Ask the expert
Leukaemia
Question
My 16 year old daughter has neurolymphblastic leukeamia. She is on the four treatment system and is on the second set. She had a stroke three weeks ago and is just in the process of regaining mobility in her right arm. She is having intensive physio including speech (it was the whole of her right side) and is improving. However, she has lost 10kg. The doctors wanted her to have a nasal tube for feeding but she vomitted it out and we are worried about doing it again. She is vomitting many of her meals and the nutritionist seems to be giving only protein drinks which she also vomits up. Can you help? I thought that maybe food especially for expeditions would be useful - does that sound like a good idea and can you come up with any more ideas?
Answer
It sounds like your daughters vomiting is one of the main barriers to her being fed currently. I would recommend that you discuss this with your daughter's medical team who will be able to explain why this is happening.
Is your daughter taking anti-sickness medications? Are they effective? Can anything be done to help improve her symptoms e.g. changing from oral medications to intravenous medications? The Doctors will be able to advise what is best in her case.
You mention that your daughter had a nasogastric feeding tube (narrow tube passed into the stomach via the nose) placed to assist in feeding. Was this needed because she couldn't eat, couldn't eat enough to meet her nutritional requirements, or was her swallow function affected by the stroke? Again, this is a discussion you need to have with your daughter's medical team to help understand whether replacing the feeding tube is necessary.
If your daughter requires nasogastric feeding then good symptom control of her nausea/vomiting will improve tolerance of the tube. If vomiting continues to be a problem then sometimes the Doctors/Dietitian may recommend that a Nasojejunal feeding tube (NJT) is trialled. An NJT is like a nasogastric tube but the tip goes into the first part of the bowel (the jejunum).
If your daughter can swallow diet safely, with good symptom control of her vomiting, she may find it easier to adopt a ‘little and often' style of eating. Encourage her to have something to eat every 2-3 hours rather than three big meals.
Try plain foods such as toast, crackers, cereals and biscuits. Many people find ginger helpful. Your daughter could try sipping ginger ale or nibbling ginger biscuits or cake. Sometimes cold food is easier to tolerate when you feel sick as it doesn't have a strong smell. High carbohydrate drinks are good to sip and will help her to keep hydrated.
You mention that the Nutritionist has recommended protein drinks. There are a variety of nutritional drinks available and it may be worth trying a juice based supplement that can be mixed with lemonade or sparkling water to improve tolerance. Ask the nutritionist to explain what options are available.
