WhiteBlaze Pages 2024
A Complete Appalachian Trail Guidebook.
AVAILABLE NOW. $4 for interactive PDF(smartphone version)
Read more here WhiteBlaze Pages Store

Page 1 of 2 1 2 LastLast
Results 1 to 20 of 30
  1. #1
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default Now THAT'S something you don't see every day...

    ...and this may be a question that even a nutritionist can't answer, but I guess this is the logical place to post it.

    As some of you already know, some post-op problems have left me - temporarily - with a feeding tube. Three weekends ago, I went out on a short trip here in Pa., just to see how well things were going to work. I had to take cans of liquid nutrition with me, and are they ever heavy!!! I've checked with my supplier, and they don't make a powdered form of the stuff I'm using, but I've been reading the labels on powdered baby formula, and even though the stuff is lower in protein, most of the rest of the labeled ingredients appear to be comparable at a similar caloric value.

    I understand the need to get the powder completely mixed prior to feeding - I'm on my second tube now, and I don't want to see this one fail because of a clog that might have been avoided.

    So, for all of you nutritionists out there, here's the question: in the interest of reducing weight and volume in my pack for short (2 - 5 day) trips this winter (and to keep the cans from freezing out there), is it reasonable to substitute formula for nutrition if I adjust my caloric intake to compensate for activity and temperature? Any QUALIFIED thoughts will be appreciated; all other thoughts may be assigned to the "round file". Thanks!

  2. #2

    Default

    shelterbuilder,
    I am not very qualified to give advice as I am a paramedic and not a doctor, nurse or nutritionalist but with my experience of treating and transporting people with feeding tubes, I don't think that it would be a problem.
    I think that as long as you matched caloric intake with actual caloric burn you would be fine nutrition wise.
    I would certainly be far more worried about blockages. Most of the time that I have contact with feeding tubes is due to blockage. As long as the formula was "thinned" enough and the tube flushed correctly, I think that you may be on to something here,
    Good luck!

    geek

  3. #3
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Jim Adams View Post
    shelterbuilder,
    I am not very qualified to give advice as I am a paramedic and not a doctor, nurse or nutritionalist but with my experience of treating and transporting people with feeding tubes, I don't think that it would be a problem.
    I think that as long as you matched caloric intake with actual caloric burn you would be fine nutrition wise.
    I would certainly be far more worried about blockages. Most of the time that I have contact with feeding tubes is due to blockage. As long as the formula was "thinned" enough and the tube flushed correctly, I think that you may be on to something here,
    Good luck!

    geek
    None of MY medical professionals want to give me any advice on this, except to warn me that I'll clog the tube - no one wants me out in the field in my "delicate" condition! HOGWASH! (To be fair to them, I don't think that this question has ever been asked of them, since most of their tube feed patients are content to "retire from the real world" and reduce their activities accordingly...but not me!)

    Thanks.

  4. #4

    Default

    Quote Originally Posted by shelterbuilder View Post
    None of MY medical professionals want to give me any advice on this, except to warn me that I'll clog the tube - no one wants me out in the field in my "delicate" condition! HOGWASH! (To be fair to them, I don't think that this question has ever been asked of them, since most of their tube feed patients are content to "retire from the real world" and reduce their activities accordingly...but not me!)

    Thanks.
    Medical professionals are always reluctant to give advice unless it has been through research studies and controlled environments due to liability issues with insurance companies.
    Since no one seems to have an answer for you...why don't you see if you can get the approval of one of your "medical professionals" to do the research yourself and then apply for GRANTS (!) to do this research?
    Getting paid to hike may be a good outcome of having to deal with the feeding tube!

    geek

  5. #5
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Jim Adams View Post
    Medical professionals are always reluctant to give advice unless it has been through research studies and controlled environments due to liability issues with insurance companies.
    Since no one seems to have an answer for you...why don't you see if you can get the approval of one of your "medical professionals" to do the research yourself and then apply for GRANTS (!) to do this research?
    Getting paid to hike may be a good outcome of having to deal with the feeding tube!

    geek
    I LOVE IT!!

  6. #6
    Registered User TN_Hiker's Avatar
    Join Date
    04-25-2005
    Location
    Kingston Springs, TN
    Age
    59
    Posts
    267

    Default

    I admire your attitude and determination. KICK BUTT!!!!

