Vegetative State: Special Diet needs
 

Hello, all. This may be a new idea for this site but even an incapacitated person has diet needs and some of you may be able to help with suggestions, past experiences, family, maybe friends who've had a loved one hurt in a similar manner. So give and take with me when you're able to. Obie.

Hi Obie,

I'm a neophyte too having joined the forum 2 months ago so welcome. Being a Scot could you explain what the term 'foopah' means and how is this, in anyway, connected to dieting? Without knowing more about your indisposition it is not easy to know how best to advise you. Is your incapacity temporary or likely to be permanent?

I had a granddaughter who was severely disabled so I'm not without an appreciation of the skills and demands required in managing those of limited or restricted capacity.

Looking forward to hearing further from you.

Hi, Duparc. Well, for me, a foopah is a mistake; probably a foolish one. And actually my Lady was hurt by Hospital staff who did not attend her properly after the Docs over medicated her. She was left alone as she went down beyond her ability to bring herself back. When they finally went back to her room they found her with blue lips and fingernails. Of course, they pushed the button but she was left with a severe brain injury because of lack of oxygen. That was on 2-19-04.

I joined this list looking for others with similar problems to discuss dietary needs with. My Lady and I are vegetarians who eat a bit of meat infrequently and that's how I'm feeding her presently. She was Diabetic and had Blood Sugar considerations that I've dealt with using a LoBAG-type diet but she'll loose weigh too fast if I don't beef up her diet a little before long. Thanks for asking. Obie.

Hi Opie,

i've got a few questions.

is she able to eat normal, or does she take food through a tube into her stomach? and what is a LoBAG-type diet? is her diabetes well controlled on her current diet?

thanks

Duh!
 

and what is a LoBAG-type diet? is her diabetes well controlled on her current diet?

never mind, a little research goes along way. google is a good thing.

Hi, Babe. As a matter of fact, yes, she has a PEG Tube. And yes, I'm controlling her Blood Sugar with diet which contains 43 different elements for each meal; I think she's the best fed person in Arkansas. Presently, her Bl/Sug is in the low 1-teens and I'm satisfied. When she went into Hospital, she weighed 292 pounds. I think she's presently about 170; probably gonna go to around 135-140. When I get there, though, I need to have a plan to stop the weight loss without spiking her Blood Sugar; don't want to have to do Insulin for her.

We recently added something from Dr. Christopher called Pancreas Panacea. It contains a special Cedar Berry that he found repairs the Pancreas and returns it to normal in about 6 months.

LoBAG stands for Low Biologically Availale Glucose. A LoBAG Diet is a new idea that emphasizes low carbos; in fact it recommends, I think it is, 20% carbs, 30% protein and 50% fat. I don't prefer those numbers but I do like the low carbs. Back to you, Obie.

You have raised a delicate question indeed regarding the diet of your wife.

Firstly, allow me to commiserate with you and your goodlady and to share our common commiserations as on the same date I lost a 45 year old daughter to BC.

I'll quote a couple of anecdotal tales which might help in deciding on an appropriate diet and possible treatment.

I was a fit man until around the age of 43. At this stage I adopted vegetarianism. Around the early stages of this diet health problems began to arise which I put down to middle-age rather than the diet. At the age of 58 I had to have an emergency quadruple by-pass after being on the diet for over 16 years. Prior to that I had suffered from other ailments that required surgery but at no time did I suspect that there may be a connection between the diet and my accruing health problems.

On recovery from the cardiac operation I resolved that if I were about to die that I was going to die happily, so abandoned all care and took to saturated fats. I returned to bacon and eggs for breakfast cooked in animal fat (dripping/tallow) with fried fatty-steaks, chops, stews, and etc at other meals. Much to my amazement not only did I recover rapidly from the post-operative effects of the operation, but, today, some 16 years after the operation, I am in remarkably good health with no aches nor pains, off all MDs prescription pills, and continue to believe, and feel, that I still have a future! Had I left my care to the medics or nutritionists I'd be dead by now. Reading Aitkins and others came later.

My daughter who passed away on February was 5' 9" tall and size 24! She was a city-dweller who lived on so-called healthy fast-foods cooked in the microwave.

The indisputable evidence that is arising today is that insulin is a killer, and, so too, are almost all fats/oils that are not saturated and probably all processed foods. Using the microwave for cooking is also suspect.

