CARACAS, Venezuela (AP) — The world got its first glimpse of Hugo Chavez since he underwent a fourth cancer-related surgery in Cuba more than two months ago, with photos released Friday showing the Venezuelan leader smiling alongside his daughters in Havana.
Along with images of the puffy-faced Chavez came a government explanation for why no one has heard from the longtime president since his surgery: He's breathing through a tracheal tube that makes speech difficult.
Chavez's government described his condition as "delicate" and said he continues to undergo "vigorous treatment for his fundamental illness."
The images and new details filled a vacuum of information about Chavez's condition that has unleashed rampant speculation in Venezuela. Government officials say Chavez has been recovering in Cuba since his cancer surgery Dec. 11.
The four photos show Chavez reclining on what appears to be a bed, his cheeks reddish, and a blue pillow behind his head. He smiles broadly, while his daughters Rosa and Maria lean in close to him.
Three of the images show Chavez looking at Thursday's issue of the Cuban Communist Party newspaper Granma, his daughters flanking him. Chavez's son-in-law, Science and Technology Minister Jorge Arreaza, showed the photos on Venezuelan state television.
Chavez's hasn't been seen publicly or heard from since he left for Cuba on Dec. 10. During previous treatments in Havana, he spoke on TV or appeared in photos.
Information Minister Ernesto Villegas said Friday that the tracheal tube makes talking difficult for Chavez.
"After two months of a complicated post-operative process, the patient remains conscious, with his intellectual functions intact, in close communication with his government team," Villegas said, reading from a statement on television.
Villegas reiterated that Chavez has overcome a respiratory infection that arose after the surgery, "although a certain degree of (breathing) insufficiency persists."
"Given that circumstance, which is being duly treated, Comandante Chavez is currently breathing through a tracheal cannula, which temporarily hinders speech," Villegas said.
Villegas also said Chavez's doctors are "applying vigorous treatment for his fundamental illness," an apparent reference to cancer. He said that treatment "isn't free of complications."
Government opponents have been demanding more information about Chavez's condition, and have asked why he hasn't spoken to the nation to explain his condition.
Dr. Jose Silva, a pulmonary specialist and president of the Venezuela Pulmonology Society, told The Associated Press that based on the government's accounts, doctors must have performed a tracheotomy on Chavez, cutting an opening in his windpipe to facilitate breathing. He said he thinks Chavez is breathing with the help of a ventilator through a tube attached to his windpipe, and speculated the president's track suit was zipped up to the neck to hide the tube.
Patients with breathing problems often require a tracheotomy to avoid damage to the vocal chords when a ventilator is used for an extended period, Silva said. "As long as he's depending on the respirator, he can't talk."
Based on the government's account and the way Chavez looked in the photos, with his head propped up on the pillow, Silva said it's possible the president has developed severe myopathy or polyneuropathy — disorders of the muscles or nerves "that are seen in critically ill patients and that that can lead ... to it taking longer than usual to be freed from ventilating support."
Chavez has acknowledged taking steroids during earlier phases of his treatment, and their use can lead both to bloating and to other problems. Silva said steroids can be a factor in patients who develop severe disorders of the nerves or muscles.
Such ailments would explain why Chavez still needs the support of a ventilator more than two months after the surgery, Silva said. In these types of cases, he said, "the recovery takes weeks or months, and the person is incapacitated during that time."
Dr. Carlos Castro, scientific director of the Colombian League Against Cancer in Bogota, Colombia, said it's normal for a patient's face to swell after being on a ventilator for a long time, though he also speculated the puffiness could be due to medications Chavez has been taking.
"They're not telling us anything about his 'fundamental illness,'" Castro said. "They don't touch that subject. So, the question is: What's happened with the cancer?"
In a downtown Caracas plaza, some cheered and clapped Friday as they watched the government broadcast replayed on a television under a tent where the president's supporters regularly gather.
"I have prayed like you wouldn't believe for the health of our commander president," gushed Luisa Rodriguez, saying the pictures filled her with joy.
People bought photos of Chavez that were being sold in the square for the equivalent of $3 apiece.
Before leaving for Cuba, Chavez acknowledged there were risks and said that if his illness prevented him from staying on as president, Vice President Nicolas Maduro should run in a new election to take his place.
Maduro has traveled repeatedly to Havana in recent weeks and has shown documents he said were signed by Chavez while insisting the president remains in charge. On Wednesday, Maduro said Chavez is undergoing "extremely complex and tough" treatments, which he didn't specify.
Arreaza on Friday described them as "palliative treatments" but didn't give details. He said Chavez has been keeping up his spirits with "llanera" folk music playing in his room.
"He's a fighter," Arreaza said in a televised interview.
The 58-year-old president has been undergoing cancer treatment in Cuba on-and-off since June 2011. He has said he has had tumors removed from his pelvic region and has undergone chemotherapy and radiation treatment.
Throughout the treatments, Chavez has not revealed the type of cancer or the location where tumors have been removed.
The government provided the update a day after students began protesting outside the Cuban Embassy demanding the president appear and accusing the island's leaders of wielding undue influence in Venezuela's affairs.
Opposition leader Henrique Capriles said he hopes the president recovers, but also accused the government of misleading people about the illness.
"There are some government leaders who weren't elected and who appear every day on television with a different story," Capriles told reporters. In a message on Twitter, he said that "several days ago the liars said they spoke with him. ... Now, they say he can't speak. They're deceiving their own people!"
Associated Press journalists Fabiola Sanchez, Christopher Toothaker and Ricardo Nunes in Caracas, Frank Bajak in Lima, Peru, and Cesar Garcia in Bogota, Colombia, contributed to this report.
Ian James on Twitter: http://twitter.com/ianjamesap