15 days, he said.
While the Vatican didn't describe the pope's respiratory therapy, Berlucchi, at Civilian Hospitals in Brescia, northern Italy, said it could consist of massage to help clear lungs, and lessons to learn "how to breathe better, how to cough better."
Chest muscle control is commonly impaired in Parkinson's patients, who often suffer stooped posture like the pope does, further making it difficult to clear secretions from the lungs.
"Everything is complicated by Parkinson's," said Salvatore DiMauro, a neurology professor at Columbia University's Medical Center. "Whatever you have, and you have Parkinson's, you're going to be worse."