Category Archives: Weight, Food, and Swallowing

The 1,000 Calorie Shake

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

Caregiving for Throat Cancer

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…

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Gardasil HPV vaccine coverage and safety in the United States

cdc-hpv-infographic

 

Gardasil HPV vaccine coverage and safety in the United States.

Mayo Clinic Holding Clinical Trial for HPV-Positive Head & Neck Cancer

 

The bad news is, HPV+ throat cancer is on the rise.

The good news is, it is highly curable…90-95% in non-smokers where the cancer that hasn’t spread outside the neck.

The bad news is, 1 in 3 people after standard treatments have significantly long-term effects.

The good news is, the Mayo Clinic is soliciting people for clinical trials for treatments that will still be curable but with far less side effects and toxicity.

I asked John if he would have been willing to go to the Mayo Clinic for a clinical trial and he said YES.

If you would like more information about this trial, please contact: Dr. Daniel Ma at the Mayo Clinic by email: Ma.Daniel@mayo.edu

I am unable to embed a youtube video on this site, but please see more here:

Mayo Clinic | Clinical Trial for HPV-Positive Head & Neck Cancer – YouTube.

 

 

No Worries for the HPV Vaccine | dailyRx

No Worries for the HPV Vaccine | dailyRx.

 

October 10, 2013

(dailyRx News) One of the only vaccines that is known to prevent some forms of cancer is the HPV vaccine. Those who might worry about its safety have no reason to fear.

A recent study found no increased risk for any medical conditions or disorders after girls got the HPV vaccine.

Intensity Modulated Proton Therapy (IMPT) Reduces Need for Feeding Tubes by 50 Percent in Head and Neck Cancer Patients

This is very good news!

Intensity Modulated Proton Therapy (IMPT) Reduces Need for Feeding Tubes by 50 Percent in Head and Neck Cancer Patients.

HPV Vaccine Found to Help With Cancers of Throat

“We were surprised at how big the effect was,” said Dr. Rolando Herrero, head of prevention for the World Health Organization’s International Agency for Research on Cancer, and the study’s lead author. “It’s a very powerful vaccine.”

No adverse effects from the vaccine were reported.

 

Acupuncture for Dry Mouth (Xerostomia) after Radiation

Acupuncture needles are hair-thin and relatively painless.

Acupuncture needles are hair-thin and relatively painless. Thomas Del Brase photography

 

John and I are both Licensed Acupuncturists, in practice for over 25 years. In a strange coincidence while John was in the process of getting the lump on his neck diagnosed (we knew it was cancer; we just didn’t know what kind yet) a patient came to see him for loss of saliva after radiation for, yes, HPV+ tonsil cancer. He had just finished his 6 weeks of radiation and was having trouble eating and swallowing. The first treatment stimulated saliva flow immediately, and after a couple more follow-ups he was greatly improved.

When John was diagnosed a few weeks later, this man became a tremendous source of information on what to expect.

Fortunately, there is research available on the efficacy of acupuncture for radiation induced xerostomia, carried out in San Diego, California. At the time we relied on research carried out in China.

John had an acupuncture treatment every day during his 35 radiation sessions. Now, while not everyone has the luxury of having their very own live-in acupuncturist, everyone can benefit from either preventative or restorative treatments, as John’s experience with his patient showed. Frequently during John’s treatments he would feel saliva beginning to flow.

Saliva is not only necessary to help moisten food for chewing and swallowing. It is equally essential for its anti-bacterial effects for preventing tooth decay. John’s dental health was good, and in addition to his daily acupuncture treatments he wore a mouth-guard device that fit over his teeth and was filled with fluoride gel. While he has had several cavities filled in the past year his teeth have apparently been re-mineralizing.

Acupuncture releases one’s own endorphins, which are like having your own little internal opiate factory. The treatments are deeply relaxing. While John did finally lose a great deal of the thinner saliva he never lost his saliva production altogether, which made it easier for him to continue swallowing and get back into eating solid food as soon as he possibly could. His radiation oncologist noticed and commented on the fact that he never completely lost his saliva as so many did.

