Sore Throat From Intubation: Causes & Relief

Following intubation with an endotracheal tube, a frequent complaint among patients is a sore throat from intubation, often stemming from the irritation caused by the tube's presence in the trachea. The severity of this discomfort can vary widely, influenced by factors such as the duration of the intubation and the technique employed by the anesthesiologist. The McGill Pain Questionnaire is sometimes used to assess the intensity and nature of the pain experienced, which can range from mild scratchiness to significant pain affecting swallowing and speech. Furthermore, research conducted at institutions like the Mayo Clinic has explored various methods for preventing and treating this common post-operative issue.

Endotracheal intubation stands as a cornerstone of modern medical practice, frequently employed to secure and maintain a patient's airway during surgery, critical illness, or respiratory failure. This life-saving intervention, while essential, is often accompanied by a significant and unwelcome side effect: post-intubation sore throat (PIST).

The Prevalence of PIST

PIST is a remarkably common complication, affecting a substantial proportion of patients who undergo intubation. The discomfort, ranging from mild scratchiness to intense pain, can significantly impact a patient's recovery and overall well-being. This often leads to increased use of pain relief medication, and can delay speech therapy for patients requiring it.

Statement of the Problem

The high incidence of PIST presents a considerable challenge. While often considered a minor issue compared to the underlying condition necessitating intubation, it can still be a source of significant distress for patients. Failing to address PIST effectively can negatively impact patient satisfaction and potentially hinder the recovery process.

Scope of Discussion

This article will delve into the multifaceted aspects of post-intubation sore throat. We will explore the underlying causes and contributing factors that lead to its development, including both procedural and patient-related variables. Furthermore, we will examine the available management strategies, ranging from simple palliative measures to pharmacological interventions.

Finally, we will emphasize preventive measures, highlighting techniques and protocols that can minimize the risk and severity of PIST. Understanding these aspects is crucial for healthcare professionals aiming to optimize patient comfort and promote smoother recovery following intubation.

The Intubation Process: A Closer Look

Endotracheal intubation stands as a cornerstone of modern medical practice, frequently employed to secure and maintain a patient's airway during surgery, critical illness, or respiratory failure. This life-saving intervention, while essential, is often accompanied by a significant and unwelcome side effect: post-intubation sore throat (PIST).

The process involves inserting a tube into the trachea to ensure proper ventilation. Let's delve into the intricacies of this procedure, examining the techniques, personnel involved, and critical equipment utilized.

Understanding Endotracheal Intubation

Endotracheal intubation is the procedure of inserting a tube (endotracheal tube or ETT) through the mouth or nose into the trachea. This ensures that the patient has a secure and open airway for mechanical ventilation, delivery of anesthesia, or airway protection against aspiration.

The choice of technique often depends on the clinical scenario.

Orotracheal vs. Nasotracheal Intubation

Orotracheal intubation is the most common approach, where the ETT is passed through the mouth. It offers a direct view of the vocal cords, facilitating quicker and easier placement.

Nasotracheal intubation, where the ETT is inserted through the nose, is typically reserved for situations where oral access is limited, such as maxillofacial trauma. It requires specialized skills and is associated with a higher risk of nasal bleeding and sinus complications.

Rapid Sequence Intubation (RSI)

In emergency situations, Rapid Sequence Intubation (RSI) is often employed. RSI is a carefully orchestrated process designed to quickly secure the airway while minimizing the risk of aspiration.

It involves the simultaneous administration of a sedative and a neuromuscular blocking agent (paralytic) to induce rapid unconsciousness and muscle relaxation, respectively. This enables swift and efficient intubation, critical in scenarios where time is of the essence.

The Multidisciplinary Team: Key Roles and Responsibilities

Successful intubation and subsequent patient management require a coordinated effort from a diverse team of healthcare professionals.

Anesthesiologists

Anesthesiologists are the primary experts in airway management. They possess the specialized training and skills necessary to perform intubation, manage anesthesia, and address any complications that may arise during the procedure.

Nurse Anesthetists (CRNAs)

Certified Registered Nurse Anesthetists (CRNAs) are advanced practice nurses who play a vital role in anesthesia care. They assist anesthesiologists or, in some settings, independently perform intubations and manage anesthesia under the supervision of a physician.

