Category: Food ideas

Another lockdown update

It has been nearly 6 months since the start of lockdown. I thought I would update again as there are a few things that have changed or are going to and reflux has raised its ugly head again.

Exercise

I am trying to get fitter. Grabbing a week in the Lakes in July made a huge difference mentally and physically as we had a change of scene and managed lots of hillwalking so my fitness is not too bad.

I am considering doing sprint interval training (SIT) equating to 7 minutes a day. My rationale being the shorter the time need to bounce my remaining stomach around and still gain benefits from cardio etc, can only be a good thing.

Eating

I am pretty much down to 3 meals a day with a couple of smaller snacks and have halved the portion of Ready Brek for breakfast. My lowest weight post-op was 2 kg below my normal weight and this was OK so I’m happy for my weight to stay 1kg below. I can gain weight now so everything is cool.

Breakfast is 15g of Ready Brek, mainly for the additional vitamins and minerals it offers along with a good handful of berries and a good sprinkle of flaked almonds, pumpkin and sunflower seeds and the off spoonful of yoghurt or kefir.

My supper portion is being reduced with a view to ditching it altogether. Going to bed with an empty stomach did not work well at first but I feel I can do without the extra calories now and maybe my stomach has stretched so it sits lower even when empty.

Sleeping

Since lockdown, my sleep has been really good – napping is rare and the fact there is no urgency to be anywhere in the morning and no commute, means I can sleep in til 8. In fact I have returned to my younger, night owl rhythm of going to bed late and waking around 8 or 8.30. I wonder if anyone is doing any research on circadian rhythms during lockdown…..

Reflux and oesophageal sensitivity

The burning sensation of reflux has increased recently – it does from time to time and I am eating Gavsicon advance like sweets. Since my op, my oesophagus has felt sensitive but given the omeprazole I take, this may be an element of nerve damage/sensitivity triggered by secretions or food rather than it being actual acid.

Troublesome foods

Certain foods and textures definitely cause me problems, ie I can feel them or they make me cough so I try to avoid as much as possible. I loved the story of the Princess and the Pea when I was young and now feel like the oesophageal equivalent as I can detect the smallest amount of chilli, ginger, pepper or similar ‘hot’ spice in any food.

Things like breaded, crunchy and lumpy food can also cause me to cough. Very tough, well done meat or dry meat never held no pleasure in the culinary stakes but now they are impossible to get down. Stringy, tough and very sinewy meat is also one to avoid.

Things that my stomach does not like

Below is a list of things that cause problems due to displaced gastric contents, whether this is in fact acid per se, who knows but it feels unpleasant:-

  • Lying flat – prone or supine either stationary or during exercise
  • Lying on the left side even propped up, although can get away with it if sitting up and leaning on a cushion/pillow
  • Lying on the right side with knees drawn up
  • Sitting with legs drawn up
  • Going out for long walks can sometimes cause problems so I try to remember to take food or gaviscon with me
  • Bending over or squatting down even when I have not recently eaten
  • Types of food listed above
  • Tight clothing around the middle and although I have not succumbed to elasticated waist trousers, I only wear a belt if I really have to.

finishing on the positives

Here is a list of things I can do but couldn’t a few months ago

  • Eat less frequently but with larger portions – NB these are still very much reduced
  • Sleep more on my right side than I could but with a decent sized, solid pillow for support
  • Walk further, BP and resting heart rate are nice and low
  • SIT maybe the best exercise for oesophagectomy patients
  • Dumping syndrome is relatively rare now – maybe once a month or less.

I am planning to get some more bloods done soon to see if everything is tickety-boo and will use thriva.co for this as mithering my GP is also something I want to avoid at the moment.

When to eat and drink

When you can not drink with meals – it is quite a challenge keeping hydrated throughout the day. In the weeks after surgery, I was so focused on eating, I forgot to drink anything in the day. I have still not mastered this but I’m getting there. In fact I probably break all the rules when it comes to eating and drinking at the wrong time but it seems to work OK for now.

Wake up – drink at least 500-800 ml of water
8-9.30 – breakfast
10-11.30 – drink two decent sized cups of tea
11.30 – banana or morning snack
1.30 – lunch (drink water before lunch)
3.30-4.30 – afternoon snack
6.30 – dinner (drink before dinner)
8.30-9.30 – supper (usually small bowl of muesli)
bedtime – at least 500 mls of water

Sometimes I may be out and about and will grab a coffee – can be morning or afternoon.

