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  • Spinal cord injury hospital diet

    My sister is in hospital following a spinal cord injury from a fall five days ago. One issue her family might be able to help is her diet.

    She has had surgery to stabilize her C7 and to relieve pressure on her spinal cord. They went in through the front. She is barely able to walk (and the hospital won't let her move without help from nurses or PT), can't move one hand and has difficulty swallowing. She also has developed low blood pressure. She's been getting steroids. She's expected to remain in hospital for a few more days and then move to an inpatient acute rehab facility. She's in her mid-60s, on the thin side of normal weight and her main exercise was walking.

    Based on materials from Austin among other things, improving her diet would seem important. Due to her swallowing issues, she can't eat solid food or even swallow pills unless crushed. A typical meal from the hospital seems to be mashed potatoes, apple sauce, Ensure (liquid or pudding) and maybe low fat ice cream. She's getting IV nutrition. Her appetite is not great.

    What would you suggest? My main thought is more food generally and adding protein powder. Yesterday her husband brought her Muscle Milk and some soup for dinner (visiting is severely restricted).


  • #2
    It's tough for us to give specific recommendations for someone currently in an acute care setting, as that can be a complex and rapidly-changing environment.

    For example, it is not clear what you mean by "IV nutrition" here. Someone with a spinal cord injury and difficulty swallowing, but who otherwise has intact gut anatomy and function, would typically not be managed with parenteral nutrition. This is different than providing IV fluids or vitamins.

    I would speak with the hospital dietician to determine what her specific medical restrictions/limitations are when it comes to nutrition. If she's able to take things like Muscle Milk or Ensure, though, I agree that you could likely supplement with other forms of shakes and whey.
    IG / YT

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    • #3
      She was apparently getting IV glucose, not parenteral nutrition. Sorry for being misleading. An issue is that swallowing is uncomfortable and going to the bathroom is a hassle - it requires a nurse to disconnect IV and to help her walk.

      There do not appear to be any medical restrictions/limitations are when it comes to nutrition. My faith in hospital nutrition is weakened when someone who plainly needs more calories is fed low fat yogurt and ice cream.

      With luck she'll be out of hospital soon, but will then be in acute inpatient rehab, and likely face similar issues.

      As a general matter, what guidance would you have for someone in a facility who is on a liquid diet due to difficulty swallowing and who has limited mobility? On twitter you had suggested 1.2-1.6 g/kg/d for protein. https://twitter.com/AustinBaraki/sta...31605212377088

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      • #4
        My next question would be why she requires continuous IV fluids or continuous IV dextrose at all if she can take liquid nutrition (and presumably water) by mouth, even if it is uncomfortable.

        Based on the information you've provided so far (assuming no other issues/contraindications), aiming for a protein intake of at least 1.2 g/kg per day is a reasonable target.
        IG / YT

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        • #5
          She was getting IV fluids, but that has stopped. Her vitals are now stable and she is being moved out of critical care to general hospital and should be moving to rehab soon, subject to paperwork and availability.

          Do you have a recommendation for total calories or other aspects of nutrition?

          Your materials on sarcopenia, as well as my then 95 year old father going from using a walker at home to a wheel chair in a nursing home as a result of a two week hospital stay, have me rather worried about the issue.

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          • #6
            Originally posted by quark View Post
            She was getting IV fluids, but that has stopped. Her vitals are now stable and she is being moved out of critical care to general hospital and should be moving to rehab soon, subject to paperwork and availability.
            I see, this makes sense. Hopefully she does well with her recovery moving forward.

            Originally posted by quark View Post
            Do you have a recommendation for total calories or other aspects of nutrition?
            This is getting beyond the scope of what I'm able to provide via this forum, unfortunately. Beyond what we've already addressed above, I would recommend discussing some of these concerns with the clinical dietitian assigned to her case.
            IG / YT

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            • quark
              quark
              Senior Member
              quark commented
              Editing a comment
              Thank you.

              FWIW, I haven't spoken directly to this dietician, but my experience with other hospital, rehab and nursing home dieticians is that they uniformly follow RDA guidelines, often are happy with less protein and calories for older people and are not interested in published research. Many believe increasing protein will damage kidneys, even in those with no related medical issues.

          • #7
            Usually avoiding weight loss in populations where that would be deleterious is one of the primary aims of the dietician and staff physicians. It is not uncommon to have "double protein" recommended to avoid muscle wasting, for example, especially when there's a sarcopenia risk (or diagnosis).

            Discussing these things as with the staff well as what sort of exercise she can do would be our recommendations.
            Barbell Medicine "With you from bench to bedside"
            ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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            • #8
              Originally posted by Jordan Feigenbaum View Post
              Usually avoiding weight loss in populations where that would be deleterious is one of the primary aims of the dietician and staff physicians. It is not uncommon to have "double protein" recommended to avoid muscle wasting, for example, especially when there's a sarcopenia risk (or diagnosis).

              Discussing these things as with the staff well as what sort of exercise she can do would be our recommendations.
              I'd love to find dieticians and physicians who behave in the way you've found to be usual.

              I have spoken to a wide variety of dieticians at a number of hospitals and nursing homes for two parents and two in-laws, some for extended stays. I've never had any recommend any more protein than RMD and the vast majority were fine with undershooting the RMD. I used to try talking to physicians, but they would invariably suggest talking to the dietician. See my comment to Austin from this morning.

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              • #9
                Originally posted by quark View Post

                I'd love to find dieticians and physicians who behave in the way you've found to be usual.

                I have spoken to a wide variety of dieticians at a number of hospitals and nursing homes for two parents and two in-laws, some for extended stays. I've never had any recommend any more protein than RMD and the vast majority were fine with undershooting the RMD. I used to try talking to physicians, but they would invariably suggest talking to the dietician. See my comment to Austin from this morning.
                I'd be curious to know the contents of the conversation, as I haven't gotten much pushback unless contraindicated. I have no idea what RMD is either.

                In any case, we would both still recommend speaking to the dietician about your concerns and ask if they would be willing to increase her daily protein intake (if still being managed) due to concerns about muscle loss, sarcopenia risk, etc. and if not, why. That would be helpful moving forward.
                Barbell Medicine "With you from bench to bedside"
                ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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                • #10
                  Oops - RMD is Required Minimum Distribution (from a tax-deferred account). I meant Recommended Daily Allowance. The typical pushback is on the order of: this is what our tables show is appropriate.

                  Perhaps interestingly, the dietician in her acute rehab facility recommends: 1-1.2 g/kg [Estimated Needs Method (PRO)], which is close to Austin's recommendation and above the 0.8g/kg I often see as the RDA and that other dieticians have recommended have for others. She's no longer on a managed diet.

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