Tales of a Liquid Diet - Part Two (Recipes)

 

Details about a Liquid Diet after an Alveolar Bone Graft – Part Two

This post is about how we made use of the ingredients I purchased (found in Part One).  I’ll post some recipes we created, and some of the tools that we used.

You’ll notice that there are no bananas included in any of the recipes.  This is pretty unusual, since almost every smoothie recipe online calls for a frozen banana or two!  Unfortunately, Levi does not like mushed up bananas; the taste or the texture.  Usually, bananas are an easy way to add fiber into a smoothie, so we had to be creative.  Boost does have some fiber in it, and I also used frozen strawberries as a way to get some fiber into him.  I had purchased all sorts of different frozen fruits (mango, peaches, avocado, pineapple, etc.) in anticipation of using them in all his smoothies, but I typically only ended up using strawberries.  He was quite sensitive to texture, so I didn’t stray too far from what we knew worked for him. 

 

Here are some of the tools we used every day without fail:

-            Magic Bullet

o   I used this for every meal, dessert and snack.  I initially thought that I would make larger batches of smoothies and milkshakes in our full sized blender, to store or freeze, however that didn’t end up being the case.  I preferred making fresh smoothies at each meal, so they kept their taste and didn’t separate.

-            Fine mesh strainer

o   I used this with several recipes, to ensure they were as smooth as possible. 

Here is an idea of Levi’s meals schedule during the day.  He ate small amounts frequently, to ensure he was getting enough calories. 

-            Breakfast

-            Morning Snack

-            Lunch

-            Dessert

-            Afternoon Snack

-            Supper

-            Dessert

-            Night Snack

I did a bit of research as to how many calories a 10 year old male should be taking in, then I divided that by 6 (3 meals and 3 snacks).  That was where the bulk of his calories came in, and the two desserts were a bonus. 

I am not a dietician, but I do understand basic nutrition, so I did my best to estimate how many calories were in each smoothie or milkshake that I made him.  I won’t post any of those numbers here, since I do not want anyone to rely on my calculations.  I rarely measured ingredients when I made a recipe, and just kind of went with my instinct for what he needed.  My goal with this post is just to provide some general information on recipes we created that worked for us.

 

BASE RECIPES – These are used throughout the main recipes

Super Milk – yields 1 cup liquid

-            1 cup whole milk

-            ¼ cup skim milk powder

o   Whisk together well

Incredibly Super Milk – yields 1 cup liquid

-            ½ cup table cream (18% MF)

-            ½ cup whole milk

-            ¼ cup skim milk powder

o   Whisk together well

Super pudding

-            2 cups Incredibly Super milk

-            Instant pudding mix (102 g box)

o   Chocolate

o   Butterscotch

o   Vanilla

o   Lemon, etc.

-            Add incredibly super milk to box of pudding mix and whisk well until thickened

Zumma Borscht broth

-            Chicken broth

-            Table Cream 18%

-            Dill

-            Salt + Pepper

-            Splash of vinegar

Chicken Broth

-            Place chicken bones (from a rotisserie chicken or regular frozen chicken) into a large pot

-            Add water to cover the carcasse

-            Simmer for 1-2 hours

o   Strain out bones, reserve liquid and use in soups or season accordingly and drink as is

Canned Tomato Soup

-            Make as directed, using table cream instead of water or milk

BLENDED RECIPES (measurements are approximate)

Chocolate Peanut Butter Smoothie

-            Splash of chocolate Boost

-            1 heaping Tbsp peanut butter

-            2 heaping Tbsp Super Chocolate pudding

2 heaping Tbsp 10% plain Greek yogurt

-            Optional – 1 tsp Caramel sauce (to make it taste like a Reese’s bar)

Berry Smoothie (good one to add powdered multivitamin into)

-            Splash of strawberry Boost

-            2 heaping Tbsp blueberry yogurt

-            2 heaping Tbsp 5% Vanilla Greek yogurt, or 10% plain Greek yogurt

-            2 Tbsp sliced strawberries (fresh or thawed)

