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Feeding the cancer patient who becomes a transplant patient

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Hi folks,

My hubby is currently going through chemo and if all goes well, will have a bone marrow transplant in the next month or so. I've been reading through the threads on feeding cancer patients to glean ideas for the chemo phase, but the post-transplant phase presents some new challenges.

DH will be immunocompromised when he comes home from the hospital, for a couple of months. They gave us a big binder full of instructions and basically he can't eat anything that isn't cooked at home, in our kitchen, right before he eats it. So our friends can cook for me & the kids, but I have to make all of his food. He can't eat leftovers, except for something like soup that cn be re-heated ina pan until boiling (microwaving is out, because of the risk that the food won't get hot enough).

So, I need to come up with things that can either be assembled in single-serving size, frozen, and then cooked right before he eats, or things that can be cooked and frozen in single-servings and then heated in a pan on the stovetop or in the oven. I don't want to make big trays of things, a la once-a-month-cooking, because he won't be able to eat much at a time and I'm tyring to think of higher-calorie foods than the rest of the family should be eating :-)

One thing I thought of was stuffed shells or manicotti - I can take a few from the freezer at a time and bake them with homemade sauce, as needed. I also ahve a foodsaver vacumn sealer thingy, might there be some way to freeze individual portions of something and then re-heat by dropping the bag in boiling water? That should get the temp up to the safe range, vs. the microwave...

Ideas?

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  1. What comes to my mind is single serve proteins, such as hamburger patties, salmon burgers, individually portioned fish. You can buy frozen salmon burgers at Costco and at grocers, as you can hamburgers. You can easily get single servings of fish as well. You can stock your freezer with a few choices there. You can buy chicken breasts, preparing them easily, as you pull them from the freezer. I assume you are allowed to thaw frozen foods such as animal proteins and cook them.

    I want to encourage you in this endeavor. Those eight weeks will pass, and life will become more normal. Your husband is lucky to have a dedicated wife to cook his food so carefully.

    1. I volunteer at a charity which cooks food for people with compromised immune systems. It might be helpful for you to get a probe thermometer so that you can reheat things until they reach the required temperature. I'm sure it's in your binder but it's also important to cool things quickly and keep them cold enough. It's also helpful for chicken breasts etc, which you might be confident about cooking under normal circumstances but don't want to take any risks atm.

      The charity has a list of recipes on its website, which are designed for people who need feeding up - nutritional bang for your buck, as it were, for people who can often only manage small portions.

      http://www.iancraddock.com/

      1 Reply
      1. re: gembellina

        Agreed on the temperature probe and making sure you cool quickly. Cooking something in sauce in the oven from frozen makes me nervous given your doctor's instructions. Something like stuffed shells is going to be hot when you make it (potentially a couple of times, unless the noodles are done being boiled at the same time the filling is ready), then cool down either on the counter, which is slow, or in the freezer, which is going to heat up everything else in the freezer. Then dense non-liquid foods in the oven are prone to hot spots and cold spots, so even if you stuck a temperature probe in it, it might not be safe. If cooking on the spot is going to be tough, I think I'd stick to wet freezer foods - liquidy chili, soup, etc. I'd cook them on med/high heat quickly rather than simmer them, and I'd plan to add ice cubes or frozen stock immediately to cool them down before going in the freezer. I'd reheat in a saucepan rather than the oven. It might also be helpful to make a list of easy on-the-spot foods, in case coming up with them is hard when you're stressed. Not sure what he likes, but I'd say maybe scrambled eggs with butter, fried chicken tenders, noodles and meat sauce. I guess it will depend a lot on what he feels like eating.

        Best wishes from here, too. I hope it goes as smoothly as it can.

      2. I was thinking about my white bean and pasta soup, lot's of protein, carbs, and flavor. You could make that, then freeze in small portions for reheating as needed. Wondering if you could make mini meatloafs, then freeze, cook as needed. I always like to have meatballs on hand in the freezer. Bake them, then freeze, add to sauce to finish the cooking process. Best of luck on the treatments, hang in there!

        1. When my friend went through this he barely wanted to eat for a long time and anything more solid than soup was repellant for months, so I would start with a big cache of soups frozen in small servings. Best wishes to you both.

