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PEG TUBE REVIEW

ToBeGolden's picture
ToBeGolden
Posts: 697
Joined: Aug 2010

I could have entititled this tread: "Vomiting In All The Right Places". I walked into the oncologist's examining room and promptly vomited. For good measure, I missed the barf bag I was holding. Actually some made the barf bag and some hit the floor. I was also in a quite unresponsive state.

One good thing, was that the time for my infusion was moved up a coupld of hours. (You would have to witness the crowd at SCCA to understand that statement.) The staff wanted IV anti-nausea meds on board pronto. I guess missing the barf bag had its benefits. (Really, I did not miss the bag on purpose.)

Now for the serious part for this post. (You thought it would be just more stand-up comedy?)

I saw a PA, and she strongly suggested a PEG Tube. I declined at the time; but realize that a PEG Tube might be in my future. So I would like to review some of the things I think I know about PEG Tubes. I'm certain that not all my concepts are correct, and I would like you (my friends) to correct me when your experiences differ. I've not had to have a PEG Tube so far.

  • The PEG was inserted because you were not able to maintain nutrition/hydration. Sometimes, the PEG was inserted before nutrition was a problem.
  • The PEG was inserted due to mouth/throat pain
  • Getting fed through the PEG does not lower the nausea.
  • It is possible to vomit out the PEG.
  • PEGs have their own set of complications: pneumothorax?, infections? clogging?

Well, you get the idea of the information, I'm after.

However, to PEG or not to PEG will not really depend upon the answers (sorry to say). I'll try to maintain weight and nutrition/hydration by mouth. If this becomes too challenging, it's off to PEG-LAND. Rick.

Ladylacy
Posts: 491
Joined: Apr 2012

My husband had a peg tube inserted before he started treatment in August 2010 for laryngeal cancer.  It was a god sent because after about 2 weeks he couldn't take anything by mouth.  He had that tube from August 2010 until early May 2011.  Good thing because once he had surgery in March 2011 we found out that his throat was closed off from the radiation.  Then when a second cancer was found in April 2012, at first they weren't going to do a peg tube until they were really looking at his weight.  So another was inserted in May 2012.  He still has it but doesn't use it now but only to flush it out.  He just had a PET/CT scan and if it is clear the doctor will remove the tube in April.  He is able to drink once a dilation was done in October.  He can eat solid foods, not good but can eat and swallow.  He never had any trouble with the PEG tube, either times.  No infection, no clogging, etc. but I can say that without it, he wouldn't be here today.  If you don't need it, all you have to do is flush it daily. 

His tube was inserted when he was out down thru his throat into his stomach and then out  thru the stomach, lower than his navel.  He keeps it clean and does it himself.  Very easy to remove it once you don't need it again. 

If after it is removed, and he would need another, we would do it in a heartbeat.

Sharon

blackswampboy's picture
blackswampboy
Posts: 341
Joined: Jul 2012

but sorry you had to go there.

I had PEG tube inserted prior to treatments, due to weight loss.

never had nausea with the PEG tube, but I suppose that depends on the type of treatment received.

never vomited out my PEG. but I have forgotten to close it, and dribbled nutrition product across the room (also a good way to get attention). it does leak a bit around the insertion point.

it's clogged a couple of times, but clearing the clog not a big problem. I never put anything but osmolite, water, or gatorade into the tube--but sometimes if you cough while feeding, solidified nutrition from your stomach can get up into the tube. 

I've had mine for 8 months, and have just recently stopped using it. I've lost a few lbs. since stopping.

all in all, it saved my bacon.

best wishes!

corleone's picture
corleone
Posts: 168
Joined: Jul 2012

Please note that this answer is based mostly on my experience.

·         The PEG was inserted because you were not able to maintain nutrition/hydration. Sometimes, the PEG was inserted before nutrition was a problem.

In my case the PEG was inserted 2 weeks into radiation, before I needed it. Generally it’s better to have in inserted earlier, to avoid the issues that add up to the ones you already have during treatment. 

·         The PEG was inserted due to mouth/throat pain

Yes, to keep nutrition (that would not be possible by mouth, due to pain).

·         Getting fed through the PEG does not lower the nausea.

In some cases it might actually increase the nausea by mechanical irritation of the gastric mucosa, but that is rare. More often though, the administration of the fluid via PEG should be slowed down, or the total volume decrease or fractionated in small portions to prevent nausea.

·        It is possible to vomit out the PEG.

Not sure of that. It is possible to allow gastric content to flow back but: the nausea is caused by different mechanisms, mostly involving receptors in the moth and neck area, so that wouldn’t decrease the nausea.  

·         PEGs have their own set of complications: pneumothorax?, infections? clogging?

Infections around the stoma (entry place) level most often. Pneumothorax shouldn’t be, unless the procedure is not done correctly. Clogging, you mean of the tube? Yes, that is often, but you need to make sure you deliver only liquids that are supposed to go through the tube. Other: very rarely peritonitis, but that only in special circumstances. The tube also might come off, but depends on how you “wear it” and the tube type. Granulation tissue around the stoma (appears later, if the friction at that site is increased).

