c. 2005 Religion News Service

VATICAN CITY _ Pope John Paul II on Wednesday (March 30) had a plastic feeding tube inserted into his nose, down the back of his throat and through his esophagus to carry nourishment directly to his stomach.

The Vatican announced the measure about two hours after the 84-year-old Roman Catholic pontiff appeared at his study window to bless pilgrims in St. Peter’s Square. As happened on Easter Sunday, he made only unintelligible sounds when he tried to speak into a microphone.

Vatican spokesman Joaquin Navarro-Valls said in his first bulletin on the pope’s condition since he left a Rome hospital March 13 that John Paul “continues his long and progressive convalescence.”

Surgeons placed a different tube in his throat Feb. 24 to ease breathing problems caused by the combined effects of influenza and Parkinson’s disease, and this has affected his ability to speak.

The pope has looked increasingly thin and drawn in his five appearances at his window since returning to the Vatican. He has grimaced and seemed to be having trouble swallowing. The nasal, or nasogastric, tube will enable the pope to get better nutrition.

“To improve caloric intake and favor a valid recovery of strength, enteral (alimentary) nutrition has begun through the positioning of a nasogastric tube,” Navarro-Valls said.

Doctors said the difficulty in swallowing probably was caused by Parkinson’s disease, a degenerative neurological condition from which John Paul has suffered for at least 15 years. It has left him confined to a wheelchair and affected his vocal chords.

Doctors said the nasogastric tube, which is made of soft, clear plastic, may be uncomfortable and cause nausea but is not painful. The pope’s tube differs from the one recently removed from Terri Schiavo, the severely brain-damaged Florida woman at the center of an international controversy over whether she should be allowed to die from lack of nutrition.

Schiavo’s tube was a gastronomy, or G-tube, which delivers processed food directly to the stomach, instead of through the nose.

Although a temporary measure, the pope’s nasogastric tube can remain in his nose indefinitely. Food and medicine are given in liquid form from a container that is attached to the tube.

(OPTIONAL TRIM FOLLOWS)

The tube apparently was inserted after the pope’s late-morning appearance at his window because if it had been done earlier it would have been visible.

Italian news agencies had previously reported that the pope might return to Rome’s Agostino Gemelli Polyclinic hospital for surgeons to insert a Schiavo-like tube directly into his stomach.

The operation Schiavo had, a percutaneous gastrostoma endoscopy, known in Italian as a PEG, is still possible if the pope does not recover enough strength from the nasal feeding to resume eating normally. After giving him local anesthesia, surgeons would make an incision in his abdomen to position the feeding tube in an opening of his stomach.

Feeding through a nasogastric tube is a less extreme measure than through a stomach tube, but it carries the risk of ulcerations and sores, doctors said.

Neurologist Gianni Pezzoli, president of the Italian Parkinson’s Disease Association, told the Italian news agency ANSA that the insertion of a nasogastric tube usually is followed by a stomach tube.

“It is necessary to see how the tube will be tolerated. Keep in mind that after some weeks in place the tube tends to cause annoyance and to ulcerate where it curves in the esophagus and the stomach. Because of this it is removed and replaced with something definitive like the PEG,” he said.

Pezzoli said that once the pope’s nourishment problem is resolved, doctors can think of removing the breathing tube that has impeded his speaking.

Vatican officials, who have been meeting regularly with John Paul, have said that he is able to speak to them, but the last time he spoke in public was March 13 when he greeted pilgrims before leaving the Gemelli hospital.

On Easter Sunday and again Wednesday, the pope’s attempts to speak produced only hoarse rasps, and he brusquely waved away his microphone.

John Paul’s Wednesday appearance was a curtailed version of his weekly general audience. An unseen aide read the pope’s greetings in Italian, German and his native Polish and led pilgrims in the Lord’s Prayer, and the pope blessed the crowd by making the sign of the cross.

Navarro-Valls said the pope’s regular public audiences “still remain suspended.”

“The pope,” he said, “spends many hours of the day in an armchair, celebrates the Holy Mass in his private chapel and is in working contact with his collaborators, directly following the activity of the Holy See and the life of the Church.”

The spokesman said Vatican medical personnel are caring for John Paul under the direction of his personal physician, Renato Buzzonetti.

MO/PH END RNS