Surprisingly I rarely get reflux at night through drinking and it doesn’t often disturb my sleep having to go to the loo.

 

 

 

 

Cafe serving small portions

How to enjoy eating out

Eating out will friends and family is one of life’s pleasures. It will never be quite the same after surgery, however it is possible and not just on special occasions.

In fact the good thing about eating out after oesophagectomy is your next meal is never very far away, so you can fit in with other people relatively easily.

The first time I ate in a restaurant after surgery, I felt very self-conscious and got upset.  However it taught me that I must get over myself and not feel like that and accept this is me now and others will have to do the same. This was half the battle and I never looked back. I am now so indoctrinated with my new style of eating, when I look at the amount my friends and family have on their plates, I can no longer imagine myself eating that quantity of food.

These days, restaurant and cafe owners are used to people making all kinds of requests over food choices, allergies and free from requirements so there is no reason for anyone to feel embarrassed or awkward. Besides post-oesophagectomy patients fall under the Disability Discrimination Act so the law is on our side if someone is funny about asking for a small portion or wanting to charge an adult full price for a half portion.  The Oesophageal Patients Association have a downloadable card you can flash at cafe and restaurant staff to say you can only eat small portions.

Here are my top tips for eating out.

1. Avoid sniffy eateries

The worst places to eat are the ones that get sniffy about only having a starter or an adult asking for a child’s portion so maybe avoid if you can. A fellow patient told me that when asked for a child’s portion, it came on a child’s plate, which they found really humiliating. If an eatery does this kind of thing, do not go back. I find these have been chain pub restaurants or places that are not overly clued up on food allergies or offer any gluten/dairy free/vegan options.

2. Quantity

If you can, choose somewhere with a good choice of starters and sides as you can combine both of these. Menus are often available to view online beforehand. If others are having starters, then either order one and eat it with theirs or ask for it to be brought with the mains.  Waiting for the mains is no big deal as we eat more slowly so are likely to finish at the same time as those with normal portions. It is always worth asking whether a starter-sized portion of a main is available. Some Italian restaurants do this. Some places do smaller portions, which is great but to be honest, even a child’s or older person’s portion can be too much.  The perfect places to try are tapas bars as all the portions are small. If the meal is a long affair, enough time may have elapsed for your starter to have shuffled down enough to have room for a coffee/tea or a small amount of dessert.

3. Where and share

Cafes in supermarkets, large garden centres, National Trust properties or places with a communal eating areas like Altrincham Market are great.  The people serving or selling the food do not know the exact number of people in your party or who is eating or what. Ask for a small, clean plate and decant any excess food off your plate to ensure you are not overfaced. Equally, and I do this alot, share a main course. People who have todders do this all the time. Provided you are sharing only food bought at that establishment and not your own, there should be no issue.

As mentioned above, tapas bars are perfect for sharing. The Fumo chain do Italian type tapas called cicchetti where you can get one or two dishes to share and the food is delicious.

4. Ask for a doggy bag

It takes a bit of front to ask but I have done this a few times now and it has worked so well.

Pizza Express are very amenable to doggy bags for mains and desserts as are Toby carveries. I had an ordinary sized carvery for lunch and asked for a take out for later. I’ve not tried asking for a doggy bag in a higher class restaurant but to be honest, their portions tend to be on the smaller side so there is often no need.

5. Make time

When eating out, it is always a good idea to ensure you don’t have to rush off anywhere after eating. This gives you time to enjoy the food and that is has settled safely before you leave and there are no impending signs of dumping.

6. Quality

It goes without saying that you should choose somewhere with a good hygiene rating and decent food on offer. As we have to eat smaller sizes, eat something that tastes good and has been cooked to good standards. As we are more susceptible to stomach upsets, it is not worth taking the risk if something does not taste or look cooked or quite right. If in doubt, it is fine to leave it.

Give quiche a chance

Quiche with olives and cherry tomatoes

In the days after I came home from hospital, the first solid food I tried was quiche.  I could eat a good sized portion as the texture is soft and easy to digest. Quiches contain eggs, cheese and milk combined so are packed full of nutrients and are calorific.