Citrus Milkshake

-            Scoop of 5% plain Greek yogurt (OR 10% MF plain Greek yogurt)

-            1 Tbsp lemonade concentrate

-            2 Tbsp orange and pink ice cream (I bought Rainbow ice cream)

-            1 glug pineapple juice

-            Can add some super lemon pudding

Butterscotch smoothie (good one to add French vanilla protein powder to)

-            1/4 cup super butterscotch pudding

-            1 scoop plain 5% MF Greek yogurt (OR 10% MF)

-            Splash of vanilla Boost

Liberte Greek yogurt smoothie

-            2 scoops of

o   Key lime pie, apple pie, coconut,  or mango Liberte Mediterranean yogurt

-            2 scoops 10% plain Greek yogurt

-            Splash of Vanilla Boost

-            (Add caramel sauce to apple pie yogurt)

-            Strain the coconut smoothie

Cinnamon Bun Milkshake

-            Splash of vanilla Boost

-            2 scoops Haagen Dazs vanilla ice cream

-            2 scoops Plain Greek yogurt (10% MF)

-            Splash of maple syurp

-            1/8 tsp cinnamon

Lemon Lime milkshake

-            2 scoops super lemon pudding

-            2 scoops Plain Greek yogurt (10% MF)

-            2 scoops green ice cream (from the rainbow ice cream container)

-            Dash of lime juice

Strawberry Milkshake

-            Splash of Strawberry boost

-            2 scoops plain Greek yogurt (10% MF)

-            2 scoops Haagen Dazs vanilla ice cream

-            1 spoonful sliced strawberries

-            1 spoonful strawberry jam

Caramel Milkshake

-            Splash of vanilla Boost

-            2 scoops Haagen Dazs vanilla ice cream

-            2 scoops 10% plain Greek yogurt

-            2 tsp caramel sauce

 

Breakfasts were usually a Berry Smoothie (since it was easy to add his multivitamin into it), and the rest of the recipes were reserved for snacks and desserts.  His favorites were the Chocolate Peanut Butter smoothie, and the Citrus Milkshake.  Lunch and Supper was always soup, often Zumma Borscht broth, or Chicken broth.  We were given many different kinds of soup during the three weeks, but he liked those two the best.

I always gave him the choice of which recipe he’d like me to make for him.  Typically, our household operates on the premise that whatever is made is eaten, but that had to be adjusted for this situation.  I needed him to have an appetite for the meal, so I asked him what flavors sounded good to him.  We had a list on the fridge, so he could glance at it and tell me what he wanted.  I just made sure to keep a stock of yogurts and Boost in the fridge, and I had previously made a couple batches of chicken broth that I stored in the freezer.   

Having a child on a liquid diet is a big job, and it felt like I was constantly mixing up something for him!  If I had made bigger batches and put them in the fridge, it wouldn’t have been as hands on, but he wouldn’t have eaten them as well.  I’m not saying that we didn’t ever keep extras, or leftovers.  We did, and he did eat them.  It’s just that I understood his need for fresh smoothies at each meal.  We worked together as a team to make sure he was getting appropriate calories and nutrients, while also enjoying what he was eating. 

 

Thanks for reading!

 

Tales of a Liquid Diet - Part One (Ingredients)

Details about a Liquid Diet after an Alveolar Bone Graft

 

As of today, Levi is all finished his liquid diet!  Three weeks of recovery down…woot!

Today, the surgeon has given him the all clear to move on to soft foods.  He still can’t chew using his front teeth, so he will cut things up into smaller bites and move them to his back molars.  He won’t be able to have anything hard or crunchy for another 6 weeks or so.  The tissue covering the bone graft is still quite soft and fragile, so we want it to continue to heal as fully as possible before something disturbs the site. 

I learned so much about a liquid diet during these past three weeks, and I felt I should share some of my research in case there are other families in need of some help.  It was hard for me to find much information on liquid diets online that weren’t designed for weight loss.  There were a few websites that talked about liquid diets after dental surgery, but mostly they just told me to “blend anything and everything, and add cream to make it more liquidy”.  This sounded absolutely awful to both Levi and me!  The taste and texture of a concoction like that didn’t sound appetizing at all.