  7. #7
    WFR/Guide chiefdaddy's Avatar
    Join Date
    08-13-2007
    Location
    Manhattan
    Age
    49
    Posts
    221
    Images
    29

    Default

    Check out Muscle Milk, this is the best mixing I have found and it taste good..cookies and creme is my fave!

  8. #8
    Registered User
    Join Date
    01-26-2007
    Location
    maine
    Age
    63
    Posts
    4,964
    Images
    35

    Default

    Find an older RN.

    I trust them more...

  9. #9
    Getting out as much as I can..which is never enough. :) Mags's Avatar
    Join Date
    03-15-2004
    Location
    Colorado Plateau
    Age
    49
    Posts
    11,002

    Default

    I have nothing to add..just to say Ithink it rocks you are getting out there!

    Have a blast!

    Paul "Mags" Magnanti
    http://pmags.com
    Twitter: @pmagsco
    Facebook: pmagsblog

    The true harvest of my life is intangible...a little stardust caught,a portion of the rainbow I have clutched -Thoreau

  10. #10
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Mags View Post
    I have nothing to add..just to say Ithink it rocks you are getting out there!

    Have a blast!

    Just doin' what I have to do, so I can do what I want to do!

  11. #11

    Default

    I am an RN and can give general information but of course you're not my patient and I can't assess the situation myself.

    Do you have a very narrow NG tube? Or is it a comparatively large PEG tube? Have you already had clogs and learned to flush them? These are questions that you should consider.

    It is rare that a short-term feeding tube is irreparably clogged so that it has to be removed; usually it is either a positioning issue or a fixable stoppage. They clog or get up against the tissue and you flush a few times and everything is dandy. On the other hand, the feed is usually not mixed in the field from powder with possible clots in it.

    Have you thought about straining it if clots might be a problem? Does baby formula clot anyway? (I don't know anything about powdered formula clotting or not.)

    In the hospital, you are allowed to leave feed hanging for 24 hours so you could probably transfer cans to a sterilized container like a platypus for the first 24 hours but it would be a lot of trouble, especially if you're going to be mixing powder after that anyway.

    What type of formula are you taking? Ensure? Glucerna? What I would worry about with the baby formula is what it would do to my digestive system. No doubt you noticed some changes when you went on the feeds. I probably would try this experiment at home first because you don't want any surprises on the trail.

    Another and related issue is that the electrolytes may be different for infant/pediatric/adult formulas. There are so many different kinds. I would be more worried about this than the number of calories for a short-term change.

    Another thing I would worry about is the water. I suppose you're using municipal system water at home. Feed and a plastic tube make a nice environment for things to grow, make sure you really treat well any water you use to mix feed or to flush the tube, even consider boiling it.

    Okay, maybe that will help a little and stimulate your thinking on the subject.

  12. #12
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Appalachian Tater View Post
    I am an RN and can give general information but of course you're not my patient and I can't assess the situation myself.
    Do you have a very narrow NG tube? Or is it a comparatively large PEG tube? Have you already had clogs and learned to flush them? These are questions that you should consider.
    It is rare that a short-term feeding tube is irreparably clogged so that it has to be removed; usually it is either a positioning issue or a fixable stoppage. They clog or get up against the tissue and you flush a few times and everything is dandy. On the other hand, the feed is usually not mixed in the field from powder with possible clots in it.
    Have you thought about straining it if clots might be a problem? Does baby formula clot anyway? (I don't know anything about powdered formula clotting or not.)
    In the hospital, you are allowed to leave feed hanging for 24 hours so you could probably transfer cans to a sterilized container like a platypus for the first 24 hours but it would be a lot of trouble, especially if you're going to be mixing powder after that anyway.
    What type of formula are you taking? Ensure? Glucerna? What I would worry about with the baby formula is what it would do to my digestive system. No doubt you noticed some changes when you went on the feeds. I probably would try this experiment at home first because you don't want any surprises on the trail.
    Another and related issue is that the electrolytes may be different for infant/pediatric/adult formulas. There are so many different kinds. I would be more worried about this than the number of calories for a short-term change.
    Another thing I would worry about is the water. I suppose you're using municipal system water at home. Feed and a plastic tube make a nice environment for things to grow, make sure you really treat well any water you use to mix feed or to flush the tube, even consider boiling it.
    Okay, maybe that will help a little and stimulate your thinking on the subject.
    Ah, that's what I like - "food" for thought!

