Dear Sherry -
I know you say your weight loss is slowed, but you may have some critical problems with absorbing food and liquids on the horizon. Sincerely hope not,but if so, here is another approach to long term weight problems.
I have copied and pasted an article, but you can search the web for TPN and find out more.
I learned about this from a friend surviving ovarian cancer, but has progressed. She does this at home. All the best!
are at obvious risk of malnutrition and dehydration. Without nutritional support and hydration, such individuals will become increasingly weakened. As their immune system function is reduced, they may die from infections before death can occur from malnutrition or dehydration.
Malnutrition is caused by inadequate intake of calories, protein, carbohydrates, fats, vitamins, minerals, trace elements, or any combination. The effects of malnutrition depend on its severity, duration, and which specific nutrients are lacking. The effects include: weight loss, listlessness, and depression; decreased ability to resist infection, to recover from illness, and to withstand surgery or other treatments; impaired wound healing; decreased cardiac and respiratory muscular strength, confusion, coma, and eventual death.
Dehydration is the loss of body water in excess of intake. It is caused by decreasing fluid intake or inability to conserve fluids as a result, for example, of renal disease or severe diarrhea. Dehydration results in dry mucous membranes; decreased sweat, saliva, and tears; muscle weakness, rigidity, or tremors; confusion, hallucinations, and delirium; abnormal respiration; coma; and eventual death.
Elderly people become more susceptible to malnutrition when they become critically ill or experience physical, psychological, or social factors. The social factors affect their eating habits, i.e., poor dental status, decreased mobility, social isolation, confusion, poverty, or depression. Many are too weak or unable to feed themselves and require hand feeding. Hand feeding is time consuming. It is claimed that some hospitals and nursing homes use tube feeding because sufficient staff time cannot be allocated to hand feeding.
Some patients cannot be hand fed because they have difficulty swallowing--a condition sometimes associated with stroke and other neurological disorders--and may choke while being fed. Others, refuse to open their mouths, spit out food, or take in food and fluids so slowly that they cannot be hand fed an adequate diet on a long-term basis, even by a willing and devoted caregiver.
Nutritional support and hydration -- refers to artificial methods of providing nourishment and fluids. The two modes of delivery are:
- Enteral or tube feeding, in which nutritional formulas are delivered via a tube into the digestive tract, and
- Parenteral is primarily intravenous feeding in which nourishment is delivered via catheter into the blood stream. Total parenteral nutrition (TPN) is an intravenous procedure that supplies sufficient nutrients to maintain a person's weight indefinitely.
Tube feeding and TPN are used primarily for people who are unable to take sufficient amounts of food and fluids by mouth or who are unable to digest and absorb them adequately. In general, tube feeding is used when the patient's gastrointestinal tract is capable of digesting and absorbing food normally. Intravenous techniques are used when the gastrointestinal tract is blocked or when disease interferes with digestion and absorption of foods and fluids.
Tube Feeding Techniques
Feeding tubes are placed through the patient's nose or a surgical opening into the gastrointestinal tract and a "formula" is administered in a single dose using a large syringe, by a gravity drip method, or by feeding pumps. Most formulas are bought premixed, although blenderized table food is sometimes used. Premixed formulas vary from those with standard ingredients to those with defined chemical composition tailored to a specific metabolic disorder. Although no formulas have been developed specifically for elderly people, special formulas are given for patients with kidney, liver or respiratory diseases.
Rapid infusion of enteral formulas into the gastrointestinal tract can cause regurgitation, aspiration, vomiting, or diarrhea. Conversely, very slow infusion can result in inadequate nutrition and hydration.
The patient's experience of tube feeding varies depending on whether conscious, unconscious, or confused. Tubes can cause irritation of the nose and throat and difficulty swallowing. For some, insertion of the tube can be frightening, and cause gaging. Others, learn to insert and remove the tubes themselves.
Intravenous Feeding Techniques
The most commonly used intravenous feeding techniques are:
- Total parenteral nutrition (TPN), in which a formula is infused into a vein--usually a large, central vein in the patient's chest; and
- The infusion in which water, saline or glucose solutions, and medications into a small, peripheral vein--usually in the arm.
TPN formulas are concentrated and can cause inflammation, occlusion, or clotting in small veins with low blood flow. In high-flow, central veins, the TPN formula is rapidly diluted. However, a constant and accurate infusion rate is critical. TPN formulas provide an ideal growth medium for certain organisms and TPN catheters are often left in place for a prolonged period increasing the risk of infections.
Nutritional support and hydration are the most controversial of life-sustaining technologies for people who are unable to swallow, digest, or absorb adequate amounts of food and fluid by mouth. Giving food and water is fundamental aspect of caring for another person. Failure to provide food and water--even when it requires tube or intravenous procedures--is deeply troubling for many people.
The different views about withholding or withdrawing nutritional support and hydration remains a difficult dilemma with important clinical, legal, ethical, financial, and political aspects.
- Is withdrawing nutritional support and hydration from a terminally ill or severely debilitated person killing them or merely allowing them to die?
- Is the suffering caused by malnutrition, starvation, and dehyration acceptable to the patient?
- Is the suffering associated with the aspects of tube or intravenous feeding procedures acceptable?
- Since the procedures are covered by Medicare and Medicaid for many patients, is the increased use proper use of limited public funds?
Then, the difficulty of determining which patients are terminally ill adds to this life or death decision.
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