blender recipes for tube feeding/ do's & don'ts

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Thank you for the great answers and tips. Pals has been having ensure, instant breakfast (and something called two cal which he would only drink once, but is hi cal and would be good for tube feeding since he won't have to taste it). However, it was $50 for 12 cans. He has tolerated all these well so hopefully he will continue to do okay when he gets them by tube. He has lost a lot of weight since last year, and i'm hoping this will stabilize with the tube. Insurance hasn't been paying for the ensure so far, but maybe after the tube is done?
 
clewbcg, just wanted to say Hi. We visited your area last year at about this time and stayed at the Homestead Lodge. It sure is beautiful country around there. We drove down to Moab to see Arches National Park and really enjoyed it.

I have been using a product from Nestle called Resource 2.0 in my peg tube. I haven't tried drinking it because it, like Boost and Ensure, are something that would make me gag for sure. I have had no problems with it by tube however and it really helps me to get the calorie. I take three 237 ml (8oz) boxes per day, my morning smoothie and whatever normal food I can manage to swallow The formula is supplied by our provincial government at a reduced price and I pay about $100 per month at current consumption which is I think about 1/3 of the normal. I am one of the people in the race that Dana mentioned and although I think that I'm behind Thelma's Dad now because I have not gained more weight in the past couple of weeks, I have gained 11 pounds in the two months since I got my tube. I'm sure that no matter what you put in your husbands tube he will gain weight and energy and won't have to struggle as much to eat.

Good luck!

Barry
 
Barry you're not behind my Dad at all. He seems to have hit a plateau at the 10-pound mark. He's pretty confident that he'll gain more though. He is happy with the Nestle Resource 2.0 and he is still eating a little by mouth. The list of foods he is able to eat is pretty limited now. He does enjoy a good bowl of my Mom's home-made gnocchi. My Mom adds extra olive oil to his portion and he does eat mashed potatoes, cake and pudding. I'm sure there's more but I can't think of them right now.

It's still anybody's race so keep eating! :)
 
gnocchi

Thelma;
Ok, being from a WASP background where my parents thought that pizza was ethnic food (really, I never had one until I was a teenager and bought it myself) can you explain gnocchi to me? Or even better, can you give me your mom's recipe (if it's not a secret lol)? I eat a lot of mashed potatoes with gravy, chili, egg salad, chicken salad, tuna salad, scrambled eggs with alfredo or hollandaise sauce, boost chocolate pudding, and yogurt. My wife also makes a fabulous 6 egg souffle (either cheese or lime) which is easy to eat. I'm so glad that I don't have to worry about cholesterol or I'd really be pooched.

Kind of off the Peg tube topic but whatever, I'm hungry and always looking for new food ideas!

Barry
 
clewbcg
Your doc will write an order for a tube feeding regimen when your husband is discharged with the feeding tube. I am not sure if Ensure is covered since it is available over the counter (OTC) but my Dad's canned food was covered by Medicare. The doctor must write an order for the tube feeding AND document that the tube feeding is his primary source of nutrition and your husband is not able to sustain himself through oral method for Medicare coverage. (Most commercial insurance companies follow Medicare guidelines.) I imagine the doctor already knows this but from my experience docs sometimes need some prompting. :smile:

Thelma and Barry,
I have to say now that Dad has been on regular food for his tube feeds he has gained 2lbs! Finally! So look behind you Thelma's Dad and Barry because here he comes. For what it is worth the GI doc did not expect him to gain any weight but rather maintain - he was wrong before and I am hoping he is wrong again. The dietitian was planning on 10+ so I am hoping he can get to where the two of you are now!

Dana
 
Go Dana's Dad! My local dietitian told me that I wouldn't gain any weight with the tube, I just wouldn't lose any more. When she said that I thought to myself "If I have to have this stupid hose I'm sure as hell going to gain weight with it". Anyway she is young, eager (and cute) so I'm having fun letting her know how much I've gained. I am looking over my shoulder!
 
this is another one of those subjects that I've avoided because I was too afraid to even imagine myself having a feeding tube. But if I decide to try to stay alive with ALS, I'm going to need one, and I'd like to stay alive longer than I first imagined I would.

