Pope receiving nutrition through feeding tube

VATICAN CITY -- In another sign of Pope John Paul II's growing frailty, the Vatican said Wednesday that the 84-year-old pontiff was getting nutrition from a tube in his nose and acknowledged his convalescence from throat surgery last month has been "slow."

Vatican spokesman Joaquin Navarro-Valls said John Paul was fitted with a nasogastric tube to "improve the calorie intake" and help him recover his strength.

The statement was issued shortly after the pope tried unsuccessfully to speak to the crowds in St. Peter's Square for the second time in a week. After managing just a rasp of his voice, he blessed well-wishers by making the sign of the cross with his hand and withdrew from his window.

A nasogastric tube is common in people requiring supplemental nutrition. The tube is threaded down the nose and throat into the stomach and liquid food is fed through it. While uncomfortable, no sedation or surgery is required. The patient can eat and speak with the tube in place.

Dr. Barbara Paris, director of geriatrics at Maimonides Medical Center in New York City, said the tube might be just a temporary measure to boost John Paul's nutrition during his recovery.

But she said it also could be the first step toward a more permanent feeding tube. In that procedure -- known as PEG, for percutaneous endoscopic gastrostomy -- a surgical incision is made in the abdomen to permit a tube to be passed directly into the stomach.

The nasogastric tube is less invasive and simpler than the PEG procedure, but is not generally used for long-term supplemental feeding, Paris said.

Terri Schiavo, the severely brain-damaged woman at the center of a legal battle in the United States, was fed for years by a PEG tube before it was removed this month.

It wasn't clear when the pope's nasogastric tube was inserted, but it was first acknowledged by the Vatican on Wednesday. None was visible during John Paul's brief appearance at the window Wednesday.

Italian media have said the pope's doctors were considering a PEG tube because John Paul was having trouble swallowing. The procedure must be done in a hospital, and Navarro-Valls' statement appeared to indirectly deny any hospitalization was planned.

Another Vatican official confirmed there was no plan to return John Paul to the hospital.

In the Vatican's statement, the first medical report on John Paul since March 10, Navarro-Valls said the pope was continuing a "slow and progressive convalescence" from a tracheotomy Feb. 24. In that surgery, a tube was inserted in the pope's throat to help him breathe.

The spokesman said John Paul spends "many hours" seated in an armchair, celebrates Mass in his private chapel and has work contacts with his aides "following directly the activities of the Holy See and the life of the church."

But Navarro-Valls said the pontiff's public audiences remain suspended.

He said medical assistance was being provided by the Vatican medical staff under the direction of the pope's personal physician, Dr. Renato Buzzonetti -- an apparent reference to reports that outside medical help had been called in.

The insertion of the feeding tube was the latest in a series of interventions for the pontiff, who has battled Parkinson's disease for years as well as hip and knee ailments that have made it virtually impossible for him to stand.

In addition to the tracheotomy, he has had an inflamed appendix and benign tumor on his colon removed and he underwent hip replacement surgery after falling in the bathroom in 1994. He was shot in the abdomen in 1981.

The pope was rushed to Gemelli Polyclinic hospital twice last month with breathing crises. He last spoke to the public March 13, shortly before being discharged from the hospital a second time.

Since then, he has been unable to speak publicly. On Easter Sunday, he tried but failed to deliver his "Urbi et Orbi" blessing to tens of thousands of people gathered for Easter Mass, making only a few sounds into the microphone before giving up.

A similar scene was repeated Wednesday when John Paul tried to utter a few words after an aide read greetings and prayers. Like Easter Sunday, many in the crowd had tears in their eyes as they saw the pope's futile efforts to speak.

"He looks very frail but certainly very committed to seeing his people," said Kate Strauss, an American tourist in St. Peter's with her family. "We happened to be here by chance and we just had no idea we'd get a blessing from him and a blessing for the babies."