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>This is the Way We Don’t Lose Weight

March 19, 2011

>…or not too much, we hope!

Here’s the math. Joy went into her cast weighing 25 lbs. She now weighs almost 30 lbs. So the cast weighs 4.5-5 lbs. Her surgeon told us that during the four to five weeks kids spend in a spica cast (a body cast), they often lose 2-3 lbs. Joy simply can’t afford to lose that much weight: it is as much as she gained in the past two years.

Joy has always had a small appetite, partly because she is petite, and partly because her oral motor skills are delayed. Now her abdominal volume is also decreased by the cast, which is shaped something like a corset. The cast is cut out at mid-line in the front, a space about as wide as my hand, in an open “U” shape. This allows her stomach, when she eats, to expand outward into the hollow part of the “U.” But as you might imagine, this isn’t very comfortable. So she still eats less at a time than she did before surgery.

The irony is that after surgery, her nutrition needs to be in tip-top shape, especially with protein, calcium, vitamins and minerals to help her surgically broken leg bones fuse back together and grow strong.

The first bit of successful advice came from the hospital: frequent, small meals. This feels like Joy snacks all day long. For now, it is true. Her two current favorites are heavily buttered 12-grain toast, and diced breaded chicken. Allowing her to eat by snacking, now that she’s feeling a little better, approaches the same amount of food she was eating daily before surgery.

The second trick was improvised. It started with Joy’s favorite juice: V-8 Fusion. It isn’t inexpensive, but it is 100% fruit and vegetable juice and given Joy’s relatively slowly-expanding repertoire of textures, which limits the variety of fruits and veggies she can eat, its a great way to get adequate vitamins and minerals and a fair amount of fiber (for juice) from a natural source. Joy likes five of the six available flavors.

Joy’s caloric downfall, since she stopped drinking formula from a bottle just before she turned two, has been her dislike of anything milk-based besides yogurt, cheese and ice cream, which she’ll only eat in small amounts. She doesn’t like soy or almond milk either. That meant that that old caloric standby of marginally-nourished children, PediaSure, was out. I couldn’t even sneak it super-chilled into a milk shake or a fruit smoothie.

But I discovered this week that V-8 Fusion, which is intensely flavored for juice, covers the flavor of PediaSure. I started with about two ounces of vanilla PediaSure to six ounce of juice and have crept up to 3 ounces to five ounces of juice in smoothie concoction that tastes good even at room temperature. So every 8 ounce cup of V-8 Joy drinks is now spiked with about 100 extra calories of PediaSure. So far vanilla PediaSure passes with Strawberry-Banana, Passion Fruit-Tangerine, and Cranberry-Blackberry flavors. Next up will be Goji-Raspberry.

Of course the real test will come when the cast is removed and we put her on a scale in two and a half weeks. After 31 days of not moving a voluntary muscle from mid-chest down, I’m sure she will have lost much of the little muscle mass she had. But  she’s actually eating better than I imagined she would. So I’m hopeful that she’ll lose less that she might have.

P.S. This surgery also affected Joy’s height. She was 37.25 inches tall before surgery. Her derotational osteotomies (the procedure that reseated the head of her femurs more deeply in her hip sockets) temporarily shortened length of her femurs. So initially she may be a little shorter. But her surgeon told me that the surgery stimulates bone growth so over the course of the next two years, she’ll not only regain the height that was surgically lost, we may see a greater increase in height than we would have seen over the same time period without the surgery.

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