Because of your goodlady's indisposition I would be hesitant to subject her to a diet that is too low in carbohydrates which could cause severe constipation so that's a no-no! Neither you nor her need this additional problem. However, a reduction in carbohydrates could go towards improving her condition.

Not only have I been honing my diet over the past years but for the last 10 years I have developed an interest in pharmacology and would like to make a couple of suggestions to you (off topic) which might be of some help to your wife. If you adopt them, then you do so at your own risk, but, I am unaware of any known risk from them.

Your wife may be getting Phenytoin to help relax her muscles but this drug has a wider utility of which most MDs are probably unaware. If she is not being prescribed this drug then it is worthy of consideration. Not only will it help to relax her physically but will also help her emotionally.

Add ubiquinone (CO-Q10) to her diet. Purchase the dry substance and add it to her meals at around 100 mgs 3 times daily. You might wish to take some yourself to increase your own energy level.

There's an old and well researched drug on the market that again has a broad utility, yet, paradoxically, it has not been fully tested; it is Hydergine. Your MD may recognise this for use in cases of senility which is rather regretful. It is a very useful brain preservative and can cure heavy snoring and ADHD-like behaviour and it is certainly worthy of testing it on your wife at 4.5 mgs x 4 daily (or approximately every 5 hours).

Those substances are benign, non-toxic, non-addictive, they are not narcotics, and generally are not contra-indicated. I take them on my own volition and have done so for the past 10 years and I have experimented with them and hence the reason why I feel reasonably confident at recommending them to you. If your MD dismisses them then they can be purchased on the open market if you feel sufficiently confident to do this.

I recognise that you might be slightly overwhelmed at this advice, but, the discretion is solely yours whether or not you wish to adopt it.

Both you and your goodlady have my very best wishes.

PS The word queried, 'foopah', should read 'faux pas'.

hi obie,

hope you had a nice christmas.

i should explain that i'm a nurse and have worked for thirty years in neuro intensive care units. i have, i think, a very good picture of your plight. about your lady's tube feeding - do you make it yourself or do you use one of the canned products? and echoing duparc's mention - how are her bowels? (well, let's face it, what goes in must come out and we don't want to mess with a system that's working).

If you haven't use fitday.com, you might want to look at that site. it's a nutritional database, you put in your info and it gives you a detailed report of the nutrition. most people just use the fat, carb, protein report but it also reports vitiamins, minerals and the rest.

right off the top of my head, the easiest way to gain or stop losing weight is, of course, to eat more calories. doing this without affecting her blood sugar is the tricky part. protein shakes come to mind first.

dr weil, in prevention magazine this month (Jan i think) has an article on supplement drinks. i'm at work now, but i can find it if you think it might be handy.

i hope this helps.

Hi, Babe, thanks for the post. Actually, my Lady was a RN also, Certified Nurse Midwife, loved it, worked L&D, Nursery, Mother/Baby for 40 years. She trained in England, was always whisked to the front of the line because of it. When we married, she had this sweet little English brogue.

Christmas? Well, there wasn't much of it; neither Thanksgiving, Halloween, July 4th, Easter. A Naturpath and I share 4-6 hour shifts per day. I work 7:30a to 1:30p and 7:30p to 1:30a each day, haven't had a day off since 4-14, don't have much time for anything but to take care of my Lady. Good thing I enjoy this, huh?

And I watch her BM's pretty close. In fact, I've thought for some time that we all need more fat, good fat, than we're getting. I've been adding more fat and plenty fiber to her food and it's really paying off. In fact, I'm feeding her food, not the canned stuff; not into manufactured food. I learned that the cans contain maltodextrin, I think the sweetest sugar there is. It's what they gave her in Hospital, literally drove her Blood Sugar sky high, took a sample evry two hours or so, stuck her with Insulin day and night. Amazing what they'll do; even to their own.

Anyway, don't mean to sound bitter but this was the sweetest woman I've ever known and she just lived to serve the Doctor, assist the patient. And she never had GI troubles of any sort, doesn't today.

When I brought her home, Hospice began helping me, soon they were making demands on me aboutr her diet so I went to the USDA Nutrient Values and I charted every element I feed her. Her meals use over 40 elements for each meal. I prepare 6 meals at a time twice per week and she fasts one day per week presently. If you'll furnish an e-mail address here or to obie~ozarkisp.net, I'll send a copy of her Food Plan, her Daily chart, other documents I'm using for her care for you to see.

