Hello all,

My brother, Joe, refused to get a peg tube. After spending five days in the hospital, he finally agreed to a nasal feeding tube.

Does anyone have any feedback regarding the relative benefits of each type of tube?

Many thanks in advance -
Jean

I should have noted that he just finished chemo and radiation last week (tongue cancer).

Jean,

I refused to get the Peg and wound up in the hospital a few times near death (at least I looked like it). Two weeks after Tx I allow them to put the nose tube in and within a week of steady hydration & 3000 cals per day Carnation VHC I was allowed to pull it out myself at home. It really got my stubborn butt over the hump. It wasn't fun to sleep with or take a shower with but it did what it was supposed to so I'm glad my wife made me do it.

Nose feeding tubes hang out in front of your face all the time in plain sight, and require no surgery to put in. PEG tubes are hidden under your shirt until you want to hook up to it and use it, and require a very minor surgery to put in. Personally I think that given what he has been through that a 20 minute surgery is nothing. I also think that getting back out into the world as soon as possible is a healing process... I don't think I would do that with a big tube hanging off the front of my face while I was in the mall. I needed my tube for MANY months after the end of treatments. Having 4 inches of tube hanging out of my nose, irritating the inside of my nasal passages, and feeling it in the back of my throat all the time would be unacceptable. The PEG is too easy a choice. Nasal tubes are meant to be used for VERY short periods of time as a rule.

I would say, it depends on how long he needs it. I didn't need a PEG during radiation but had a nose feeding tube after laryngectomy surgery for two weeks. It didn't irritate my throat, I don't remember problem with showering but then I had a hole in my neck, so had to keep water off neck anyway while it healed. It was able to provide same nutrition that PEG does. Tube got tucked behind ear while not in use. Not pretty, but for me, preferable for short term use.

Don't start a war, I'm only answering the question asked. For long term use, PEG is probably the best, but eating if you can also works.

Take care,
Eileen

Had to laugh about the don't start a war comment. Do a search on the message board for PEG and you will see those that got by without it and swear by toughing it out, and those like me who used it don't agree on some things. The bottom line is that if you cannot get enough nutrition by mouth, you will get sick, you will heal slower, and you will be sapped of energy. Nutrition and healing are two sides of the same coin. If a patient has lost too much weight, it is the doctor's responsibility to intervene. They gave me no choices. They had a line in the sand for what % of my body weight I could lose, and when I hit that in spite of not wanting the PEG, I was the proud owner of one, and in retrospect glad for it for 13 months. Having said all that, there are some here that got through the process without having one.

After Buzz had his surgery, an NG tube was placed, and was used for several days, but kept slipping out, requiring trips down to x-ray each time. After the third time, Buzz refused to let them put it back. Before beginning radiation/chemo, he had a PEG placed and says that it was a life saver!
Having had both the NG and the PEG, he stands by his preference for the PEG.
Good luck to you!

Lois & Buzz in NC

Eileen,

Since you started this war, I'll continue...LOL

I can only speak to the nose tube and Jean you said he has already finished Tx so he is/was just like me in that respect.

The nose tube took the doc about 1 min to insert it in my nose and while I swallowed water, down my throat. While not something I got a kick out of, there was zero pain or discomfort. They then taped to my nose to prevent it from coming out and sent me to be X rayed. The reason for the X ray is that they leave the metal strip in the tube that helps give it rigidity so they can glide it into your stomach so they can X ray your stomach and make sure the tube is positioned correctly. After they saw it was in place they just pulled the mteal strip out.

Now I did wake up the first night in a very wet bed as I had forgotten their cautions and I had gotten my arm tangled in the tube somehow and had pulled it out and my food was just pouring on the bed so they had to put another one in and X ray me again. Having it done twice in 10 hours was not thrilling but at least I knew what to expect the second time around. After that I was careful to avoid pulling on it as it does come out without discomfort so you just don't notice it inching out. I also pinned it to my shirt to make it more difficult to tug on.

The reason I said it was difficult to shower with is that your tape will get wet or damp and you should retape after showering and I just didn't want to spend that much time everytime I took a shower BUT it felt sooooooooo good to have hot water pounding on me so I put up with that inconvenience.

It was very easy to put water and meds and liquid food in the tube and it got it past my throat which was a good thing. I was still able to eat with it in and as far as Brian's war like comment about not wanting to go to the mall with that thing hanging out of his nose....believe me the last thing I wanted to do 2 weeks post Tx was to go ANYWHERE so that never crossed my mind.

As I said I only had it in a week and I felt like it had gotten me over my nausea hump and I was able to eat foods again without tossing my cookies so I called my doc one am and he let me pull it out myself and the rest is history.

That's my story and I'm sticking to it. Either way the purpose is the same and that is to get him needed hydration, food and meds so his healing can begin.