MarineE5
Posts: 755
Joined: Dec 2005

Rick,

I had no choice in the matter from the beginning. My Surgeon told me from the get-go that I would need it, as I had part of my tongue removed along with a Trach. It was my only source of nutrition and liquids. I was not able to swallow fluids until the Surgeon removed the Trach roughly 2 months after surgery. I had to sip a small glass of water in front of the Surgeon and from that point on, I was allowed to slowly take in soft foods to start with and build from there.

The PEG for me was not an issue. It is recommended that we keep the insertion site clean. I would use a Q-tip with some Hydrogen peroxide on it to clean the area around the PEG. I like to take a shower each day and that cleaned the site as well. I think the main thing with the PEG is to FLUSH it twice before and after each feeding with the syringe given to you. If the PEG seems like it is building up a film in the tube, you can flush it with some Ginger Ale. Another thing, anything that you inject into your stomach should be at room temperature. If it is too hot or cold, it can cause you to have stomach cramps.

My Best to You and Everyone Here

phrannie51's picture
phrannie51
Posts: 3777
Joined: Mar 2012

simply because I was skinny to start with.  I was happy with that, as down the road I really wouldn't have liked having to add any pain to the equation.....

I had times when I became nauseated with the tube feedings....usually the few days after chemo.  Feeding and hydrating more slowly and more often remedied that.  Also, taking Zophran or Compazine 30 or 40 minutes before feeding helped.

I had no idea you could puke it out...It might depend on what type of PEG they use....it took quite a bit of strength to yank it out  when it was time for it's removal.

I used three way anti-bacterial salve around it to keep the granulization at bay (it makes it slippery for friction plus keeps bacteria down)....

Maybe you could carry a bucket everywhere....it makes a statement, and you don't have to puke on the floor to get the attention you need concerning nausea Smile.... I'm really sorry you're going thru all this....constant nausea is really hard to live with.

p

Mikemetz's picture
Mikemetz
Posts: 348
Joined: Nov 2011

I had my PEG inserted in the nick of time, on the third try, shortly after starting my treatments.  Like others have said, it was a life saver.  It was easy to clean around the insertion point with a Q-tip dipped in hyrogen peroxide.  I responded well to my anti-nausea meds, so never had a thought that I would vomit back though the tube.  My wife wrapped me up every day with an Ace bandage around my torso, and under a shirt, the tube was hardly noticeable, and very easy to manage in my daily travels.

Some HNC patients didn't need the PEG, and they are very lucky.  But, if you need it, you REALLY need it.

Mike

 

VivianLee5689's picture
VivianLee5689
Posts: 546
Joined: Aug 2012

Rick,

David received his PEG before starting treatments and that has helped a lot.  He hasn't ate many calories by mouth since September.  Even though he didn't get all the head and neck cancer treatments he has dealt with a lot of nausea and dehydration.  Having the PEG has allowed him to get much needed meds and fluids when I can't tempt him to put them in his mouth.  I don't know about vomiting through the PEG.  Honestly I have never heard of that.  I hope everyone's input will help you make the best decision for you.

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

Back in 2004 when I was going through treatment, I thought I could make it without the tube.  How wrong I was!  As treatment started, my condition got worse and worse.  I had it put in and the next day was hospitalized for a week due to my rundown condition.  By the end of the year, I had recovered and was feeling pretty great.  In mid December, I had it removed.  That lasted a few years before I started having trouble swallowing again due to an esophageal stricture.  I started being dilated every 4 to 6 weeks and swallowing food was no problem but I just wasn't able to get enough liquid down.  I voluntarily had the tube put back in which took care of my hydration problem.  Little did I know it would become another life or death tube in June of 2011.  That's when I had mandible reconstruction failure.  As I type this, I am doing a slow gravity feed.

I have never had a problem with infection, cramping, vomiting through the tube or anything else you were worried about.  I would suggest that if you around around friends who like to tell funny jokes to keep the cap on your tube.  It will act as a volcano if you start to laugh or experience pressure coming from your stomach.  Come to think of it, my tube has gotten clogged maybe three times since I've had it.  A little warm water and a gentle push with the syringe promptly took care of that.

CivilMatt's picture
CivilMatt
Posts: 3007
Joined: May 2012

Rick,

 

Got the PEG because of recommendations from doctor and the H&N forum.

 

First PEG went south during week 5 of treatments.  To use the first PEG became terribly, terribly  painful.

 

Second PEG week 5 of treatments, always worked great.

 

2 meals a day by PEG, 1 meal a day by mouth.

 

Never got nauseated, 2 cans of Jevity at a time, hang it high, put it on fast drip.

 

Had PEG popped at 2 weeks post.

 

Looking back, it is an easy way to get nutrition, but I could have managed without any PEG at all.

 

My reasoning is because I worked so hard at continuing to swallow and stay totally hydrated at all times.  Give much deserved credit to John (Skiffen16) and the December – January H&N crew for getting me prepared to do battle.

