Fred is 89-year-old retired gentleman with grown up sons, currently living independently in his own home in London. In May 2016, he had a PEG feeding tube placed due to dysphagia, primary cause unknown. He remains nil by mouth with an undefined diagnosis for the cause of his dysphagia to the current day.
Fred was a very active man at the time of his PEG placement. He was an avid mountain walker, as well as a keen gardener and enjoyed socialising in the pub.
When his feeding tube was placed, Fred weighed 50.3 kg. With a height of 1.72 m, he had a body mass index of 17 kg/m2.
His dietitian set the following nutritional goals for Fred:
As Fred was a very active patient, aim to achieve a feeding regimen to suit his lifestyle and retain his quality of life
Increase his body weight
Ensure good feed tolerance
To help Fred keep active and limit his time on a feeding pump during the day, his dietitian started Fred on a 1.5 kcal/ml fibre feed overnight, with one 125 ml bolus top up using a syringe during the day. This suited him for a short time, but then Fred started complaining of not tolerating the overnight feed well. He reported symptoms such as nausea and occasional vomiting. This led to Fred experiencing a low mood and affected his quality of life.
Over the next few years, Fred’s overnight feed type was changed several times, but he kept eventually reporting symptoms of gastrointestinal intolerance, which may have been linked to having a feed overnight due to his positioning in bed.
In January 2020 Fred’s feeding regimen was changed to stop overnight feeding all together, and to instead meet his nutritional requirements through bolus feeds during the day. He started off on 5 feeds a day which was soon changed to 4 x TwoCal Bolus daily.
Fred remains settled on this regimen and no longer experiences symptoms of gastrointestinal intolerance.
His dietitian reports ‘By getting his calories in a small volume via bolusing with TwoCal Bolus 200 ml 4 times a day, which he tolerates well, his weight is now slowly increasing and he is able to maintain his quality of life’.
She adds ‘Fred is very happy. He feels he is able to do the things he loves – walking, gardening and the occasional trip to the local pub to socialise. He feels stronger since he was changed to bolus feeding with TwoCal Bolus 200 ml, 4 times daily’.
Athanasia Papalamprou, Community dietitian, London
