Nasogastric Intubation

How would you like to be able to work or play all your waking hours? No stopping for breakfast, coffee, lunch or dinner. When you go to bed you plug into a machine and it feeds you while you sleep. How cool is that? Well I accidentally tried it. I will explain.

In October 2023 (4 months ago) I had to have a tooth removed. Normally not a drama. This time the tooth, one of the upper back ones, revealed an 8mm hole into my sinus cavity. Three months later, after several attempts of “let’s see if it fixes itself” and small stitchy things I still had the hole although it was a lot smaller.

At first the hole was a bit annoying and produced several strange effects. I could no longer suck up liquid from a glass or water bottle. When I tried, air just came into my mouth through my nose but no drink. Mouth washing was also a little strange with more coming out of my nose than my mouth. Anyhow eventually I became used to the hole and was even able to play tunes with it. I was sort of fascinated to know if I could swim with it but a shoulder problem meant I never had the chance to try.

I didn’t think it was a big deal medically but my dentist was very concerned about the risk of food going into my sinus and possible infections. He sent me to a specialist.

No problem said the specialist, not a big job (under general anesthetic in an operating theatreā€¦.), we just move some bits around and block up the hole then it’s a week or so of Nasogastric intubation – simple.

A week of what? Quite simply they put a pipe up my nose, down my throat and into my stomach then we just pump the food in. No eating by mouth allowed because that would upset the stitches.

DISCLAIMER: I hope I am just on a 12 day visit to this world so my thoughts and experiments reflect this. I have much sympathy for people who have to suffer this for an extended period of time.

So that’s what they did about a week ago. I came home the day after the operation just as the medical equipment lady was delivering the pumping system and my food for the next 12 days.

Over the next few days my body recovered from the anesthetic and we tried to build up some sort of routine. Basically each day I needed to ingest though my tube 1 litre of high energy food, 250ml of vitamin mixture and 1.5 litre of water.

We had several different strengths of liquid food to work through: 1,000kcal per litre, 1,500kcals and 2,000kcals. A little medical pumping system, with programmable feed rate (so lots to explore there), lots of tubes, plus a selection of big syringes for “manual feeding”. A nurse came in twice a day to hook me up, disconnect me and generally make sure I was behaving.

After a few days we gave up on the overnight “feed as you sleep” thing. That was a shame. For a few nights I was actually OK sleeping while piped up. The problem was I had to be sitting up in bed which was fine the first few nights, but eventually my back was complaining and I was getting less and less sleep.

One question was how fast can I feed. For the first two days I just had 500ml to feed, while I became used to it, so our first tests were at a relaxing 40ml/hr (25 hours for one litre). Each day we moved the rate up a little and soon moved to the 1L containers. It was all very much “see how you feel”. After a few days we settled on 130ml/hr (7.1 hours per litre). I’m sure we were being quite conservative, but I really didn’t want an upset stomach. We are keeping a close eye on my weight and varying the calorific intake so it doesn’t go up too much.

Each day we start the feeding at 4pm then I watch TV and work on the PC (like now) till the pump finishes. The first few nights that was about 4am. Quite quickly we upped the rate so it was finishing about midnight. Much more civilised. After feeding I had a proper night’s sleep.

I never feel hungry but most of the time I do feel full of liquid (which I am) and a bit sickly. I really don’t like to move around too much during the day so I’m not very productive at the moment. Certainly no training.

Multiple times during the day we use the syringe to manually feed in the vitamins mixture and 1L of water. They did say if the tube gets blocked we should try squirt Coca Cola into it. Says a lot for what Coca Cola does for your stomach. Must give it a try though. I did ask if we could squirt in coffee etc but they were not very keen.

The syringe “manual feed” is in itself quite interesting. The very first time we tried it, with the nurse driving, didn’t really work for me, seems I really had to do it myself to get the flow right. It’s a large 60ml syringe and I soon found out that if I “fed” slowly 5ml at a time it just went in as expected. When I tried faster than this it felt like the water was filling into my Esophagus so I had to swallow. If I really went fast I could fill my Esophagus to the point that I could gargle with my vocal cords. Several times this proved to be a useful trick when my throat was really dry. With experience I can now load up the 60ml in less than 30 seconds. That equates to a rate of 7.5L per hour. Certainly not a rate I would be comfortable pumping.

The most unfortunate effect is that I can’t really talk. Well I can actually talk but the pressure movements in my nose seem to make the tube hit a really sensitive area so it’s really uncomfortable. Remember what it felt like at your last PCR test – that sort of thing. I did find that by experimenting with the pipe and tilting my head I could sometimes speak properly but it wasn’t very consistent. Also it seems the pipe goes down through my vocal cords so after a while they become unhappy with the intruder. So all in all best not to speak.

Several days later: Only two more days to go now. I am definitely getting used to it. I feel much better during the day and am almost productive – although I am limiting myself to working without power tools. I feel somewhat tired during the day and we are limiting the calorie intake so that I don’t put on weight. When I’m feeding in the evening working on the PC the dangling pipe keeps making me think I am wearing headphones. No feeding discomfort at all. Over the last few days I think my nose has blocked itself up so much that the pipe doesn’t seem to be moving around as much so it’s much more comfortable. Seem to have a sore throat this morning though which is being annoyed by the pipe.

Last day: Not a very good night as the stuff in my throat kept waking me up. Just went out for a walk. I feel remarkably unsteady considering I would usually be trail running this time of year. Hopefully it’s all to do with my sitting around all day for the last 10 days. Fingers crossed everything will be OK tomorrow and the pipe comes out.

Well that was easier than expected. The surgeon was happy with my progress and said the feeding pipe could come out. Lots of rules about what and how I can eat for the next 2 weeks but so far so good. Unfortunately it’s going to be a while before I see Fish and Chips again.

Next it was into the “pipe removal” department. This is the moment I was a little wary about. Turned out to be no problem at all. Once she had removed the stitches inside my nose she gently pulled the pipe – and kept on pulling. Honestly it must have been 1 metre long – it was like watching a magic trick as the pipe just seemed to keep on coming out. No pain, not even very uncomfortable. Fascinating.

Leaving the hospital it felt like a weight had been lifted off my back. It was a whole new world. I seem to have spent so long (12 days) living the ups and downs of my rather uncomfortable pipe – I was elated when it was gone. It was almost a similar buzz to finishing a long distance race. These races can take many, many hours of real stress and discomfort and all the time I know it is going to end soon. Then suddenly it does stop when I cross the Finish Line – a whole new world.

Well that was quite an experience. Cool it certainly was not. Having white tape on your face and a pipe disappearing up your nose could never be mistaken for a good look. Although it is not unlike the nose pipe of the Stillsuit in the movie “Dune”. As a lifestyle it left a lot to be desired. But already I look back on my 2 weeks of discomfort and sort of miss it. Just pumping the food in gave me so much time for doing stuff. Unfortunately I didn’t actually feel like being productive so, apart from a few project designs, I spent most of my time reading “How to Build a Car” by the brilliant Formula 1 designer Adrian Newey and watching TV.

The first thing I did when I returned home without the pipe was to drink a glass of water. Well almost. Drinking normally no longer seems to work. Either I have forgotten how to swallow or I need to spend some understanding how my new mouthscape works after the operation. Onward and Upward.

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