          1. Was also going to suggest soups that incorporate proteins like chicken, beans, etc. and greens. Can be made ahead and frozen in single-serving sizes. Stews might be a good idea too . . . likely he's not going to be super hungry, but he needs to be nourished to help his body recover from the assault. If you want to "beef up" any soup, you could also make some rice at the time you're heating his meals . . . easy to stomach and filling, too. And if you run out of make-ahead options or he needs something different, scrambled eggs can be appealing to someone who's feeling crappy and they're quick and protein-full.

            I wish you guys the very best. These are hard times, I know . . . hope it all goes as smoothly as possible. Hang in there.

            GG
            http://www.semisweetonline.com

            1. From what I hear, people recovering from this type of thing usually prefer pretty bland food at first. Some thoughts:
              Instant couscous- takes a couple of minutes to make (just add boiling water) and you can cook a small portion separate from the rest of the family.
              Baked potato- scrub, bake in microwave ( or regular oven if you have time), then scoop out the middle right when he's ready to eat.
              For make ahead meatloaf or mini casserole, consider putting portions into muffin tins, baking, then freezing. These should heat up quickly and will be small enough in size for a limited appetite.
              All the best to you.

              1. Thanks so much for all of your thoughts and suggestions. I cook dinner most nights anyway, though often it's things that I've precooked and then assemble at dinnertime. I've been thinking this week about how to do things differently..we're lucky in that I'm at home with the kids anyway, so I'll be able to make hubby's lunch, but I can't spend all my time in the kitchen, either.

                Single-serving proteins, themometers to check temp (I have one), soups and stews, and couscous are all great ideas. I was thinking that i could use the ice-water-bath method to cool pots of soup etc quickly, thus avoiding the heating-up-the-freezer problem. Also that I could freeze cooked rice in one-cup portions, then make small batches of fried rice which would let me use up any leftover meat or veg from the previous night's dinner (I'd fry the heck out of it in the wok). Korean-style soups are easy to make in single-serving sizes, too, and I already keep the ingredients on hand. So thanks, everyone, for jump-starting my brain :-)

                1. wishing you and your husband strength and a successful recovery... lots of thoughts already here, but...
                  -stuffed potato skins are great to freeze and small portioned.. freeze stuffed with protein of choice or add when reheat

                  -stratas/casseroles that can also be made in individual muffin size portions -- mexican tortilla strata, savory bread pudding with veggies of choice, mini pot pies or beef wellingtons, etc.

                  -polenta is pretty quick to make... also spread into a thin layer, cool, and slice and freeze. then reheat and crisp polenta squares to be served w/ sauce/protein of choice

                  -stuffed chicken breasts

                  -batch of meatballs to use in pasta, sandwiches, omelettes...

                  good luck to you both!

                  1. Thought I would post an update..thanks again to all who commented. I jumped the gun on making this post as hubby ended up needing a lot more chemo, but at last has been cleared to go to transplant. We have been lucky food-wise in that other than an aversion to fish, his appetite and interest in food has stayed intact throughout the last several months of treatment.

                    His hospital admission is in a few weeks and it's great to have this list of ideas at the ready. There is so much else to do, I can't even think about cooking right now (which is shocking and unstelling, to someone who spends most of her time thinking about food!).

                    4 Replies
                    1. re: gimlis1mum

                      Amazing and excellent news about his appetite, gimlis. Keep up the good work. The caregiver is God's right hand.

                      1. re: gimlis1mum

                        If his appetite is up, there are easy Mexican dishes that can be done quickly and you can vary the heat from none to very hot. I like doing carne asada tacos, cubed steak cooked on a grill pan with a little lime and salt and then served in tortillas (I hope you can store buy these) with some onion and cilantro, maybe a wedge of avocado... If the veggies need to be cooked, then toss the onions on the grill with the beef and maybe some mushrooms and peppers.

                        Enchiladas are also pretty easy. Tear apart whatever protein you like and mix it with cheese and anything else you want to add. line them up in a small baking dish, add some salsa and more cheese on top and then bake to melt the cheese.

                        While I am on the cheese kick, maybe a grilled cheese with tomato soup, good old childhood comfort food.

                        Good luck to you and to him.