    It's a PEG tube - I sneezed out the NG tube while I was in the hospital, then the first PEG tube failed (positioning issues) and had to be replaced - I really don't want to go there again, thank you very much. "Start with water, end with water...and the occasional "soda flush". No problems since replacement. I'm currently on Nutren 1.5, usually fed via gravity.

    Straining is an excellent idea, in the event of a clump - I hope to avoid clumps by being extra careful with mixing. I'm figuring on 5 feedings: breakfast, mid-morning, lunch, mid-afternoon, and dinner. I'm also figuring that the powder may mix better with warm water (100*-110* F). Mixing, straining, water temp can be figured out during home testing. Digestive system "anomalies" can also be worked on during this time.

    Electrolytes are, at this point, an unknown. Where exactly would your concerns focus?

    Raw water issues haven't been addressed at length...yet. I was out 3 weekends ago with cans of nutrition and used raw water for flushes and hydration with no ill effects during or after the trip. (I tolerate iodine reasonably well...at least, I used to!)

    So that's where I am right now...any more thoughts??

  13. #13
    Registered User Suzzz's Avatar
    Join Date
    07-30-2007
    Location
    Dieppe, New Brunswick, Canada
    Age
    57
    Posts
    346

    Default

    Hi there,

    I second everything said by Jim Adams and Appalachian Tater. And as I've said before in another post... blocage needs to be your numbr one concern. You get a blocage out there, you're screwed. That being said have a look at diet products such as Slim Fast. Compare the ingredients, you'll see they are the same and it costs a lot less. But as suggested by Tater, try at home first.

    Good luck!!! You're an inspiration.

  14. #14

    Default

    It's pretty hard to actually clog a PEG as long as you flush it well. I've crushed plenty of pills to make a slurry to give by PEG, sometimes they weren't crushed as well as they might have been, but the big chunks soften up and flush right through anyway. I had forgotten about that! And you're right, warm water works much better. I never saw any difference with soda water.

    The water concern would be more with things growing in the tube than making you sick from ingestion, the same water would be going in your stomach without the PEG anyway and nothing magical happens to it in your mouth and throat. But you will be drinking a bit more of the trail water than you normally would, so it could push you over a threshold and make you sick where it wouldn't if you consumed fewer organisms. Consider boiling.

    I see no reason why you can't hike while you're eating unless you get regurgitation, but I actually don't know WHY you have the PEG. Your feeds are over an hour? Make sure you check residuals before infusing, sometimes your digestive system acts differently when you start hiking. You're throwing a lot of new variables into the mix.

    The electrolytes would primarily be a concern because you could get diarrhea. Try it out for 48 hours at home before trying it in the field!

    Something else to consider: how does the hip belt on your pack interact with the PEG tube and insertion site? You definitely don't want any irritation or pulling or leaking.

    Here's a link for the Nutren 1.5:
    http://www.nestle-nutrition.com/prod...4-9C57D7D69FB5
    I also wonder if you might need MORE calories because you're hiking, depends on how long you'll be out.

    You know, they do make powdered tube feedings, I see "Emsogen" on the internet. Call a couple of medical supply places and talk to a pharmacist to see about actual availability.

  15. #15
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Appalachian Tater View Post
    It's pretty hard to actually clog a PEG as long as you flush it well. I've crushed plenty of pills to make a slurry to give by PEG, sometimes they weren't crushed as well as they might have been, but the big chunks soften up and flush right through anyway. I had forgotten about that! And you're right, warm water works much better. I never saw any difference with soda water.

    The water concern would be more with things growing in the tube than making you sick from ingestion, the same water would be going in your stomach without the PEG anyway and nothing magical happens to it in your mouth and throat. But you will be drinking a bit more of the trail water than you normally would, so it could push you over a threshold and make you sick where it wouldn't if you consumed fewer organisms. Consider boiling.

    I see no reason why you can't hike while you're eating unless you get regurgitation, but I actually don't know WHY you have the PEG. Your feeds are over an hour? Make sure you check residuals before infusing, sometimes your digestive system acts differently when you start hiking. You're throwing a lot of new variables into the mix.

    The electrolytes would primarily be a concern because you could get diarrhea. Try it out for 48 hours at home before trying it in the field!