Intensivists

Intensivists are physicians specializing in critical care medicine. They oversee the care of intubated patients in the Intensive Care Unit (ICU), managing their ventilation, addressing underlying medical conditions, and coordinating weaning from mechanical ventilation.

Registered Nurses (RNs)

Registered Nurses (RNs) provide continuous monitoring and care to intubated patients. They administer medications, manage ventilator settings as directed, monitor vital signs, and provide crucial support to the patient and their family. RNs are also vital in post-operative care and pain management.

Pulmonologists

Pulmonologists are respiratory specialists who may be consulted for patients with complex lung conditions or those experiencing difficulties with ventilation. They provide expert guidance on optimizing respiratory support and managing pulmonary complications.

Speech-Language Pathologists (SLPs)

Speech-Language Pathologists (SLPs) play an essential role in assessing and managing swallowing difficulties (dysphagia) that can arise after intubation. They conduct swallowing evaluations and recommend strategies to ensure safe oral intake once the patient is ready to eat and drink.

Otolaryngologists (ENTs)

Otolaryngologists (ENTs), also known as ear, nose, and throat (ENT) specialists, are consulted when patients experience complications involving the larynx or vocal cords following intubation. They can diagnose and manage conditions such as vocal cord paralysis or laryngeal stenosis.

Essential Equipment for Airway Management

Successful intubation relies on a range of specialized equipment, each designed to facilitate the procedure and ensure patient safety.

Endotracheal Tube (ETT)

The endotracheal tube (ETT) is the primary device for establishing and maintaining a secure airway. It is a flexible tube made of biocompatible material that is inserted into the trachea.

Laryngoscope and Video Laryngoscope

The laryngoscope is an instrument used to visualize the larynx and vocal cords during intubation. It consists of a handle and a blade that is inserted into the mouth to lift the tongue and epiglottis, providing a clear view of the glottis. Video laryngoscopes provide an indirect view via a camera.

Stylet

A stylet is a malleable metal or plastic rod that is inserted into the ETT to provide rigidity and aid in directing the tube through the vocal cords.

Laryngeal Mask Airway (LMA)

The Laryngeal Mask Airway (LMA) is an alternative airway device that can be used in certain situations as an alternative to an ETT. It is inserted into the pharynx and forms a seal around the larynx, providing ventilation without direct insertion into the trachea.

Ventilator

A ventilator is a machine that provides mechanical ventilation to patients who are unable to breathe adequately on their own. It delivers controlled breaths and monitors respiratory parameters to ensure adequate oxygenation and carbon dioxide removal.

Suction Catheter

A suction catheter is used to remove secretions from the airway, ensuring a clear path for ventilation.

Oropharyngeal Airway (OPA) / Nasopharyngeal Airway (NPA)

Oropharyngeal Airways (OPAs) and Nasopharyngeal Airways (NPAs) are adjuncts used to maintain airway patency in unconscious patients by preventing the tongue from obstructing the airway.

Unraveling the Causes: Why Post-Intubation Sore Throat Occurs

Following the complexities of the intubation process, it is important to understand the factors that contribute to the common yet uncomfortable issue of post-intubation sore throat (PIST). Several elements are at play, ranging from the immediate mechanical impact of the procedure to longer-term physiological responses and patient-specific vulnerabilities.

Mechanical Trauma During Intubation

The physical insertion of the endotracheal tube (ETT) is often the primary instigator of PIST. The delicate mucous membranes lining the larynx and trachea are susceptible to injury from both the ETT itself and the laryngoscope used to visualize the vocal cords.

Mucosal Injury and Inflammation

The laryngoscope, while essential for guiding the ETT, can cause direct trauma as it maneuvers through the oral cavity and pharynx. This initial injury sets off an inflammatory cascade, leading to swelling, redness, and pain in the throat.

The ETT, even when inserted with utmost care, can further irritate the sensitive laryngeal and tracheal mucosa. The risk of injury is heightened in patients with anatomical variations or those requiring difficult intubations.

Physiological Factors and Tube Dynamics

Beyond the initial trauma, physiological factors related to the ETT's presence play a crucial role in the development and persistence of PIST. The duration of intubation, the size of the tube, and the pressure exerted by the ETT cuff all contribute to the discomfort experienced by patients.