What I know about PEG's vs. Nasogastric tubes is that Nasogastric tubes are for short term use more so. They go into the stomach and that is where the they deliver the feeding, medication or water you put through them. The PEG on the other hand is inserted into the stomach through a small incision, and guided down to the jejunum, a part of the small intestine and that is where it delivers the feeding and all else you put into it. They can stay in place for longer periods of time, are not so easily dislodged, and you have less chance of aspiration from the feeding. They can come out on their own and also migrate back up into the stomach or become kinked, however, this will be evident on visual examination or when it may appear blocked and cannot be cleared with flushing. If this happens you would need to go to the radiology unit where it was placed and have it checked under xray. It would then be replaced if needed. Replacement is as simple as taking the old one out and a new inserted through the same hole all under xray to assure proper placement. Hope that information is helpful to anyone that is considering which is the best route to go.

Thank you, everyone, for your thoughtful, peaceful comments.

My cousin (doctor) suggested that a PEG tube is a better option for Joe because he feels that the nose tube is actually irritating his throat. Joe is going back to the doctor's today for another consult. He is continuing to lose weight and I don't think he is properly hydrated, so I am hoping that he chooses to get the PEG. His wife is dead-set against it - I don't know why - but my guess is that he will go for the PEG. It seems to be taking too long to get the food/water in through the nose tube.

Thanks again,
Jean

Jean,

They gave me a syringe to insert into the nose tube and all I had to do was suck up the liquid in the syringe and inject into the tube. I could push (inject) as fast as I wanted and it didn't take anytime to hydrate or feed myself so I don't understand your "taking to long" comment?

Remember I'm not advocating one over the other, I'm just explaining my nose tube experiences. The goal is the same for either and one, the nose tube, is usually intended for short term use or when the patient can't have a surgical procedure.

David, he has to pour the Jevity can into an IV bag and then it drips into the tube. I am not sure why it takes so long - maybe he can increase the flow.

He decided to stick with the nose tube. His doctor insisted that he have at least 8 Jevity cans per day. Despite gentle reminders from his wife, my mom and me, he was only getting 3-4 cans a day. I think and hope that Joe will listen to his doctor!

The doctor also gave him some sort of topical cream (prescription - sorry I don't know the name) for his terribly sore neck. The radiation really burned his neck and his skin is bright red and cracking. It is just so hard to know what to do to try to help ... sometimes it seems like it is just best to leave him be for a while.

Radiation ended 12/21. I am not sure what IMRT means. He had the same kind of radiation as the chef from Chicago had.

Thanks.

Jean

Jean,

My husband came within 5 pounds of medically needing a PEG tube. I'm not sure if the two weeks post treatment were tougher on him or me. Watching someone whither away is terrifying.

Even though the docs gave him the impression that it was his call, they would have intervened if his weight hit a certain point. Although, they were relying on me to provide daily weigh ins.

Regarding the sore neck, if you look at the icons by the date...and, if you send me an e-mail address I can show you a pretty amazing before and after picture. There was a point in time that I thought my husband would carry his RT scar for life. It is truly amazing how the body can heal itself.

For the sore, we used a saline soak and aquafor. We had an rx too, but that didn't work as well. Although, everyone is different.

I took pics throughout my husband's recovery, sometimes he needed some visual reminders that he was indeed making great progress.

The first 2 weeks post treatment were extremely traumatic. One of those weeks, his primary input was IV fluids.

I wasn't so gentle with the reminders. Your brother should have daily fluid and calorie goals set by his medical team. When my husband's mouth was really bad, his docs eased up on the calories for a week, although they also arranged for home health care to give him IV fluids and to monitor him daily.

IMRT is explained more on the main part of this site. You can put in a search for it. When most people refer to RT here and they've been treated within the past few years they are likely referring to IMRT.

Good luck!

I have a Peg tube. I got before I started treatment. It has been 2 months since I completed treatment and I still have it. It is a sight, but I can not imagine having one on the front of my face. It is hard enough dealing with hair loss for all to see. I would have went with the peg. I did not want either, but my fiancee talked me into it, and I sure need it.

I had the nose tube following surgery, what an irritant. The drugs kept my mind off the pain from the surgery, but the constant pressure of that junk crammed up my nose was not real fun, and it was really a cumbersome process taking fluids through it due to the size of the tube. When I had to go back and they decided on Radiation and chemo I really wasn't given an option (Good thing I had not found any discussion on tubes at that point!! LOL) I was told that I may or may not need it but it was better to have it put in prior to treatment than try to have it done halfway through treatment when I would be weaker, immune system's shot, etc. All I can say is about 5 weeks into treatment that tube became my best friend!! It helped sustain me post treatment by supplementing my calorie intake post treatment. I agree, I didn't really want it in the beginning but I'm sure glad I had it once I needed it.