I had wondered to myself if people had to use a formula, or could they blend something and pour it down. Now I know. :)
 
Mango, if I have any advice to give it is this, Don't fight the tube! I know that it isn't an appealing step to have to take but I also know that I would probably not still be here without it. Never give up, never surrender.
 
I had no idea that Medicare would pay for the nutritional supplements ! With my husband and I both existing mainly on supplements, we're putting away 6 containers a day, and it's adding up $$ pretty quick.

This Forum is great. In 24 hours, I've learned how to clean my BiPap (thanks, Rose ! As of today, I'm germ free :lol:) and hopefully get reimbursed for our supplemental food.
__________________________

A sign of the times: This doesn't belong on this thread, or anywhere else, but yesterday morning, I saw a neatly dressed elderly couple (white hair) going through the recycle trash cans out on the street awaiting pick-up. You don't see that in suburbia too much. Actually, I've never seen it before here. While I was dithering about what to do (Take them money? Take them my recyclables? It's that ALS lack of executive function again) they drove off. Makes me verrrrrrrry grateful that Paul and I can still afford food supplements, even if we can't eat steak any more.
 
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Folks - missed this thread earlier. Here is my simple trick to get more natural food easily. I take a can of soup, lentil vegetable or split pea, black bean and vegetable, rarely with meat as I don't have a super blender. I just open it and dump it in the blender with half a can of water and blend it to death. I split that in two and add a can of ensure to each half to up the calories. Gives me two meals and I can do it all myself still.
Dan
 
Beth, I know what you mean about reality checks for the hard times so many now face! And, I too was amazed at how expensive the ensure and other similar brands are. Its good to know that medicare will pay.

Dan, that sound's like an easy method. :)
 
So, Medicare will only pay for supplemental calorie "drinks" if you have a PEG. Is that correct?
 
I'm not sure how this reimbursement works. It sounded to me like if your doctor prescribes it, they will pay, but I don't know if you have to get a specific brand or what. I order our "Resource 2.0" over the Internet. Maybe my ALSA rep will know.
 
From CMS website...

180.2 - Enteral and Parenteral Nutritional Therapy
(Rev. 1, 10-03-03)
CIM 65-10

Covered As Prosthetic Device

There are patients who, because of chronic illness or trauma, cannot be sustained through oral feeding. These people must rely on either enteral or parenteral nutritional therapy, depending upon the particular nature of their medical condition.

Coverage of nutritional therapy as a Part B benefit is provided under the prosthetic device benefit provision which requires that the patient must have a permanently inoperative internal body organ or function thereof. Therefore, enteral and parenteral nutritional therapy are not covered under Part B in situations involving temporary impairments.

Coverage of such therapy, however, does not require a medical judgment that the impairment giving rise to the therapy will persist throughout the patient’s remaining years. If the medical record, including the judgment of the attending physician, indicates that the impairment will be of long and indefinite duration, the test of permanence is considered met.

If the coverage requirements for enteral or parenteral nutritional therapy are met under the prosthetic device benefit provision, related supplies, equipment and nutrients are also covered under the conditions in the following paragraphs and the Medicare Benefit Policy Manual, Chapter 15, “Covered Medical and Other Health Services,” §120.

Parenteral Nutrition Therapy Daily parenteral nutrition is considered reasonable and necessary for a patient with severe pathology of the alimentary tract which does not allow absorption of sufficient nutrients to maintain weight and strength commensurate with the patient’s general condition.