Our local cancer center offers weekly acupuncture sessions. Check with your oncologist for a reputable Acupuncturist in your area. This works.

In case you would like to share this information with your own acupuncturist, here is the treatment we did on a daily basis:

Bilateral ear points: Shenmen, Point Zero, Salivary Gland 2′ and Larynx.
Bilateral: Lung 7, Kidney 6
Ren 24
Affected side: Alternating. One day Stomach 5 threaded to Stomach 6, the next day Small Intestine 17. These were discarded later in the treatment series as these areas became to painful to treat due to radiation burns.

PEG Tube Recipes (in Colors of the Rainbow!)

Go for the colors of the rainbow!

One of the great advantages of the PEG tube is that you don’t have to concern yourself with how your recipes taste.  This means you can get an amazing variety of foods through it!

TWO THINGS BEFORE YOU TRY THESE RECIPES:

Before using anything but canned formulas like Ensure, be sure to read this excellent blog, You Start With a Tube: Blenderized diet, tube feeding and related stuff.

Also, make sure you are using the right kind of blender.  See my post, It Starts With the Right Blender.

I went with five basic colors for smoothies, based on the Five Elements in Traditional Chinese Medicine.  Why?  Because each color nourishes a particular organ system, leading to a balanced diet.   After all, it just makes sense that if you vary the color of the food every day, over the course of 5 days you’re going to be including all essential nutrients.

Besides, it didn’t hurt my spirits or his to introduce a little playfulness to the process. With each recipe add small amounts of each ingredient until your blender is full.

Don’t worry if you can’t find some of the ingredients….this is just intended to give you some ideas.  Improvise!

TIP: Some ingredients you will ALWAYS use, like a scoop of protein powder along with fish oils, flax oils, and fresh ginger.  Your base liquid consists of whole milk, Ensure, or Boost Plus.  Don’t just use fruits– also use vegetables and grains as well.  After that, think color!

BLUE MONDAY

Purple/red cabbage

Frozen blueberries

1 apple

1 slice ginger (great for digestion)

1/2 lime, seeds and pith included

1 teaspoon flax oil

1 teaspoon fish oil (or 3 fish oil capsules, oil squeezed out of capsules)

1/4 cup coconut milk

1 teaspoon liquid acidophilis

1 cup whole milk

1 packet Instant Breakfast

1 scoop protein powder*

1 Ensure or Boost plus

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

RUBY TUESDAY

1 beet root

1/2 bell pepper

1/2 red apple

V8

Frozen raspberries, frozen strawberries, or Gouqizi

1 scoop protein powder

fish oils

flax oil’

1/4 cup coconut milk

1 cup whole milk

1 can Ensure Plus or Boost plus

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

This can be found in cans in the Asian or Thai section of your supermarket..

WHITE WEDNESDAY

1 cup whole milk

1/4 cup coconut milk

Vanilla Instant Breakfast

1 scoop protein powder

1 slice fresh ginger

1/2 cup Greek Vanilla Yogurt or Vanilla Ice Cream

1 apple

Cauliflower stems

fish oils

flax oil

1 Ensure Plus or Boost Plus

1/4 cooked quinoa or white rice

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

Sooo good for you!

GREEN THUMB THURSDAY

2 broccoli stems

spinach

kale

wheat grass

cilantro

flax oil

fish oils

1 cup whole milk

1/4 cup coconut milk

Kombucha multi-greens drink

1 scoop protein powder

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

ORANGE YOU GLAD IT’S FRIDAY

1 tin sardines in mustard sauce

1 cup whole milk

baby carrots

frozen corn

frozen pineapple

Gouqizi (Chinese Wolfberry) (or may use 1/2 orange including pith and seeds)

1 teaspoon flax oil

liquid acidophilis

1 slice fresh ginger

1/4 cup coconut milk

1/4 cup protein powder

1/2 orange

Orange Gatorade

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

frozen sweet cornMELLOW YELLOW WEEKEND

Frozen sweet corn

1/2 banana

frozen pineapple

1/4 cup Quinoa ( a high-protein grain that is cooked like rice)

Tin of sardines in Mustard Sauce

Whole milk, Ensure, or Boost Plus

Protein Powder

slice of Ginger

flax oil

Pulse twice for 15 seconds, then blend twice on highest setting for 50 seconds.

