I had a PM asking some pertinent questions, so I thought I'd also provide the answers here.

What I did for sleeping was put a thick cushion and then my pillows between my head-shoulders and the wall, then another pillow under my knees, so I slept mostly in an upright position which helped drain stuf. I've now graduated to mostly sleeping on my side as usual, with a pillow between my knees to help back problems.

Dealing with the trach, just a hole, but as long as it was open, it was difficult to talk. The best bandage was what the nurse practitioner made, rolling up a square of gauze and then pressure-taping it down -- If I remembered to press my finger on it, I could talk -- Had to change that one several times a day until the stoma (hole) started to close.

Nurse practitioner also gave me a couple of Aqua-Guards, a clear plastic with tape around the edges to cover the stoma while taking shower -- Turns out one only needs to take in several spoonsful of water to drown! Showering was difficult because there are bandages on the trach stoma, PEG stoma, and wrist to deal with -- Least trouble was the 'cheeze grater' gizmo on my thigh. The in-hospital and follow-on care from the Univ of Washington Medical Center (Otolarengology Group) has been super.

Also, talk to your follow-on crew (in my case a very knowledgeable nurse practitioner) about a food pump to go with the PEG if your husband has difficulty maintaining the higher rates of can-draining.

With my previous radiation-PEG, the tube was large enough to accommodate gravity feeding and my gut could handle it -- Now the tube is smaller and must be pumped, about four-five syringe loads per can and that turned out to be too fast.

I acquired a used Kangaroo pump and some feeder bags from EBay and Craig's list , but was still having problems with the food (I use the term loosely, of course!) going in and passing through me rather rapidly, depleteing me of water and minerals in the process. I consulted with the dietician at the food supply house (Option Care, a recent acquisition of Walgreens, and tied to Nestle-Carnation) and she recommended that I set the delivery on the pump to 100 ml/hr -- I had been using 300 ml/hr, which was still much slower than my previous PEG's gravity feed or the current PEG in manual mode.

In retrospect, I should have just had my follow-on crew arrange for a pump, but I was kind of curious about it all and I'll put it in my taxes for this year, so I'll at least recover some of the cost -- I even got a roll-around stand for the pump and bags.

Time for math -- A can of food is 250 ml, so manual or gravity doing a can in 15 minutes is roughly 1,000 ml/hr. Problem is that I should be getting 2,000 or more calories per day, and at about 300 cal/250ml can, that means I need to transfer 1,667 ml of food -- At 100 ml/hr, that's almost ***17 hours***.

David has been touting Nestle-Carnation VHC for some time now because it packs about 560? cal/can, which would cut down the PEG time considerably (2000 cal/560 ca is only four cans). Dietician sadly reported that VHC is classed as a drinkable OTC and not Medicare-reimbursable.

However, the dietician came up with another Nestle calorically dense product called Nutren 2.0, which has 500 cal/250ml can; three cans per day exceeds the RDI for the 20 key vitamins. Four x 250 ml/can /100 ml/hour is now only ten hours, a great improvement over 17! Also, the Nutren 2.0 is drinkable (some of the others intended purely for PEG, like Novartis and Osmolite, aren't exactly tasty.

The dietician told me that extra food is not returnable, being classed as a pharmecutical -- Any thing left over can be donated, like to a Food Bank.

http://www.nestle.ca/en/products/brands/Nutren/2.0.htm

I've also been gradually increasing my delivery rate and am up to 150 ml/hr, so that lowers my PEG time to less than seven hours. In fact, as I type this, I am ingesting a can of Nutren 2.0, plus I can even sleep with the pump going, although it does beep when the bag is empty.

Some folks may be leery of using a used pump, but even the medical supply places are likely furnish a used one -- The pumping is done be external pressure on one of the bag tubes, so the food never enters the pump -- It doesn't get dirty and doesn't need to be cleaned. The bag, with tubes, connectors and cut-off valve are called a 'pump set' and should be changed daily -- New sets come with the food from the medical supply house.


Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.