And I'm under the impression that I should be careful about adding too much Protein. For example, today she got 48 grams of Protein and my Daughter mentioned that an active adult woman needs about 46 or 47, I think she said. So, yes, I'm going to have a time of it trying to get more calories without adding too much of something else. I only hope the repair I'm atttempting on her Pancreas will kick in at about the time her weight gets down further and that we'll have that help also. And she's loosing weight, too. She was 292 when she went in Hospital, and she about 170 now. And I'm starting to check off sort of the things that were wrong with her; such a good feeling.

Well, sorry, didn't mean to write a book. Let me pass it back to you and I'd like to answer Duparc's latest post. Regards, Obie.

not, it doesn't sound like you've had a good year, so far. i do agree with you about the canned tube feedings. you can smell the sugar and chemicals coming off of them when you open the cans. it always made me wrinkle my nose.

i must stress i am not registered dietian (can't even spell it right!) so this is all unoffical, kinda off the cuff things that have past through my mind while taking care of patients in coma. i've always thought that patients in coma expend more energy that we realise. they often are in constant motion, hard muscle clenching or extending movements, the work of breathing is often harder and since they don't go into real stage 4 rem sleep, they can't rejuvenate their body. and thus they have greater caloric needs than people realise. i don't know if this is true in your case.

i think as long as her kidney function is normal; that is she puts out about the same amt of fluid that goes in, and her BUN and creatinine(measure of waste products in the blood and how well the kidneys clear it) is normal, it should be ok to add some protein. in my hospital normal BUN is 8-20 and creatinine is 0.4-1.2 but labs vary and so the normals may vary a little from place to place. the drs (can't think of their name right now) who wrote protein power have a formula for figuring out daily protein need. i see if i can find it. but i think any changes you make should be slow and easy.

and, forgive if i sound nosey, but you sound tired. when was the last time you slept more than a few hours? or had a day off? trust me here, i work night shift, and know all about sleep deprivation. i know this is a labor of love for you, obie, but you must take care of yourself too.

i'm sending you my email. i would be greatly honored to see any of her paperwork you would like to share.

me again
 

there is a little problem with your email obie~ozarkisp.net, should it be obie~ozarkisp.net?

thanks

Duparc, I wanted to respond to some of the items in your last post, sorry for the delay. And I hated to hear you lost your daughter; 45 is just too young to pass away, although My Lady saw them go as young as 36-37, those to a wasted life, mostly, unless they were in accidents of some sort.

Now, as to the Drugs you mention, permit me to admit that I'm definately into the Alternative Camp; don't like pharmaceutical drugs. I'm sorry if others feel I'm too severe in my contemplation of what has happened to us but not only did they do this to us, it appears that they did it on purpose, changed a $30,00 Hospital trip into one costing $185,000, they left us with absolutely no assistance whatever; just "Get her out of this Hospital of we'll move her ourselves tomorrow", and that after they had purposefully over-medicated her, then left her alone to go down all by herself, then used their magic to make her conditions worse than they had ever been.

The Phenytoin, also known as Dilantin, is a seisure medication guaranteed to result in Hepatitus and Toxic Epidermal Necrolysis. The Hydergine, also know as Dihydroergotamine Mesylate guarantees Bradycardia. I really don't think I can go there with her. She's never had Liver-Kidney conditions or heart trouble of any kind and I hesitate to chance these kinds of reactions. I appreciate your suggestions, though; I know you mean well. We're just not into drugs for these very reasons.

And thank you for your best wishes. This experience is a frustrating experience that will just not go away and I appreciate the interaction with you.

And by the way, I don't object to correcting my spelling or usage but you should know that I'm a Conversational Editor and I'm from Texas, find humor in almost everything; including the way I spell some terms. Best regards, let's post again, Obie.

Duparc, I wanted to respond to some of the items in your last post, sorry for the delay. And I hated to hear you lost your daughter; 45 is just too young to pass away, although My Lady saw them go as young as 36-37, those to a wasted life, mostly, unless they were in accidents of some sort.