So, I set out to create a meal plan that would satisfy two criteria:

    1) That it would be appetizing to Levi (so that he would actually eat it)

    2) That we could maintain his weight throughout the three weeks

I’m pleased to say that we succeeded on both points! 

My biggest goal was to maintain his weight, which we did.  Losing weight would have slowed his healing, and he did not have any extra weight to lose in the first place.  So, we weighed him every morning, and adjusted his calorie intake accordingly. 

As for taste and enjoyment, we figured out some pretty yummy recipes.  I’m not saying Levi wasn’t tired of liquids by the end… because he was.  Especially soup!  He was a rockstar though, and rarely complained about the situation. 

Now, on to some details about our preparation and execution.  When I learned about his surgery in June, I started to compile some ingredients that I knew we would need.  The hospital had given us a list of ideas for ingredients and recipes.  I used some of the information on there to add to my grocery list ahead of time. 

I knew that some of the meal replacement drinks would be expensive, so I wanted to budget more efficiently.

I also purchased some extra yogurt while it was on sale, and froze it until we needed it.  Just a note, I discovered that yogurt freezes well, but only when the milk fat percentage is quite low.  The higher fat Greek yogurt that I froze was quite runny when I thawed it. 

When we saw the dietician in the hospital right after Levi’s surgery, she didn’t tell me specifically how many calories we should aim for Levi to have each day.  She just said to focus on protein and fat and monitor his weight.  

Those were the guidelines that I operated on, so the following products were purchased with the intent to increase the fat and protein in his meals.  She mentioned that meal replacement drinks (such as Boost) were an option, but were not necessary.  I decided to occasionally use Boost, but I did not rely on it.

In the first couple days of his liquid diet, we struggled to find recipes that would give him enough calories, but were a small enough volume to fit in his tummy.  Many basic yogurts, ice creams, etc. didn’t have enough calories in the volume that he could physically ingest in one meal.  He’s a small kid, so I needed to figure out a way to increase the calorie count while decreasing the volume.  The following list includes some of the products I found that helped with that.

Most of my research was for his breakfasts, snacks and desserts.  Lunch and suppers were always soup, which were lovingly pre-made for us by family and friends.  (Thank you, thank you!!)  Often I would strain the soup, and he would just have the broth.  His favorite soup by far throughout the three weeks was Zumma Borscht (a cream based potato and sausage soup).

He struggled a bit with texture throughout this experience.  He didn’t like soup to be too thick, and he didn’t like smoothies to be too runny!  We worked together to adjust the recipes so they were to his liking.  I wanted him to be vocal about whether it was appetizing to him, because I needed him to eat well and often.

I will post some specific recipes in part two, but I wanted to list some of the ingredients that I found the most helpful.      

Here are some of my favorite finds:

COMMONLY USED INGREDIENTS (and my reasoning for using them):

-            Boost Plus Calories (vanilla, chocolate, strawberry)

o   This formed the base for many smoothies and milkshakes, but I didn’t rely on it as his only source of nutrition, since the sugar content is quite high.  I specifically bought the version labelled “Extra Calories” so we would have more calories with less volume. 

-            Liberte Plain Greek yogurt (10% MF)

o   I was quite pleased to find a 10% MF yogurt.  Along with a higher fat content, it also had some protein, and only 5 g of sugar per serving.

-            Liberte mediterranean dessert collection (9% MF)

o   I purchased four flavors: Coconut, Mango, Apple pie, Key lime pie (there is a raspberry flavor, but raspberry seeds don’t blend or strain well)

o   These were a favorite, since they had a good fat and protein content, and great flavors.  I didn’t have to add much to make them taste good.

o   Note: we did have to strain the coconut yogurt, as coconut does not blend well.

-            Haagen Dazs vanilla ice cream

o   I wanted a high calorie vanilla ice cream, and this hit the mark.  It has 360 calories per ¾ cup serving.  I added it to his dessert milkshakes for an extra boost of calories.

