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.