Saturday, 20 July 2013

Another PEG Pouch, Please

As was mentioned in the last episode, Smiley Faces, there’s a new Royal at the Castle.  There have been a few new admissions in the past two months, four others to be exact.  The Castle has two wings with ten ensuite bedrooms in each making a total of twenty accommodations.  Now the Castle houses nineteen permanent residents with one room kept for overnight guests from a list of about five regular visiting Royals.  Some of the Royals have been living at the Castle for years and only one has checked out during this period to move back to his native country, India.
Anyway, of the five new Royals, four of them have PEG tubes in their stomachs, including the newest member, Princess Oliophilo.  Before these new arrivals, there was only one Royal with a PEG tube and information about him and PEG tubes in general is in the ever popular blog article called B’org Feeding Tubes.
PEGs are handy for the Castle Management, partly because a big portion of the cost of upkeep for each Royal is the provision of food. PEG formulas are a lot cheaper and ordered in like medication.  Also like medication, a doctor’s prescription is required for each formula and the formulas may come under a different heading of expenditure.  The formulas are ordered in bulk as they have a long shelf-life.  The nurse is the one who changes the formula pouches, but it can be done by a carer.  Medications are also administered through the PEG feeding tubes.
The Castle has a chef who prepares a lot of the food from scratch.  He orders in fresh food regularly, prepares and cooks it.  Most of the Royals who can eat need a carer to assist them. This can take up to an hour for each meal and be quite arduous.  PEG formulas, on the other hand, are produced en masse in a factory with cheap ingredients and it takes a minute or two to change the pouch.  A machine measures the input regularly throughout the day and has a lovely beeping noise when it’s empty or not working properly.  In addition, there’s no discussion with anyone about what the Royal with a PEG likes to eat or wants as these Royals can’t speak or communicate in a way that would be meaningful in this matter and their relations don’t seem to have much input either.  The Royals get the same type of pouch every day.  They’ll be having a similar pouch for the rest of their lives too and they range from twenty-something to forty-something years old.
Iris noted that there used to be a ratio of 16:1 Royals using PEGs and now it was 4:1.  Four times as many.  One fourth the total number of Royals.  This seemed to her to be a sign of the times, “times” being a span of about four years.  Four years ago, Iris went to the doctor about back pain and was referred to a physiotherapist.  About four months ago, she went to the doctor again with the same condition, but this time was offered x-rays and asked why she wasn’t taking any medication.
Iris was pondering this when Petunia returned from bringing Lady Louise to her weekend retreat.  She stood with one hand on her hip and asked Iris what she had planned for the day with the attitude that Iris was probably unprepared.  Iris was as polite as she could be, gave a list of possible activities, and then realised that Petunia had something she wanted to do.  They decided to work together with a lot of the Royals to put together invitations for the big barbecue in August, which Petunia had already started the day before.  Iris wished Petunia would just say what was on her mind.  When she saw the invitations, Iris was a bit dismayed when she immediately noticed three mistakes on them.
Castle Health Care
Invite You to our
Annual Barbeque
Even the Royals with PEGs will be attending with their relatives.  Iris mused that someday the BBQ might be an activity of the past that was no longer done because all people popped pills and ingested fluids for their sustenance instead of eating food (which will be true if they travel to and end up on Mars, like the at least 78,000 who are planning to do this in 2022).  What do they think they’ll eat?  Not real grilled hamburgers, that’s for sure.
With instructions like the ones below, it’s no wonder more and more PEGs are showing up.  Iris made some comments (in pink).
1) It takes too long to eat a meal and it’s not fun anymore. (True for lots of business people too.)
2) You are coughing and choking while eating or drinking such that you or your caretakers become anxious.  (Never mind the possibility that the caretakers might be suffering from an anxiety disorder.)
3) Pills are too hard to swallow...literally! (Some people choose a PEG tube initially just to help with taking all their medications).  (This is ridiculous.  Medications come in liquids and pills can be crushed or opened.  In fact, medications need to be in liquid form to be administered in a PEG tube.)
4) Your respiratory status has been declining and your ALS team is concerned that a delay in tube placement could make the procedure too difficult in the future.  (Too difficult?  Does this mean that the person would actually die a natural death without a PEG tube?)
5) Unhealthy, unintentional weight loss that alters your strength.  (Of course, there are lots of other ways to help people gain weight, but the government does not support them.)
Iris was a big fan of real food and she felt sorry for the Royals that were reliant on the provision of PEG pouches.  She wondered if there was a connection to the Royals on a PEG food plan and the aspirations of others to live on Mars.

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