Duration of Intubation

The longer the ETT remains in place, the greater the likelihood of mucosal irritation and inflammation. Prolonged pressure on the tracheal walls can lead to ischemia and necrosis, exacerbating the sore throat.

Endotracheal Tube Size

The diameter of the ETT is another significant factor. Using an oversized tube can cause excessive pressure on the surrounding tissues, leading to increased pain and potential damage. Proper sizing is essential to minimize this risk.

ETT Cuff Pressure

The cuff of the ETT is inflated to create a seal within the trachea, preventing air leakage and ensuring effective ventilation. However, excessive cuff pressure can compress the tracheal mucosa, impairing blood flow and causing tissue damage. Conversely, inadequate cuff pressure can lead to aspiration and ineffective ventilation. Maintaining optimal cuff pressure is a delicate balance that requires careful monitoring.

Patient-Related Risk Factors

Not all patients are equally susceptible to PIST. Certain pre-existing conditions and lifestyle factors can increase the risk and severity of post-intubation discomfort.

Age, Gender, and Pre-existing Conditions

Studies suggest that female patients may be more prone to PIST, potentially due to anatomical differences in airway size. Similarly, elderly patients and those with pre-existing respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), may experience heightened sensitivity and inflammation.

History of Smoking or Respiratory Illness

A history of smoking significantly increases the risk of PIST, as it compromises the integrity of the respiratory mucosa and impairs the body's natural healing mechanisms. Similarly, patients with pre-existing respiratory illnesses may have more sensitive airways, making them more vulnerable to intubation-related trauma.

Procedural Factors During Intubation

The technique and skill of the clinician performing the intubation can significantly impact the likelihood of PIST. Careful technique, appropriate equipment, and a minimal number of attempts are crucial for minimizing trauma.

Laryngoscopy Technique

The manner in which the laryngoscope is used is paramount. Excessive force or improper positioning can lead to direct injury to the larynx and surrounding structures. Proper training and experience are essential for performing laryngoscopy atraumatically.

Use of Suctioning

Suctioning is often necessary to clear secretions from the airway during intubation. However, aggressive or indiscriminate suctioning can damage the delicate tracheal mucosa, contributing to PIST.

Number of Intubation Attempts

Each attempt at intubation carries a risk of further trauma. Multiple attempts significantly increase the likelihood of mucosal injury, inflammation, and subsequent sore throat. Experienced clinicians strive to achieve successful intubation with the fewest possible attempts.

Recognizing the Signs: Clinical Presentation and Potential Complications

Unraveling the Causes: Why Post-Intubation Sore Throat Occurs Following the complexities of the intubation process, it is important to understand the factors that contribute to the common yet uncomfortable issue of post-intubation sore throat (PIST). Several elements are at play, ranging from the immediate mechanical impact of the procedure to long-term physiological responses. Accurately recognizing the signs and being aware of the potential complications is crucial for providing timely and effective post-intubation care.

This section delves into the typical clinical presentation of PIST and explores the possible serious complications. This is critical to improve health outcomes. Finally, it outlines the diagnostic approaches used to assess the patient’s condition.

Common Symptoms of Post-Intubation Sore Throat

The most frequently reported symptoms following intubation include a sore throat, difficulty swallowing (dysphagia), and changes in voice quality (hoarseness). These symptoms can range in severity. It depends on individual patient factors and the specifics of the intubation procedure.

Sore Throat

The hallmark symptom of PIST is, of course, a sore throat. Patients often describe a scratchy, painful sensation that may intensify with swallowing or speaking.

This discomfort is typically the result of mucosal irritation and inflammation caused by the endotracheal tube's presence.

Dysphagia (Difficulty Swallowing)

Dysphagia, or difficulty swallowing, is another common complaint. The trauma and inflammation from intubation can affect the muscles and nerves responsible for swallowing.

This can lead to discomfort and a fear of choking. It can also affect a patient's ability to eat or drink properly.

Hoarseness

Alterations in voice quality, such as hoarseness, are also frequently observed. These voice changes typically arise due to irritation or minor injury to the vocal cords during intubation.

The severity can vary from mild raspiness to significant voice distortion. It can potentially impact communication abilities.

Potential Serious Complications

While most cases of PIST are self-limiting and resolve within a few days, serious complications can arise. Early identification and intervention are essential to prevent long-term sequelae.

