My Father just had surgery (1st sept 2010 Partial Maxillectomy + Palatectomy). He has been prescribed Chemotherapy after stitches heal. We need to get his weight up so that he can withstand chemo.
My question is How much Ensure should be used to bring him up to the 3000 cal Diet? One more thing to add is he prefers ensure in milk and not in water.
Another question is, does a person require 3000 Cal or 3000 Kcal?

Does your father have the benefit of seeing a dietitian? Many of us have found Carnation VHC to help make it easier to get the necessary calories in. It has 560 calories per 8 oz can. Does your father have a feeding tube? If so, the formula is a little thick, I thin mine down with a can of water. The doc is probably telling you 3000 calories (not sure what Kcals are), even more is ok. High calorie milk shakes can help get alot of calories in also. If your father has a feeding tube, what formula does the doc recommend? Here in the US, a feeding tube will come with prescription formula to order thru a medical supply company.

Best of luck with your fathers continued improvements.

My husband takes 6 cans Ensure Plus per day half through PEG tube and half through feeding pump during sleep. His weight has remained steady. Ensure Plus in U.S. has 360 calories per can (if that helps).

I am from india. From what i have read from forums, I feel doctors here in India are not have interactive with patients. May be because of the shere Patient/doctor Ratio. He had a Free Flap reconstruction and had a feeding tube through his mouth. First we were told to feed him through the Tube. After 10 Days were were told to start giving him spoon full of water and see if can gulp it down. gradually it was increased to 500 ml. As soon as he was up to 1.5 ltr per day the doctors removed the PEG. We have been told that we can give anything that is crushed enough so that he can gulp down. Currently he is consuming 1.5 ltr of cow milk, about 6 scoops of ensure, rice boiled and mashed in milk. I dont think he is getting enough calories in.

I feel for you! I suspect you are right and any additional calories he can take will help. Before Jim has his PEG tube installed I used a high calorie protein powder ordered via internet and added that to his liquified foods to boost calories. He was in similar position early on and his calorie intake wasn't nearly enough.

I also use a high protein powder added to my feeding formulas. Protein is very important to the healing process. Here is a link of easy foods. Maybe try some canned peaches, yogurt, puddings, milk shakes to help get more calories daily. Im surprised that the feeding tube was removed before he was more stabilized. Other countries do things differently. A couple times, I tried to eat rice and almost choked to death! If he can eat rice with milk then he should be able to eat other things too like oatmeal and sof scrambled or poached eggs. Best of luck.

http://oralcancersupport.org/forums/ubbthreads.php?ubb=showprofile&User=7386

Once again it looks like my CCC doctors and medical team have quite different opinions then the standard OCF party line. Their advice has been that I only need 2,000 calories a day to be healthy and active. I just went to the Mayo Clinic's daily calorie calculator and it also said 2,000 calories (Male - 62 - 5'11" 135 lbs -checking Active w/ daily exercise)

That works out to 6 cans a day of Ensure Plus. I lift weights, do Pilates, mow the lawn, etc. For me the issue of energy was thyroid related and not calories. Don't get me wrong, if you can get 3000 calories a day into your dad, GREAT. But for many oral cancer patients, eating is a chore or difficult, and 2,000 calories is just fine.

I had so many things to worry about during these three years, it was great not to try and get 3000 calories down yet still be compliant with medical advice.
Charm

Well I have to differ. When I was getting 2000 a day I didn't feel near as active, if you were, as when I consumed 3000 a day. And if adding weight is any indication of calories in vs calories consumed, I didn't gain a pound of weight my entire first year post Tx of consuming 3000 cals a day and I have to feel that if I was only getting 2000 a day during that same period then I surely would have lost weight and therefore I would conclude that 2000 was not enough to offset the "behind the scenes" healing activity that must have been going on. Whew!

Hmm, i too feel that he needs more proteins. The other day he had some rash on skin. I immediately took him to the doctor to check it out. We live on the first floor and he had to climb down and then up the stairs. The next day he was complaining of pain in the thighs region (the kind when you squat too much). I guess all this chemo, radiation, surgery have taken a toll on the body. He is weighing in at 60 Kgs. at 5' 8". But all now he has left is fat.
I have started adding Whey protein powder from On Nutrition in his milk shakes, about 150 gms daily. lets see how things go.
And yes, eating really does become a chore for the patient. He has very limited items to eat from, and more over he has to gulp it down with a cough here and there. No enjoying the Food!!

