Ensure... how many did you have?

MMDowns

Friends,

I am a bit irritated and I am not sure if it's warranted.  So I need advice (of course), help, tips, etc... My husband lost 12lbs during the first week of treatment. Chemo, rads, all that fun stuff  took us for a loop.  Anyway, he has since then gained 9lbs back and keeps playing win/ lose with the last 3lbs. During chemo week he loses the 3lbs and then during the other weeks gains it back.  We met with a dietician around his 3rd week and she was very nice.  But, she told my husband she wants him to consume 2200 calories a day.  Uhhh, what!?  He's going through chemo and radiation and his appetite, while better now, was still coming back from chemo and the taste buds were shot week 3.  Then he meets with his rads oncologist. He tell him 1400-1600 calories a day. Ok, that's more like it, realisitic & doable.  So last Monday was the second dose of chemo.  They weigh him and shocker; he lost 2lbs.  Again...chemo week.  So the dietician sees him last week and she again says you have to have 2200 calories, etc... So he tells her that his dr said 1400-1600 is good.  She goes on and on about muscle loss and all that jazz.  At this point I am annoyed. I get where she is coming from but this  man is living off of Ensure and oatmeal.  I know we need to watch the weight but his stomach has shrunk and there is no way we can get in 2200 calories.  Today is Tuesday.  He's had fluids once so far, today is the second day.  He sees the rads dr again and he tell him that he needs to have 6 ensure's a day.  Now I am irritated.  It's the same 3lbs every time.  Not 13 and not 30.  We are one week and 3 days away from the end of treatments.  I know things change from day to day, but I am being positive and praying that his throat still looks and feels good next week.  The following week is the last chemo and I know what will happen then.  Less of an appetite, harder to get fluids in, harder to "eat."  I think he is doing a great job gettting in calories.  It usually averages 1400 to 1450 everyday.  I am thinking he needs to use whole milk with oatmeal but that's all he eats.  The rest is liquid.   Am I the one that is being unrealisitic? This is all new for us.  But now my husband, the rule follower no matter what, is convinved that he HAS to get 6 Ensure's in no matter what. Tips on getting the Ensure in without causing irritated stomach?  Also, he is no longer regular and when he has not gone that makes it even HARDER to drink the Ensure.  He takes Senokat but sometimes he has to take two doses to make a difference.   I don't want to be the one that harms him in the end but at the same time I think the dietician set really unrealistic goals for cancer patients.  Thoughts??  Please let me know.  Thanks, friends!

CivilMatt

take this ensure and shove it

MMD,

This is why we push nutrition and hydration as the actions with more bang for your buck.  I would take all dietitian advice with a grain of salt and strive to do the best you can and no more.  They all mean well, but having been in your husbands shoes, good luck.  If it takes from dawn to dusk, so be it.  Try and eat or drink or PEG as many calories as you can.  I know it is asking a lot, but you need to do it and getting better and recovery depends on it.  Don’t give up, don’t be upset or mad, just meet it head on and you will be ok.

I don’t think I know of any H&N members which starved to death (some get close).

Happy meals,

Matt

SuzJ

Not a guy..

I was also told 2500 a day, its actually not that hard to do, it just goes against everything I was doing.. eating healthy, etc. just making sure I get all the good stuff in as well is proving a pain. I admit I

Just making sure I get all the good stuff in as well is proving a pain. I admit I havn't got anywhere close. Try my fitness pal, but dont use it for the dieting, use it for the counting, the potassium, the protein.

I try and enter my food before I eat it. I feel soooo guilty as I add stuff in, as I was losing for so long....

Joel4

i just finished treatment and

i just finished treatment and this is my first week "off".

just have a couple of questions.  Does your husband have a PEG?  I had a PEG put in at the beginning though my throats worked fine until week 7.  At this point I am an exclusive tube guy.

I have lost about ten pounds and my nutritionist said the same thing, shoot for 2200 calories.  Some days I hit it and some days I don't.  I strive to hit it but don't let it get me down if I don't.  One thing we do is add carnation instant breakfast and whole milk to the ensure.  While I could still use my throat I ate scrambled eggs made with whole milk every morning.

sounds like the nutritionists advice is reasonable to me, you may have to google high calorie smoothies and come up with your own concoction with peanut butter or something.  His weight loss isn't bad but you have to look down the road and assume that his throat may become more irritated as time goes on.  For me it was like a switch flipped, one day I could swallow and the next day it was off the charts painful.

it as a struggle for sure, but my advice is for you guys to strive for the 2200 but don't get down when you don't it.

Good luck and I'll be praying..

Chicklette

SuzJ said:

Not a guy..