                        1. re: gimlis1mum

                          Best of luck to you and your entire family, especially the patient! He is lucky to have someone looking out for his needs---culinary and otherwise!

                          1. re: gimlis1mum

                            Thanks for the update. I hope you have a good outcome. It is wonderful to know that you plan on taking good care of your husband. God bless.

                          2. I would consider that his appetite may be poor so try to focus on things he usually likes and freeze individual portions of them then heat in microwave to necessary degree of heat. Who is telling you food doesn't get hot in the microwave? The microwave can super-heat foods, as anyone who has burned and blistered his mouth will attest. Use an instant kitchen thermometer to check food temperatures if you are uncertain. When you heat a cup of soup and it's madly boiling in its cup in the microwave, that's HOT.

                            2 Replies
                            1. re: Querencia

                              I think that they are thinking of how spotty and uneven microwaved food can be; although you can obtain even heating if you are aware of this, they are probably dumbing it down to make sure someone doesn't serve a semi-heated meal.

                              1. re: sandylc

                                yes, that was it exactly - the uneven heating of food in the microwave.

                            2. I know I need to read through all your comments, but I had to write. OMG - this sounds so like what I am going through right now! My hubby has a recurring case of hodgkin's and we were supposed to be going for a BMT this week, but because he has one nodule left (tonsil, of all things) they want to do more chemo, so we've been pushed back about 8 weeks.
                              My hubby is a picky eater so I'm hoping to get some ideas through your post & comments; I'm thinking lots of hot dogs, eggs, mashed potatoes & pudding. I would really love to hear your experience. I am keeping a blog for my family and friends. If you are interested, let me know. I don't want this to be one of those 'check out my site' type of comments.
                              I hope things are going well, especially if you are in recovery!

                              2 Replies
                              1. re: CDogRun

                                Hi CDogRun,

                                Oh, how I know how hard it is to wait when you are ready to go on transplant - we've had the plug pulled on us twice - but it really is best to have that "clean" scan heading into it. Think of it as having 8 more weeks to clean and prepare.

                                As others have said, each person's experience is different, and unfortunately there's just no way to predict how your hubby will feel about eating until you are on the other side of the transplant. We were lucky in that DH's tastes weren't really affected - he did have an aversion to fish for a while, and didn't like the taste of plain water, but those were easy accomodations and went away after a few months. As I recall his appetite recovered faster and he was eating LOTS of food every day, after about 2 months.

                                We did get confused about what exactly was allowed - the info we got from the big binder of pre-transplant patient info was a little different from what the transplant coordinator told us, which was different from what the dietician told us upon discharge. Mostly in terms of how restricted - the transplant coordinator said no leftovers at al, the dietician said leftovers OK if you chill them right away and eat within 24 hours. I think it comes down to how conservative your care team is.

                                What ended up working for us was something like this: I'd make a cooked breakfast for DH (eggs, frozen hash browns, hot porridge, etc). Then I'd either cook lunch or have something on hand that he could get for himself with minimal effort - a single-serving of homemade soup and sandwich fixings (the meat had to come from a package and be heated to steaming then chilled first). No fresh veggies but DH likes peperocini so he used those to give sandwiches some crunch.

                                At dinnertime, I'd make sure that DH ate right away while the food was hot, which took some coordiation because some of the meds have to be taken an hour before meals, etc. At the same time that I'd plate out DH's dinner I'd portion out a few extra servings into single containers and put it in the fridge right away to start cooling. If DH wanted seconds, he'd get a container from the fridge. After everything cooled I'd label the containers with the date and time. If DH wanted something for lunch the next day he could just check the label to see if it was in the 24-hour window.

                                Any frozen or canned food was okay (after baking or boiling to heat it), so I could have just gotten a bunch of cans of soup and Banquet entrees but I'm a locavore freak and compulsive cook, so making things myself worked better for me. I think I made 2 batches of soup, pasta fagioli and Italian wedding (DH's favorites) and froze them the month before. I'd take a container of soup from the freezer, label it with the date and time, and then DH would have 24 hrs to heat it and eat it.

                                Check out the "Chemohounding" thread for more ideas...I also did lots of brothy soups, especially bone broth with oxtail, or Korean beef and radish soup - DH had to drink lots of liquid each day to help with the post-transplant meds and sometimes it was hard to get that much volume into him. Soup helped.

