I have had so many conflicting opinions on this from nutrition and dieticians at CC Ohio.

It is super costly and if insurance was not available I don't think it would be offered.
Any one have 2 cents to add?

I had ppn only once( same as tpn only through a peripheral line) They used to only use it when you were very malnurished, but I've seen it used more frequently when a patient is going to be npo for a length of time. Supossed to replace the nutrients your body needs. From my point of view, I hated it. Burned the veins, lots of lab tests to monitor things, intralipids really grossed me out, fat emulsion dripping in your veins, ok that grossed me out.
Maybe it was my state of mind at the time. If they feel you are that depleted, maybe you ought to think about it. Jan will prob have more info.
LoriP

I've been on it twice -- once for a week after the emergency colectomy because I was so malnourished, and the other time for a month after the obstruction surgery since I was NPO for over 3 weeks with the NG tube. Yes, it is very expensive and I am lucky my insurance covered most of it. I do think it is of a great benefit though. I still lost a tremendous amount of weight during the month after the obstruction, and without the TPN it would have been much, much worse.

TPN is capable of vast benefits and also vast risk. It can save you from spiraling into severe malnutrition and poor wound healing, but it can also lead to sepsis and liver failure, so it is not used indescriminantly.

I was on PPN once with minimal benefit and on TPN once for a week or so. Gained weight and my wounds healed while I was NPO.

Jan

I have had it twice. The first was when I was first admitted to the hospital when I had my colon and finally admitted I needed help and was about 20 lbs underweight. I was on it for the week I was in the hospital. I wasn't aware of risks involved so I begged the next surgeon a year later to do a central line while I was under so I could have it again and put on some much needed weight. He agreed and I did it at home after my surgery for about 3 weeks. It helped tremendously get my health back and my weight up. I was really malnourished and underweight and had no appetite.

My doctor here in South Carolina has declined to do it a couple times because of the risks to the liver and infection from the line and instead offered an NG tube...no thanks.

Hi Holly,

I was put on TPN for a week prior to and a week after my last surgery. I hadn't been able to eat solids for 3 months and my weight had dropped considerably so my surgeon wanted to build me up before he operated. He told me that this sort of surgery and recovery burns up a lot of calories (no kidding! )

Anyway, my recovery was the fastest of all the 9 operations I've had to date and although the TPN didn't put that much weight on me I certainly started to feel the benefits within just a couple of days (more energy etc). I did still lose weight with this surgery but nothing like the amount of weight I'd lost with the others.

It was a pain having to have bloods taken every day and my blood sugar level tested etc but worth it to me to have recovered so quickly.

Shell

Carnation makes a shake (powdered) that packs a whopping 500 calories per portion. I don't think I have seen them available in the store but they are available online and I believe they have a sugar-free option. These are recommended for cancer patients because of the high calorie content and the ease of digestion. Maybe this is something Chris could benefit from.

Sue

Hello Holly.

Doctors placed me on TPN after being NPO for seven days. I was discharged at day 13, to await my surgery date, and remained on TPN for a total of 3 weeks. During the time in the hospital on TPN, they were always coming in to ***** my finger...checking sugar levels. After adjusting everything with the TPN, I was sent home to await surgery.

We did not have a visiting nurse come every day, my husband and I were trained at the hospital on how to hook the TPN up at home (keep things sterile), they give you an IV pole, backpack to carry the TPN around in, etc. Home Health Care delivered/installed a mini fridge in our bedroom for the "milkshake bags".

I gained weight quickly, but was also receiving IV prednisone daily via the central line. The doctors will adjust calories depending on your need.

A visiting nurse only came once a week to check the port/centeral line and to draw blood.I remember gaining quite a bit. Gaining weight while not being able to enjoy food, well, it was different to say the least. I was only allowed clear liquids during that time.

I remember the doctors telling us about the effects it could have on the liver, but they also felt it was the best route for me..to gain weight/nutrition before surgery. All those weeks without food and I was still running to the bathroom...uh, don't miss those days...they seem so long ago.

Our insurance covered the TPN 100%, guess we were lucky.

I wish you and Chris the best of luck.

**OPPS Bill, I typed a naughty word and didn't even notice it until I saw all the ***** The "P" word, ...you know what they do with the needle to your finger.

Anybody suggest using Sandostatin injections to reduce his high ileostomy output? Cheaper and safer than TPN, plus you don't need to be hooked up to a line all the time. You may even get better insurance coverage for it.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&d...205786&dopt=Abstract

Jan

I was on TPN for several weeks long ago before I later had j-pouch surgery. I was hospitalized at the time with a flare and though eating, I was losing about a pound a day. I was told that inflammation uses lots of calories.

I was also told the reason for the TPN was so that if I did require surgery, I wouldn't be too weak for it.

It didn't seem like too big a deal at the time. A doctor friend put in the central line and the nurses would attach the bottles of white stuff on the IV pole. I was taught how to so it all myself with a bag of white stuff and a portable back-pack pump. At first I had to do it day and night. Later I had to use a bag only at night.
I called the pump "Harvey" and he/it spent the night on our king-size bed between my husband and me. A visiting nurse came to our house twice a week to check on me, and that was interesting because she was a nursing graduate of the university of which my husband was president at the time.

After I didn't need the supplements, I was told to keep the line in my chest for a couple of weeks with the three tubes capped in case I had to go back to the TPN.

I was instructed to keep eating while using the lipids or else my gut would turn to "mush." That didn't sound good, so I did eat even though I wasn't hungry.

I guess it helped because that flare subsided and it wasn't until a year or two later that the results of a colonoscopy suggested I needed surgery, but I was able to have the one-step surgery because I wasn't too sick at the time. When I think about it, it was wise of our insurance company to pay for it all (BC/BS) because it eliminated the need for the extra one or two steps of j-pouch surgery which I presume would have cost them much more money.

I hope your health situation keeps getting better and better. You've been through too much pain and worry already.

I would get on the phone and insist that dr Fazio call you back. Keep calling until he does (or at the least, someone from his office). If you are requesting a specialist consult, you should get one. If you can't even get a GI in, there is a real problem at the Clinic.

You may want to just go to the Chief of Staff's office for intervention. It completely baffles me that the ombudsman and patient advocate are so ineffectual. I am afraid that if you wait for the Joint Commission to intervene, it will take much too much time.

There is the possiblity that TPN is the best solution. However, you and Chris need to be convinced of this, not bullied into it, especially if you will have to pay out of pocket.

Jan

I hope the insurance carrier does not give you an issue over this....sometimes I wish they knew what we go through.

TPN totally saved me after my colectomy. I developed a fistula right below my belly button that was leaking from a hole at the very end of my small intestine. I was off all food (even clear food) for 5 days!! I felt terrible. Absolutely no strength, plus none of my skin was healing. The nurse actually said to me ("well you can survive 14 on saline, and you're only at 5...")... ughh...
Then I got the TPN put in, and it was a night and day difference for me. Everything healed very quickly, and I had 100% more energy. It really helped me out. If only it could make your stomach feel full...

I was on TPN at home for 4 month in 1990 before my colon was removed after a 30 day hospital stay on TPN also due to extrem weight loss.
I got aproved for home heath care because my doctor would not realease me from the hospital with out it.

I was able to build up on it enough to have surgery and my pouch made.