Help me help my friend eat?

[AgathaMystery]

Wise women of MN - please give me some advice about my friend.

She has metastatic cancer with quite a short prognosis, but her immediate issue is calories. She has lost so, so much weight (didn’t have much to start with) & can now barely tolerate any food.

She has a referral to a nutritionist but god knows how long it will take. No one seems concerned enough to place an NG tube and she doesn’t want this anyway. Her issues are:

1. saliva - it is thick/non existent so swallowing is difficult. She has meds to increase it but as anyone who has taken these meds knows, it’s all horrible.
2. taste - she used to enjoy all foods but especially umami/spicy. This is now impossible.
3. appetite - has none
4. has ensure/build up drinks but is struggling terribly with the fatty, greasy, artificial taste
5. things she absolutely cannot eat/ tolerate due to her cancer:
6. cheese
7. fruit (anything with a pith)
8. most veg
9. bread
10. cakes
11. potatoes
12. pasta

There seems to be no system within NHS to help her. God knows I have tried. Because her prognosis is so bleak no one seems worried about her weight.

Can anyone suggest anything? She’s so sick of ice cream and milk shakes. I have literally, on my knees, begged her to eat.

My dear friend also had short prognosis but she did have a feeding tube. She came round to my house to join us for a celebration. She had always loved her food but was now so diminished with what she could eat. I did several trays of really tiny but tasty things. Like a bit of home made pate on a tiny toast and mini buffet food,etc. Everything was morsel. It was the most that she eaten in months and I delighted with the memory.

I know you mean well but begging your friend to eat doesn't help. She doesn't need reminding of her problems. Your job as a friend is to keep her spirits up. And if she mentions something she likes, get it to her no matter how hard.

Thank you. That’s helpful.

She can manage crackers. I’m not sure about pâtè - I think almost nothing appeals.

Unfortunately we are beyond the keeping up of spirits. Today I sat with her and just held her as she cried.

That must be so hard to see, I’m sorry.
Does she actually want to eat? I’m not sure in those circumstances it’s always the best thing, not eating is part of the process of dying. It is horrendous to witness though. My grandad effectively died from malnutrition from
his cancer as he couldn’t eat and although I remember little of it my dad was pretty traumatised.

I can’t see the point in begging a dying person with no appetite and difficulty swallowing to eat though. Hard as that is to say.

Hi can i start by saying i am not a dietician but i have worked with clients at end of life for eating and drinking difficulties. Forgive me if some of this seems insensitive but diffirent considerations need to be taken at different stages in a person's journey.
You can get artificial saliva spray
https://www.amazon.co.uk/oralieve-Oralieve-Moisturising-Mouth-Spray/dp/B0796YF9QT/ref=asc_df_B0796YF9QT/?tag=googshopuk-21&linkCode=df0&hvadid=696285193871&hvpos=&hvnetw=g&hvrand=7540645653053611191&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9046923&hvtargid=pla-2281435178338&psc=1&mcid=a9a8a650e9c732acbbbe62b522b32f1c&hvocijid=7540645653053611191-B0796YF9QT-&hvexpln=74&gad_source=1
It might be helpful. How is her oral mouth care? Some people prefer low foaming toothpastes at this point, sensodyne is quite low foaming without being specifically low foaming. Mouth care is important for comfort and a dirty mouth can be a potential cause of chest infections.
Check if smell is distressing. Know of some clients that smell would deter them from trying anything. Particularly difficult if you are on a ward and the hospital food trolley is wafting smells about.
Check if psychologically the thought of eating a large amount is off putting ( it can be a small amount by most people's standard but still seem huge to your friend). If so decant things into smaller tubs/plates/tiny spoons. Sounds daft but can help. Has anyone done a malnutrition universal screening tool (must) on her? GP can do it or ward staff (if on ward it absolutely should have been done). If it's been done then the medics/care team can chart changes in her nutritional status.
I don't know your friend's situation but there can be a point when this becomes a medical ethical decision. Is providing alternative means of feeding going to do more harm than good? Many people lose their ability to feel hunger or thirst if they are nearing the end and no amount of encouragement or alternative means of feeding will change that. Metabolically the body can under go changes so even if you were to get all the proper nutrition into someone, their gut simply can't pick up and use the nutrition. Passing an n/g tube can range from unpleasant to extremely distressing depending on the individual and it might not be in your friends best interest at this stage.
I'm sorry both you and your friend are in this situation and being the person at the side desperately try to help can be horribly distressing. If your friend can still take a little sweet food try Cadbury pots of joy, flake etc they are absolutely rammed with calories.

If her mouth is very dry how about these hydration sweets to try to make sure she's at least getting fluids.

www.jellydrops.com/

When my friend was having chemo and my dad was dying of heart disease, both had a really bad taste in their mouths, and dry mouths which made everything unpleasant but both found that very citrusy drinks were the most tolerable. Things like lemon Fanta.if you can find anything that still has sugar in it rather than sweeteners then just that bit of sugar would be helpful to give her a boost of calories and energy.

On the same lines very fruity slightly tart smoothies might work, I'm thinking blackberry, raspberry, lemon juice. You can also add 'hidden' calories into smoothies by using things like avocado macadamia or cashew butter, something mild in flavour but with good fats. You might need to play with proportions and keep it quite thin in consistency using apple juice or something similar.

What about eggs? Again not an overly strong taste but full of good fats and protein and lots of textures to try they can be very soft and light is scrambled with a little milk or cream, or more solid if made into an omelette or baked in a muffin tin.

i sympathise. My partner has an illness where he needs calories but also has no appetite. We did see a nutritionist who recommended bulking out food with high calorie things eg adding extra milk powder if making a sauce. A lot of ideas were cheese based though which I see is a non starter.

Possibilities: thick Greek yoghurt (Tim’s dairy is good) with nutty granola. Individual Pies - small enough to cope with but quite calorie dense. Keema peas (lamb mince curry) with yoghurt stirred in. Rice pudding made with coconut milk with something nice (golden syrup?) stirred in. Soups (eg lentil or squash) with added coconut milk.

Good luck. Don’t put too much pressure on yourself or your friend. accepting things won’t be eaten but it’s worth a try helps.

Thank you all. All super helpful suggestions and not all insensitive. I am going to look into the spray and the other suggestions.

I am honestly not sure if any assessment has been done regarding malnutrition. I feel out of my depth. I’m a midwife and can handle trauma, bleeding, dead babies, dying babies. You name it. But this is my friend and there is this monster eating her alive. It is absolutely horrific.

I will re read these suggestions tomorrow and see what will help. I’m aware she may be very close to the end.

I'm so sorry, my mum is in the same position and it's really hard to get calories into her as she has very little appetite 😢 there are a few things she is able to manage -

Porridge (we add cream and butter to up the calories)
Whipped feta with a drizzle of honey and pitta bread
Boost breeze as an alternative to ensure (is a clear fruit drink rather than milky)
Daal and rice
Small pastries or hot mini sausage rolls
Thinly sliced pear or apple
Rich tea biscuits

Hope this has given you a few ideas to try

Thank you @Noseybookworm & much love to you as you navigate this with your mum x

Thank you and much love to you too x it's so hard but you sound like a wonderful friend

Avocados are high in calories. Or pâté.
Does she have a blender? You could make her some nice soups.
Or what about the coffees that come in cans? They have lots of calories too.

Thank you. Anything that had an artificially sweet taste is a no no for her - likewise anything chocolate tastes of chalk apparently . Also anything too salty is no good. Nuts she cannot eat at all - can’t digest them.

She can tolerate soups. I can definitely bulk them. I will have a mess about tomorrow with some yoghurts too.

What about homemade guacamole with lime juice to go with the crackers? That's full of good fats. Or hummus with extra virgin olive oil?

I was seriously ill with chemo toxicity last year and didn't eat properly for months. What I did manage to eat, though, was farleys rusks (the full sugar ones) with hot milk, chicken noodle soup without the noodles, chocolate horlicks made with milk, cottage pie ready meals (all are NOT equal! I found the Bisto ones palatable) and Pringles crisps with full sugar coca cola. Definitely not a balanced diet, and no good for anyone with a wheat or dairy intolerance.

I think the thing is to forget everything you know about what she should be eating, and concentrate on what she thinks she might like to eat. If that is nutella on ritz biscuits then let her have that. Where there is the option to make a meal more calorific or nutritious and she can tolerate that then do that. Drinks made with full fat milk. Creamy soups, and/or add a little grated cheese to soup. The full sugar option of everything. Butter not low fat spread. If she wants a ready meal at 3am then she should have a ready meal at 3 am. And how about a mousse or fool made with cream instead of a yoghurt? Or some cheesecake? If she is able to tolerate dairy/fat of course. And milkshakes? Either readymade or home made.

For me, it was important to be able to have very small quantities of what I wanted when I wanted it. I was really lucky (and still am) to have a wonderful husband and that my sisters came to help out in relays.