Now, as to the Drugs you mention, permit me to admit that I'm definately into the Alternative Camp; don't like pharmaceutical drugs. I'm sorry if others feel I'm too severe in my contemplation of what has happened to us but not only did they do this to us, it appears that they did it on purpose, changed a $30,00 Hospital trip into one costing $185,000, they left us with absolutely no assistance whatever; just "Get her out of this Hospital of we'll move her ourselves tomorrow", and that after they had purposefully over-medicated her, then left her alone to go down all by herself, then used their magic to make her conditions worse than they had ever been.

The Phenytoin, also known as Dilantin, is a seisure medication guaranteed to result in Hepatitus and Toxic Epidermal Necrolysis. The Hydergine, also know as Dihydroergotamine Mesylate guarantees Bradycardia. I really don't think I can go there with her. She's never had Liver-Kidney conditions or heart trouble of any kind and I hesitate to chance these kinds of reactions. I appreciate your suggestions, though; I know you mean well. We're just not into drugs for these very reasons.

And thank you for your best wishes. This experience is a frustrating experience that will just not go away and I appreciate the interaction with you.

And by the way, I don't object to correcting my spelling or usage but you should know that I'm a Conversational Editor and I'm from Texas, find humor in almost everything; including the way I spell some terms. Best regards, let's post again, Obie.

Babe, did I indicate an ~? Sorry if I did but your post came right on through. In fact, I'll go now and assemble that packet for you.

The board automatically replaces all "at" symbols with the ~ to reduce the chance of spammers getting hold of your email address.

Best wishes to you and your Lady, Obie.

Em

EmmaB, thank you; very thoughtful of you to assist me with that info. I'd have never figgggered it out for myself. I like the name Emma, My Lady's sister's name is Emma. Thank you, again. Obie.

Ms. Scruff, thank you for the contact. Your picture makes you look like such a cute person. Do you have questions about my Lady's condition or her needs or can I assist you somehow? And your stats make it look as though you're right on track. My Lady was 292 at one time, kept putting it off, was kinda cavalier about loosing weight, having Uterine Ca, low pH, high Carbo diet, et cetera. She's at about 170 right now; can't really weigh her presently. More if you'd like it. In Arkansas, I'm Obie.

hi
 

hi obie,
i'm still here. ihad to go out of town for a family emergency, and when i came back i found i could't use yahoo mail. go on line yes, get yahoo mail to open no! sigh. so i will read your files when i can yet the darn this to work right.

Obie;while I recognise and appreciate your reluctance to try the substances mentioned in my previous post I cannot, however, understand where you possibly could have gained the knowledge on their side-effect.

Had those drugs been 'guaranteed' to cause the side-effect you mentioned, my guess is, that they would have been removed from the market. Any side-effect recorded to date has been mild and in the decendancy. Their record of use shows they are benign and probably less detrimental than the 'alternatives' you utilise. I do not wish to be seen to be taking you to task but simply wanted to correct your mis-information. Those drugs have a much wider and beneficial utility to that for which they are prescribed.

Hi, Duparc, and good to hear from you again. And no problem, I'm glad to explain. My Lady was a 45 year RN and her Medical Bible was the current Nursing Drug Book. I suppose every Nurse has one.

The data I relayed came from that publication; about as "official" as one can get. In the very front of the book, in the How to Use This Book section, Page 4, is reflected "The most commen adverse reactions [those experienced by at least 10% of the people taking the drug in clinical trials] are in italic type; life-threatening reactions are in bold italic type; and reactions that are common and life-threatening are in bold capital letters". Now, one can only guess which type the data I supplied happened to be reflected in.

And the "alternatives" you mention, Duparc -- I mean, I've had Doctors actually advise me to be careful with Supplements. My reply is always that Supplements are actually, roots, leaves, berries, flowers; they're food.

And since we're having this discussion, I must remember that my original purpose in originating this thread was to seek to improve on her low-Carb food plan. For instance, I don't know how to figure the LoBAG calculations so as to arrive at the recommended 20%, 30% and 50% levels of Carbs, Protein and Fat; need some help with that. If you can assist me, please do but no more drugs; don't want to practice medicine in any regard whatever.

Thanks for your post, always enjoy hearing from you. The best, Obie.

Oh, by the way, my Lady's Blood Sugar is improving and I want to ask how many Calories, Carbs, Protein, Fat and Fiber she should have, if any of us know or have an idea, please. Obie.

Okay Obie, I gave the advice gratuitously as 'off-topic'.