    Something else to consider: how does the hip belt on your pack interact with the PEG tube and insertion site? You definitely don't want any irritation or pulling or leaking.

    Here's a link for the Nutren 1.5:
    http://www.nestle-nutrition.com/prod...4-9C57D7D69FB5
    I also wonder if you might need MORE calories because you're hiking, depends on how long you'll be out.

    You know, they do make powdered tube feedings, I see "Emsogen" on the internet. Call a couple of medical supply places and talk to a pharmacist to see about actual availability.
    No more pills for now, although when I first came home, there were 4 every 6 hours. The soda (ginger ale, Pepsi, etc.) seems to help clean out clogs - I'm assuming from the fizzing action of the carbonation. (Old nursing trick, taught to me by OLD nurse! )

    Point well taken RE: organisms and boiling; also RE: electrolytes.

    I can usually suck down 2 8oz. cans of Nutren in less than 10 minutes (that's about 750 cal.) via gravity, plus lots of water before and after. Two at breakfast, 2 at lunch, 2 at dinner, one each mid-morning and afternoon = 3000 cal. If I need more calories, I can always throw in a couple of extra cans at snack-time.

    I haven't been checking residuals since I came home - vaccuum pressure tends to hurt a bit. Peg site is mid-way between nipple and navel, so it's not really in the way of the hipbelt; if the end dangles down, I just move it and cinch up the belt.

    I was told by my supplier that Nutren 1.5 isn't available in powdered form, and he only carries Nutren. Thanks for the lead on the Emsogen; I'll ask around.

  16. #16

    Default

    Quote Originally Posted by shelterbuilder View Post
    Thanks for the lead on the Emsogen; I'll ask around.
    Oh, I didn't mean Esmogen in particular, but just a powdered general purpose adult tube feed.

  17. #17
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Appalachian Tater View Post
    Oh, I didn't mean Esmogen in particular, but just a powdered general purpose adult tube feed.
    Understood.

  18. #18

    Default

    Quote Originally Posted by Appalachian Tater View Post
    ...
    Have you thought about straining it if clots might be a problem? Does baby formula clot anyway? (I don't know anything about powdered formula clotting or not.)
    ...
    With good mixing and name brand powdered baby formula, there is generally little residue left in the bottle. Sort of like the residue from hot chocolate. Consider also that in a bottle, it all passes through the nipple. I don't have any idea how that compares to a feeding tube.

    Cheaper formulas tend to be clumpier. I am not sure if your use of the word clot is more technical than a clump.
    "Sleepy alligator in the noonday sun
    Sleepin by the river just like he usually done
    Call for his whisky
    He can call for his tea
    Call all he wanta but he can't call me..."
    Robert Hunter & Ron McKernan

    Whiteblaze.net User Agreement.

  19. #19
    Registered User shelterbuilder's Avatar
    Join Date
    03-29-2007
    Location
    Reading, Pa.
    Age
    68
    Posts
    1,844
    Images
    18

    Default

    Quote Originally Posted by Alligator View Post
    With good mixing and name brand powdered baby formula, there is generally little residue left in the bottle. Sort of like the residue from hot chocolate. Consider also that in a bottle, it all passes through the nipple. I don't have any idea how that compares to a feeding tube.

    Cheaper formulas tend to be clumpier. I am not sure if your use of the word clot is more technical than a clump.
    More food for thought...it's been MANY years since we did the baby formula thing (our "baby" now has 2 of his own ). Again, this is for "trial and error" at home. Thanks.

  20. #20

    Default

    Quote Originally Posted by shelterbuilder View Post
    More food for thought...it's been MANY years since we did the baby formula thing (our "baby" now has 2 of his own ). Again, this is for "trial and error" at home. Thanks.
    There's a quite a variety of speciality formulas now too. You probably wouldn't want any that say "helps stop spitup". There are thickening agents in some. For instance, my youngest son needs Enfamil AR (acid-reflux). It has a protein in it which helps to sort of gel the formula quickly. It may need to be in the stomach for onset though.
    "Sleepy alligator in the noonday sun
    Sleepin by the river just like he usually done
    Call for his whisky
    He can call for his tea
    Call all he wanta but he can't call me..."
    Robert Hunter & Ron McKernan

    Whiteblaze.net User Agreement.

Page 1 of 2 1 2 LastLast
++ New Posts ++

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •