The 1,000 Calorie Shake

This goes down easy

Between the time John was diagnosed (January 11, 2012) and the time he started radiation and chemotherapy on March 12th, we knew we had to get some extra weight on him…fast.  He weighed 158 pounds, and at 5’7″ this was mostly muscle from working out regularly at the gym.  We had to let go of some ideas about “healthy eating” (which for us was low fat) and increase his fat intake.  We succeeded in putting 10 pounds on him, which was much harder than it might seem. John naturally does not have a big appetite and never has eaten much food at one sitting, so condensing as many calories as possible into one glass was essential.

We also knew that after two weeks of radiation he would start to have trouble swallowing solid food.  It was agreed that he would need a feeding tube (or PEG tube).  We were also going to need a high calorie drink that would fit in the tube.  Fortunately, I was in touch with a woman whose husband had just finished his treatment, and she gave me her 1,000 Calorie Shake recipe.

The thousand calorie shake just starts at 1,000 calories….and it can be modified in many ways.  This is just a baseline to get you started!  You don’t need a special blender for this recipe, either.

The Basic Version can be either swallowed or put through the PEG tube.  Notice that I only use vanilla flavor.  This is because Cisplatin (chemotherapy) or radiation can make flavors like chocolate taste metallic or strange for awhile, but vanilla seems pretty harmless.

Sometimes even now, five months after the end of treatment, John’s throat gets sore from eating new foods, and I’ll make up a quick 1,000 Calorie Shake to keep him going.

Basic Version with Ice Cream:

Ingredient Calories Protein Fat grams
8 oz Whole Milk 150 8 8
Veggie Protein Powder* 129 22 1
Instant Breakfast, 1 packet Vanilla 130 5 0
1/2 cup Vanilla Ice Cream 150 3 7
Boost Plus or Ensure Plus 360 14 14
Malted Milk Powder, 3 Tblsp 90 2 2
Totals 1009 54 32

Here’s a denser version, with Greek Yogurt for probiotics and Coconut Milk:
You might want to check out this article on The Ten Benefits of Coconut Milk.

Ingredient Calories Protein Fat grams
8 oz Whole Milk 150 8 8
Veggie Protein Powder* 129 22 1
Instant Breakfast, 1 packet Vanilla 130 5 0
4 oz Vanilla Greek Yogurt 160 4 10
Boost Plus or Ensure Plus 360 14 14
1/4 cup Coconut Milk 138 1.37 14.3
Malted Milk Powder, 3 Tblsp 90 2 2
Totals 1157 56.37 49.3

Want to add more fat and protein?
Add 1 raw egg

Ingredient Calories Protein Fat grams
1 raw egg 78 6 5

Pulse the egg in at the end or it makes it too frothy.  DO NOT add the egg through the PEG tube.

*Let’s talk about protein powder:

An excellent source of plant proteins

Because these shakes are inevitably dependent on dairy products, I used a plant based proptein poweder instead of a whey (dairy) based or a soy based powder.  The Life Basics Vanilla Plant Protein Powder tastes good and gets its protein from a combination of Pea, Hemp, Rice with Chia Seed.

See my upcoming post on Five Element Feedings, where I show you how I got really creative using 5 colors of the rainbow in making daily drinks in the BlenTec blender for John.

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Posted on September 14, 2012, in Feeding Tube Support (PEG tube), Information about HPV cancers, Weight, Food, and Swallowing and tagged , , , , . Bookmark the permalink. 22 Comments.

  1. THANK YOU!!! THIS IS AMAZING!!! I did not know how I was going to bring myself to pour “Ensure” into his stomach day after day. Bless your heart!!!!!!

  2. Is there a difference between dry milk powder and ‘malted milk powder’? My fiance has just been diagnosed with throat cancer (and now has an ulcerated mass). Getting anything in him is like pulling teeth! His PEG tube placement is 2 weeks away.
    What they’ll put him on once it’s in, I have no idea. I would prefer to prepare his ‘meals’. I’m not sure if they’ll let me.

    • Dear April– I’m glad your fiance is getting a PEG tube. Take some time to read through the various materials here on feeding tubes and recipes. We were given a formula by Nestle called Nutren 2.0 to put through the PEG tube, but my husband couldn’t keep it down, probably because it was so high in fructose corn syrup. While we were told not to put any regular foods down the PEG tub I found it a necessity and did a lot of research on it first. Especially see my post It Starts With the Right Blender, and then the PEG Tube Recipes post. This website was incredibly helpful: http://youstartwithatube.blogspot.com/

      Malted milk powder has more calories and tastes better but it’s not an important part of the recipe and you can easily skip it. As difficult and painful as it is so do so, your fiance also needs to keep swallowing something every single day!

      Wishing you the best, and please stay in touch.

  3. I have been blessed to find your and your husbands journey on the world wide web. While I am getting him to take in what he can, when he can, it’s simply not enough. The radiation oncologist we spoke with today, is going to have him hospitalized to get his body nourished and ready for treatment. PEG tube placement is still 11 days away. And he is withering away to nothing.
    We have decided this is the best course of treatment for him, given the fact that;
    1) He NEEDS treatment.
    2) They cannot treat him unless his body is ready.
    3) He will not stop working unless he’s hospitalized.
    So, I spoke up. He wouldn’t tell the doctor he’s been working (burning more calories than I can get in him), so I did. I will not let this cancer spread anymore than it’s going to while he hangs onto his stubborn pride.
    I will continue to use this as a valuable resource over the course of his treatment and after.
    Thank you SO much for sharing your story and information. I am sure it will be invaluable to me (us) during this entire process!

    • Please keep reminding him how very treatable this cancer is, and how large the percentage of people who come out the other side of hell and resume their lives.

      Getting through the treatment is his ONLY full-time job for now. John’s radiation oncology nurse prepared him by saying that people who accept that this IS their full-time job are the ones who get through it the best.

  4. Tim had his PEG tube placed Monday, 8/13/2013. His radiation oncologist had him admitted the Thursday before. We just came home last night. He was severely constipated from his pain meds. They gave him the (ugh) formula in the hospital. I gave him his first feeding (which he did NOT want). He’s in self pity mode at the moment, I believe. At any rate, I fed him the basic version of the 1000 calorie shake. (I haven’t received his protien powder yet, so I added 12g of Green Vibrance) That was at 2am EST. His only complaint is that he feels like it’s going up into his esophagus. They have me doing Bolus feedings. Any advice on how to alleviate that issue?

    • This is tough. Make sure he’s sitting up when you put anything through the feeding tube and then don’t lie down for awhile, encourage him to walk around a bit if possible.

      The constipation makes it feel like nothing is moving and then he won’t want any more going in.

      There were lots of times John didn’t want anything through the tube (no appetite is still no appetite whether you’re swallowing or not) and being constipated made it much worse, as did lying down after a big bolus of liquid. As time went on we had to do smaller and smaller amounts at any given time.

  5. Thank you for sharing your story. I am 20 years down line with the same diagnosis having competed twice a day 5 days a week for 6 weeks radiation treatment and a radical neck surgery but Chemo was not an option in my day. All my serious deficits are the result of the radiation with loss of speech, a chronic PEG for home blended meals,and a trach tube secondary to bilateral vocal cord paralysis. Despite my disabilities I am still in the gym every other day for a minimum 2 hours pushing weights around. It’s my method of stress relief not to mention an addiction.
    I was able to stay active as a medical physician until the speech disability was prohibitive 3 years ago. Most post radiation damage is slow to show up but relentless in the long run. I am hoping you have a far better long term outcome then I given there have been significant advances in treatment protocols since my day.
    I was reading about your 1000 calorie blended meal which looks interesting. I had one observation that you list one raw egg as having 31 grams of protein. I suspect this is a typo.
    Since it is on your web site you might make corrections.

    • Thanks for catching that. We were just told that the Mayo Clinic is doing clinical trials to develop a protocol for newly-diagnosed HPV throat cancer. While there has been significant treatment protocols compared to 20 years ago the side effects are still harsh, but as John’s radiation oncologist said, they need to cure you, first and foremost.