Laryngeal Edema

Laryngeal edema, or swelling of the larynx, is a potentially life-threatening complication. It can lead to airway obstruction.

The swelling is usually a result of trauma or an allergic reaction to the endotracheal tube. Close monitoring and prompt intervention, such as administering corticosteroids or, in severe cases, reintubation, are crucial to manage this condition.

Vocal Cord Paralysis

Vocal cord paralysis, although rare, can occur due to nerve damage during intubation. This can result in a weakened or breathy voice. It can cause difficulties with swallowing and an increased risk of aspiration.

Diagnosis typically involves a laryngoscopy. In some cases, surgical intervention or speech therapy may be necessary to improve vocal cord function.

Aspiration Pneumonia

Aspiration pneumonia is another concerning complication, especially in patients with dysphagia. Impaired swallowing mechanisms can lead to the aspiration of saliva, food, or gastric contents into the lungs.

This can result in a serious lung infection. Careful monitoring of swallowing function, appropriate positioning during feeding, and prompt treatment of pneumonia are vital in preventing and managing this complication.

Diagnostic Approaches

The diagnostic process for PIST and its related complications begins with a thorough clinical assessment and patient history. This involves gathering information about the patient's symptoms, medical history, and the details of the intubation procedure. Further testing may be needed to make a definitive diagnosis.

Clinical Assessment and Patient History

A comprehensive clinical assessment includes evaluating the patient’s description of symptoms, assessing voice quality, and observing swallowing function. The medical history is crucial. It can identify any pre-existing conditions that may increase the risk of complications.

Laryngoscopy

Laryngoscopy involves using a flexible or rigid scope to visualize the larynx and vocal cords. This allows for direct examination of the structures. It helps in identifying any signs of inflammation, injury, or paralysis.

This diagnostic procedure is invaluable in differentiating between simple PIST and more severe complications. It is a definitive approach for diagnosis.

Relief and Recovery: Management and Treatment Options

Following the complexities of the intubation process, it is important to understand the factors that contribute to the common yet uncomfortable issue of post-intubation sore throat (PIST). Several elements are at play, from the mechanical trauma caused by the endotracheal tube to patient-specific physiological responses. As a result, managing and treating PIST requires a multi-faceted approach. This involves pharmacological interventions that target pain and inflammation, as well as non-pharmacological strategies that support healing and comfort.

Pharmacological Interventions for PIST

Medication plays a crucial role in alleviating the discomfort associated with PIST. The selection of appropriate drugs depends on the severity of the symptoms and the overall health status of the patient.

Analgesics: Managing Pain After Intubation

Analgesics, or pain relievers, are often the first line of defense against PIST. Over-the-counter options like acetaminophen and ibuprofen can provide relief for mild to moderate pain. However, in cases of severe pain, stronger analgesics such as opioids may be necessary. It's essential to monitor opioid use carefully due to the risk of side effects and dependence.

Lozenges and Gargles: Soothing Relief

For localized throat discomfort, lozenges and gargles can provide soothing relief. Lozenges coat the throat, reducing irritation and providing temporary pain relief. Salt water gargles are also effective for reducing inflammation and promoting healing. Medicated gargles containing mild antiseptics can further aid in preventing secondary infections.

Topical Anesthetic Sprays

Topical anesthetic sprays offer another approach to managing localized pain. These sprays contain numbing agents that temporarily relieve throat discomfort. However, they should be used with caution, as they can impair swallowing and increase the risk of aspiration.

Steroids: Addressing Inflammation

Steroids, such as dexamethasone, can be used to reduce inflammation in the larynx and trachea. These are typically reserved for cases where inflammation is a significant contributor to the sore throat. Steroids must be administered under medical supervision, considering potential side effects such as increased blood sugar levels and immunosuppression.

Antibiotics: Targeting Secondary Infections

While PIST is usually not caused by infection, secondary bacterial infections can occur, particularly if the mucosal lining of the throat has been compromised. In such cases, antibiotics may be necessary to combat the infection and promote healing. The use of antibiotics should be based on clinical assessment and, ideally, microbiological testing to ensure appropriate antibiotic selection.

Non-Pharmacological Interventions: Supportive Care

In addition to medication, non-pharmacological interventions play a vital role in managing PIST. These strategies focus on promoting comfort and supporting the body's natural healing processes.