I was also told 2500 a day, its actually not that hard to do, it just goes against everything I was doing.. eating healthy, etc. just making sure I get all the good stuff in as well is proving a pain. I admit I

Just making sure I get all the good stuff in as well is proving a pain. I admit I havn't got anywhere close. Try my fitness pal, but dont use it for the dieting, use it for the counting, the potassium, the protein.

I try and enter my food before I eat it. I feel soooo guilty as I add stuff in, as I was losing for so long....

Not a recommend diet plan

My husband could certainly relate ... he's been trying so hard to lose weight and eat healthy.  Now i have been telling him to eat everything likes because once treatment starts he won't be able to.  He will lose weight.  He can worry about dieting when he is better.  It just seems to go against everything he had been trying do for so long.

Noellesmom

Here's the deal

Jim consumed a minimum of 3500 calories a day from the beginning. He started at 175 pounds and six months later he was at 119. Radiation just keeps pounding the body long after treatment is finished.

Although Jim was able to eat anything and everything (which was amazing because he had base of tongue and hypopharyngeal cancers) at one point we needed something for appetite stimulation and his gastro prescribed Megestrol.

Nutrition and hydration. Your new mantra.

AnotherSurvivor

I concluded that dieticians

I concluded that dieticians are idiots, the not terribly perceptive results of home ec training.   Mine decided I could maybe add gravy to my mashed potatoes.  She left and never returned, my wife was pissed (at me).  

Have him get down whatever he can.  Your infusion center support is critical.  Mine was loaded with some of the best people I have ever met, and I am alive because of them.  Mine had many practical suggestions, based on decades of experience.  I went for nearly two months for daily saline hydration. 

My wife started making chicken soup, and made a point of NOT separating out the fat, and NOT adding thickeners like corn starch.   I was only able to drink the broth, no chewing.   We then added an egg to each bowl to create egg-drop soup.  Total about 110 calories.  I then discovered a Nestle product - benecalories - a nutrition paste that dissolved in the soup.  It added 330 calories, so I was getting down 400 calories per bowl.  Four bowls a day will keep you alive.  Post-WW II Europe survived on about 1,500 per day for two years or more. It is the SUSTAINED shortage of calories that is dangerous.  As he feels better, up the calories, it does speed recovery.  I only later was able to add nutrition drinks like Ensure.  Amazon has a very high calorie form called Very High Calorie (540 calories for 8 oz).  That continued well into my recovery period, at least six weeks.   About week 3 post I was able to start getting down 2,000 per day.  My weight has now been unchanging at 180 lbs for 3 months.  If he is getting down milk and oatmeal he is doing really well.

Sprint Car Dude

Eat

Sounds like he is doing great if he is only at a 3lb deficet. There were weeks I would lose 10 lbs a week. The body is fighting so hard right now don't worry about losing or gaining. Just keep eating what ever it is that he can eat. Then eat it some more. Try to get some protien in him because at some point the body really craves the protien and will steal it from the muscles. I estimate about 25 lbs of my loss was muscle. Keep on fighting the fight. The next 2 months will be really trying times. Good Luck.  

MMDowns

Thanks for all of the advice!

Thanks for all of the advice!! Love hearing new ideas. We are definitely getting it in. He had five ensures today and his bowl of oatmeal.  we will be swapping out 1% milk with whole NHL and maybe even some 1/2 @ 1/2.  I just want him to be as healthy as he can. We have 12 treatments left! 

MMDowns

Joel4 said:

i just finished treatment and

i just finished treatment and this is my first week "off".

just have a couple of questions.  Does your husband have a PEG?  I had a PEG put in at the beginning though my throats worked fine until week 7.  At this point I am an exclusive tube guy.

I have lost about ten pounds and my nutritionist said the same thing, shoot for 2200 calories.  Some days I hit it and some days I don't.  I strive to hit it but don't let it get me down if I don't.  One thing we do is add carnation instant breakfast and whole milk to the ensure.  While I could still use my throat I ate scrambled eggs made with whole milk every morning.

sounds like the nutritionists advice is reasonable to me, you may have to google high calorie smoothies and come up with your own concoction with peanut butter or something.  His weight loss isn't bad but you have to look down the road and assume that his throat may become more irritated as time goes on.  For me it was like a switch flipped, one day I could swallow and the next day it was off the charts painful.

it as a struggle for sure, but my advice is for you guys to strive for the 2200 but don't get down when you don't it.

Good luck and I'll be praying..

He does have a PEG. His rads

He does have a PEG. His rads dr had us put one in before treatments and i am so glad we did. Especially during his chemo weeks.  So far so good on the throat. I am praying it stays that way. He can swallow just fine but the thick mucus is accumulating and I can tell it's getting more difficult to swallow the Ensure. But he had 5 today pius his oatmeal so I consider that a small victory. Thanks for your kind words! 