-            Adams 100% natural peanut butter

o   My goal with this purchase was to increase protein without increasing sugar. 

-    Table Cream - 18%

o                           o   I used this to make some base recipes, and easily add calories.  I didn't want to use whipping cream, since I felt that may be too rich and potentially upset his stomach. 

Skim milk powder

o   This was one thing that the post-op sheet recommended.  It adds calories without adding liquid bulk.  I’ll talk more about how I used this in my next post about recipes.

-            Pediasure (only if needed, as it doesn’t have as many calories as Boost)

o   I wanted to love this, since it has less sodium than Boost, but I only ended up used this at the very beginning of our adventure, since I realized Boost Extra Calories was going to be necessary

NUTRITIONAL ADDITITIONS:

-            Nutridom Kids Multivitamin powder (11 vitamins, 6 minerals)

o   We needed a way to give him a multivitamin that wasn’t a tablet or gummy.  We could have dissolved a tablet, but this was much easier to mix into his smoothie every morning.  Take note: the label says “unflavored”, but it definitely has a fruity tang to it.

-            Dream protein (24 g serving has 17 g whey protein isolate, 5.4 g whey protein concentrate and 600 mg inulin) – French Vanilla Flavor

o   We added half a scoop of this into his smoothies now and then.  The dietician requested that we aim for about 30 grams of protein daily, so a full serving of this would have almost met his requirements for the day.  We didn’t need to add that much extra into his diet, but it was nice to have the option of adding protein without adding liquid.

-            Boost Just Protein powder (21 g serving has 18 g protein from whey protein isolate) - unflavored

o   I purchased this as a way to add extra protein into his soups.  It dissolved quite nicely, and didn’t change the flavor of the dish.  Since the Dream Protein (above) was French Vanilla flavored, we couldn’t add it to his savory dishes.  

 I hope this was helpful for those who may be going through the same process, and interesting for those who just wanted to read a bit more about our experience.  

Thanks for your prayers and support during this time... we've definitely felt them!

Stay tuned for Part Two!

Alveolar Cleft Repair: Part 3

Details about the Procedure

In this post, I will provide an accurate description of the procedure that Levi went through.  There are some anatomical images, so just take that into consideration if you prefer not to see those types of images.

 

The term “alveolus” can be confusing, as it is used both in reference to the lungs and in reference to dentistry.  For my purposes, any use of “alveolar” or “alveolus” here is in reference to the bony socket for the root of a tooth.  The alveolar bone is shown in green on the image of the skull.

The following x-ray is not of Levi’s mouth, but it is very similar to how his bone structure looked prior to this repair.  His cleft lip and palate were on the left side of his mouth, with the cleft extending from the back of his hard palate (the roof of his mouth) up through his alveolar bone (gum line).  The repair was necessary to provide bone tissue so that his adult teeth will have somewhere to grow down into.

Here is a very simple image and explanation of what the surgery was all about.  Read on further for a more detailed explanation of what the surgeons did.  

Step one of the repair was to harvest some bone tissue from Levi’s hip.  They used bone from his iliac crest (highlighted in red on this photo).  They used his left side, which conveniently was the side Levi was hoping they would operate on!  We asked why they chose to use Levi's left hip, and the surgeon said that partly it was convenience of positioning during the surgery, but also that most kids are right side dominant.  Using the left side means he will be able to take full strength kicks, etc. with his right leg once he's cleared for physical activity again.  The bone from his hip will take about 5 years to grow back completely. 

The surgeon said the piece of bone they took was about 2.5 x 3 cm.  They also harvested some marrow.  The bone they took was slightly malleable (about the firmness of the green scrubbing side of a kitchen sponge), so they could mold it into the gaps in his mouth.  

The bone was placed in the proper position, and sutures were used to close the gum tissue around it, as is shown in the image below.  The surgeon said Levi has about 100 sutures in his mouth, which are thankfully absorbable.   