It is not easy to be definitive about LC dieting as there are variations but as a 'rule of thumb' the LC diet should consist mainly of fat and protein (saturated fat is usually regarded as the most nutritious) with some vegetables, preferably dark green. Thereafter, it can be varied according to personal requirement. Adding fiber is a matter of either need or choice The theory is (and this is being substantiated by some interesting research findings) that the lower the carb intake the greater the health benefit.

The percentage of fat to protein, in general, is a matter of personal choice although there is a lot of theory surrounding it. If you wish to lose weight take more protein and less fat; if you want to stabilise weight then reverse this. The more fat the higher the satiety. Carbs play a small part in the diet and no more than that. Vegetables in particular are recognised for their additional nutrient value.

From my own experience I enjoy a very low carbohydrate diet but seem to need some carbs. Whenever I try to do without carbs I lose the 'feel-good' factor both physically and mentally. Others on low-carbing will have variations to this view but the general 'thrust' will probably be seen as about right.

I hope this will be of assistance to you.

Nice to hear of the improvement in your wife's health.

I would highly recommend (especially since you are using a vegetarian diet) using Spirulina algae as a protein source. It contains high levels of naturally occurring B-12 (normally lacking in the vegetarian diet) and beta-carotene.

2 tsps. (6 grams) contain 4 grams of protein at 20 calories and the following percentages of the recommended daily value.
360% - Vit. A (as beta-carotene)
2% - Vit. E
30% - Vit. B1
35% - Vit. B2
2% - Vit. B3
10% - Vit. B6
230% - Vit. B12
8% - Iron
6% - Phosphorus
3% - Magnesium
14% - Chromium

and other stuff

Duparc, thank you. I wonder if you have a feel for a range of gram volumes for Protein and Fat for an incacitated person about 160 pounds who is doing well ["...well" meaning she's maintaining a B/Sugar about 115] on 55 Carbs per day. My problem is I don't know how high to go on these two nutrients and I think over 45 or so grams of Protein per day may put a strain on her Liver/Kidneys and something inside says "Don't go out of sight on the Fat". Back to you, please. Obie.

Hey, Cindy, thanks for the post. Let me ask if you have a take on Whey Protein at all? Of course, I'm using as natural a diet as I can for her and each element [45 in all] contributes some Protein in most cases. Then as I'm completing it, I add up the figures and if I need more of something like Protein, I add the Whey presently. Maybe I should add her Meal Plan as an attachment; don't know how exactly, just yet, but it's pretty cool.

Do you know how to do that, can you help with this? I think you'd like to see what I've come up with, let you see exactly what I'm in the process of doing. Obie.

Link to a possible source of helpful information regarding feeding tubes
 

Obie,

I'm very sorry to hear about your wife's condition, and I hope that you manage to find the resources you need to feed her the best diet you can.

I'm a brand new LC'er (just started this type of diet on Jan. 4th), so I'm certainly not qualified to offer up any real advice as to diet related concerns.

This being said, my uncle was diagnosed with esophageal cancer last February, and had to use a feeding tube as well, and as part of my efforts to help my Mom and my aunt figure out things with the whole feeding tube routine, I came across a website called "Kathy's EC Cafe" http://www.eccafe.org/index.html and within that website, I stumbled upon something else called ACOR EC Group Discussions, where I found a wealth of information on feeding tubes and nutrition. Here's a link to the ACOR EC Group page:

http://www.eccafe.org/ecg/index.html

Once I signed up for this particular newsgroup, I was able to search for posts about the whole feeding tube routine, and discovered lots of helpful things.

I read all sorts of hints, like how to clean the tubes properly (use club soda if there's residue on the tube), adding protein powder, green powder and essential fatty acids and the like. Much of this info that I found was passed onto my Mom and my Aunt who were doing most of the caretaking. My uncle was rapidly losing weight, and we needed to get as much nutrition happening as possible. Without going into too much detail, I just wanted to pop in here and suggest this possible resource for you.

By the way, my uncle was diabetic, so we had to scramble to find things to feed him since most of those canned formulas were very high in sugar. Furthermore, the canned stuff...well it gave him intestinal discomfort many times as well.

Wishing you the best in finding the best foods for your wife.

citrus

Dear Citrus, I just signed up for the ECOR Group and "Thank you" for that referral; I'm sure it will be valuable. I'll try to keep you posted as to how I do. Obie.