MMDowns

CivilMatt said:

take this ensure and shove it

MMD,

This is why we push nutrition and hydration as the actions with more bang for your buck.  I would take all dietitian advice with a grain of salt and strive to do the best you can and no more.  They all mean well, but having been in your husbands shoes, good luck.  If it takes from dawn to dusk, so be it.  Try and eat or drink or PEG as many calories as you can.  I know it is asking a lot, but you need to do it and getting better and recovery depends on it.  Don’t give up, don’t be upset or mad, just meet it head on and you will be ok.

I don’t think I know of any H&N members which starved to death (some get close).

Happy meals,

Matt

Thanks Matt! That is kinda

Thanks Matt! That is kinda the attitude I have. Everything with a grain of salt. I know they mean well but I ask don't think they've had chemo or radiation. So we will do what we can. We will have to just work a schedule where he gets six in. He had five today and oatmeal so that's a good thing.  

AnotherSurvivor

Well, if he can get down milk

Well, if he can get down milk, he is golden, you can hide anything in that.  I started mixing peanut butter into mine.  It has crazy amounts of calories, but it needs to be well blended.  At my worst I was maybe doing 500 every 2-3 days.  It only lasted a week, but it did take off the weight.   I made a mistake with milk.  I thought it was coating things and contributing to misery.  It may well do some, but I finally concluded it wasn't the milk, it was the corn syrup, which most of those nutrition drinks use to get their high calorie ratio.  

phrannie51

I'm with Matt on this...

They HAVE to say what they say, but secretly they know through experience with other patients that weight loss, sometimes great, sometimes not as great is going to happen.  I used Boost VHC....it has 530 calories for an 8 oz carton....it took 14 swallows to get it down.  Ensure only has 220 calories per 8 oz's....so VHC is what I call "bang for your buck"!!  I bought by the case online, and it seems to me that shipping was free.  There is no decernable taste difference between the two, at least for those of us with no taste buds.  Because I was using a tube towards the end, I did hav to thin it a tiny bit with whole milk.

Weight loss is subjective....if a person is over weight to begin with losing 20 or 30 lbs is no biggie....if a person is thin to start with, every lb counts....I lost 20 lbs during treatment...a relatively low amount of weight to lose going through this....BUT, I was skinny to start, and weighed 77 at the end.  I did make sure to get as many calories in per day as I could....somedays it was lacking, some days I could really pump it in....

p

MMDowns

phrannie51 said:

I'm with Matt on this...

They HAVE to say what they say, but secretly they know through experience with other patients that weight loss, sometimes great, sometimes not as great is going to happen.  I used Boost VHC....it has 530 calories for an 8 oz carton....it took 14 swallows to get it down.  Ensure only has 220 calories per 8 oz's....so VHC is what I call "bang for your buck"!!  I bought by the case online, and it seems to me that shipping was free.  There is no decernable taste difference between the two, at least for those of us with no taste buds.  Because I was using a tube towards the end, I did hav to thin it a tiny bit with whole milk.

Weight loss is subjective....if a person is over weight to begin with losing 20 or 30 lbs is no biggie....if a person is thin to start with, every lb counts....I lost 20 lbs during treatment...a relatively low amount of weight to lose going through this....BUT, I was skinny to start, and weighed 77 at the end.  I did make sure to get as many calories in per day as I could....somedays it was lacking, some days I could really pump it in....

p

He uses the Ensure plus.  It

He uses the Ensure plus.  It has 350 calories and something like 13 or 14g of protein.  He had five yesterday and that seemed good.  He went by Cancer Action today and they gave him cases of this protein supplement that is for PEG use only.  I have never heard of it but the rads nurse reccomended it.  I am also going to get Carnation Instant breakfast and mix it with the Ensure (via suggestion from another SCC patient).  He is at 174 now, and we would love it by the next & last chemo round that he gains at least 4lbs. It doens't seem like a lot but you know how hard it is to gain a lb.  Any weight gain is golden at this point.  He was never a heavy man and is average height so anymore weight loss would probably not be great.  His problem is he knows he's losing muscle mass.  He's been an athlete his whole life and that's what's really hurting him.  When we first started dating he was around 175/176 but with muscle mass. So, it's going to be an uphill battle.  But one we will gladly fight.  Thanks for your words of wisdom    I appreciate it! 

