http://www.montereyherald.com/mld/montereyherald/news/world/11270248.htm
Pope getting some nutrition through tube, Vatican says
BY LIZ SLY
Chicago Tribune
ROME - (KRT) - Pope John Paul II is receiving added
nutrition through a tube in his nose, the Vatican
announced Wednesday, acknowledging for the first time
that the pontiff's recovery from throat surgery has
been slow.
The pope, who is breathing through a tube in his
throat, was fitted with the feeding tube after
widespread reports that he has been having difficulty
swallowing food.
The announcement came two hours after the pope made
another brief appearance at the window of his
apartment, during which he struggled, but failed, to
speak to pilgrims gathered in St. Peter's Square for
his regular weekly audience.
Just as he did Easter Sunday, the pope tried to speak,
but all he managed was a few rasping grunts before a
hand pulled his microphone away. He also appeared to
have difficulty controlling his movements - his head
lolled and his neck twitched.
But he managed to make the sign of the cross to bless
the crowd, while a bishop read the customary greeting
in several languages.
The Vatican didn't say when the tube was inserted, but
there was no sign of it during his four-minute
appearance at the study window. Medical experts said a
nasal feeding tube, which would typically remain in
place between meals, would have been visible had it
been present.
This latest twist to the saga of the 84-year old
pope's health problems brought closer the possibility
that the Vatican may one day have to grapple with the
dilemmas posed by a permanently incapacitated pontiff.
Although the Vatican said the pope spoke before he
left the hospital March 13, he has not spoken publicly
since.
The Vatican portrayed the tube's insertion as another
step toward his recuperation from the tracheostomy
performed two weeks ago to alleviate breathing
difficulties he experienced after coming down with
influenza. "To improve the calorie intake and
encourage a complete recovery of strength, feeding has
begun through the positioning of a nasal gastric
probe," said the statement issued by the pope's
spokesman, Joaquin Navarro Valls.
The communique was less upbeat than previous ones,
however, and for the first time the Vatican used the
word "slow" in reference to the pope's recuperation.
The pontiff is continuing his "slow and progressive
convalescence," Valls said. "He spends many hours of
the day in his armchair, he celebrates Mass in his
private chapel and he has working contact with his
collaborators."
The statement also said that all the pope's public
engagements for the coming weeks have been
"suspended."
It was the first time the Vatican has reported on the
pope's health in about three weeks, and the silence
has fueled speculation that his recovery has lagged.
The Italian daily Corriere della Sera reported Monday
that the pope would soon be readmitted to the hospital
to have a feeding tube inserted into his stomach.
A similar tube was used to feed Terri Schiavo of
Florida, before it was removed. Schiavo is dying
slowly of dehydration and starvation.
The Vatican has spoken forcefully against the
withdrawal of Schiavo's food and water, and the
pontiff has been clear on the broader subject, saying
that feeding tubes constitute a "proportionate" and
"obligatory" means of keeping otherwise disabled
patients alive.
In a speech last year at an international conference
on treatments for patients such as Schiavo, the pope
said: "I should like particularly to underline how the
administration of water and food, even when provided
by artificial means, always represents a natural means
of preserving life, not a medical act. Its use,
furthermore, should be considered, in principle,
ordinary and proportionate, and as such morally
obligatory."
In the pope's case, the nasal feeding tube is a less
invasive procedure than the one used in the abdominal
application and is usually intended to be temporary. A
plastic tube is inserted through the nose, down the
esophagus and into the stomach, enabling processed
food to be delivered directly to the stomach, medical
experts said.
The tube is uncomfortable, but it does not prevent
movement. Given that the pope's mobility is already
restricted by Parkinson's disease, the tube is
unlikely to significantly impede his activity, said
Gianni Pezzoli, a neurologist who heads the Italian
Parkinson's Association in Milan.
"The fact you have the tube does not tie you to the
bed. You are able to move around. The little tube is
often blocked on the nose with a piece of tape," he
said. "Besides, the fact is that the pope is no longer
very agile in any case."
Whether the pope will recover his ability to eat
normally will depend in part on the causes of his
swallowing difficulties. If they are linked solely to
his recent throat operation, the extra nourishment may
help him recover his strength and aid the healing
process.
But if his swallowing difficulties are caused by the
muscle degeneration associated with Parkinson's
disease, he may never be able to eat properly again,
medical experts said.
Pezzoli said he suspects muscle degeneration is
involved.
"It is clear that the decision to apply the tube is
also due to the fact that the pope is suffering from
neurological difficulties that affect his deglutition
(swallowing), as a consequence of the Parkinson
disease he is suffering from," he said.
If that is the case, it may soon become necessary to
perform the more drastic procedure of inserting a tube
directly into his stomach, because the nasal tube
will, over time, cause ulceration and infection in the
stomach and the esophagus, said Luisa Riccardi, a
gastroenterologist at Perugia Hospital.
Normally, a nasal tube can be left in place 7 to 10
days, after which it can be replaced if there are no
complications. But in the case of weakened patients
with muscle degeneration, such as the pope, a nasal
feeding tube is often inserted as a prelude to the
more drastic stomach operation, called a percutaneous
endoscopic gastrostomy, she said.
Riccardi suspects doctors have prescribed a period of
nasal feeding to help build the pope's strength in
preparation for the stomach operation.
The stomach tube also wouldn't confine the pope to
bed. "It is a more practical, efficient and suitable
feeding system in the long term," Pezzoli said. But it
is also, usually, irreversible.
"Whoever has this procedure performed, it is for a
permanent purpose," he said. "It is rarely
reversible."
---
(Alessandra Maggiorani contributed to this report.)
---
© 2005, Chicago Tribune.
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