Since the alimentary tract of such a patient does not function adequately, an indwelling catheter is placed percutaneously in the subclavian vein and then advanced into the superior vena cava where intravenous infusion of nutrients is given for part of the day. The catheter is then plugged by the patient until the next infusion. Following a period of hospitalization, which is required to initiate parenteral nutrition and to train the patient in catheter care, solution preparation, and infusion technique, the parenteral nutrition can be provided safely and effectively in the patient’s home by nonprofessional persons who have undergone special training. However, such persons cannot be paid for their services, nor is payment available for any services furnished by nonphysician professionals except as services furnished incident to a physician’s service.
For parenteral nutrition therapy to be covered under Part B, the claim must contain a physician’s written order or prescription and sufficient medical documentation to permit an independent conclusion that the requirements of the prosthetic device benefit are met and that parenteral nutrition therapy is medically necessary. An example of a condition that typically qualifies for coverage is a massive small bowel resection resulting in severe nutritional deficiency in spite of adequate oral intake. However, coverage of parenteral nutrition therapy for this and any other condition must be approved on an individual, case-by-case basis initially and at periodic intervals of no more than three months by the carrier’s medical consultant or specially trained staff, relying on such medical and other documentation as the carrier may require. If the claim involves an infusion pump, sufficient evidence must be provided to support a determination of medical necessity for the pump. Program payment for the pump is based on the reasonable charge for the simplest model that meets the medical needs of the patient as established by medical documentation.

Nutrient solutions for parenteral therapy are routinely covered. However, Medicare pays for no more than one month’s supply of nutrients at any one time. Payment for the nutrients is based on the reasonable charge for the solution components unless the medical record, including a signed statement from the attending physician, establishes that the beneficiary, due to his/her physical or mental state, is unable to safely or effectively mix the solution and there is no family member or other person who can do so. Payment will be on the basis of the reasonable charge for more expensive premixed solutions only under the latter circumstances.

Enteral Nutrition Therapy

Enteral nutrition is considered reasonable and necessary for a patient with a functioning gastrointestinal tract who, due to pathology to, or nonfunction of, the structures that normally permit food to reach the digestive tract, cannot maintain weight and strength commensurate with his or her general condition. Enteral therapy may be given by nasogastric, jejunostomy, or gastrostomy tubes and can be provided safely and effectively in the home by nonprofessional persons who have undergone special training. However, such persons cannot be paid for their services, nor is payment available for any services furnished by nonphysician professionals except as services furnished incident to a physician’s service.
Typical examples of conditions that qualify for coverage are head and neck cancer with reconstructive surgery and central nervous system disease leading to interference with the neuromuscular mechanisms of ingestion of such severity that the beneficiary cannot be maintained with oral feeding. However, claims for Part B coverage of enteral nutrition therapy for these and any other conditions must be approved on an individual, case-by-case basis. Each claim must contain a physician’s written order or prescription and sufficient medical documentation (e.g., hospital records, clinical findings from the attending physician) to permit an independent conclusion that the patient’s condition meets the requirements of the prosthetic device benefit and that enteral nutrition therapy is medically necessary. Allowed claims are to be reviewed at periodic intervals of no more than 3 months by the contractor’s medical consultant or specially trained staff, and additional medical documentation considered necessary is to be obtained as part of this review.

Medicare pays for no more than one month’s supply of enteral nutrients at any one time.
If the claim involves a pump, it must be supported by sufficient medical documentation to establish that the pump is medically necessary, i.e., gravity feeding is not satisfactory due to aspiration, diarrhea, dumping syndrome. Program payment for the pump is based on the reasonable charge for the simplest model that meets the medical needs of the patient as established by medical documentation.

Nutritional Supplementation

Some patients require supplementation of their daily protein and caloric intake. Nutritional supplements are often given as a medicine between meals to boost protein-caloric intake or the mainstay of a daily nutritional plan. Nutritional supplementation is not covered under Medicare Part B.
 
Gnocchi :)

Barry, I only noticed your question about the gnocchi today! I wish I could give you the recipe but it's a totally hand-made process and is best when taught to you by an experienced Italian lady :)

Basically gnocchi are pasta dumplings traditionally made with potato. My Mom makes these completely by hand, no pasta machine or anything. I could get the recipe from her but I think it would be easier to find a reputable Italian store that makes fresh pasta where you could buy them. The consistency of gnocchi are perfect for my Dad because they're kind of mushy. My Mom likes to make them with a rosé sauce. It's delicious! I personally have never made them on my own but have assisted my grandmother on many occasions when I was a girl. They are fun to make!

I am not sure if my Dad can still eat them au naturel. My mom now has to blend them a little but he has gained a total of 12 pounds now since getting his feeding tube and I am thrilled about that. This week he's supposed to get his Panasonic Toughbook with Dynavox. He's excited about it!
 
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