Levi is not supposed to brush his teeth right now, but uses both a medicated oral rinse twice a day, and a basic salt water rinse a couple times during the day.  

We are so thankful for the medical team that was involved with Levi’s procedure.  This surgery has been on our minds for a long time now, and we’re happy to have it completed and to move on to the next stage... which is braces!

Currently, we’ll focus on healing and recovery, and then in a few months we will start his braces journey!  

 

For further reading about cleft lip and palate, and more details about alveolar bone repairs, the following websites are some of the most informative that I have found. 

 

https://www.craniofacialteamtexas.com/cleft-lip-and-cleft-palate/what-causes-cleft-lips-and-palates/

https://www.texaschildrens.org/departments/cleft-lip-and-palate-clinic/alveolar-bone-graft

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706037/#:~:text=There%20are%20several%20different%20graft,a%20process%20called%20creeping%20substitution.

Alveolar Cleft Repair: Part 2

 

Our Hospital Experience

We were so grateful to have a private room at JPCH, something we haven’t had the pleasure of experiencing in his previous surgeries!

There were a few added amenities which were a nice touch (such as a mini fridge, a desk and a double bed for a parent), and it was so nice to have a quiet space for our three days in the hospital. 

We made good use of the mini fridge, so we did not have to purchase any food while we were there.  We brought sliced meat, cheese, lettuce and tomatoes to make sandwiches for lunches, along with some veggies and fruit.  For suppers, I had baked a pizza at home, and brought along some slices.  We found a microwave in a communal family room at the hospital, so we warmed them up there.  I brought muffins and fruit for breakfast, and some extra snacks for throughout the day. 

 We settled into our room fairly quickly, and made sure Levi was comfortable in his space.  We had brought a variety of activities to keep him entertained, including new books, a few card games, an old iPod loaded with audio books and our Switch.  The Switch was by far the most popular activity, since we had specifically purchased Minecraft for just this purpose!  He’s quickly become a big fan!  His hospital room also had a screen with access to Netflix and Prime Video, where we found a couple movies to watch. 

When he wasn’t playing games or watching shows, he was doing his best to stay rested and hydrated.  He had an IV in his arm that allowed for a continuous fluid drip.  This ensured that he stayed hydrated despite a very sore and swollen mouth.  Once he was feeling up for it, he was allowed to start taking in some clear fluids.  This meant lots of apple juice! 

The technique for eating and drinking after an alveolar cleft repair means that Levi has to take everything in via a syringe.  The goal with this method is to avoid having any food touch the surgical site in his mouth.  The surgeon said there are about 100 stitches in his mouth, and we don’t want anything getting trapped in that area, or disturbing the graft site.  Since the surgical site is quite large and encompasses the roof of his mouth and the left side of his gum line, he uses a medical syringe with a soft piece of tubing attached to the end.  He tucks the tubing into the right side of his cheek, and swallows from there.  He can have anything to eat or drink, as long as it can go through the syringe.

The nurses were not very familiar with this type of surgery, and it turns out that there is nothing designed for this type of feeding, so we worked with the nursing staff to figure out a system that worked.  We experimented with different sizes of syringes and tubing until we came up with something that worked.  As a reference for any families with cleft kids, we discovered that a 60 mL syringe with a narrow end, paired with ¼” diameter soft blue surgical tubing worked the best.  They allowed us to cut the tubing to the length we needed, and sent us home with a roll of it so we would have enough to last for his whole liquid diet.  They also provided us with several extra syringes. 

During the process of figuring out the feeding system, we found that it was very important to advocate for ourselves and for Levi.  The nursing staff relied on us to tell them what worked for Levi and what didn’t, so it was important to speak up. 

We had a consultation with a dietician as well, which was very informative.  Levi’s liquid diet will last for three weeks, and it is important that we do our best to maintain his weight.  She discussed the importance of fat and protein to increase the calorie count in his meals.  Low fat liquids take up space in the stomach without actually providing needed nutrients.  She reminded us that there are taste buds all the way down a person’s throat, so it’s important that the foods we are giving Levi still taste delicious!  I will write a separate post about the recipes we are discovering as we learn about this liquid diet. 

