Stimulating appetite when there is no interest in food

MsReliable

Thanks again to everyone who supported us in moving Dad from Vegas to NY. I actually made it home for 3 weeks before Dad had another stroke and went into hospital. He was there for 6 weeks with multiple illnesses, and made it to rehab last week. 

He was COVID+ for 3 weeks in hospital and it drastically reduced his appetite. After another (now negative) week in rehab, he has lost another 5 pounds, for a total of 20. Instead of weighing 120 or 122, he weighs 101. On top if it he has swallowing issues now, which I think are more from fatigue than the stroke - he was able to eat sandwiches in the few days before the positive COVID test.

He can taste the food (can describe the taste to me) so I don't think it's a COVID loss of taste. But he will only eat a bite or two at a time. We are trying regular ice cream, magic cups (protein supplement in the form of ice cream), applesauce, ensure shakes, and all the supplements they have at the rehab. From home, we bring finely minced steak and turkey, garlic mashed potatoes, ice cream cake...all the things he loves, but he still won't take in much and continues to lose weight.

While there are a few medicines that can stimulate appetite, few are studied in the elderly. The most common seems to be a progestegen (Megestrol Acetate) - which was used in the past to treat BPH (he also has an enormous prostate). But some doctors also use mitarzapine. Beyond that it seems that an NG tube and a PEG tube are on offer, but I don't want to subject him to either of those unless I have to. He pulls at anything inserted and it would be an issue.

Does anyone have suggestions? I am running out of ideas.

Many thanks!

M1

Ms. R, I think you are absolutely right not to think about a PEG/feeding tube--he has a terminal illness, and those are very invasive measures that are hard to discontinue once you start.  There are not many meds that reliably increase appetite--marijuana may work better than anything, if you are in a state where it's available.  But you might do better to prepare yourself that he may not come back from this, the insults are cumulative.

Have you thought about a hospice evaluation?  Good luck, I know it's hard.

MsReliable

Thank you M1 for taking time to reply. Part of me knows that we should talk to the palliative care team, and I have danced around it with the rehab team and my sister (she and I are the only children and we are pretty well aligned on his treatment so far, but I am the HCP). 

But...(and there's always that but, right?)  - yes his issues are cumulative. But his most acute problem now is the weakness and fatigue. I want to give him a chance to recover as much as possible; he needs energy to do that. 

Perhaps I am being too optimistic, but I am not ready to call him terminal yet. I will gratefully take the reminder to prepare for the time when palliative/hospice is indicated. Thanks for that.

Iris L.

Hospice is not only for those patients with six months to live.  Hospice can also help with patients classified as "failure to thrive" with weight loss, such as your LO has.  

Iris

MsReliable

Thank you Iris, I did not know that. Do you know if Medicare covers hospice in that situation?

Marta

Indeed, yes.  Hospice for failure to thrive is covered by Medicare. My husband was on Hospice for nearly three years for weight loss.

mommyandme (m&m)

Medicare pays for all my mother’s  hospice needs and they provide a lot…equipment, meds CNA, nurse, doctor etc… My mother has been with hospice since February and she’s still eating.  

Regardless if this is terminal or not, hospice sounds like good plan.  They can really help you and make sure he’s comfortable, whatever his needs are. 

It sounds as if he’s past palliative care. 

I’m sorry for your troubles and concerns, this is so hard.  

elisny

Another vote for checking out hospice.  My mother has been on and off for about 3 years.  She entered the last time in July 2020, and is still on.  She is in a slow fade.  As long as she continues to decline, she will remain on hospice.  And . . . I think she is getting close to her departure.  She eats less.  She sometimes skips meals altogether.

On another note:  Please take a look at: -

https://www.vnsny.org/article/eating-patterns-at-the-end-of-life/#:~:text=When someone is dying, the,liquids before the appetite disappears.

You may also benefit from reading Being Mortal, if you have not already read it.

My take: If your Dad isn't up to eating, let him be -- if and when he is hungry, he will eat.