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Posted on Wed, Mar. 30, 2005 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.) --- (c) 2005, Chicago Tribune. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Protect your mail server with built in anti-virus protection. It's not only good for you, it's good for everybody. http://www.houseoffusion.com/banners/view.cfm?bannerid=39 Message: http://www.houseoffusion.com/lists.cfm/link=i:5:152296 Archives: http://www.houseoffusion.com/cf_lists/threads.cfm/5 Subscription: http://www.houseoffusion.com/lists.cfm/link=s:5 Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=89.70.5 Donations & Support: http://www.houseoffusion.com/tiny.cfm/54
