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#147260 - 03/18/12 02:00 AM PEG formula
kercrh Offline
Member

Registered: 03/18/12
Posts: 1
Loc: New Jersey, USA
My brother is stage 4 Esophageal cancer-is unable to eat or swallow. Unfortunately he is in La Paz Mexico and his care is marginal at best. They finally inserted a feeding tube today. We (his family) will be cleaning and maintaining it. We don't know the best formula to give him-he hasn't had anything but IV fluids for the past week so his body needs nutrition just not sure what is best. And no there is not a doctor on hand to tell us.

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#147261 - 03/18/12 02:29 AM Re: PEG formula [Re: kercrh]
Brian Hill Offline
OCF Founder
Patient Advocate (old timer, 2000 posts)

Registered: 03/18/02
Posts: 4678
Loc: Laguna Niguel, CA
While there are prescription liquid foods that my hospital recommended to me, I used over the counter (no prescription) Ensure® in my PEG bag. I did this for about 13 months with only little oral supplementation of blender drinks my wife would make for me, of fresh fruits and vegetables. These were very nutritious, and if he can tolerate some of it it affords you a chance to add healthy fats like olive oil and flax oil to the vegetable juices, protein powder (whey not soy) and enough fruits to add some sweetness to it.

Towards the end of my PEG use I was able to begin to eat some things by mouth that were not too painful. Chilled, canned, peach slices in syrup were the best - they were cool, and slipped down my sore throat with a minimum of effort. There are other liquid foods available at a store like WalMart from other manufacturers, and of course all of them can also be ordered on line from Amazon.

If you buy from Amazon, please use the OCF link to buy. It costs you no more and they help OCF with a 6.5% commission to the foundation on every purchase made through our link.

Remember to count calories and try to see that he gets at least 2000 per day. Hydration is also important so for every two cans of Ensure, I added 1-2 more of plain water to the mix. Do not forget to clean the PEG tubes very careful right after feeding by flushing with water, or club soda. These liquid foods will clog it up if you do not immediately clean it after each use.

Good luck with this, I am sure that others will post to your message thread soon. Weekends have the fewest number of posters on the boards, but more will certain answer you soon.



Edited by Brian Hill (03/18/12 02:41 AM)
_________________________
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.

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#147278 - 03/18/12 06:25 PM Re: PEG formula [Re: Brian Hill]
EricS Offline
Patient Advocate (1000+ posts)

Registered: 01/03/09
Posts: 1844
Loc: Idaho
OK! Let's talk Liquid Nutrition!!

This is a favorite subject of mine actually so this post might get rather long, but it is with the intent to shed light and help!

Now I was PEG dependent for 18 months before I really started trying solid foods, even now the lions share of my nutrition is liquified, either blended, juiced or Ensure as due to my swallow issues I'm unable to eat enough solids to maintain a "healthy" weight.

Before cancer I was a tank of a guy, 5'9" on a good day and 210 lbs and in good shape from lifting weights, wrestling and running etc... I lost a total of 70 lbs during treatment and after surgery, leaving me wasted and weakened and a scrawny 140 lbs. When I needed to gain weight and build myself back up, I found that without the ability to eat most solids getting back to optimum weight and putting on good muscle was going to be a challenge, which is fine because I rather like challenges.


Nutrition for your brother is "vital" or to translate in Spanish "Muy Importante!" clap clap clap! Cancer and the bodies own immune response puts the cancer patient into a hypermetabolic state where they burn through calories and macro nutrients (fat,protein, carbohydrates) at an alarming rate and due to certain hormone responses nutrition "uptake" slows. Coupled with limited intake this all sets the stage for "cachexia" or cancer related "wasting" syndrome, basically why cancer patients get scary skinny really quick, which adds to a poorer prognosis.

So! What can be done you ask?!?! Thankfully "mucho" or "much" for those non Spanish speaking individuals out there! smile Ensure Plus is a great start, has all of the essential vitamins and minerals for complete nutrition and is usually what's recommended for "interim" sole source feeding. It's 350 calories per bottle with 11 g's (grams) of Fat, 50g Carbohydrates, and 13g's of Protein.

Now there are several survivors on these forums that recommend Carnation Instant Breakfast VHC (very high calorie) it's 560 calories per can, 30.6gs fat, 49.2gs Carbohydrates, 22.5gs protein and a product I would consider a good start as well.

Here's the issue though with using just these products alone, "very low"(Ensure is 15% protein, VHC is 16%) on protein which is vital as his body is fighting and recovering. In fitness training for athletes there is a term called the "Golden Ratio" of Fat, Carbs & Proteins that top athletes in training (ratio varies slightly depending on the type of training they do and sex of athlete)use as a rule to fuel their bodies optimally. The ratio (again depending on the training) is 40-50% of calories from Carbs, 20-30% fat, 20-30% protein. For men looking to build or maintain muscle, the fat and protein portions are a vital area to stick, even more so in the cancer patient as per this article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2311497/).

