A few minor updates... June 26

I feel like nothing has really happened since my last post in January - which is definitely a good thing medically speaking!

You were out of casts and back at school walking three days a week and using your chair two days a week by the end of January. After you learned about patterns, you were continually finding them in our everyday routines and your favorite to say is "chair walker chair walker chair". We are working on next year's pattern becoming "crutches chair crutches chair crutches!"

In February you started playing T-Ball, which you absolutely LOVED! We will definitely be doing that again next year! Unfortunately, your braces did not hold up so well and I had to do several repair jobs on them throughout the season... can't wait to hear what your doctors say about that at the next appointment :)

In March we had some fun at Spring Break with Grandpa and Nanny. Got to go swimming, fishing, took a road trip to see Pops and Gigi. 

You continue to amaze me with how fearless you are. You have started walking up and down the stair by yourself instead of scooting on your bottom one step at a time. You have no issue with wiggling your way up onto or down out of a chair, the couch, beds, etc. It doesn't surprise me anymore to walk in on situations like this:

Your class went on their field trip to the park across the street from the school in April and you thought it was the coolest thing ever to get to play with your friends. They blew bubbles and wrote with sidewalk chalk then had a snack on the play ground. So. much. fun.

School wrapped up more quickly than any of us were ready for and now here we are! It's summer time! You got to spend some time with Nanny last week while Mama was at work and came home with all sorts of new accessories -

Yesterday, we took a trip to Sea World with Daddy's side of the family and you were absolutely fascinated with watching the trainers swim with the animals. You kept asking when it was our turn to swim with them and didn't quite understand what I meant when I said they had been practicing for a long time to learn how to swim with the whales and dolphins. Apparently, you know how to swim and that should be enough! You favorites were definitely the dolphins and sharks.

Today, we went to the dentist and had an appointment with GI doctor. Dentist took some quick x-rays and said everything looks good. He also said that your roots aren't quite as long as they should be, which isn't unusual for kiddos with medical issues since the "stuff" needed for growing teeth before they pop out usually go towards other, more pressing needs in the body. He said not to be surprised if you lose you teeth earlier than your friends and have to wait longer for your adult teeth to come in since they weren't growing under the gum line yet.

GI was thrilled to hear that you have only had two tube feeds since school let out and are eating all. day. long. Unfortunately, your weight is down from our last visit so he wants us to try to find something to boost your calories. If we can't get it on the upward trend again in six weeks when we go for a weight check, we will need to start doing at least one tube meal per day to make sure you're getting those extras in. It is a negligible amount, we only need to increase your intake by 10% of the calories to make a difference; but he doesn't want the downward trend to continue. The tricky part is: you like low calorie foods. You would eat broccoli and carrots all day long, but would need to eat about 1000 times as much as you normally do in order to see the calorie difference! We'll play around with some of the cooking methods and see where we can boost some of the fats in your diet and hopefully that will make a difference because the drink they sent home to sample tastes disgusting!!!

That's all for now - we'll check in at the end of the summer after we see ENT, Ortho, and GI again!

Blended Diet - One Year Later

I’ve been meaning to write this post for a while, and even took pictures last time I did all the prep work, but haven’t sat down to put words on paper (...screen...) until now. There has been a lot of sharing and questions on one of the Facebook groups I am part of about storage methods, delivery methods, volume and calorie amount, etc so I thought I would document our blended diet system.  I will start out by saying that I will be forever thankful for the mom who shared this post about their traveling blend system because it COMPLETELY changed the game for us last summer and I have spent the last few months tweaking their system and making it work for us because it.is.A.MA.ZING!

I will also say, that I know this system won’t work for everyone, every tubie is different and has different needs, but this works for us and has simplified the feeding process for us - and in the world of medical kiddos, any system or process needs to be as simple as possible because no one has time for complicated...oh wait, that’s for parent of any kid 😊

Last intro item, we have been blending for a little over a year now and as your needs have changed, so has our system. I started out using silicone ice cube trays to freeze one ounce portions of each ingredient then would blend up one of each cube for the day. That was a storage nightmare. So I started cooking, portioning and freezing each day’s ingredients in a mason jar and would prep about a week at a time. Then I figured if I could prep for a week, I could prep for a month and have it all done. I bought the wide mouth tallest jars I could find and could fit one day at a time in each jar. I would pull it out of the freezer and put it in the fridge to thaw the night before. We would blend it, pour each portion into our daily jars and heat them up as each meal came. Again, storage.

