by John Thavis
Catholic News Service

ROME (CNS) -- Following a tracheotomy to alleviate breathing problems, Pope John Paul II may have to reduce his public appearances, rely more heavily on nonverbal communication and live in as sterile an environment as possible, said a neurological expert in Rome.

"He can carry out his papal duties, because the intellect is intact. But everything will certainly become more complicated," Dr. Fabrizio Stocchi told Catholic News Service Feb. 28.

Stocchi, whom the Vatican has consulted in the past about the pope's condition, said the insertion of a tube in the throat has clearly helped the pontiff breathe more easily.

The tube is likely to be left in after the pope leaves the hospital, which means an elevated risk of infection, Stocchi said. As long as the tube is open, the pope will have to limit his activities, especially around other people, and he will not be able to speak, he said.

"He can move his lips, but the air is not going past the vocal cords. In this situation, he could communicate by writing" or perhaps even by mouthing the words, Stocchi said.

Stocchi, a professor of neurology at the Institute of Neurological Research at Rome's Sapienza University, is considered one of Italy's best experts on Parkinson's disease. The pope is believed to suffer from the disease.

The pope's tracheotomy was needed because a flu-related inflammation of the larynx, perhaps aggravated by the pope's neurological disorder, caused recurring throat spasms and an inability to breathe.

Stocchi said the tracheotomy tube helps deliver more air to the lungs, but the air is less moist, less warm and less pure than in normal breathing. It increases the risk of infection, even though it is fitted with an external filter, he said.

"That means he has to stay in an environment that is kept as sterile as possible," Stocchi said. For example, he said, doctors would be unlikely to approve papal audiences if he were breathing through an open tube.

However, closing off the tube -- even for an hour or two at a time -- is possible if the pope regains normal breathing to some extent, Stocchi said. In that case, the pope could function more normally. He could also speak, since air would move past the vocal cords, but it would be a lower and less audible tone, he said.

"Giving speeches would be problematic. But with the tube closed, he could meet with people and even move to other environments," he said.

Stocchi said he presumed the Vatican was refitting the pope's apartment to deal with his new medical condition. For such patients, he said, that would typically include having a respirator at hand, which could be used in emergencies to deliver air through the tracheotomy tube.

Stocchi said treating Parkinson's disease in someone like the pope was not necessarily a complicated matter. Patients of the pontiff's age are given doses of levadopa to keep symptoms under control, he said.

In younger patients, he added, a much more complex regime of drugs and treatment might be tried.

He said one complicating factor for the pope is his increasingly curved posture -- head and neck tilted way forward. That in itself decreases respiration, he said.

Stocchi said he knows from experience and from speaking to other international experts in the field that the Vatican has consulted far and wide with neurological specialists in an effort to make sure the pope has the best possible care.