  6. OK, every patient who has gone through radiation therapy for a head and neck cancer needs to know about a potential vascular issue that is not uncommon.
    I am 21 years out from radiation therapy for my metastatic tonsillar cancer. A few weeks back I had a transient neurologic event called a TIA. I immediately requested an ultrasound of my carotid arteries to see if there was a problem. I’m a physician so I knew a TIA is nothing to mess around with.
    Turns out I had a critical narrowing or stenosis of the internal carotid artery. I then read everything I could on the topic and soon discovered that carotid stenosis is a rather common long term effect of radiation. I had no idea and none of my many physicians ever said a word about this possibility.
    I then flew to the Cleveland Clinic from Tulsa, OK, underwent several more tests and eventually a stent placement int he stenotic artery. The procedure was done by a Vascular SUrgeon by the name of Dr. Clair at the Cleveland Vascular CLinic who had plenty of experience in this area. I was there for 3 days.
    So be smart and start having regular carotid artery scans after discussing this topic with you doctor or better a vascular surgeon. If you do have an issue go to a highly specialized Vascular Clinic like the Cleveland Vascular Clinic.

  7. This is an excellent point you brought up. John has had a CT scan with contrast of his neck and they’ll be watching this closely. A 10 year survivor I know had a (fortunately) small stroke, not a TIA, got a stent and is rehabbing well

  8. Thank you so much for your blog and this recipe! My fiance just finished week 3 and has already lost about 8 lbs. He is finally ready to consider the feeding tube but that is going to take some time & I have to feed him until then. So far he can chug these shakes and I sneak flax or coconut oil into anything I can get him to eat. He goes for chemo#2 tomorrow& we are terrified as the first one made him so sick and he got hypoglycemia as an unexpected side effect. I was so hesitant to give him ensure due to all the sugar& corn syrup but now I am just grateful to get anything in him. He had the basic shake last night& the dense one this morning& seems much more alert & less nauseous. Thank you 1000x!

    • You are so welcome! Check out the other shake recipes, too. These became a necessity. We were given cans of Nutren 2.0 by Nestle with 500 calories in 8 ounces, which starts looking pretty attractive as the weight starts dropping. (John’s most drastic weight loss came after the end of his treatment, when his metabolism was so ramped up for healing and he still couldn’t eat.)

      The ingredients in the Nutren 2.0 started off with water and then corn syrup and got purely chemical from there, with nothing recognizable as actual food.I just couldn’t imagine how he could survive on that stuff, and without telling him what was in it I put it in his shake and no joke, he puked it right back up. As hideously sore as his throat was I only tried it once more, again in desperation, and again he threw it right up. I still have expired cases of the stuff. I couldn’t even give it away to a homeless shelter or something because it isn’t food! I could use Boost or Ensure but always blended it up with other ingredients including fish or flax oils. I didn’t know about coconut oil then but that’s just excellent!

      John saw his ENT this week who told him he doesn’t have to come in for check-ups any more. He’s never seen a recurrence after 18 months out and John is past 2 and 1/2 years. So hold on to the long view, and please let me know if there’s any way I can help.

  9. Thanks for your reply. Things got a lot harder for us here and now we are down to him just “eating” keifer for about 12 days now. He missed his last chemo today as he is to weak to go through the chemo for the third time. We are on the last week (#7) and I hope he makes it thru radiation. Not sure what to do about chemo. I was wondering if you know about anyone not completing chemo and what their outcome might look like, we are not being given any information on this. I greatly appreciate any help/advice you might have.

  10. John was only able to do one of three scheduled chemo sessions because of a rare reaction. He has recently been declared out of the woods. Radiation is THE primary treatment, so try not to worry about the chemo too much.

    Can you add some protein powder to the keifer? Would help with healing.

    Just get through this last week, and then ALL his energy will go to healing. You can do this.

  11. Hello, I’m just checking in after being off this site for many months. I am now over 20 years out from diagnosis and treatment (surgery and high dose radiation) for a squamous cell cancer of a tonsil.
    I’m in my 4th year living with a tracheotomy as a result of radiation damage to nerves to my vocal cords and a PEG tube placed at the time of the trach.
    I have been extremely active all my life and even now continue to lift weights aggressively several times a week.
    I have learned a lot about how to support my nutritional needs in the past 4 years.

    I’m very grateful for having survived a sudden onset severe pneumonia, my first, with respiratory failure necessitating 11 days on a ventilator and 18 days in the MICU followed by 12 more days of in-hospital rehabilitation in May this year. Those 30 days in the hospital were horrible but I’m alive and grateful as mentioned.

