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Hi. Dr Rick here. I completed an Internal medicine internship in NYC and have two decades of clinical experience. How can I assist you today?
Hi - do you understand my question?
I am sorry to hear about your wife's ordeal.
Unfortunately, there is nothing you can do to strengthen the villi in the intestines.
Strenghten? or regrow?
It sounds like you are doing the right thing.
I do not believe you can overfeed her, especially since her MD wants her to eat more.
Have you been able to consult with a nutrition specialist who has experience with TPN with oral feeding?
The problem is her emotional state. With TPN she feels like its life support. This was a way for her to get better. She noticed a difference with the O2 at first but now doesn't think there's progress as she's locking up. I point out about how much juice she's consuming.
THey will not get stronger with anything you can do and, given the radiation and other therapy, they may have a hard time regrowing as their basement membranes have been destroyed and replaced with scar tissue.
That being said, areas that are not damaged too bad will, with time, regrow villi as best as they can.
It would be best to have her examined by a nutritionist and a comprehensive feeding plan tailored specifically to your wife's exact condition.
Ok, let's take the regrow with time approach. So is it good to give them more food then they can handle? That is to slowly increase the intake. Like building muscle with increased weight. or is that useless and will only cause her pain?
All you can do is try to get your wife to see how the TPN is there to get her stronger and get her over this difficult hump.
No. You do not want to give them more food then they can handle....perhaps more then they want, but just up to the edge of what her body can handle.
We're doing that. Have nutiricianist from TPN and 02 doctors but I get the feeling they don't really know with 100% certainity.
It does not work anything like building muscle. Try not to think of it that way.
That is probably correct....many times even the experts are pushed toward their limits and can't give exact advice. At that point you can only do what your wife wants and what your heart tells you to do.....
ok, so 2 days ago I introduced 1 spoon of pureed banana. Today 2 spoons. She says she's locked up. Do I take it back down to 1 spoon or keep at 2? When do I increase to 3 spoons?
I guess i'm trying to understand the time frame with how villi will regrow.
I'd go back to one. Then, once she breaks free and can tolerate one, go up to two...or maybe 1.5.....there is no right or wrong here.....
not much black and white....just a lot of grey :(
The villi may never recover in enough numbers to allow her to eat more orally......and, if they do it could take many months...
The TPN should meet 100% of her nutrition needs at this point and what you are getting into her would be "bonus" calories.....
I understand. About the Juven tissue builder. It says 2 packets a day. Should I increase to 3? About Reuteri probiotic, package says 1 spoon a day. I increased that to 2. Should I increase that to 3. My wife is an extreme case and i'm trying to help her fight.
Correct TPN does 100%. The juven + probiotic are attempts to help increase the villi. That's why I wonder about increasing to 3 each.
I think you should ask the nutritionist those specific questions as she knows your wife's situation better then I could ever hope to using online chat as my only tool....I'm sure you understand this....
More probiotic does not equate to more, or faster regrowth of, villi. It is not that kind of relationship.
The nutrition in the TPN will help her body regrow the villi....
Ok. I will continue talk with her. But she didn't know the answer to how villi get stronger. Btw, it was Dr Thomas / this service that recommended the Hyperbaric O2 treatments. None of her other doctors knew about it enough to suggest it.
Dr. Thomas does a very good job. I'm glad he was able to help you and your wife.
Is there anything else you would like to ask me today?
FYI, my mom thought you (on line doctors) all must be quacks (she's old school) but you're not. Dr Thomas proved that. Thanks to you all. We are done today.
I hope I have proven it also :)
You have. Thanks
Give my very best to your wife?
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you can please give me a “10” rating in all areas. It has been a pleasure to assist you today. Thanks in advance, Dr. Rick MD FACS
thank you very much. I will
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