Cancer weight loss program - don't enroll (ever!)

This week the Oncologist referred Robin to a Nutrition doctor. The Oncologist was raising a "red flag" about Robin's weight. On August 15th before the first chemo she weighed 129lbs. On September 4th before the second chemo she weighed 124lbs. This week before the third chemo she weighed 119lbs. To the clinical staff this is a disaster in the making. Robin had assumed that since she gained about ten pounds in the last year then it would be no big deal if she drops back ten pounds to her normal weight'. I had even assumed that if she got a little low then she could always beef up a little bit on French fries and milkshakes. In fact, the clinical folks have said that all the things we had considered diets "no-no's" in the past should now be part of her daily diet - preferably lots of high protein and high fat foods! They suggest using butter generously, use milk in place of water in soups and hot cereals, eat lots of cheese, drink beverages that contain calories such as fruit juice, make sure to eat dessert! This advice sounds crazy in our diet conscious society!

Here is how the Nutrition doctor (an internal medicine specialist) summed up the current issues:

1) Any downward trend during treatment is unhealthy. If Robin were to get too weak then they might have to suspend chemo and/or radiation treatments briefly, thus delaying her progress in fighting the cancer.

2) At this stage her body is experiencing "inflammation" and when she loses weight her body is drawing it from her muscles - not from her fat stores. The loss of muscle mass can become critical in some patients because the heart is all muscle! (people who have eating disorders such as bulimia often die of heart attacks because their heart loses too much mass). To compound things, if Robin eats extra to make up for the lost weight her body will be very efficient at converting the food and storing it as fat. So any muscle mass she loses now may be "permanently" lost muscle until after the treatments are over and she can get back to a normal routine of eating and exercise.

3) To top it all off - Robin is at the very beginning of the radiation phase and this is the phase in which weight is a critical issue because eating becomes so difficult. During chemo her ability to orally consume foods comes and goes. During radiation it's quite possible that she will reach a point at which she cannot consume any foods orally due to pain from mouth sores and raw, irritated tissue in her mouth and throat.

4) The first few weeks of radiation are the most dangerous. During this period patients are most likely to start eating less orally and not making up for it by getting nutrition through their feeding tube. In a matter of a few weeks patients can lose quite a bit of weight before they get control over their diet. In some cases patients are admitted to the hospital and they are given IV nutritional fluids which contain everything you need to keep on weight.

In Robin's case we've created a weight gain plan! Her minimum food intake is 1,800 calories a day which she can get through six cans of Nutren Probalance (it's like ensure). Each morning we draw six squares on a piece of paper to represent the six cans worth of calories which she's required to consume. As she eats things for breakfast, snacks and lunch she writes items in a square. When the items total 300 calories she crosses off that square and starts writing in the next square. By the evening she has to make up any open squares by pouring cans of Nutren in thru her feeding tube!