Obie, the good news is (which is contrary to many cherished beliefs) that natural protein and fat (nothing processed) is not harmful to the liver or kidneys. Your goodlady, however, requires specialised care which takes us into another arena.

I suspect CitrusKiss may have directed you to possibly the most appropriate forum for your needs.

My thoughts are with both you and your wife at this moment and you have my very best wishes. Would loved to have been of more assistance but don't think it would be appropriate to do so.

Kind regards!

Hi Obie,

Glad to hear you signed onto ACOR's EC Group mailing list. Now the thing is, there's going to be a lot of information in this mailing list that isn't exactly relevant to you, and the posted information on that list can get rather depressing.

However, because this group of people often utilize feeding tubes and are concerned with nutrition, (particularly because many are also dealing with a compromised digestive system, due to cancer), there just may be a wealth of information in this list for your own needs.

Here's another suggestion, to help tailor your research efforts.

Because you've signed onto the mailing list, you'll be allowed to search the archives, and of course, you'll be able to narrow your search to just feed tube and/or nutrition issues.

Here's the link for the archives page:

http://listserv.acor.org/archives/ec-group.html

From there, click on "search archives", and another page will come up, prompting you to enter keywords you'd like to search for. You can type in "feeding tubes" and things like that to read all the archived posts around this particular issue.

This way, you won't be bombarded with "too much information" about all the facets of dealing with esophageal cancer, which isn't relevant to you.

Another thing you might want to try, is a google search on "feeding tubes" and "feed tube nutrition" and anything else you can think of. Instead of "searching the web" from google, or searching "news", click on "Groups", which will provide results of bulletin boards, newsgroups and mailing list discussions about whatever you typed into the search bar in google.

There, you'll find all sorts of people dealing with feeding tube situations, and they will have lots of information too.

I like looking through "groups" because there I can read about people's actual experiences with things rather than just commercial websites that might pop up in a normal "search the web" type of search.

Not only will you find information on nutrition, you'll also find information about the various types of feeding tubes, the types of pumps available, how to clean them, regulating the flow of the feed and maintenance issues such as how often these tubes need to be replaced.

I hate to suggest this, because again, the topic is depressing, but another thing you could do searches on, is the term "cachexia", which is an awful side effect (to put it mildly) of those who are bedridden with late-stage cancer. If you can manage to skim over the bad things about this, you will find information on how to stop overly quick or dangerous weight loss, and often you'll find good information on nutrition, and in lots of cases, in conjunction with the use of a feeding tube.

By the way, one of the reasons those canned formulas are good for feeding tubes is because they've been manufactured to have just the right viscosity for the tube, reducing residue and possible clogs. However, you're going to want one that is high calorie, and finding one that works might take some trial and error. If you have the time, you can puree home cooked food in the blender...and you'll find info on that as well in the EC Group archives. Or, you can "better" the canned formulas by adding protein powder and/or "greens" powder or what have you. This being said, you always have to keep in mind the viscosity of the fluid, and how to keep the feed tube system clean. But like I said in a previous post, you can use club soda to really clear out the tube instead of just plain hot water. You'll want to use hot water all the time, and after using hot water to sterilize the tube after a feeding, you can then clear out any remaining gunk (residue) with the soda.

Anyway, hope I haven't bummed you out or gone on too much.

Just hang in there, and keep researching - you'll find the information you and your wife need.

Best wishes,

citrus
PS - edited to add: if you go to Kathy's EC Cafe, and then click on the ACOR EC Group page from there, you'll find a page which gives you some simple hints about using the ACOR EC Group - one which might help you out is how to stop receiving the "daily digest" in your e-mail inbox every day - which may just be way too much information for your purposes. However, you'll still be a member of the group and be able to do searches of the archives (as I indicated up top in this post) for all feed tube and nutrition issues. I thought this might be a good idea in your situation. I think there's a link on the EC Group page of Kathy's EC Cafe to "turn off" the daily mailings, as if you're on vacation or what have you, without actually unsubscribing to the list - thereby leaving you with the ability to search for what you need. Good luck :)

PPS - if not in the EC Cafe website, there'll be a link to "turn off" the daily digest in the "daily digest" email itself - should be at the beginning (within the first couple of paragraphs) of the email from ACOR's EC Group email that you are probably getting everyday now (and perhaps don't want).