In Malaysia, Singapore and many other countries, ready made formulas are usually purchased for loved ones who are on tube feeding. Tube feeding, either nasogastric (through the nose) or PEG (through the stomach) is usually done for patients who develop neurological disorders such as dysphagia due to complications from illness such as stroke, ALS or dementia. Sometimes, it is fitted in on short term basis for patients who are undergoing treatments which had interfered with their ability to swallow or eat.
Purchasing complete nutrition formulas is expensive especially on long term basis and not everyone is able to afford the cost. Many family would struggle to be able to afford such formulas for their loved ones especially in this trying time..
My mother developed dysphagia from her end stage Alzheimer’s. As the result, the amount she consume orally is no longer enough to sustain her life. We are in Thailand and the doctors recommended nasogastric tube. My mother has been fitted with a Ryles tube and is now on tube feeding. Before my mother was discharged, we had a teaching nurse coming over explain about nutrition and feeding. We also have a dietician who taught us how to cook the food for the tube feeding.
In the end, we decided to order the food daily from the hospital since the hospital happened to cook and cater for these food as there is a demand for it. Imagine, we are not even staying in the city area but a small agriculture pekan on the outskirts of Bangkok. The daily food cost 100 baht (less than RM13) and it comes in 4 enteral bags as they eat 4 meals a day. If I don’t opt for enteral bag, there is option for them to come in plastic bags (via bolus feeding style) which cost 60 baht (less than RM8) for 4 bags. The food is prepared fresh daily. Below is one of the bags which I use it to administer to my mother via the connecting tube (the tube cost 12 baht each and for single use only):
To my knowledge, there is no hospital in Malaysia or Singapore that provides such service.
I also discovered that many hospitals in Thailand actually produces videos to teach caregivers how to prepare these food for tube feeding. The videos are in Thai language but ….as expected, learning about food is one of the first things we learn when we stay in a foreign country because we gotta eat. I picked videos which I am able to understand most of their content, and recalling what the dietician and nurse had taught me in the hospital, I have attempted to translate some of these videos to help those who may want to cook the food for tube feeding.
My mother is on the food feeding using the real food. It took time for my mother to adjust the food as her condition was quite critical when she was hospitalized. Also, it would take time for the body to adjust to the new diet. Initially the food took time to digest. But the food really nourishes her and she regained strength. That is why I hope to make these available to help my fellow Malaysians and Singaporean friends who need to care for their loved ones.
The colour of the food depends on the vegetable that is being used. Orange is from carrot, yellow is from pumpkin and green is from green vegetable.
Please visit my Health Blog at the Tube Feeding due to Alzheimer’s/dementia/dysphagia Resource page for full details of preparation and ingredients. You may also check out my YouTube playlist on these topics.
IMPORTANT:
- Please discuss with your doctor or dietician before starting this diet especially if your loved one got condition such as diabetes, high cholesterol, gout, etc.
- Preparation must be done in a hygienic manner. Tools need to be boiled before use. Hands need to be clean and ingredients is washed well. It is better to wear gloves, face mask and wear clean clothes. The nurses had told me that some patients get readmitted to hospital due to digestive issue when the food is not prepared in a hygienic manner or they are fed with food that are prepared for more than 24 hours.
The preparation methods is quite standard but of course each hospital would have slight deviation. You can access to some translated recipes from Saraburi Hospital and Siriraj (main general hospital in Bangkok) to have an idea. I would summarise the gist so that you have an idea:
1. Prepare once a day and divide into 4 portions. One portion for the immediate meal. The next 3 portion needs to be stored in the fridge. Each time you prepare, it needs to be consumed within 24 hours. Unfinished contents must be discarded after 24 hours.
2. Items you would need: a blender, cooking pot, stainless steel fine sieve, spoons, a jug with measuring, funnel (corong turas) and 4 containers to store the portions (I would recommend Pyrex airtight containers, glass bottles or Mason jars).
Image from Siriraj YouTube video which I have translated in this post.
3. All these items, including sponge or brushes that are used for cleaning need to be SEPARATE from the rest of household use. This is because the digestive system of the person on tube feeding is sensitive and slightest contamination may result in food poisoning or diarrhea which may require hospitalization. We definitely cannot use the same blender which is used to blend sambal chilis, serai (lemongrass), spices and meat to blend the tube feeding food.
Also, before you do the cooking, you should boil the steel items in a huge pot of water.
4. General ingredients:
- Pumpkin (can replace with carrot if no pumpkin)
- eggs
- lean chicken meat
- green vegetables
- banana (but only the ‘nam wa’ or pisang awak can be used as other types would cause phlegm. Replace with papaya)
- little bit of sugar and salt
- oil like corn oil (do not use palm oil or animal oil as it may clot up the tube)
4. The food are weighed and then placed in a pot to cook.
5. After cooking, the food is blended till it is fine with a little water. Then sieved using the fine stainless steel sieve. This is to ensure there is no solid that may risk clogging up the tube. Re-blend food that could not be sieved by adding a little water.
6. Pour the contents of the blend in the measuring jug. Then add water to make it to about 1000 ml. Divide into 4 equal portions of 250 ml each and store in 4 separate containers (glass jar, Pyrex container, Mason jar, etc).
7. Food to be stored in the top shelf of the fridge. Do NOT store in the freezer, the fridge door or vegetable compartment (not cold enough and may spoil the food).
8. When reheating for feed, take the feed in the container and soak in hot water (water should be maximum 80 degrees). DO NOT microwave or reheat contents directly in a pan as it would destroy the nutrient constituent. After removing from the fridge, the feed needs to be consumed within 2 hours.
Image from Siriraj YouTube video which I have translated in this post.
9. Reminder again: Each preparation need to be consumed within 24 hours. After that, it needs to be discarded. If not, it may result in diarrhea or health issues for the patient.
Hopefully this helps for those who are looking for more affordable ways to prepare tube feeding food. In Thailand, many households cannot afford milk formulas so they opted to prepare their own food or if the hospital nearest to them supply these food, they would order from the hospital.
Please visit my Health Blog at the Tube Feeding due to Alzheimer’s/dementia/dysphagia Resource page for full details of preparation and ingredients. Below are videos on this topic:
