My mother had a whipple operation two weeks ago; this follows a partial kidney removal  three months ago. She now has only 1/2 a kidney, the other was removed years ago.  Further, she is facing a lobectomy of her right lung in approximately four months.  Each and future surgeries are a result of renal cancer.  Given the above, what kind  of diet does she require, any examples of menus?  Thank you all for any input.

I assume from your letter that the original renal (kidney) cancer has spread, causing the further surgeries.  I'm very sorry she is going through this.

For those of you who haven't heard of the Whipple operation, this was mentioned in a forum letter on pancreatitis:  Whipple Procedure.

First (and I emphasize this mostly because most older patients with multiple problems are members of HMO's or on Medicaid) older patients and those with multiple problems, especially ones which may eventually be terminal, have just as much right to all possible attention and comfort as younger patients with better outlooks.  This includes consultations with a registered dietitian.  Too often I see HMO's sort of "shuffle off" patients who either are elderly and going downhill, or those who are their own worst enemies (smoke, won't follow dietary instructions or take their meds).  The last I can see to a degree; if you won't help yourself, why should others put themselves out overmuch.  But all patients should be given the best advice, pain relief and counseling available.

There are three primary needs here:

1.  A diet which will not make her problems worse.  This includes one appropriate for someone with impaired kidney function, plus one which will accommodate her insulin impairment because of the Whipple Procedure.

2.  A diet which will help her heal and regain strength from the surgeries, without interfering with medications she is taking, and,

3.  A diet which she will enjoy as much as possible in the months or years she has left.

To balance these needs, I wouldn't even take a stab at it.  I am not a dietitian and cannot possibly recommend an eating plan.  It's vital that appropriate menus be planned with the dietitian utilized by the hospital, HMO or clinic, and the sooner the better.   Stand your ground and insist on her behalf, if you meet resistance. Try to include foods she enjoys.  Your mother undoubtedly has so much on her mind already she shouldn't be the one to have to take it all in.  So be prepared to take notes and ask questions.  Good luck, and let us know how it works out.

Hi.   My husband has elevated blood sugar and the nurse gave me an 1800-calorie meal plan brochure for him to follow - hope he does this but I don't know how he will accept this. Anyway, I need to know the sugar content of fruits and vegetables and have been unable to find any information regarding this. Can you email me with some website or some place I can contact.  Thank you. 

Your info wasn't specific enough to tell me the whole story.  I'm going to take a guess that your hubby was not diagnosed with full blown diabetes, just with elevated blood sugar.  My husband had a very slightly elevated blood sugar twice, but no symptoms of diabetes, and the second time the Dr. said "I bet you had a Coke just before you came in."   "Never drink the stuff," my husband replied, and as the Dr. frowned again over the readings, hubby added, "Just a huge glass of orange juice."  The Dr. told him that would do it too.  Since then Floyd has lost some more weight and cut back on his orange juice drinking, and his blood sugar has leveled out.

The point is that consistently elevated blood sugar readings are an indication of future diabetes.  In fact, in itself, elevated blood sugar isn't very healthy.   Most pre-diabetics are overweight.  If that is your husband's case, the 1800 calorie diet is designed for him to lose weight.  That will help him lower his blood sugar and either delay or prevent the onset of full-blown diabetes.  There's lots of advice throughout this site on how to sneak people into eating better, including weight loss.   I'm going to point you to some resources, but first, here's some handy hints:

• Try to fix lower calorie versions of foods that he likes to eat, but try not to fall into the trap of nutritionless snacks like olestra-fat chips, or fat free snacks (often having as many calories as fatty ones) or excessive amounts of artificially sweetened non-nutritive foods.  If you attempt to change him to completely different foods, it'll be tougher to get him to comply.
  
  

• Serve meals in smaller portions on smaller plates.  Buy new dishes if you don't have any medium size plates.
  
  

• Serve meals that are attractive.  Garnish with edible decorations like carrot curls, parsley, slivers of red or green bell pepper, chopped herbs, or anything else you can think of that would be eaten.
  
  

• Eat less more often.
  
  

• Eat heavier meals early, very light ones late in the day.
  
  

• Go heavy on salads and veggies (we don't count potatoes, corn and other starchy foods as veggies, even if they are).  Go easier on the fruits which are higher in sugar and calories.
  
