Tuesday, October 1, 2013

The Mechanics of Tubefeeding

I feel like you want me to describe every aspect of tubefeeding, because on this blog there's no such thing as too much information....except poop....I draw the line at poop. I have standards, ok??

Eric O'Gorman gave a lovely description of eating a meal here. There are a few differences (different blender [Although, since I wrote this post, I've gone back to using a Vitamix because I feel like it does a better job], he's using two hands while I only use one, his blend is a bit thinner, etc.) but otherwise same idea. Many tubies (most tubies?) are young infants or are incapable of feeding themselves, so they have caregivers who do all the work. We'll call these caregivers "moms" because dads are adept at disappearing when it comes to changing poopy diapers and tubefeeding. My daughter has never been tubefed so I don't speak from personal experience but this sounds like the type of job I'd run away from. Regardless, caregivers--moms--prep and administer the food the same way. 

My meal begins with a blender. In this case, I'll be using the Blendtec for this demo.

"This is my Blendtec...there are many like it, but this one is mine."


Other people use a Vitamix, and that's perfectly fine--if you're a LOSER!! Just joking; actually I have both, and I go back and forth in preference. Right now, I'm using my Vitamix because the Blendtec has given me trouble blending some foods completely; plus the Vitamix is helping support the Oral Cancer Foundation. There are plenty of other blenders too. The Ninja has gotten good reviews. Other tubies use Magic Bullets, normal blenders, food processors, or even immersion blenders and make sure to put their blend through a strainer to take out any chunks. But if you really want to pulverize your food; if you're an American who grew up on violent video games and mass shootings every other Tuesday and you want to see your bloody rare steak decimated beyond all recognition then you should really use a Vitamix or Blendtec. For that matter, if you're a peace loving Canadian who wants all races and all vegan food blended in the great melting pot of life, then these two blenders are for you. I could see it go either way. They're the blenders for everyone!

Next, we add the ingredients. This is my typical lunch:

Just for fun, I blend the containers up too; because the Blendtec can do that

I'm "doubling up the recipe" so I have enough food for tomorrow's lunch also. So, I've got 2 bananas, 2 hard-boiled eggs, plain whole-milk yogurt, sunflower butter, almond butter, a delicious bar of dark chocolate for the anti-oxidants (because if there's one thing I hate, it's oxidants; tiny little sons-of-bitches!), fish oil (for the omega 3s, whatever those are...I'm not a nutritionist, ok?!?), stool softener (I said I wouldn't talk about poop!), and 16 ounces of green tea. 

On the other hand, if you've been married to the same woman for eleven LLLOOOOOOONNNNNGGGGG years, then maybe you'd prefer these ingredients:

Is it just me or does my blog have an alcoholic tone?


Not me, though. Nothing but green tea for this fellah! Wait, am I nearly out of wine?!?

At this point, I put the ingredients in the pitcher:

How'd that get there?

Then, hit the Soups/Syrups/Fondues button on the Blendtec...

The Control Center

Wait 90 seconds while my food is obliterated (I had to hold the lid down because I put quite a bit of food in for this blend). And voilĂ ! I've got myself a couple meals that are both delicious AND nutritious!


It tastes exactly how it looks!! Like crap. It tastes like crap.


The next step is food consumption. This step begins with setting the table.



Blendtec should be paying me for this publicity, am I right??


I've laid (I've lain? What's the right word here? I'm not an English major, alright?!?) Betsy's 2nd best dishtowel down on the table in case of any messes. I've noticed the Blendtec pitcher does not pour as cleanly as the Vitamix pitcher, so there are apt to be errant drips--maybe you should look into that, Blendtec, eh? Betsy's best dishtowel is in my lap because I am an expert at feeding my lap various odoriferous concoctions. My blend is of course on the table, along with 8 ounces of water to flush my meal down once I'm finished. I also have my syringe in the ready position in the syringe holder, and I have my plunger. The rubber tip of my plunger is doused with cooking spray because it's a pain to push it into the syringe if it isn't lubed up. 

I've tried several other types of syringes, including syringes with silicone tips that don't need cooking spray and can be used practically indefinitely. The problem with all these syringes is that they are much more awkward for me to operate with one hand. My Medline syringes are thin enough that they fit into my syringe holder but fat and short enough that I can push the plunger one-handed.

So now I hook my tube up to the syringe. Let's take a look at that shall we?


