Malnutrition & Dehydration

It really sounds like J could use some intervention to provide better nutrition than he is receiving now. You did not mention if he is having trouble swallowing from the tumor or the effects of radiation. If so, things should begin to improve approximately two to three weeks after chemotherapy and radiation therapy have been completed. You mentioned that J has some cardiac issues. You mentioned that the plan at MD Anderson was a “tri-modal” approach so I assume the next step in treatment is CT and or PET scan to determine treatment response and then surgery. So it looks like you have consulted with a surgeon and he/she feels that J’s cardiac issues can be managed for surgery?

 If that is the case, then J will probably be getting a feeding jejunostomy tube (J-tube) as part of the standard esophagectomy surgical procedure. It appears that J could use the benefit of the nutritional support now. If he is physically suitable for a major surgical procedure like an esophagectomy, the placement of a “J-tube” is a walk in the park.

 MD Anderson is clearly a national leader in the treatment of esophageal cancer so you are certainly in the right place to get the best treatment and advice for J. Given the combination of fluid retention and poor nutritional input I would be pushing for more personal time with J’s oncologist and less case management from his PA.

 I would be asking someone to explain the logic for not moving forward with a “J-tube” at this point.

Best Regards,

Paul Adams

McCormick, South Carolina

DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009

Cisplatin, Epirubicin, 5 FU - Three Year Survivor 

Sounds really simple, but you may want to try Boost shakes. I used to make shakes of all sorts for my mom when she didn't want or could not eat. 

Hello,

We keep Ensure at the house. My dad is able to eat almost everything but there are times when he doesn't feel hungry, or thirsty...I am constantly reminding him to hydrate. To "ensure" that he maintains his strength as longs as possible, on those days when he doesn't feel like eating as much, he drinks the Ensure.

If you don't know the product, you can get it anywhere (supermarkets, Walmart or any pharmacy type store) and they offer different formulas for different needs but focus on protein and nutrients. Here is their web address if you need it. He said they taste good too. - Theresa

http://ensure.com/

ualgal said:

Thank you all

I appreciate all of your suggestions for my husband's nutritional needs.  Unfortunately, all of them have been tried without success. He isn't able to tolerate dairy products at this time. Says they are like sandpaper on a sunburn.   It's almost 3 weeks since his last treatment and the swallowing has certainly gotten easier, however that hasn't been the real problem.  The liquid/food will not go further than the GE junction.   The esophageal spasms start - we think esophagus sphinchter is trying to do its job of getting food into the stomach but has been so damaged it cannot go in the stomach. These spasms are extremely painful.  Then the regurgitation starts, not vomit, clear mucous which lasts about 20 minutes or so.  We are just hoping this is going to improve soon, so we can get on with his body healing.  

I did find a product called Protein Shot - 3 ozs. & 25 grams of protein.  It isn't milk based...more like raspberry lemonade.  Also, liquid multi vitamins are helping get the nutrients in him.  A piece of toast can be taken, though it takes about 3 hrs to get it down (this includes the spasms & regurgitation time).  If this doesn't improve in the next 7 days, we'll have to see go in to doc.

Thank you all for sharing and for providiing me a place to do the same.  It's really great to have you all.

Marcy

Hi Marcy-

Sorry your husband is having a difficult time with nutrition. 

My husband, Lou, is having the same issues and it is so frustrating trying to find something for him to eat that won't cause him so much pain. 

We contributed his pain to the effect of proton radiation that ended Jan 2nd, plus ulcerations and a fungal infection that were seen with the EGD he had mid-Feb.

We know it takes time to heal, but it's been almost 3 months now since proton therapy ended. 

Thursday he had a CT scan and on Friday we learned he has mets to his lungs. He is to start chemo again on April 3rd to see if we can shrink these new nodules. He did have luck with that happening when first diagnosed in Dec 2009. 

 I'm worried about him going into chemo in such a weaken state. He only drinks a couple Boosts a day-not enough. So I was interested in the Protein shots you mentioned. Are they available in stores? I looked online and saw one called Profect that seems like it would be good. It's not only for bodybuilders like so many seem to be. But it doesn't look like it's in stores. What type do you get?

 In the beginning of our journey in 2009, Lou was unable to eat for 10 months due to different issues and complications. At that time, I found a product called Nestle VHC (very high calorie) now renamed Boost VHC. It has 530 calories and 23 proteins. Only available online. He did well with those, but this time around, they really bother him so he drinks just the Hi Protein ones from the store. He does not have a feeding tube.

The protein shots sounded interesting though. Only 3 oz, so it wouldn't be too much to take.

 Sorry to ramble on.........it's just so frustrating and heartbreaking!

Thanks-

Marta