* Our protein powder of choice:

An excellent vegetable protein powder, and very digestible

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.

Support from the Imerman Angels: “I Promise You, I Will Not Let You Go.”

Ten weeks after John’s last radiation treatment for HPV+ tonsil cancer it seemed as if his recovery had stalled for good. Still unable to eat even soft foods without pain, he was getting cranky when not utterly withdrawn and I was getting exhausted. Most of the time it seemed he wasn’t really “there,” and who could blame him? I’d be checked out of my body, too, if I was in that much pain for so long. But I was lonely. I missed him, and was beginning to wonder if he’d truly ever be himself again. His doctors all thought things were coming along just fine, but they’d never actually been through everything he had, had never been in unrelenting pain, week after week.

first rad 3 Worse yet, I’d gotten two phone calls that week from men in their 50’s, newly diagnosed with the same cancer, looking for advice. Overhearing one of these conversations, John said in frustration, “You don’t know what it’s like to go through this. None of the doctors can tell you what it’s really like. No one knows how this feels!” I had to agree with him. No matter how much empathy I was capable of, I truly didn’t know what it was like to, among other things, be bolted down into a hard, form-fitting mask six times a week for up to 50 minutes at a time. In my meditation that night I again asked for help for John.

As a cancer caregiver I’ve been repeatly reminded that all you have to do is ask. Not only does help arrive, but the right kind of help arrives, sometimes delivering a better and more precise solution than what you’d asked for. This was one of those times. The next day I got a call from a Cancer Center volunteer (I’d never gotten a call from them before), wanting to know how we were doing. I described John’s frustration with having no one to talk to who actually knew what he was experiencing. John entered treatment a strong, healthy guy who worked out 5 times a week, and instead of getting better once this was all over he was still weak and tired and in pain and discouraged.

The volunteer had me look up Imerman Angels on my laptop, explaining that they match cancer patients and caregivers with people who’ve survived the exact cancer you are dealing with. She strongly suggested that I could also get help from fellow caregivers who’d been down the same road, and so I filled out the online form on the spot. I also sent the link to John, doubting he would follow through and understanding I couldn’t push him to do so….but he did.

Imerman Angels logo

The Imerman Angels organization found us a match more quickly than I could have dreamed.

Two days later when John was at physical therapy the phone rang, and Hector introduced himself in a rich warm hispanic accent as an Imerman Angel who had been matched with John. He asked me a few questions about where John was in his treatment timeline and then told me that it had been a year since his own treatments for HPV+ throat cancer had ended. Like John, he’d come into his diagnosis strong, fit and healthy, and like John he’d had surgery, chemo, and the strongest and lengthiest radiation treatments they give for any cancer. Like John he’d had a feeding tube, and like John he’d been beaten up more than the average person by the chemo.

“I was training for the Iron Man when I was diagnosed,” he told me. “I lost 60 pounds of pure muscle. I couldn’t eat or talk for a month. I ended up on dialysis for awhile from the chemo. I want you to know this….I am working out at the gym again. I rode my bike around Lake Michigan this morning. I am training for a marathon again. I have my health back. I know exactly how John feels right now, that this will never end, that he will never have his life back. But I will tell you this, John will start feeling like himself again, and very soon.”

Hearing this from someone who had actually been through the same ordeal was the most reassuring thing imaginable. Hearing from somene who had been athletic before, and had come back from the weight loss and fatigue and treatment toxicity to resume an athletic lifestyle was the very thing John most needed to hear. It spoke directly to John’s greatest fear.

Hector went on to tell me that his wife “was the hero of my story,” and asked if I would like to talk with her some time. I had to go to work and scribbled down his Chicago phone number. I wasn’t sure if, in his current state of withdrawal and apathy, John would call him back.