Well, I guess I can chime in on this one also. I have been taking in 10 cans of Ensure High Protein for just over a year and a half now. Prior to that I was taking in 10 cans of the regular Ensure. I have been on Ensure, via G-tube, now for in excess of five years. The way I figure it is that I have consumed roughly 15,000 cans over that stretch,.... and I do not own a single share of Abbott stock.

I spread out my consumption in 2 can feedings, 5 times a day. Each feeding is followed by 400 to 500 Ml of water to flush my tube. On occasion I pop a serving into the microwave and put a healthy serving of whipped cream on top. It is amazing how much it makes it taste just like hot chocolate. Oh, yes, probably 99.5 percent of the cans I have consumed have been chocolate. It is one of the very few flavors that I can still taste.

My best to your dad as he travels this seemingly endless road.

Bill

Thanks for chiming in. At 230 calories a can, ten cans of Ensure High Protein a day works out to 2,300 calories a day.
I was surprised to see that regular Ensure has 250 calories a can, but your whipped cream (one cup is 154 calories) probably makes up those 200 less calories

Unless you are really athletically active , like DavidCPA's bike riding, 3000 calories seems high. I'm also glad to hear that you have been able to thrive with a G tube for 5 years.
Sounds like you can still swallow though as otherwise I really want to know your trick in "tasting flavors" through a G tube.
Charm

David

I'm amazed that you can get by on only 3,000 calories with biking 100 miles a week. When I was doing marathons and triathons, my calorie intake was substantially higher than that. I agree that anyone as active as you could not get bye on a mere 2000 calories.

Actually, even I get more than that. My six cans of Jevity at 355 calories equal 2130 and my two big glasses of white wine down the G tube add about another 310 and lets not forget the 8 calories of two cups of coffee (my breakfast blend is half coffee and half Jevity) so I'm close to 2,500. Since I don't train for races anymore, that seems to be about right.

Charm

Charm,

I'm efficient!!

Actually I'm down to about 60 to 70 miles a week. I just can't seem to find enough time anymore!!! ugh. If I was wealthy and didn't have to work I would ride every am but that lottery seems to evade me.

David you can't win the lottery twice..... You already won it once by still being around to talk about it.

True words Brian!!!

I'm wondering if at this point in my husband's recovery (about 5 months out) it's more important that he get the calories than how he gets the calories. He can get about 2500-3000 but only if about half of it is through the drinks(carnation,ensure).
I figure as long as he gets the calories---fine. But one of the nurses seems to think that he should be moving quicker towards more "regular food" and less"dependence" on the cans.
Thoughts?

HE needs to work on swallowing, IF the sores in his mouth will allow it. He needs to keep those muscles that control it all working and the nerves that feed those muscle functioning. Start soft and easy, my favorite was canned chilled peach slices... I ate gallons of them over months, But soft scramble eggs got introduced and soups.... you have to start somewhere. Supplement with blender drinks and the liquid diet.

Yes he needs to exercise those swallowing muscles and yes he needs all the calories he can get. Eating is not enjoyable at this stage so in addition to whatever I was trying to eat I always drank a can of VHC mixed half and half with whole milk (over 700 cals) with each meal or 3 times a day, everyday. I did this for well into my 2nd year of recovery. I ate everything with sauces or gravy forever. TV dinners, the real fatty ones, were useful for dinners. For lunch I liked sunny side up eggs and pancakes with plenty of syrup. Even though I avoided sweets pretty much my entire adult life I wound up having a strong sweet taste post Tx so I migrated towards the sweets to get some enjoyment back in my meals.

Thankfully, he is doing well with the swallowing. I think as I've mentioned before it's the portions that makes the calorie intake difficult. He just seems to fill up so much quicker when he's eating regular food than he ever did in the past. And in general, food just doesn't interest him in the same way it did before.
I'm going to suggest the milk/can combo.
Did people find that their appetite slowly just starts coming back? I'm guessing the dry mouth doesn't help too much either in terms of enjoying a meal.