Feeding Tubes

Many medical conditions, diseases, disorders, and people of all ages require the use of feeding tubes.Tubes are used as nutritional support for patients who would other wise be unable to attain proper nutrition by mouth. Some people use tubes as assistance while also taking food by mouth, others are fed solely by their tubes. A doctor does not make the decision to place a feeding tube lightly. Normally proceeding placement the patient will experience excessive weight loss, the continued loss of vital nutrition in blood tests, and a severe decrease in life quality. Many tests that asses digestive organ function also prove helpful for doctors when contemplating the placement of a tube. 
There are many types of tubes which are categorized by where they enter the body; there are also different brands and styles of tubes. Tubes can be thick with a long hose, or small and desecrate looking very similar to the air valve of an inflatable beach-ball. The type and style of tube a patient received depends on the problem they are encountering, the treatment they are receiving, or the organ that is malfunctioning.

  • Nasogastric tube (NG-tube) An NG-tube is a small thin tube inserted through a persons nose, throat and down into the stomach. The tube is usually attached with tape to the side of the face to hold it in place. NG-tube feeding is usually only a temporary solution. 
  • Nasojejunal tube (NJ-tube) This is similar to the NG-tube except it passes through the stomach into one of the upper parts of the intestine called the jejunum.
  • Gastrostomy Feeding (G-tube or peg tube) G-Tubes are surgically inserted with an endoscope. These are a more permanent option for patients who will require longer term tube feeding. The G -Tube is placed directly into the stomach.
  • Gastrostomy-Jejunostomy or GJ-tube (Transgastric-Jejunal or TJ tube): The GJ-Tube is surgically inserted into the stomach but has an attachment that bypasses the stomach down into the jejunum.
  • Jejunostomy or J-tube: A surgical incision is made in the abdomen wall, however the stomach is bypassed completely and it go directly into the jejunum. 
  • Total Parenteral Nutrition (TPN) is the practice of feeding a person intravenously, normally through a central line. It passes digestive organs completely sending vital nutrients directly into ones blood stream. (Information sited by:http://www.livingwithreflux.org/enteral-feeding-tubes/)

Many patients with feeding tubes have no visible illness. Many conditions that require a tube are due to a malfunctioning organ, or the complete failure of ones digestive system. While many of us profess our deep love for these tubes, it is not an ideal situation. While yes they give is life and important sustaining nutrition, we do not love the way of life which has been thrust upon us. I don't know one person with a feeding tube who is extremely grateful they have one, but I also don't know one person who wishes they didn't need it. It is a hard life adjusting to low, or no, oral consumption. Watching everyone around you enjoy a meal, or even just snacking on the couch can be difficult. Eating is a basic and essential function to human life. Living without something that is within ones nature takes a heavy toll on the individual. Many of us will tell others "I don't even think of food any more!" But it's not true. We all still wish to bite into a juicy cheese burger, or take a big scoop of our favorite ice cream, we just do not want the associated symptoms that come along with oral consumption. Food is not the enemy of a tubie, it's our failing bodies. 
Many of us have odd habits to kick the drive for oral consumption such as gum, flavored drinks, lozenges, hard candies, or even chewing up food and spitting it out! Some tubies are so sensitive to oral consumption however, they are unable to consume anything, including water, by mouth. 

There are many different options for feeding through a tube
. A patient can be bolus fed, which is where a designated amount of formula or blenderized food is pushed through a syringe a few times a day. Or a patient can be on continuous feeds where they must be hooked up to a small pump which regulated formula into their body consistently. The feeding preference can be up to your prescribing doctor or Dietitian, it all depends on reason for insertion of the tube; excessive weight loss, inability to digest food, GERD, or a disorder of particular organs. 
Continuos feeds are normally associated with patients who have trouble absorbing nutrients, and who are unable to tolerate large volumes of formula at a time. Continuous can mean: 24/7 feeding, only at night feeding, or feeding for a certain amount of hours during the day. (Just cause I'm sure your all curios, night feeding is not weird at all. You just put your pump next to your bed and let it run. You don't feel the formula going in. Patients with aspiration issues do not normal feed at night however due to the possibility of drowning themselves.) The rate of feeding and time frame are determined by your dietition depending on your caloric needs. Bolus feeds are normally associated with patients who use tubes on a more intermittent basis than their sole nutrient factor, and who's bodies can tolerated larger volumes of fluid at one time. Many people with feeding tubes are sustained by doctor prescribed formula. Formula is normally shipped to ones home every month from a local health care facility along with their feeding supplies, such as extension set, feeding bags, flush bags, syringes, drainage gauze, and other tubie essentials. This formula contains all the proper nutrients a person would receive from eating orally. However, many formulas are full of corn syrup. Some patients due to this ingredient choose to go the "blenderized diet" rout which consists of real food puréed in a heavy duty blender.

