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The Patient Advice and Liaison Service (PALS) PALS will provide advice and support to patients, their families and carers. It also provides help to sort out any problems or concerns you may have. You can contact PALS free on 0800 052 6088. Making a comment, suggestion or complaint We would like to know what you think of the services we provide to you. We like to know when we are doing well and when things go wrong, so that we can put them right. Contact us on 01865 336786. Translations and Braille This leaflet can be provided in alternative formats on request. These include other languages, large print, Braille, Easy Read, audio-cassette, computer disc or PDF. NHS Direct NHS Direct offers health advice 24 hours a day, 365 days a year and can be contacted on 0845 4647 and online at www.nhsdirect.nhs.uk Produced by Registered Dietitians Community Health Oxfordshire Version 1, May 2010 Nutrition and your bone marrow transplant What should you eat to help your recovery? This leaflet has been designed to help you to eat as well as possible throughout your transplant. It includes information on: v Foods available in the hospital v Foods suitable for relatives and friends to bring in for you v What to eat if your appetite is poor Eating well can help to: Nasogastric feeding Some patients need to be fed using a nasogastric (NG) tube. This is a very thin tube, which as the name suggests, is passed up your nose and down into your stomach. It is a very simple procedure performed by the ward nurses, and most patients find the tube relatively comfortable. Special nourishing liquids can then be slowly fed into your stomach through the tube. You can still eat at this time if you wish. Patients likely to be recommended to have NG feeding include those who: v Are underweight or have lost a significant amount of weight before admission v Decrease your risk of infection v Are aged 60 or over v Prevent loss of muscle v Keep you feeling well v Have another illness that can increase their risk of infection v Are having a type of transplant that will make their mouth and throat extremely sore Dietitian The Dietitian will visit you during your admission for transplant. If you feel you need to see the Dietitian in the near future, please tell your Nurse. You can also contact the Dietitian when you are not on the ward by telephoning 01865 235421 1 v Have not eaten well for more than three days The Dietitian, Nurse or Medical team will discuss this with you if they feel you would benefit from this. 6 Suggestions for suitable foods to bring in ü Full fat yoghurts (not probiotic, live or Bio *) ü Shop bought desserts such as mousses, trifles, rice puddings, custard, jellies ü Shop bought milkshakes ü High energy drinks e.g. glucose energy drinks ü Cheese and biscuits (not blue or some soft cheeses *) ü Wrapped biscuits, cakes, cereal bars (keep in an airtight container once opened) ü Scones, croissants, scotch pancakes ü Wrapped sweets and chocolates ü Snack pots e.g. Pot noodle ü Sandwiches with suitable fillings, e.g. cheese and pickle, cold meat (vacuum wrapped), tuna, sardine, well-cooked egg (no salad or pepper *) ü Fresh fruit (peeled *) ü Any tinned foods ü Fruit juice (long life or pasteurised*), squash, fizzy drinks ü Chilled ready meals (must be kept chilled at all times and reheated as per instructions until piping hot) *- when you are neutropenic (See “Neutropenic Diet” leaflet for details) Important v Make sure any perishable foods are kept cool on the way to the hospital and are stored in the fridge v Check the fridge regularly and remove any out of date foods v The fridges are not suitable for frozen foods 5 Nutritional problems that can occur during this time You might find that you have a poor appetite during your stay, and many people experience taste changes. There could also be times when nausea, vomiting, diarrhoea, dry or sore mouth may decrease your wish to eat. If you do experience these problems, they are unlikely to last throughout your admission, and there is a great deal that we can do to help with medications and advice on suitable foods. It is quite normal for patients to eat less for two or three days at some stage. Try not to worry if this happens to you. However, you will probably feel better if you can eat some food or nourishing drinks at this time. Foods available in the hospital for you v Cereal, porridge and toast are available for breakfast. v You will be given a daily menu to choose your lunch and supper from. The house keeper can also provide soft moist, neutropenic, Halal or vegan menus as required. v Biscuits, cake or fruit are provided between meals when drinks are served. v “Snack boxes”, which include a sandwich and other snack items, and “Lite Bites” which are hot snacks, are available at any time via the housekeeper or nurse Friends or family are welcome to buy a takeaway meal or snack for you from the hospital restaurant, but if you are neutropenic we advise that this happens when meal service starts. 2 Extra foods available on the Haematology ward The day room has facilities for making drinks and simple snacks. There is a microwave, milk dispenser and ice machine. Fresh bread, spreads, cereals, porridge and a variety of tinned foods, including baked beans, soups, custard, rice pudding and fruit are available there. This food is for the patients, so help yourself, or ask one of your visitors, the Housekeeper, the Dietetic Assistant or your Nurse to help. Neutropenic diet This is extremely important to minimise the risk of you getting an infection from your food. You should be given a leaflet entitled “Dietary advice for patients with neutropenia”. Ask the Nurse or Dietitian for one if not. Once you are neutropenic with a neutrophil count less than 0.5, you can still choose from the normal menu, but need to avoid the following: v Salad v Any sandwich containing salad v Uncooked pepper – don’t use the pepper sachet Ways to increase your intake of nourishing foods v Make the most of times when you are feeling well v Choose options marked ED from the menus as these provide more energy v Eat small frequent meals and snacks, if you are not able to eat normal sized meals. This is also useful to help prevent sickness. v If you can’t manage a main course, try Build up soup and a pudding, cheese and biscuits, or cereal v Have nourishing drinks such as ward cocktails or milk. If you are not able to eat normally, nourishing drinks can be a good solution, especially if your mouth is sore. Ask the Housekeeper, Dietetic Assistant or Nurse to make you a cocktail to try. If taken regularly, these can help you to recover quicker. Try to eat a little at meal times, but take cocktails between meals. Ready made supplement drinks are also available. How can relatives and friends help? v Egg mayonnaise sandwich (contains pepper) v Timing visits with mealtimes can make eating more enjoyable, especially if you eat together v Fresh fruit unless you peel it v Ask them to get alternative meals from the restaurant, or snacks from the dayroom for you, if preferred. As this limits your choices, there is also a neutropenic menu. You may choose from either the normal menu or neutropenic menu. 3 v They could bring in foods that you are familiar with and enjoy v Bring in suitable snacks or ready meals. See next page for ideas. 4