The next solution was to use thermoses to keep the blend warm all day. So I would heat the tea kettle, pour the water into the thermoses to heat it up while I blended each morning and it would keep the blend piping hot all day long. Awesome. Except when we travelled. And then you started needing less by tube because you were eating more by mouth so we were pouring a portion out each day. Enter the post I linked above...

We used that system while we were gone for a week last summer and it was amazing. Didn’t have to worry about keeping things cold or hot, mix up one meal at a time, wash out the bottle and done! When we got back home, I went back and forth - I knew that we couldn’t afford to continue using the pouches from the store because of the expense but I loved having things ready for an individual meal. PLUS - you was getting more calories in a slightly smaller volume so you were eating even more by mouth because you weren't as full from tube feeds.

So I tried looking into methods to replicate the pouch recipes but could never figure out the best way to do that. Then it clicked one day: use the blend recipe you are already using. Duh. We know you doesn’t have any intolerances to any of the ingredients, it already works into our budget for those items, we can make some little tweaks for calories and done! So that’s how we got where we are now: 

This is part of 90 pouches, which will last anywhere from 30-45 days. Some days you gets three tube feedings, some days just two if you have eaten well orally. Each pouch is mixed with 2-3 ounces of either homemade broth, coconut water or prune juice so each feeding is 303 calories plus the liquid used and about 150-160mL, which is almost twice the calories at half the volume of our old method. Win. Win. WIN.

I pull out one tub each Saturday to go to the kitchen freezer and pull out pouches the night before for the next day.

Recipe:

Coconut milk - 1 cup

Honey - 3 oz

Olive Oil - 4 oz

Chicken - 6 oz

Rice - 126 grams (~1.5 cups)

Bananas - 180 grams

Spinach - 144 grams

Blueberries - 90 grams

Sweet Potatoes - 213 grams

Peanut Butter - 6 TBSP

Yield: 15 pouches at ~300 calories each

Process:

I spend one day cooking everything and dividing it into six portions. Each portion is a triple batch from the daily jar system and makes about 15 pouches - so the first win was taking what would have been three days worth of food and it makes five to seven days worth of pouches. I did not use coconut milk or peanut butter in her blends previously so those were huge calorie and nutrient boosters - yay healthy fats! 

The next day I blend each bowl and fill the pouches. One batch of pouches fits in one of these amazingly perfect sized ice cube trays and four trays fit on the bottom shelf of our freezer. I have had some issues with the blender not quite getting everything blended perfectly, but since I am 100% convinced it is user error and I’m overfilling the jar I am going to do a double batch instead of triple next time I make pouches. 

This method works super amazingly well for several reasons:

1. Already mentioned the higher calories in smaller volume aspect of things. We saw a huge increase in your oral intake when we started this method.
2. If you're not hungry, we don’t mix a pouch. It’s that simple. Way less waste!
3. We can vary the liquid in the blend based on what you needs. Beginning of the fall / winter sick season you are getting lots of bone broth. Random episodes of constipation, we run prune juice one mix a day for a few days to help you out. Otherwise, coconut water for the extra vitamins and minerals. 
4. I spend 2 days prepping and you're ready for up to a month and a half - and that two days is being shortened as I get more used to the amazing-ness that is the InstantPot... 12 cups of rice in 15 minutes? Yes please!
5. It is super simple for ANYONE to feed you now! For school I send a jar with the pre-measured liquid, one pouch, shaker bottle and scraper - teacher or nurse dumps it all, shakes it all up and it’s done. No measuring, no issues.

A couple downfalls:

1. I still have to worry about keeping them frozen when we travel. This is much easier to do now than with the jars, and if we are gone for more than two days I go back to the store pouch system but I always see a drop in your oral intake because of the higher volume.
2. The pouches themselves are an expense. It balanced out for us since I was able to make the food stretch a little further, but that is something to consider. We tried refillable ones but they weren’t as quick and simple as these disposable ones.
3. It’s messy. The video on the site where I ordered the pouch filler makes it look so simple and easy, and it is, but when you’re making 90 of them your kitchen won’t be as spotless as the commercial...of course, any batch cooking or blending system will do the same.

So that’s where we’re at now; as your needs change this might too, but this is a flexible and adaptable enough system that I see us sticking with this base for a while. You have gained almost three pounds since last June which is the most gain you’ve had in...ever... We will continue to encourage oral intake and drop feedings as needed but for now we are in a good holding pattern and I’m loving it!