MMDowns

AnotherSurvivor said:

Well, if he can get down milk

Well, if he can get down milk, he is golden, you can hide anything in that.  I started mixing peanut butter into mine.  It has crazy amounts of calories, but it needs to be well blended.  At my worst I was maybe doing 500 every 2-3 days.  It only lasted a week, but it did take off the weight.   I made a mistake with milk.  I thought it was coating things and contributing to misery.  It may well do some, but I finally concluded it wasn't the milk, it was the corn syrup, which most of those nutrition drinks use to get their high calorie ratio.  

That's good to know!  I have

That's good to know!  I have read as well that milk is actually good and doesn't contribute to the nasty thick saliva.  Thanks!!

caregiver wife

Hi calorie nutrition

There are several liquid nutrition products with about 500 calories per 8 ounces.  4 cans a day is a LOT easier than 8!!  Husband uses Two-Cal HN by Abbot.  Available only thru medical supply as is not sold over the counter.  I see Walmart online has several different high cal products.  I don't know about different insurance coverage, but Medicare pays for liquid nutrition for persons dependent on feeding tube through there durable appliance coverage.  After 5 years of struggling with the cost, it was an Abbot rep who told me how to get this covered and what medical suppliers were available in our town.  Watch the water intake so as not to get dehydrated on this type of product.

Crystal

caregiver wife

Hi calorie nutrition

There are several liquid nutrition products with about 500 calories per 8 ounces.  4 cans a day is a LOT easier than 8!!  Husband uses Two-Cal HN by Abbot.  Available only thru medical supply as is not sold over the counter.  I see Walmart online has several different high cal products.  I don't know about different insurance coverage, but Medicare pays for liquid nutrition for persons dependent on feeding tube through there durable appliance coverage.  After 5 years of struggling with the cost, it was an Abbot rep who told me how to get this covered and what medical suppliers were available in our town.  Watch the water intake so as not to get dehydrated on this type of product.

Crystal

MMDowns

caregiver wife said:

Hi calorie nutrition

There are several liquid nutrition products with about 500 calories per 8 ounces.  4 cans a day is a LOT easier than 8!!  Husband uses Two-Cal HN by Abbot.  Available only thru medical supply as is not sold over the counter.  I see Walmart online has several different high cal products.  I don't know about different insurance coverage, but Medicare pays for liquid nutrition for persons dependent on feeding tube through there durable appliance coverage.  After 5 years of struggling with the cost, it was an Abbot rep who told me how to get this covered and what medical suppliers were available in our town.  Watch the water intake so as not to get dehydrated on this type of product.

Crystal

Thanks!  We have a place

Thanks!  We have a place called Cancer action that gace my husband  One -CAl by HN but that was all it had.  It has 360 calories so we will be trying those. We are also going to try adding carnation instant breakfast to the ensure along with whole milk, that will up the calories to about 500.  We will try anything.  He dropped two more lbs and now I am officially worried.  

rsp

Idea for More calories

There is something called Benecalorie that you can buy on line.  It is a small container of liquid that you add to any food.  It adds 330 calories to whatever you are eating.  It has been a life saver for my husband.  I believe we have already gone through 4 cases.  It is not cheap (I think around $36 per case of 24.) It is tasteless and comes in 1.5 oz. cups.  I add it to his High Calorie Boost (also bought on line).  The HC Boost is 530 calories.  When Benecalorie is added, it becomes a 860 calorie drink!  If you add a cup of ice cream (280 calories), you have a drink over 1,000 calories!  I blend it up, and he drinks as a milkshake.

It takes him about an hour to drink it, but hey... two of those a day and he has in his calories!

 

Best of luck to you.  It is a long road, but doable.  Thank goodness for this site.  I have learned so much from the wonderful people on here.  It is so nice to talk to people who have/are going through the same thing.

MMDowns

rsp said:

Idea for More calories

There is something called Benecalorie that you can buy on line.  It is a small container of liquid that you add to any food.  It adds 330 calories to whatever you are eating.  It has been a life saver for my husband.  I believe we have already gone through 4 cases.  It is not cheap (I think around $36 per case of 24.) It is tasteless and comes in 1.5 oz. cups.  I add it to his High Calorie Boost (also bought on line).  The HC Boost is 530 calories.  When Benecalorie is added, it becomes a 860 calorie drink!  If you add a cup of ice cream (280 calories), you have a drink over 1,000 calories!  I blend it up, and he drinks as a milkshake.

It takes him about an hour to drink it, but hey... two of those a day and he has in his calories!

 

Best of luck to you.  It is a long road, but doable.  Thank goodness for this site.  I have learned so much from the wonderful people on here.  It is so nice to talk to people who have/are going through the same thing.

Good tips! I will look in to

Good tips! I will look in to that! Anything to cut down on trying to shove in 6 Ensures  but add calories. Yes, this website has been a God send. It's one of the blessings I give thanks for.