“Will you do me a favor, Hector? If John doesn’t call you back, will you please call him again this weekend?”

And in the kindest, warmest gentlest voice imaginable, in that velvety rich accent, Hector said the words that marked the beginning of our next phase of healing:

I promise you. I will not let you go.

I hung up the phone, sat down, and bawled like a baby.

When I came home that night John had talked with Hector for over an hour and was buoyed by the conversation. The next day I called his wife Susie. We laughed at the conflicting feelings of loving someone with all your heart and working your hardest to save their life while simultaneously wanting to kill them. “When you’re done with treatment you think, ok, now I’ll start to get better,” Susie said. “But the first ten weeks after the end of Hector’s treatment were hell. They don’t tell you how long it is before you really start feeling better on a day to day basis!” Both Hector and Susie reassured us that not only was John still going through the hardest part of the entire journey, but that he was very close to the end of that terrible phase.

Susie described Hector during that ten weeks after treatment as “not being in his body.” Friends would visit and say that despite the drastic weight loss Hector looked great, and Susie would stare at them, wondering why they couldn’t see “that wasn’t Hector!” I explained to her how I felt that John couldn’t even really see me, or consider what was happening to me throughout all this, and she bluntly said, “You’re right. He can’t right now. But he will.” She continued, “I promise you, John will be back in his body again. You’ll know it when you look back and talk about this in the past tense. You’ll know it when you can talk about it with wonder and amazement as something you survived together.” This was exactly what I most needed to hear, and she was right. A couple of days later it was as if John started coming ‘back online’ again, at first briefly, and then for hours at a time.

the mask Two weeks later on July 14th, a date neither of us will ever forget, as we were sitting out on the deck, John started talking about everything that had happened…in the past tense. He turned and looked at me in wonderment, as if really seeing me for the first time. “How does someone get through something like this without someone like you by their side?” he asked. I looked at his clear, open face, into his concerned and caring eyes, and with tears running down my cheeks said, “Welcome back.”

And now? John’s recent follow-up PET scan was all clear (NED, baby!), he’s started back to work part-time, he’s rehabbing the nerve damage to his shoulder from the chemo and he’s slowly working out at the gym again. He’s mostly eating solid food now, though it’s not yet a pleasant experience. His wicked keen sense of humor is back in full force, and he is enjoying life very, very much. Best of all, just as Hector promised, he’s starting to feel better every single day. We know that this is just the beginning, and that it will be a full year before John is completely over some of the side effects, but we now both have hope that he will continue to recover.

From the Imerman Angels website:.

Imerman Angels was created on the belief that no one should have to fight cancer alone and without the necessary support. At 26 years old, Jonny Imerman was diagnosed with testicular cancer and began his fight against the disease. Throughout his experience, Jonny was lucky enough to have loving support from his family and friends but had never met anyone his age who was a cancer survivor. He wanted to talk to someone just like him, someone who truly understood, and was intimately familiar with his experience. In short, he was looking for someone who had already beaten the same type of cancer. This was the beginning of Jonny’s vision and in 2003, it became a reality when he founded Imerman Angels.

Please help me spread the word about this amazing organization. Whether you’re a confused caregiver, a patient wishing you could talk to someone on the other side of what you’re going through, or someone who has survived and wants to mentor someone who is currently struggling with your same diagnosis, the Imerman Angels are truly wonderful. For the original published article and the comments received, see The Monday Night Cancer Club diary by smileycreek,  http://www.dailykos.com/story/2012/08/06/1117020/-Monday-Night-Cancer-Club-I-promise-you-I-will-not-let-you-go.

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HPVANDME | A Non-Profit Organization

Support for those supporting people with HPV+ throat cancer

You start with a tube...

Support for those supporting people with HPV+ throat cancer

HPV Origin Throat Cancer

Diagnosed July 6, 2012 via Tonsil Biopsy

Caregiving for Throat Cancer

Support for those supporting people with HPV+ throat cancer