                                Your hubs won't be able to eat food that friends bring you, but you will, so let them feed you. My son's teachers actually sent us food during the whole time my hubby was in the hospital and it was a Godsend - that first night, I couldn't have boiled water. If people ask you what they can bring, a combination of prepared foods, groceries and gift cards was great because it gave me the flexibility I needed to feed myself & the kids, depending on what else was going on.

                                All in all the recovery was not that bad, just hard to keep with the restrictions. Sadly the transplant didn't work (cancer still there, bleah) so hubby has been getting more chemo and we are hoping to get him to a second transplant.

                                I'd be interested to read your blog.

                                1. re: gimlis1mum

                                  Since this (CHOW) is primarily a blog about food, I'll just give you the address: http://noonesark.blogspot.com/

                                  I think you'll enjoy it a little. May remind you too much of what you have been thru & are going thru again. I can't imagine doing it twice, and we haven't even done it once yet. Reading one of your other comments - my hubby is also doing autonogulous (?).

                              2. First of all, best wishes for his treatment success and recovery.

                                Among the other good suggestions you've gotten about freezing single serve proteins, etc... I'll add that for medical reasons of my own, I've had to research steroid treatment and diet...

                                It's not just the immune compromise that you have to be concerned with: if he's on steroids, it raises blood sugar, usually to the point of diabetes and destroys lean body mass/muscle and causes excess fat in its place.

                                Endotext.com has a consensus opinion in it by academic endocrine experts that a person on steroids "must eat a high protein diet" in order to avoid deterioration by this process.

                                If you make soup, make it with plenty of meat, or float an egg in it, tofu, whatever he can feel like eating.

                                2 Replies
                                1. re: mcf

                                  Well, the first transplant was autologous (his own cells), so no steriods needed. But in general I'd been pushing protein on him all along (fat too) because I figured his body needed it just to cope/recover from the chemo. I found a nice high-protein shake at Costco, it has 30g of protein (compared to Boost high-protein, which has only 12, I think).

                                  1. re: gimlis1mum

                                    You're on the right track, then... I buy my MIL the Muscle Milk lite shakes at Costco, very low sugar, plenty of protein and the best tasting of all the ready to drink ones, except maybe EAS chocolate caramel mocha... or something like that.

                                    Glad no steroids for now. That really helps.

                                2. Best of luck to your husband and also to you and your family. This is certainly a difficult time for you. It sounds like you're on the right track with following the instructions for what he can and can't eat. I just wanted to suggest that soft, bland foods will probably be best because he may have graft versus host disease, which attacks the mucous membranes in the mouth, or possibly a yeast infection in his mouth. Either will make it difficult to eat and spicy or crunchy foods will likely be impossible.

                                  1. Banning the microwave is not going to make your work easier. Ask them what internal temperature they want the food to reach and invest $15 in a good instant-read food thermometer. Microwaved food can be super-hot---people burn their tonsils on the cheese on the pizza--depends on how long you zap it and at what temp. Being able to freeze something nourishing that your husband likes and can eat (maybe shrimp bisque full of Cuisinarted shrimp---very high-protein) would be a work saver for you.

                                    1. My husband was sick for a very long time before he died---my advice is that if a person doesn't LIKE something and on top of that is going through treatments etc, he isn't likely to eat it no matter how nourishing it may be. So focus on things you know he will eat and enjoy. For example, my husband would happily have lived on sweet potatoes and would eat them when he wouldn't touch anything else so I used to freeze quantities of sweet potato mashed with crushed pineapple (the way he liked them best). If I had given him tofu, I guarantee that he would not have touched the dinner. Stay with what they like: they have enough problems already, to have to choke down something they think is gross.

                                      1. The stuffed shells and manicotti may be too heavy for a sick person. Appetite can take awhile to come back. I have cooked for both of my sick parents so the prior comment is based on my own humble experience. My Dad lost 90 lbs in less than a year, and although he can now eat, he has never really regained the appetite he used to have. At his weakest I was making him mashed potatoes, seasoned wax beans, and a protein selection. (often fish for the protein) Always had fruit cups, jello, popsicles, small treats, rice pudding, and puddings on hand. Most of all I wish you both strength and divine courage during this time.