Humidified Oxygen: Maintaining Airway Moisture

Humidified oxygen helps to keep the airway moist, which can reduce irritation and promote healing. Dry air can exacerbate throat discomfort, so humidification is particularly beneficial in patients receiving supplemental oxygen.

Voice Rest and Hydration: Essential Measures

Voice rest is critical for allowing the vocal cords to recover from the trauma of intubation. Patients should avoid speaking excessively or straining their voices. Adequate hydration is also essential, as it helps to keep the throat moist and promotes overall healing.

When to Seek Specialist Referral

While many cases of PIST resolve with conservative management, some patients may require referral to a specialist. Referral to an Otolaryngologist (ENT) is recommended if symptoms persist or worsen despite treatment. An ENT can perform a thorough examination of the larynx and vocal cords to identify any underlying structural abnormalities or complications.

Speech-Language Pathologists (SLPs) are also valuable in the management of PIST, particularly if patients experience swallowing difficulties (dysphagia). SLPs can assess swallowing function and provide strategies and exercises to improve swallowing safety and efficiency, reducing the risk of aspiration.

Prevention is Key: Strategies to Minimize Sore Throat After Intubation

Following the complexities of the intubation process, it is important to understand the factors that contribute to the common yet uncomfortable issue of post-intubation sore throat (PIST). Several elements are at play, from the mechanical trauma caused by the endotracheal tube to patient-specific risk factors. However, many of these factors can be mitigated through meticulous preventative strategies implemented during the intubation procedure. Focusing on prevention is paramount, aiming to reduce both the incidence and severity of PIST, ultimately enhancing patient comfort and recovery.

Minimizing Trauma During Intubation: Technique and Technology

The cornerstone of preventing PIST lies in minimizing trauma during the intubation process itself. This requires a two-pronged approach: refining technique and leveraging technology.

Refining Laryngoscopy Technique

Proper training and technique in laryngoscopy are essential. This means ensuring that clinicians are not only familiar with the anatomical landmarks but also proficient in visualizing the vocal cords with minimal force and manipulation. Hasty or forceful intubation attempts significantly increase the risk of mucosal injury, leading to subsequent inflammation and sore throat.

Judicious Use of Stylet and Video Laryngoscopy

The stylet, when used correctly, can aid in guiding the endotracheal tube (ETT) through the vocal cords. However, over-insertion or aggressive manipulation of the stylet can cause trauma. Similarly, while video laryngoscopy offers improved visualization, it's crucial to understand its nuances. Excessive force or improper technique, even with video assistance, can still result in injury. Utilizing video laryngoscopy with proper technique reduces the number of attempts at intubation.

Selecting the Right Tube: Size and Cuff Management

Choosing an appropriately sized endotracheal tube is crucial to minimize mucosal irritation.

A tube that is too large can exert excessive pressure on the tracheal walls, leading to inflammation and pain. Conversely, a tube that is too small may require higher cuff pressures to achieve an adequate seal, again increasing the risk of mucosal injury.

Cuff Pressure: The Delicate Balance

Cuff management is equally important. Overinflation of the cuff can cause significant tracheal damage, while underinflation can lead to air leakage and the need for increased ventilation pressures, potentially exacerbating mucosal irritation. Regular monitoring and adjustment of cuff pressure, aiming for the recommended range, are essential.

Laryngeal Mask Airway (LMA): A Viable Alternative?

In certain clinical scenarios, the Laryngeal Mask Airway (LMA) can serve as a valuable alternative to endotracheal intubation. The LMA is a supraglottic airway device that is less invasive than an ETT and can be associated with a lower incidence of PIST. However, the decision to use an LMA should be based on careful consideration of patient factors, the nature of the procedure, and the clinician's expertise.

Prioritizing Infection Control

Infection control plays an indirect but vital role in preventing post-intubation complications. While not a direct cause of sore throat, secondary infections can exacerbate existing inflammation and prolong recovery.

Strict adherence to infection control protocols, including proper hand hygiene and sterile technique during intubation, is essential to minimize the risk of secondary infections and optimize patient outcomes.

Adhering to Established Protocols: A Systemic Approach

Finally, adherence to established protocols for Airway Management is crucial. Standardized protocols ensure a consistent and evidence-based approach to intubation, minimizing variability and promoting best practices. These protocols should be regularly reviewed and updated to incorporate the latest evidence and technological advancements. Consistent adherence to these protocols creates a safer environment for patients undergoing intubation.

