Morning of the 1/2 way point

Well, here it is Wednesday morning and I thought Dave would up date this. Today marks the 1/2 way point in the radiation treatments. Taking things one day at a time, but I am very glad we are here.

Monday we went to see Dr. Debo (ENT) and he took a good look at Dave's tonsils and throat. All looks good. We talked about his nutrition and weight - he is down 9 lbs since the last visit three weeks ago. Dave's chief complaint is still that food tastes bad, so Dr. Debo reemphasized that the feeding tube would probably be his main means of nourishment, but that he still needs to try to eat - essentially "recreational eating" to keep his mouth (teeth, gums, jaw, tongue, etc) and throat healthy. Dr. Debo also put in a referral for us to see a nutritionalist. After the appointment w/ Dr. Debo, we then went on to the radiation clinic for his daily dose (#16), and I stopped in and talked with Miss Ellie (the Patient Navigator - she works for the American Cancer Society and Chesapeake Hospital) about how to get Dave to understand about his daily nourishment. We have to wait for Tricare to approve the referral for the nutritionalist. She left a message with the local American Cancer Society dietitian to give us a call.

Tuesday - treatment #17, went smoothly - still the chief complaint is sore throat and the taste of food. Had ENSURE plus for every meal and ate two scrambled eggs at lunch. Dave really has no desire to eat anything, primarily because everything taste bad. He even had a hard time getting the Juven down last night.
We talked with a dietitian yesterday, and she gave us some good tips. The main thing is that Dave has essentially given his nourishment over to the feeding tube and Ensure, we are up to 3 bottles of Ensure Plus a day and will probably increase that to 4 here shortly. The key is to keep his weight steady. If he continues to lose weight, increase the number of bottles (one bottle is 8 oz). She gave us some alternatives to mitigate the cost of the Ensure - Walmart's generic "Equate" is comprable, I just have to make sure that I get the "Plus" form (350 cal), and our local VA hospital has a cantena and she think we can get the Ensure there for less as well. Other notes:
- nothing thicker than the Ensure down the feeding tube
- don't force the 8 oz of ensure in at once - slow down and take it in over 10 or so minutes
- keep up on the fluids - 6-8 cups a day (we are doing pretty good on this one)
- try lemon/lime or lemonade in water to make it taste better
- Dave is having a hard time swallowing the multi-vitamin - switch to children's chewable (2 a day)
- if constipation becomes a problem (since he is essentially on a liquid diet) talk to our nurse about daily fiber or other options.
The bottom line is to keep experimenting to find something that tastes decent for Dave to eat, stick with the Ensure to maintain Dave's weight, and keep the fluid level up as well.

Hopefully Dave will update this later today - take care and thanks again - Marjie