Caroline's Breakfast

Just finished feeding Caroline her breakfast. If you ever get to do that... here's how it goes (numbers correspond to objects in the picture; click on the picture to see it bigger):

1. Prevacid (to help with stomach irritating): One 15 mg tablet dissolved in a bit of water [4]; 15 minutes before the rest of her breakfast, you connect her g-tube [2] to the port that was surgically implanted in her stomach wall; then you connect the large syringe [3] to the g-tube and pour the prevacid solution in; you'll need to use a bit more water to get it all in.

4. Water: Caroline gets 9 ounces of free water throughout the day; this is used to flush her tube at the end of each meal; she also gets 8.5 ounces of water mixed with each meal, hence the two water bottles

5. Tegretol (or Carbemazepine; a seizure-control medication): One 100-mg tablet crushed in the mortar and pestle [6].

7. Depakote (another seizure-control medication): three 125-mg capsules filled with tiny granules, called sprinkles; open the capsules and dump the sprinkles into a little cup [8], in which you also put the crushed up tegretol [5]

9. Scale: Turn on the scale and find a measuring cup and spoon [10]; place the cup on the scale and "zero" the scale (press the "on/zero/off" button to make the scale read 0

11. Polycose (carbohydrate additives for Caroline's food): measure in 1 gram of polycose into the measuring cup (using the spoon)

12. KetoCal (Caroline's food; a formula that helps maintain the ketogenic diet, which helps control Caroline's seizures): measure 28 grams of KetoCal into the measuring cup (I usually zero the scale after putting in the polycose)

13. MiraLax (a laxative because ketocal can be a bit constipating): add 1.5 teaspoons of MiraLax to the measuring cup mixture.

Now you're almost ready to feed. Take the water bottle [4] with 8.5 ounces of water and pour it into the measuring cup, mixing it al up until you have a thick milky-looking soup. I usually don't put all 8.5 ounces in--usually more like 7.5 ounces. The remaining water I use to flush the tube after the feeding.

Next, add a bit of the free water to the bottle that used to have 8.5 ounces of water; after adding the water, you should have between three and 5 ounces of water in it (depending on how much you used to mix); these 9 ounces will have to last through four feedings, and you need at least 1.5/2 ounces for flushing each meal; so you have to ration appropriately.

Now you take your measuring cup full of KetoCal mixture, the small cup with the tegretol and the depakote, the water bottle, the g-tube, and the syringe into Caroline's room. You hook the g-tube up to the feeding port in her tummy, connect the syringe, and you're ready to go. First pour in a bit of water and then add the tegretol and depakote; you'll need to add some more water immediately to help the depakote and tegretol not clump up; if they clump (which they are prone to do), they can clog the tube, and that's a pain. Once the medicine is in, you can start pouring in the KetoCal; pour in enough to fill the syringe mostly full, then wait for it to drain most of the way down and add some more. Continue until all the KetoCal is gone; then pour the remaining water into the syringe and let the water run out into her stomach. This will flush the tube and the tube port. When it's all the way in (only a little left in the tube), clamp the tube with the white clamp, remove the tube, and you're done.

Almost. Now you need to wash the measuring cup, tube, syringe, mortar and pestle, and medicine cup. We have a bottle brush and dish soap which work really well to clean the syringe and tube: keep them connected, put some water in the syringe, add some soap, and clean with the bottle brush. This method has allowed our g-tubes to last much longer than they would have otherwise (which is good, cuz they're not terribly cheap).