  

• Try to include more beans, lentils, peas and whole grains in his diet, and less meat.  
  
  

• Serve fish in some form several times a week.  Season it well, even dip in egg white and a little flour or crumbs, and cook in a grill or on a non-stick skillet until toasty.  Make pita or other sandwiches with drained tuna, the kind packed in water, with added non-fat or low fat mayonnaise or Miracle whip, finely chopped onion, celery, even cucumber, radishes and/or carrot, with lettuce and tomato slices.  Salmon croquettes made with egg whites is another great choice.
  
  

• Hit the seasonings.  Hopefully he likes foods well-seasoned, and if so, you are in luck, because herbs and spices can make veggies taste heavenly.
  
  

• Use one egg white for each yolk you remove in recipes calling for eggs.  An omelet with half or more of the yolks removed, well seasoned, cooked in a non-stick pan with a few drops of olive oil and a coating of cooking spray, and filled with herbs, tomatoes or greens, with or without fat free cheese, is an excellent meal.
  
  

• Exercise!  This will also help take off weight and improve cholesterol and blood sugar readings.
  

There's another thing you can do if he is very close to the line or actually diabetic.  In addition to exercise, one of the most important things a diabetic can do is combine easy-to-digest foods that raise blood sugar rapidly with hard to digest items, like whole grains, beans, and fibrous vegetables.  This slows down the release of sugar into the bloodstream, giving the body (or the insulin injection) a chance to dispose of the sugar.  This is why my husband had a slightly elevated blood sugar; he hadn't eaten, and was depending on orange juice for a lift, and sugar in fruit juices is rapidly absorbed into the bloodstream.

This combining of food types is true whether or not a person is insulin-dependent.  But the most important thing of all is to keep off the weight!   Diabetes is rampant in the USA, like nowhere else on earth, mostly because of the easily-available, rich, over-refined diet, high sugar content of much of our food, the increasing overweight population and sedentary lifestyles.   Add stress, pollution, etc. and it's no wonder diabetes has become a major health problem and a big burden to our health care system. 

To count the calories:  

• The USDA has a searchable database that will provide you with the nutritional value of nearly every food you could think of. Just enter a food, select from the form of that food from a wide menu, indicate the amount you wish to have analyzed, and you'll get more data than you know what to do.

My wife had a whipple (pancreaticoduodenectomy) on April 19th, '02 . That's around 5-6 weeks ago she now has a very hard time to keep down any kind of food.  We re-admitted her as she had lost too much too fast.  Now on IV for 6 days she eats very little; small amounts of jello, fruit, yogurt, etc.  If she lies still it's not too bad, if she moves much at all she gets nauseated and vomits.  Any information that could possibly help us through this would be very greatly appreciated.  Thank you

My sister had a similar problem after a case of pancreatitis after the Dr. failed to diagnose a bad gall bladder.  Eventually she got so she could eat, but still has pain after several years.

I really don't have many suggestions.  I only know of three things that help SOME people under some circumstances with nausea:  ginger and/or ginger ale (preferably ice cold), some prescription drugs, and marijuana, which is not an option in many countries including the US of A, due to the government's preference to collect tax on legal addictive substances and fears of other uses and its consequences (auto and workplace, etc.), and inattention to or non-acceptance of it's medical usage.   She may have to periodically have an IV for a while.  If you doubt your doctor's attention in the matter, don't hesitate to ask for a consultation, and if it doesn't clear in a few more weeks, I'd demand one.  And if she gets where she can hold anything down, maybe a hospital dietitian could help from then on.

Here's some resources:  since usually this is done because of cancer, your wife's case may or may not fall into that category.  Note some references about having to take pancreatic enzymes and about nutritive support by tube directly into the small intestine.  If you wife is also undergoing chemotherapy and/or radiation, this might be the best choice for the present.

John Hopkins on Pancreatic Cancer

Medhelp

karger.com  (Note: this technical explanation simply means that sometimes the food is not being passed out of the stomach, which indeed would lead to vomiting.   I believe there are drugs which may assist with this problem.)

Excite (this one may be most useful to you.)

I'm sorry, but I really don't have any other suggestions.

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