By systematically implementing these preventative strategies, healthcare providers can significantly reduce the incidence and severity of post-intubation sore throat, leading to improved patient comfort, faster recovery, and enhanced overall outcomes.

The Institutional Framework: Hospitals and ICUs in Post-Intubation Care

Following the discussion of preventative strategies, it is essential to examine the role of healthcare institutions in shaping the landscape of post-intubation care. Hospitals and Intensive Care Units (ICUs) serve as the primary settings for intubation procedures and the subsequent management of patients. Their operational frameworks, protocols, and resource allocation significantly impact the incidence and severity of post-intubation complications, particularly sore throat (PIST).

Hospitals and ICUs: The Epicenters of Airway Management

Hospitals, especially their critical care divisions like ICUs, are where the vast majority of intubations are performed. These facilities are equipped with the necessary infrastructure, technology, and skilled personnel to manage both routine and emergency airway situations.

The ICU environment demands a high degree of vigilance and specialized care. This is because intubated patients often have multiple underlying conditions that can complicate their recovery and increase the risk of adverse events. Therefore, the organization and operational standards of these units are paramount.

Standardized Protocols: The Cornerstone of Quality Care

Standardized protocols are crucial for ensuring consistent and effective post-intubation care. These protocols should encompass every aspect of airway management, from pre-intubation assessment to post-extubation monitoring.

For instance, clear guidelines on endotracheal tube size selection, cuff pressure management, and suctioning techniques can significantly reduce the risk of mechanical trauma and subsequent sore throat. Moreover, standardized pain management protocols, including the use of analgesics and anti-inflammatory medications, can alleviate discomfort and promote faster recovery.

The implementation of such protocols necessitates a collaborative approach involving anesthesiologists, intensivists, nurses, and other healthcare professionals. Regular audits and feedback mechanisms are also essential to ensure adherence and identify areas for improvement.

The Critical Role of Staff Training and Competency

Even the most well-designed protocols are ineffective without adequately trained and competent staff. Comprehensive training programs are essential for equipping healthcare professionals with the knowledge and skills necessary to perform intubations safely and manage post-intubation complications effectively.

This training should include hands-on experience with various intubation techniques, as well as simulation-based learning to prepare for unexpected challenges. Regular continuing education and recertification programs are also crucial to keep staff up-to-date with the latest advancements in airway management.

Furthermore, fostering a culture of teamwork and communication is essential for optimizing patient care. Clear lines of communication between different healthcare professionals can help to identify and address potential problems early on, reducing the risk of complications and improving patient outcomes.

Resource Allocation and Infrastructure

Beyond protocols and training, adequate resource allocation and infrastructure are critical for providing optimal post-intubation care. This includes ensuring the availability of appropriate equipment, such as video laryngoscopes, flexible bronchoscopes, and humidified oxygen delivery systems.

It also entails maintaining adequate staffing levels to provide close monitoring and individualized care to intubated patients. Sufficient staffing is especially crucial in ICUs, where patients often require intensive monitoring and support.

Furthermore, hospitals and ICUs should invest in technologies that can improve the efficiency and effectiveness of airway management, such as electronic medical records and decision support systems. These tools can help to streamline workflows, reduce errors, and improve communication among healthcare professionals.

Continuous Quality Improvement

The institutional framework must also embrace a culture of continuous quality improvement. This involves regularly monitoring patient outcomes, identifying areas for improvement, and implementing evidence-based practices to enhance the quality of care.

Hospitals and ICUs should establish mechanisms for collecting and analyzing data on post-intubation complications, such as sore throat, laryngeal edema, and aspiration pneumonia. This data can be used to identify trends, assess the effectiveness of interventions, and guide future quality improvement efforts.

By embracing a culture of continuous improvement, healthcare institutions can optimize their post-intubation care practices and improve patient outcomes. This commitment to excellence is essential for ensuring that intubated patients receive the best possible care.

So, while a sore throat from intubation is definitely no fun, remember it's usually temporary. Try some of the remedies we've discussed, and if things don't improve after a few days, or if you develop any other concerning symptoms, don't hesitate to reach out to your doctor. Hopefully, you'll be feeling back to normal soon!