For one week, Lucy and I will be eating a puree only diet to give ourselves a short insight into what it is like living with swallowing difficulties after head and neck cancer.
As Speech and Language Therapy students currently on placement in a community head and neck cancer setting. A large number of the clients that we work with have dysphagia (swallowing difficulties) as a result of their cancer treatment. For some clients, we might recommend a puree diet to compensate for their difficulties with chewing and swallowing. Whilst in some cases this may be a short term solution for clients until their swallow function has rehabilitated, in other cases these diet changes will be a life-long adaptation. Part of the role of the Speech and Language Therapist in this setting is to give advice to clients about possible meal options which could form part of a modified diet. This comes with the challenge of adjusting for personal preferences and consideration of cultural norms. What should you advise someone to eat for breakfast if all they fancy is a bacon sandwich?! There’s only one way to find out…
As well as swallow function, taste and sensation can also be affected by cancer treatment. Following radiotherapy, foods which are very spicy, salty or acidic can be too painful for our clients to eat. In consideration of this, we will be limiting the amount of spice, salt and acidity in our puree diet.
We will do a daily update to let you know what we’ve eaten and what we have learnt from our experiences that day. If you would like to learn more about dysphagia or donate to Macmillen Cancer Support to help support people facing cancer, during diagnosis, in treatment and beyond, please visit our Justgiving page: https://www.justgiving.com/Rachel-Tutty/
Breakfast: puree scrambled egg and avocado. Lunch: Blended chicken soup fortified with noodles, puree peaches and hot chocolate. Dinner: Puree spaghetti Bolognese and chocolate mousse.
Breakfast: Initially I put the scrambled eggs in the blender without any liquid and unsurprisingly nothing happened. I then added a splash of milk, and then another, and before I knew it I had accidentally made an egg flavoured milkshake, which was also cold. Yummy… This is when I took the picture above which looks very unappealing! After I heated it up again it regained some of its scrambled egg qualities and was actually fine.
Lunch: I was out all day at the Tower of London, so decided that I needed a portable but substantial lunch. On placement we recommend that patients fortify their food to make them more substantial. This can mean mash potato in soup, using full fat milk in cereal, or cheese in mash potato. So when preparing my chicken soup, I blended in cooked noodles. When lunch time came, the high level of starch in the meal meant it had congealed into an unpleasant, claggy texture that anyone with a real swallowing difficulty would not have managed to get down. The exact opposite problem to my breakfast!
Dinner: Really nice and filling! I would definitely recommend this to people who attend our clinic looking for ideas for a puree diet. The naughty bit of cheese on top (salt) and the tomatoes in the sauce (acidic) may be too strong for some of our patients who have very sore skin on the inside of their mouths following radiotherapy though, so we need to select who to recommend this to carefully.
Today’s key lesson: Liquid when blending is very important and not as easy to balance as it first sounds. I imagine I’m not the only person to make these mistakes on the first day of a brand new diet and it must take a bit of trial and error until you find the foods that you enjoy which you are confident in making.
Psychosocial aspect: It was stressful going on a day out knowing that I would be far away from the safety of my blender and cupboard of soft foods. I had to get up half an hour before my boyfriend in order to prepare my days worth of food, and I was still 20 minutes late because I had to clean up the mess I made doing it! All day I was thinking: Have I got enough food? What will I do if I get hungry? Will the peach puree leak in my bag? What if my boyfriend offers me one of his crisps, will I have the strength to say ‘no thank you’? (I did!). You can start to appreciate why some people would find it difficult to maintain a normal social life on a puree diet.