My life on TPN

Well, I don't have any update about my surgery at this time so I thought I would post a bit about how I get my nutrition.  Right now, I have a partial bowel obstruction which prevents me from taking in a large amount of food/drink orally which means I need to find another way to get calories, vitamins, and other nutrition.  The solution for me is called Total Paranetral Nutrition (TPN).

We start with an approximately 2.4 liter bag of TPN that contains glucose, lipids, and minerals.  We mix two vials of additional vitamins and then put in a few milliliters of vitamin C.

We connect this to a small portable IV pump.  This pump runs on two C batteries which we swap out once a day when they have expended about 75% of their power.  The pump is pre-programmed with the rate for my nutrition and empties about 95% of the bag (they put in a small amount of reserve).

Every night, we swap the old bag for a new one and Stephanie has gotten quite good at it.  My Peripherally Inserted Central Catheter (PICC) line has two separate connections so that I can receive multiple things at once.  I only use the one connection and, every night, Stephanie flushes one of the ports with 10ml of saline and 5ml of a heparin flush (reduces clotting).   The PICC line goes up a vein on my arm and finishes in the middle of my chest, right at the superior Vena Cava, just a few inches from my heart.

The second line is where I get the TPN.  Stephanie flushes this as well with 10ml of saline every night and then hooks up the TPN line.  Once we are all done, we put the bag and pump in a slightly modified camelbak lobo and I get to wear this 24/7.  The TPN line is about 4.5 feet so I usually can lay it next to me when I am sitting or, especially, when I sleep at night.  It certainly has reduced the amount of tossing and turning I do when I sleep.

I always change my shirt when I get my TPN swapped out and I take a shower as well.  They don't want you to ever turn off the TPN but, while I am getting swapped, 10 minutes for a shower and cleaning up can't hurt.   I do have to wrap the PICC line in a plastic bag to keep it dry because we need to be exceptionally cautious about getting an infection in the line.  Since I start the TPN in the evening, the bag is quite a bit more empty (and considerably lighter) by the time I get up in the morning and need to lug it around.

TPN gives me about 2400 calories per day which is just enough for a 6'3" adult male weighing 200lbs to maintain his weight.  I usually supplement this with Gatorade and various nutritional supplements throughout the day.  I have been sticking with only clear liquids since my obstruction seems to be getting a bit worse, seeming to back up more easily, even when I do non clear liquids like Ensure.  With the supplemental nutrition I am usually able to add another 400 calories per day and this seems to have reversed my weight loss.

Last full meal?  That was April 1, 2012.  We went to Red Robin with my niece and her boyfriend after a soccer game up in Denver.  I wanted to order the Bleu Ribbon Burger but someone else ordered it before me (I have an aversion to ordering the same thing someone else ordered.  Yes, I know that is weird) so I ordered the Prime Chophouse burger.  I remember eating all of it and some of the fries but that was the last full meal that I have eaten.  Had I known, I would have dealt with my problem and ordered the Bleu Ribbon burger...

The doctors have some calls in to find out if my surgery date is still on but I don't know when they will get back to me.  They do their long surgeries on Wednesday and Thursday so I don't expect an answer until Friday.  I do have my octreoscan scheduled for next Wednesday in preparation for the neoprobe guided surgery the on the 30th.  We just need the go ahead.