Diet and supplements with an ileostomy?

I'm getting an ileostomy soon (just had pre-op) and have already had a total colectomy. When I went for the pre-op I was sent home with packs and packs of Fortisip liquid food supplements. They said they give these to every patient, to use just a few days before and immediately after ileostomy surgery, but they advised me to go to my GP and get these on prescription for longer, as I am very underweight. My surgeon said the same thing.

My GP, however, told me I have to have them prescribed by a dietician because there are so many different kinds and she said she is not qualified to work out my exact nutrient needs, carbohydrate/protein ratios, whether I need supplements with or without fibre, and a bunch of other stuff. She also said there are so many flavours and different consistencies (milkshake or juice, etc.) that she can't make a decision on what to prescribe.

I've had supplements plenty of times in the past (though not from this GP) and they just gave me standard supplements. After my pre-op the other day, the nurse gave me standard packs to take home, letting me pick the consistency and flavours I like (which I already know from having them before). Neither the doctors at my pre-op nor my surgeon raised any issues with which type of supplement I got.

Why does my GP want me to see a dietician? Is it that hard to pick a type of supplement? I have no special dietary needs other than being underweight and needing more calories. My diet is pretty balanced and healthy, just lacking in calories. Is my GP over-complicating this?

Either they really care and want to ensure you receive proper nutrition and don't feel qualified to make that decision or they are lazy and don't want to be bothered with deciding what's appropriate. I would hope its the first scenario!

Hi unXmas i was on these for the week i was in hospital after my op.before my op i had something similar to these but they were carbohydrate drinks given to me by a nurse who had me on a rapid recovery program,i have been on fortisep milkshakes before but my gp wouldnt prescribe them due to telling me they were "to expensive" so was given enjuice which were ghastly,i went to my dietition and she prescribed me the milkshake ones which were a lot nicer.flavour wise thats down to the chemist to order what flavours you require,as to fibre,i would say less fibre is better,or certainly with my case anyway,i had illiestomy op 2 weeks ago.i never got a prescription when i left but i assume thats coz im fitter and healthier and havnt lost any weight post op.

Go back to your GP,just tell them you want ensure,fortisep MILKSHAKES and take the prescription to chemist and ask them for what ever flavour you fancy,personally i go for banana chocolate as they are the best tasting....

hope you get this sorted soon

Craig

nogutsnoglory said:

Either they really care and want to ensure you receive proper nutrition and don't feel qualified to make that decision or they are lazy and don't want to be bothered with deciding what's appropriate. I would hope its the first scenario!

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She's definitely not lazy, and I think she genuinely does care. She already scheduled me into appointments with her so that after I see the dietician I can report back to her. Maybe she cares too much and thinks seeing a dietician will get me better advice than she feels she can give?

hainman - I agree the milkshakes are much nicer! My GP's more concerned about the fact that the products vary widely in their nutritional content, I don't know why she thought picking between milkshake and juice and choosing flavours would also be a problem. I can't get repeat prescriptions without her consent though - I tried telling her I was happy with any flavoured milkshakes in my appointment, but she insisted it's not that simple. I've got standard ones for now to keep me going before I see the dietician, but for prescriptions after that I've got to go with whatever the dietician recommends.

ye they actually taste pretty nice,my gp wasnt awkward as such but it was a faff to get the right thing,once you have had 1 prescription i would have thought you could just ask them for the same one,i know thats what i do,Defo would stay clear of any high fibre ones,tell the dietitian you just want ensure milkshakes,not the high fibre ones and they should be ok,my dietitian is pretty on the ball that way...

With colectomy, I lost a lot of weight while in the hospital and my surgeon also had a dietitican come talk with me. I think this is a fairly common thing with bowel surgery, particularly when underweight.

Its very important to be having lots of protein in the supplement drinks so Ensure, Twocal are used here in Australia. I think fortsip is high protein too. Keep protein in mind cos even if you are not underweight (as is my case) it is essential for healing afterwards. That is probably why your GP wants you to see a dietician to make sure you are getting the best. Also I guess to ensure the rest of your diet is as good as can be (or as you can manage).
Post op, you will most likely be seen by the dietician in the hospital who can suggest the best supplements and also will advise you on what you can and cannot eat in the first few months after getting a stoma. I still have the sheet from my dietician so if you need any further info after your op I can look it out. Just ask away.

Thanks annawato. It seems like my GP is not over-complicating things at all then. I should have more faith in her as she does seem to know what's she's doing!

The main thing is you get proper care and sometimes it means inconvenience and jumping hurdles. That doesn't make a bad doc, on the contrary that can make a very thorough doc who wants a complete medical profile on which to make decisions. I know we are all just ready to be over this and feel good already but what's a little more inconvenience on our parts if we are close to finding our personal solution.