Note the six-pack abs, ladies


Normally, a PEG tube doesn't include that red part. It's called a Lopez Valve. Since I can't use my left hand to hold the syringe into the tube it would slip out pretty easily if it wasn't for the Lopez Valve, especially when I apply the force necessary to push in a thick blend. That red, rubber part holds onto the syringe extremely well so I can do this whole thing one-handed. I've only found Lopez Valves in hospital ERs and since I haven't been to the ER in a while--knock on wood--I've run out of them, so not sure what I'll do next tube change. I suppose just keep using this one until it breaks.

[UPDATE TO THIS POST: I found a way to order more Lopez Valves! Try Allegro Medical at this link: http://www.allegromedical.com//patient-care-c530/lopez-enteral-valve-p549281.html?utm_campaign=Comparison%20Shopping&utm_source=froogle&utm_medium=feed&CS_003=9164468&CS_010=ff80808111238d9d011124bf2edf5c8b&gclid=CjwKEAiAodOlBRDCjr-UlJDjtVUSJABR7fxyTAqg022UFw3qmZQWmACDGT6veQNjh5fVD_g3uovfYRoCOxzw_wcB&kwid=productads-plaid%5E95325235693-sku%5E221@ADL4ICUM9000@ADL4ALLEGRO-adType%5EPLA-device%5Et-adid%5E53190000973 or try here: http://healthproductsforyou.com/p-6217-icu-medical-lopez-valve-closed-enteral-tube-valve.html?gclid=CjwKEAiAodOlBRDCjr-UlJDjtVUSJABR7fxyVeMqQLn7bGVQGBbvLuhZwCjl4BP_P-2rL2BVMN_nvBoC57Tw_wcB or I had success ordering here: link]

Anyway, here we go; I'm ready to commence eating!! Assuming my depth perception is still adequate, I pour my blend into the syringe:


I am AWESOME at taking selfies!!

My blend is thicker than water; more like smoothie consistency. It will not go in by the force of gravity, so, I have to push it into my stomach. When I'm putting real food into my stomach, it doesn't make a difference to me how fast or slow I push the meal in. On the other hand, formulas like Ensure, Jevity, and TwoCal make me extremely nauseous if they go in too fast. My belly must know something the formula companies don't. Here we are at the halfway point:

Do you think the syringe is half full or half empty? Hmmm...

Note in the picture above that there is a weak link in my tubefeeding chain. Let's call this weak point "Lopez Junction"

Lopez Junction


Since I can't hold the syringe into the tube at Lopez Junction, there is a risk that if I push too forcefully on the plunger, the tube will pop off and spray me, and my loved ones, with the ingredients I outlined above. That would be sad. Emoticon sad. :-(  FYI, emoticon sad is the saddest sad of all.

This is the main reason I keep my blends fairly thin with water (or hard alcohol; they both work fine), and I also don't push too hard on the plunger.

When I'm done pushing in that food, I clamp the tube, disconnect the syringe from Mr. Lopez, pull out the plunger, reconnect the syringe, set it up in my syringe holder, and repeat until my pitcher is empty and all emoticons are happy once again.

:-(  ---->  :-/  ---->  :-\  ---->  :-0  ---->  :-)   (see what I did there?)

Once my meal is complete, I flush my tube with the 8 ounces of water. 

Or vodka. Again with the alcoholism, Brian??

Getting water is very important for us tubies because we can't take casual drinks like inferior people. That's right, non-tubies are inferior to me; HOW DOES THAT FEEL?!? I try to drink 16 ounces each meal (8 oz. in the blend and 8 oz. for flushing). Plus I get another 16-24 ounces of "free" water (just water by itself) and water with my meds.

After, flushing the tube, it's time to clean the pitcher. The Blendtec is great at cleaning itself. Just fill with water, add some dish soap, run for a bit and you're ready for your next meal. 

Much like my daughter, I LOVE bubbles!

It's also really fun to overfill the pitcher with soapy water and run the blender on high. Do it at your sister-in-law, Katie's ("Hey Brian, watcha doin"), house, stand back 10 feet, and prepare for some entertaining fireworks!!!

I know this sounds like a long process just to eat a meal, but it really only takes me 20-25 minutes to prep and 15-20 minutes to eat. During that time I can watch a show on my computer--with the headphones on so I don't have to listen to my wife and daughter drone on about their day. 

I hope this blog post was both entertaining and informative. If you've read all the way to the end, then you're me, Brian. You're the only one who read this far. But you're still a winner in my book, you handsome devil!!! :-)