In cancer patients there is a shift in use of nutrients in the body (caused by hormones) from building and maintenance to the immune response resulting in increased rate of muscle protein degradation and increase in acute-phase protein synthesis, with progressive depletion of lean body mass. This basically means that your body is breaking down it's own muscle into amino acids which it then uses in other areas,robbing Peter to pay Paul in other words. In general weight loss and lower percentage of lean muscle mass "is a major prognostic indicator of poor survival and impaired response to anti-neoplastic therapy."

So supplementing either of the above two choices with a Protein Powder is just good sense, I recommend Whey Protein as it has the fastest uptake of all the other kinds of protein out there which is why it's preferred by elite athletes and trainers.

As a guy it's also important to keep testosterone in the body up, which is difficult during treatment due to stress, and many of the drugs usually prescribed to cancer patients constrain testosterone production in the body (antidepressants, pain killers etc..) so it's important to make sure he's getting enough "fat" in his diet. In guys the higher percentage of fat in the blood increases testosterone in the body which is key to muscle maintenance, mood stabilizing etc.. Testosterone is arguably our most important hormone. For this reason I'd choose the Carnation VHC, roughly 50% of it's calories come from fat, in the form of Canola Oil which is considered very healthy due to it's low saturated fat content (lower than Extra Virgin Olive Oil).

You can get 24 cans of it through Amazon (use the OCF Link!!) for $31. I'd also recommend Cytosport's 100% Whey Protein Powder which is what I use, is also available on Amazon.


If you go with the Ensure, or Boost etc, have them mix it with a tablespoon of Canola Oil (120 calories & 14g fat per "tablespoon") and a scoop of Protein powder. I'd also say your brothers calorie intake is going to depend on his size, however I'd say at least 2600 calories per day, but personally I'd try for 3000-3500.

Good luck, I hope this helped, sorry for the novel!

Eric


Edited by EricS (03/18/12 06:29 PM)
Edit Reason: always spelling
_________________________
Young Frack, SCC T4N2M0, Cisplatin,35+ rads,ND, RT Mandiblectomy w fibular free flap, facial paralysis, "He who has a "why" to live can bear with almost any "how"." -Nietzche "WARNING" PG-13 due to Sarcasm & WAY too much attitude, interact at your own risk.

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#147279 - 03/18/12 06:34 PM Re: PEG formula [Re: EricS]
ChristineB Online   content
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Registered: 06/23/07
Posts: 8481
Loc: PA
I dont know what other countries have available as far as nutritional forumlas. Your brother's gastro doctor or nutritionist should be prescribing some type of liquid nutrition. There are hundreds of different ones available in the US. Ive been on several different ones myself. Check with his doctor and see what he recommends. In the US a doctor will write a prescription and a medical supply company will send the patient cases of that type of formula along with the necessary supplies.

If your brother has had an IV, then dont worry. Some IVs are designed to supply all he would need for a brief period until he gets onto the nutritional formula.

Another idea is if you cannot find anything that will ship to Mexico, then you can always purchase it here in the US and ship it there yourself. I know that takes longer but better to have it get there a couple days later than not at all. Hope you find a solution with all the suggestions you have gotten.

Good luck with everything!
_________________________
Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07, no caregiver
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo extended hospital stay, ICU & burn unit
PICC line w/ IV antibiotics 8 mo
10/4/10, 2/14/11 reconst surg
OC 3 times in 3 years
very happy to be alive smile

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#147304 - 03/19/12 01:18 PM Re: PEG formula [Re: ChristineB]
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)

Registered: 03/03/08
Posts: 3082
Loc: Alexandria VA
After 3 years this month of not eating one bite of food nor having one sip of liquid,or as the doctors say: NPO status [Nil per Os= latin = nothing by mouth], I've become a reluctant student of liquid nutrition.
Like Brian Hill, I used Ensure Plus the first time around when i could not eat. But using prescription medicine for life with no real food was not acceptable. I do not have any idea of what is available or affordable for your family in Mexico but I'm assuming regular food is both.
There are many internet forums and website on blending food and putting it down a tube but I like this one. Bear in mind that this is NOT a cancer survivor group, nor focused on cancer in any way, but mostly mothers who are caregivers to children who need lifetime feeding tubes.
Food for tubies This link brings you to their forum but on the left is a box with four sublinks that explain the concepts
Hope this helps you if you can't get medical advice on it.
Charm
_________________________
65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13

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