A few random facts about feeding tubes: 

  1. Much work must be done as upkeep for these small devices to work properly. Feeding tube care is essential to a healthy patient. They must be flushed, cleaned, and cared for multiple times a day. The stoma, which is the medical hole the tube is inserted through, in itself demands proper care as it can easily become infected.
  2. Though feeding through a tube itself is not painful, having a tube can be. The stoma becomes aggravated often as the body is unused to a foreign object protruding through it. Granulated tissue forms around the tube causing intense pain upon movement or use of the abdominal muscles. This GT is difficult to get rid of and is something tubies must deal with for the duration of their tube feeding expectancy.
  3. Tubies can do just about anything a person without a tube can do; they in no way hinder our ability to take part in everyday life. We even have the ability to participate most sports and activities freely.
  4. Swimming and bathing is something many people believe tubies cannot take part in... But we can! We do have to be careful of the venue since out stoma is easily infected, plus it's basically just an open whole to our body cavity. No public pools, lakes, or hot tubs as they can harbor bacteria. Some doctors do advise patients with suppressed immune systems to abstain from any water besides the shower, however; most tubies can swim in private pools, oceans, and private jacoozies tubs. 
  5. Venting: The act of releasing air or content from your stomach. Believe it or not some tubies need to be burped! Syringes so often trap air in your stomach; it can be quit uncomfortable! Pushing the air out of the stomach is a pleasent experience for tubies!  
  6. Tube feeding is formally known as Enteral Nutrition.

My personal Tubie experience:
My tube was placed in 2014 due to esophageal paralysis, Gastroperisis, and malabsorption. My doctor first used a trial NG tube to decide if my stomach could still handle any sort of substance. Once we decided it could, we placed the permanent G tube. My dietitian and physician decided I should be on continuos feeds, the reasoning being I could obtain more calories, and I needed a slow infusion as bolus feeds would induce vomiting/reflux. The formula prescribed by my dietitian contained predigested enzymes making it easy for my broken gut to handle. I had a PEG tube placed, which is a long hose like tube inserted into my stomach through endoscopic surgery. After 6 months we placed a more low profile tube, called a Button G-Tube, which was inserted without anesthesia into my already formed stoma. For me transitioning to no oral consumption was not difficult as food caused me great pain and suffering; due to my paralyzed esophagus food would get stuck, and due to my gastroperisis I would have horrible stomach pain if anything made it that far. Vomiting was an hourly occurrence. On the tube I was never hungry, but I was never full. With the constant infusion of formula I feel content... I guess that's the best word. I still feel the urge to eat because it's in my basic human nature, however I don't feel "hungry" anymore. In my case I was unable to take any oral consumption for the first few months of my tube placement. As time passed the swelling in my esophagus went gone as my GERD was no longer constantly eroding my esophageal wall. I was slowly able to consume liquids by mouth again, but occasionally they don't like to stay down either way. 

Many people ask how I coped with this situation, and to be honest, since I din't have another option, I just did. I saw no reason to resent the apparatus that kept me alive. On days when I feel lost and depressed about what has become of my life; being kept alive through tubes, ports, and drugs, I must remember that those things actually gave me my life back. The girl pre feeding tube was not living, she was surviving starvation. For months she didn't sleep, she didn't leave her house, she didn't enjoy her life, she didn't like what she saw in the mirror. Now when I look in the mirror I see a strong women who is empowered by her disabilities, and proud of the apparatuses that keep her alive. 

January 2017 - After my Stem Cell Transplant the peristalsis that was formally paralyzed/slow throughout my digestive tract began to move again! How odd it is to again feel the sensation of food moving in harmony with my organs! I am currently not using my feeding tube, and am able to digest, and absorb my nutrients - requiring only a slightly specialized diet and daily pro-kinetic medications!