On the day after surgery, Levi was upgraded to a full fluids diet (which is different than a clear fluids diet).  This meant that he could have some runny chocolate pudding, things like Ensure, and some strained soup.  He enjoyed having some ‘real’ food after such a long time!

Along with keeping Levi’s mouth healthy, we also had to keep an eye on the incision in his hip, where the bone graft was taken from.  His hip was quite sore to begin with, so we had him walk only as much as tolerated.  When the nurse changed the bandage and cleaned his incision, everything looked really good!  The incision is about 3” long, and seems to be healing well.  He’ll have a bandage over it for a couple weeks, and will avoid submerging it; only having sponge baths and careful showers for now.

His pain level was managed with Tylenol and Ketorolac (an NSAID, like ibuprofen, but a bit stronger), and he was also given antibiotics via his IV. 

At home, he is still taking regular Tylenol, but was given a prescription of Naproxen to replace the Ketorolac.  He is doing well with these pain meds, and says he has no pain in either his hip or his mouth.  He is sleeping well, and we are figuring out the meals that work best for him.   

It’s been a learning experience as we walk through this process.  I’m enjoying the challenge of creating delicious, healthy recipes for him, and we are forever impressed with the resilience Levi displays through all of these adventures!

Alveolar Cleft Repair: Part 1

 

The Surgery

We arrived at JPCH at the requested time of 11 am for check in.  Levi had been fasting (from both food and water) since 8 pm the night before, so he was slightly hungry and thirsty but was easily distracted by some card games and video games. 

We waited and waited for information until finally being told that his surgery wasn’t actually scheduled until 2 pm.  It was a bit discouraging, but we were prepared to wait, so we broke out more games. 

By around 1:00 Levi was incredibly hungry and we were all eager to get the show on the road!  At 1:30, we were brought into a room (the same room that he would recover in after his surgery), and waited for the surgical team to prep the surgical suite. 

Through all of this, Levi was incredibly calm and composed.  He continually impresses me with his strength in the face of uncertainty and fear.  He is one strong, brave kid.

Shortly before 3, we met with the surgeon, the anesthesiologist and the nurse.  They answered all of our questions, and brought us into the holding area where parents can say goodbye to their children before being rolled into the suite itself.  The surgeon said the surgery would take about 2 hours, and gave us all the final details of the surgery itself.  (We had learned all this information prior to this day, but for consent purposes, he had to repeat the information).  I signed consent, we prayed with Levi, and gave him a big hug.  Ryan and I were brought back to the family waiting room, and Levi was brought into the surgical suite.  

Ryan and I spent some time in prayer, then settled in to wait for the surgeon to come find us and give us a report.  

At 4:20, the surgeon came smiling into the family waiting room.  He was finished early and said that everything went incredibly smoothly.  He was very happy with how it all came together, which was so good to hear! 

We waited a little while for Levi to wake up from the anesthetic, then the nurse came to bring us into the recovery room.  Levi was pretty groggy, and a bit shaky but he came out of the anesthetic without any major complications. 

We were brought up onto the Pediatric ward, where there was some confusion as to what room he would need to be placed in.  The nurses on recovery did not realize that when a patient is sent up to the Peds ward with a PCA pump (patient-controlled analgesic pump) that the patient needs to be in an Observation room.  We got that figured out, and got Levi settled into his room.  He almost immediately relaxed into a nap, and rested for a good chunk of time. 

This allowed Ryan and I time to get our things organized in his room and prepare ourselves for the next stage of the process, which was recovery!

 

I will follow up this blog post with several others about this experience, including details about the procedure itself, our hospital stay and the recovery process at home.  Some of this information may not be of interest to the general public, but I hope to provide a resource for families who may go through this same experience in the future.  There are plenty of informational websites about the details of the procedure, but I found very little information about the process and recovery from people who had actually experienced it.  I hope that writing our experience out will be helpful to those searching for information!

Thanks for reading!