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Topic Feeding Tubes Go to previous topic Go to next topic Go to higher level

By in-faith On 2009.12.18 12:30
I have come upon numerous references about feeding tubes, but I don't know anything about them and am unclear about what is involved. My MIL may require surgery in the near future, and the concern expressed by one doctor was that the combination of the anesthetic and missing two doses of meds could result in her not being able to swallow. Another doctor suggested putting a feeding tube before surgery in to ensure meds could be given (if she wasn't permitted to take a sip of water before surgery). What are the pros and cons of feeding tubes?

By annwood On 2009.12.18 15:55
Feeding tubes are used when a patient is no longer able to swallow. In a FEW circumstances they are beneficial. By that I mean the patient does not have a terminal disease but may have a situation that is only temporary. In most cases they are used for far advanced disease like cancer, PD, etc. The problem is once one is put in it is almost impossible to get it removed. It can prolong life if that is what you are after but the quality of that life is not ideal. I have seen cancer patients go through additional weeks, months of extreme pain because they were being kept alive by a feeding tube.

In your MIL's case there are other ways to get meds into a pt before, during and after surgery. Two weeks ago I posted the anesthesia guidelines for operating on Pts with PD. They can take the meds (and should) up to 30 min before surgery. Hospice uses an empty pill capsule - opens it, puts in the meds, and inserts the capsule rectally. This also provides good absorption of the meds. Hospice will not allow feeding tubes under their care.

The placement of a feeding tube is a surgical procedure in itself.Many people have directives regarding feeding tubes (extraordinary means of life support) in their wills - check to see if your MIL does. If she does not have dementia you can ask her what she wants. If she is confused she won't be able to tell you and she would most likely pull the tube out once it is placed. This is a very personal decision and involves just to what lengths a person want to go to remain alive. Physicians are often not truly honest about this and put a great deal of pressure on family members. As I said, once it is in they won't want to take it out. There have been many well known instances of this in the news.

I refused a feeding tube for my husband. He was a physician and I am a nurse. Both of us had in our living will that feeding tubes were not to be considered - we had seen too many nightmares from them. Despite that his physicians were pressuring me to have one put in when his swallowing became a problem. I declined and they continued to give me the song and dance about his meds. I kept declining and waving his Living Will at them. I finally had to get my brother (a hospital attorney) involved. He suggested that they present it to the hospital Ethics Committee - they didn't and there was no more pressure. Hospice got involved at that point and the med problem was solved with the rectal administration. He lived three more months on ice cream, candy, milkshakes, Ensure, pudding, etc. He was happy with that diet and the goal was to make him happy. Good luck to you - this is a big decision and never easy.

By lynn On 2009.12.18 21:34
We just had an experience with the feeding tube issue. My husband with PD was hospitalized for surgery and 5 days post-op he was given a swallow study and did not pass. The attending doctor recommended strongly that he receive a feeding tube. We had previously decided with my husband's neurologist against a feeding tube so I was prepared with my answer. He now is on pureed food and thickened liquids and is doing O.K. I would recommend that you let the person who goes thru surgery recover from the hospital experience before opting for a permanent tube. Let them recover from the anesthesia and pain meds and return to their baseline prior to surgery. You can always have the tube inserted at a later time if you choose. Nutrition and hydration can be given with an IV. See the previous post for med option or have them crushed and taken in apple sauce.

By in-faith On 2009.12.21 12:37
The concern the doctor had was if my MIL was not able to swallow her pills after surgery (particularly if she missed two doses). It's helpful to know there are other options than a feeding tube.

By lynn On 2009.12.21 15:03
We have missed more than two doses after surgery and my husband has been fine once med were resumed.

By annwood On 2009.12.21 16:46
I think that a feeding tube is a pretty drastic measure for post op meds. I can't imagine she would miss more than one dose and even three doses could be tolerated.

By lynn On 2009.12.21 20:36
Agree with annwood-an extreme measure for meds.


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