 

Good Luck Rick (and watch the shoes).

 

Matt

Kent Cass's picture
Kent Cass
Posts: 1747
Joined: Nov 2009

Just kidding! This has been a subject with strong opinions in the past years, and long threads, and here we go again...

My research finds a very small percentage of people develop "complications" around the site where the PEG enters the body. I used Peroxide to wash the area on a daily basis when changing the gauze, but some time back it was put out there that good old fashioned soap is really better. Think I read that less than 5% develop complications.  

As for "clogs"- the kinda Coke one drinks is notoriously great in clearing those clogs. Worked for me twice, so I did witness.

Never heard of anyone doing the vomit out a PEG, so that's a new one on me. I did not have the suggested intake of Jevity that the Nutritionist recommended, but rather took in what I felt like I could handle, and never had a vomit issue due to Jevity. Worst of times I was only downing half of what I was advised to.

Got my G-tube installed over a week before tx started- told by my Chemo that I had no choice in the matter, and came to realize that with the C&R they had planned for me- she was right. No regrets, and kept the PEG for some 15+-months, though did not use for almost the last year I had it.

Seems to me the best advice to follow is that of your Dr, who is supposed to know you and the C you have, and the tx he/she is putting you thru.

kcass

 

jcortney's picture
jcortney
Posts: 424
Joined: Sep 2012

I fought getting the PEG tooth and nail and the crazy part is, I can't tell you why.  I just didn't want it.  My ONC finally convinced me and so I got mine.  Long story short, if I didn't have it I would have wound up in the hospital with dehydration issues at the very least and dehydtration & nutrition issues more likely.  Here I sit having finsished RAD treatment number 25 (with 5 to go) and ALL FEEDING and more than half of my fluids are via the tube.  There is no way my throat will permit me to take in 2200+ calories a day and the same can be said for 100 ounces of fluids.

So for ME, I'm ever so glad I got forced into it.

 

Oh, and no didn't make me vomit and it did leak a bit but I kept a small gauze pad under the lip.

 

Joe Cortney

Dallas, TX

connieprice1's picture
connieprice1
Posts: 299
Joined: Oct 2010

Rick,   In the beginning, my wife Connie (the patient) and I were against the peg. The stigma of having a feeding tube aside, we thought she should continue to swallow during treatment and that it would be better for her post treatment. About 2 weeks after radiation treatments started her appetite was nil and all food tasted different. We both agreed it was time for the peg and NEVER regretted it. She was not eating enough and was losing weight daily, although she had the peg she continued to drink water orally and this helped her keep her swallowing reflex and she never lost her ability to swallow. At first, I administered her food very slowly to keep her from being nauseated, later she could tolerate the drip much faster. In the beginning, she did throw up once or twice but once we slowed the drip down she was OK. As you know, everyone is different and many suvivors here never need a peg but if you are not able to get enough calories normally then you should consider the peg. One of the most dangerous things concerning H&N treatment is weight loss. Connie's peg has been removed for over a year now and she is eating well and gaining weight. I think the peg made Connie's treatment go smoother because she had an alternative nutritional source. I hope your treatment goes well and you don't need a peg but if you do, don't hesitate to get one. Wishing you great treatment and recovery, Homer & Connie 

fishmanpa's picture
fishmanpa
Posts: 1113
Joined: Jan 2013

How's that for an obscure lyric reference to the subject?

I'm waiting to hear from my team about a "PEG". It will depend on what they find when they do the surgery on Feb. 7th. I'm not opposed. From what I've been reading, "It's like a dream come true" , especially if the 'Steely' side effects go postal on my mouth and throat...

"T"

 

katenorwood
Posts: 1851
Joined: May 2012

Rick,

Just wanted to let you know how inspiring you are to me.  None of this is fair....kinda sucks.  But you have proven to be a very brave intelligent man who will get the proper answers and plunge ahead.  Gods speed my friend !    Katie

Greg53's picture
Greg53
Posts: 830
Joined: Apr 2010

Rick,

 

My experience with the PEG:

·         Got mine (about halfway thru tx) due to sores in mouth and therefore lack of nutrition.

·         It did not lower vomiting.

·         I put about everything in it.  Smoothies, medicines along with normal carnation, jevity, etc.  (just needed to clean it on occasion with coke/pepsi).  Had mine for 8 months.

·         No complications - a little crusty at times at entrance site - but pretty easy fix for me.

·         I had major vomiting issues due to gag reflex and heavy mucous/phlegm.  If I caught it soon enough I would open the valve to let some ”backflow" out.  This method, on occasion, worked and if I did it fast  limited how much I threw up.  Problem was, it was hard to catch it in time.  Someone mentioned this was a separate mechanism (backflow vs vomit) - I am sure that is correct, but when I did this, it minimized how much I threw up, which was my goal since I had trouble keeping anything down.

 

Hope this helps a little.  Haven't corresponded much to you lately, but following your battle - you are one tough SOB and love your attitude!

 

Sending you some good mojo!

 

Greg

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