    I can tell you I am a convert to buying a high end blender for food prep for your peg. one needs to have a peg tube that is large enough to accommodate blended food. While the most common size adult tube is a 20 french I have a 24 french tube which I requested.

    It is very easy to blend homemade formulas or meals with 1000 or more calories and high protein for those needing to add weight or have higher nutrition requirements because of exercise.
    Without getting into what I am currently doing in my diet, I will gladly provide the information upon inquiry. I can tell you I could not tolerate any of the “commercial” formula preps like Iso-source, Ensure, Resource etc because of increased mucous production in my throat and trachea. During my recent pneumonia hospitalization they only would allow use of one of their commercial formulas. We went with Peptamen AF which is very expensive. I was able to qualify under Medicare so I didn’t need to pay out of pocket. I still mix one or two containers a day into my overall daily calories intake but have principally transitioned to natural or normal healthy foods. Peptamen is better tolerated although not without some residual intolerance. Never the less I have regained the 35 pounds I lost in themonth of being an inpatient and added 10 more.
    I ended my community gym membership I had in place for the past 12 years and bought and set up my own home gym. THis has been a god send to me for may reasons. I’m very happy being able to push the weights around or jump on my elliptical machine when ever I want.
    The bottom line is I am happy to act as a resource for information one may need while going through or having survived treatment for cancer of the head and neck.

  12. Thank you, Don. Oddly enough I happened to know a woman who had a permanent PEG tube before John was diagnosed, and she helped me with recipes. There are many more good nutritional recipes in my post Peg Tube Remedies in Colors of the Rainbow. https://caretakingthroatcancer.wordpress.com/2012/09/14/peg-tube-recipes-in-colors-of-the-rainbow/

    I even added odd combinations like sardines which blend up nicely and give valuable fish oils. I would be happy if you added some recipes to that post in a comment so people can see the variety of possibilities available.

    • Appreciate the response and I will look at the website you posted.
      Given John previously was into weight lifting/exercise, how has he been doing in this area since completion of therapyY

  13. John has permanent nerve damage to his shoulder that restricts overhead movement and makes it very hard to lift weights. Every time he’s tried to get back to that kind of working out he finds that one side of his upper body developing more musculature than the other pulls his neck way out of place. BUT– he’s very active around the property and recently chopped, hauled and split over two cords of firewood!

    The link I posted is another article on this website; just didn’t want you or others to miss it.

  14. Reblogged this on Caregiving for Throat Cancer and commented:

    UPDATE: Knowing what I know now I would add a tablespoon of coconut oil to this mix. See also the post PEG Tube Recipes (in Colors of the Rainbow!) https://caretakingthroatcancer.wordpress.com/wp-admin/post.php?post=118&action=edit

  15. Hi it’s me again… I’m writing again to ask if you have any suggestions. He finished all his treatments 9 months ago and is still having issues with eating. He only likes to eat a chocolate banana peanut butter milkshake. He does make an effort to try to eat small amounts of solid foods but is still having a difficult time swallowing and everything tastes horrible (besides the shake). He’s putting on weight again but is very discouraged that he will ever be able to enjoy eating again. I’ve tried encouraging him to try the acupuncture but he is unconvinced. The situation is hard on him emotionally and we both worry about his health in the long run. We have always been very centered on a eating a healthy diet and wish that he could be eating better. He is convinced that nothing is going to help him and he is damaged forever. I am trying my best to find solutions as our medical team hasn’t offered any. It’s been difficult for me to help support him more as I gave birth to our son one week after he finished radiation. I’m not sure what else to do any suggestions would be greatly appreciated. Thank you again!

    • I’m sorry to hear things are so tough right now. It’s understandable to feel discouraged. The good news is he’s gaining weight, but he clearly needs help getting back to eating more solid food. I remember 9 months after treatment John was eating soft foods and foods with a lot of liquid in them, things like Cream of Wheat and soups and soft-cooked foods with lots of sauces. (I still tend to make foods with lots of sauces though he doesn’t need it any more three years out). At that point he’d say that eating was “a chore” and no pleasure in it, but that he had to do it.

      There are Swallowing Therapists who specialize in rehab for this kind of issue.Check out this article from Sloan Kettering Memorial Radiation Therapy to the Head and Neck: What You Need to Know About Swallowing. There are exercises he can do, but mostly he needs to be evaluated to see what the issue is.

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