Quiche with asparagus spears

Most supermarkets offer crustless varieties so you won’t get too full up on pastry. Higgidy is a good range as they offer slightly different flavours beyond the usual Quiche Lorraine and Cheese and Onion and they even make frittatas which have no pastry at all.

Quiche with avocado and hummus

In the early weeks I would eat half a small quiche with nothing else but then I started to eat a third or a quarter plus some vegetables or blob of hummus.

I am planning to start to make my own so I can put in extra veg and nutrients.

 

Fortifying food

After surgery, dieticians recommend fortifying food by adding calories to smaller portions.

The main recommendation is to use dairy products as they pack a punch when it comes to energy from fat and protein, as well as vital minerals such as calcium and iron. Some people develop temporary lactose intolerance after oesophagectomy so dairy is out. Instead, coconut or olive oil could be used to add calories but care should be taken as too much fat can cause dumping syndrome.

I was lucky as I could eat dairy with no issues but had to go easy drinking milk to avoid an upset stomach. When I first came home I added grated cheese or butter to pureed veg, mash potato and soups. Cream is also good but I found it frequently caused me problems so even though I love cream – I give it a wide berth even now.

Marvel
Marvel ingredients

Another recommended method which for me resulted in some weight gain (albeit only a pound or two) was the addition of a few spoonfuls of powdered skimmed milk (Marvel) to full fat milk. This can boost the calorific value by another third and it does not change the taste.  I had this on cereal, in tea and sometimes drank it straight in small quantities. Most supermarkets stock Marvel.

You could also mix protein powder as used by body builders into foods. Marvel has vitamins A and D and although some protein powder contain vitamins, often they contain sugar.

Homemade smoothies


Homemade smoothies are an easily way to eat fruit and vegetables that can not be eaten with meals. They can be prepared using a Nutribullet or smoothie maker or even handheld blender. You should however proceed with caution with smoothies as if they are too sweet or taken in too quickly, they may move through your intestines too fast. It is best to not overload your smoothie with fruit, especially the very sweet tropical varieties like bananas and mangoes. Keeping it to the size of a small glass like the one shown (300 ml) is also a decent volume.  So far, I have not had any problems with the following recipe, a handful of one or two types of berries (eg strawberries, raspberries and blueberries), a handful of baby spinach or kale and an avocado blended with some yoghurt/kefir. You can also add a handful of nuts or a spoonful of Marvel to add calories.

Ready Brek

Another great fortified food is Ready Brek. Before this year, I had not given Ready Brek a second thought since primary school. However it has all the goodness of porridge plus all the B vitamins, calcium and iron and is easy to make and more importantly, easy to get down. I had been having Ready Brek most mornings since my op and I do not take any supplements and my bloods are good for iron and B12. I usually stick to the recommended 30g portion. This can be weighed out and then milk added then in the microwave for 1.5 mins. If I am feeling lazy I buy the sachets.

I usually stick to 30g as more than that causes me to have a few dumping symptoms, like palpitations and being over full. Please note Ready Brek is a fine powder so will get broken down and absorbed quicker than rolled oats. However normal oats lack the fortified vitamins so in the short-medium term it is a good staple.

Sugary stuff, Complan and the abhorrent Fortisip drinks

Prior to being ill, I mostly avoided sugar but to bulk up before surgery, I slipped off the sugar wagon and had Complan, home made trifle and chocolate. After surgery, all of these gave me dumping syndrome so I have avoided them since.

I tried one Fortisip drink before surgery and thought it was truely hideous. If you can stomach them (I could not) they are the equivalent to whole meals so can sustain you. However I do not know why they make them so sweet and with so much sugar so they cause fewer issues in patients who have had gastric surgery and have issues with sugar.

I now eat the odd cake but they have to dense and not have fillings (like jam or cream) or toppings (like buttercream or icing). Scones and dense cakes like banana loaf do not seem to affect me aslong as I do not have too much and I eat them slowly.

I usually have a Nine Pumpkin and Sunflower bar in my bag and can eat them with a latte or cup of tea. They contain 220 calories per bar and are full of nuts and seeds as well as being a great source of magnesium. Flapjacks and granola bars are also really nutritious, however I would not recommend you eat these until at least 8 weeks post-op as they are quite lumpy and when you do, you must chew them many times before swallowing.