The key to recovery - start small

This month we were joined by Peter Mac Dietitians Rachel and Hannah, who told us that the primary role of a dietician is to prevent malnutrition, and to optimise a patient's nutritional status. They typically see patients throughout their treatment journey, including both prior to treatment and for a period of time after formal treatment ceases. 

As all of us are aware, head and neck cancer treatment may lead to distorted taste (dysgeusia) or a loss of taste (hypogeusia or ageusia), as well as the inability to swallow (dysphagia). Because eating is such an important and socially inclusive part of life, this transition during treatment, and then again back to a patient’s ‘new normal’, can be especially difficult and one in which dieticians play a crucial role. 

Dry mouth (xerostomia) is also something dieticians are involved in managing. Tips include dry mouth sprays or gels, adding extra sauce or gravy during meals, choosing ‘wetter’ dishes such as casseroles and stews, and sips of milky drinks during meals which can be more effective than water. Many people carry water bottles with them, and Xylimelts also are favoured by many of us. It was also noted that alcohol and caffeine can be dehydrating and may make dry mouth feel worse so this is something to watch out for.

For patients struggling to eat, either during or after treatment, Rachel and Hannah suggested that smaller but more frequent meals can help, and nourishing drinks like milkshakes and smoothies can be a useful top up in between meals. Keeping your nutritional intake optimal is important, and sometimes this can be achieved by adding ‘extras’ such as ice cream or cream, or butter or oils, all which can add extra energy when your appetite is low. 

Taste changes present another issue, especially because tastes and flavours can change over time, and different flavour profiles can be affected in different people. Regular experimenting with foods and flavours is recommended, and should a previous favourite food be unpalatable, simply have a break and try again down the track.  Don’t ruin your favourite foods by going too hard!

For those of us that require feeding tubes, dieticians can help manage this transition. In addition to the standard pure diet of commercial formulas, Rachel and Hannah mentioned that blended tube feeding, which is the use of pureed, real food in combination with formula such as Ensure or Resource, is an useful option for those seeking to be more part of family meals.

Transitioning away from tube feeding back to a patient’s regular diet is also extremely challenging, particularly given ongoing swallowing and taste issues post treatment. Dieticians typically advise patients to start very small, even with just 1-2 mouthfuls once or twice a day, and to choose appropriate food such as soups, yoghurt or custards. Variety is key! If a food is unpleasant or difficult to swallow, try again another time. Healing is very dynamic and unpredictable, and taste also evolves as it returns. Try to be patient with yourself. Head and Neck Cancer has some great recipe resources if you are looking for inspiration.

Many of our members discussed their previous and continuing challenges of feeling part of meal times, and also the added burden of trying to ease the discomfort of others as well. Many of us acknowledge that there can be a significant psychological impact of the loss of taste or the ability to swallow, and that sharing our struggles in groups such as this one help enormously and can make us feel less isolated.

Finally, we welcomed a few new members to the group! 

Thank you Rachel and Hannah for your generous time and ongoing support. See you all next month.