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Exercise Before and After Myeloma Treatment: What You Should Know

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Published on August 1, 2018

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Exercise and nutrition are important components to long-term health for everyone but are there specific tips for myeloma patients? Can incorporating simple lifestyle changes improve and maintain good bone health? A panel of experts, featuring physical therapist Melanie House and dietitian Alexa Welch, both from University of Iowa Hospitals and Clinics, provide guidance for individuals looking to increase their overall health through diet and exercise. The panel discusses proper nutrition, exercise and physical therapy for pre- and post-transplant patients, a review of supplements, along with answers to many of your exercise and diet questions. Jim Bond, a 26-year myeloma survivor, also shares his perspective on how diet and exercise has influenced his journey. Tune in to find out more.

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc., Celgene Corporation, and Takeda Oncology for their support.

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Transcript | Exercise Before and After Myeloma Treatment: What You Should Know

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Greetings. I’m Andrew Schorr, coming to you from Quebec City, Canada. Delighted to be here and hopefully, some of our Canadian friends are on with us. We're gonna go around the U.S. as well with some leading experts in this important Patient Empowerment Network program, produced by Patient Power, and the program is Exercise and Nutrition Before and After Myeloma Treatment: What You Should Know.

And we have some very knowledgeable experts who will fill you in. So, take notes, it's stuff you can discuss with your caregiver if you're a patient, with your family members and for you to know so you do as well as you can living with myeloma, whether you are going through treatment, like transplant, or on multiple drugs.

Lots to talk about, and we have received many of your questions already, but if you have a question, send it into [email protected]

I want to thank the companies that have provided financial support for this program, we are very grateful to them. They have no editorial control, but they want support the myeloma community. Those sponsors are AbbVie Incorporated and Celgene Corporation and Takeda Oncology. So, thanks to them.

All right. Ready to get started? Let's go first to Cleveland, Ohio, where he's joining us by phone and that is my friend, Jim Bond. Welcome back to our program. Thank you for being with us, Jim.

Jim Bond:             

Oh, you’re welcome. Thank you for having me. It’s good to be here.

Andrew Schorr:  

So, Jim, you were diagnosed with multiple myeloma, what is it, like 26 years ago?

Jim Bond:             

Yes, in 1992.

Andrew Schorr:

You’ve had a variety of treatments. You’ve been in clinical trials, and you’ve had a transplant. And then you’ve also developed a second very serious cancer, AML. So, you’ve had all together I think, four transplants. Is that right?

Jim Bond:             

That’s right.

Andrew Schorr:  

Whoa. Okay. Now, we should mention in a couple of days, Jim, you are going to once again be on your bicycle for four days, riding 328 miles. What is that ride that you’re doing now, for I think, the twelfth time?

Jim Bond:             

It is the twelfth time, and it’s The American Cancer Society Pan Ohio Hope Ride, which my wife, Kathleen, founded and leads. She got me to ride, and I’ve been able to do it 11 straight years, and I’m done training. I trained an hour this morning, and I’m ready to go. So, in two days, we start from Cincinnati and four days later, 350 of us will arrive in Cleveland, Ohio.

Andrew Schorr:  

Okay. Well, we're all riding with you, Jim. Exercise and physical fitness have played a big role for you, and we're gonna come back to that in a minute. And you're gonna tell your story of how your commitment to exercise has really helped you survive myeloma and also get the treatment you needed for acute myeloid leukemia that followed.

So, we’ll be back to you, but I want to introduce our other experts. So, let’s go to our experts, medical experts who are in Iowa City, Iowa at the University of Iowa Hospitals. First, bringing back to one of our programs, oncology physical therapist, a veteran in the field, Melanie House. Melanie, welcome to our program today.

Melanie House:   

Thank you, Andrew, it’s great to be here.

Andrew Schorr:

Thank you. And, Melanie, just to understand, you’ve been working with oncology patients, including on the transplant unit there for about how many years?

Melanie House:   

Well, oncology patients actually, for most of my career, probably in the early ‘90s I started working on some of the oncology floors. But I’ve specifically been overseeing the bone marrow transplant unit since January of 2010.

Andrew Schorr:  

And they have some myeloma patients who come through there, right, who have transplants?

Melanie House:   

Yes, actually, that’s a significant part of our population is the folks with multiple myeloma.

Andrew Schorr:  

Okay. We have a lot to talk about. Okay. But you have a colleague I’d like to introduce who is a dietitian with oncology patients and also works on the same floor as with people who are going through a lot, including transplants. So, Alexa Welch, thank you for being with us, also from the University of Iowa.

Alexa Welch:       

Glad to be here.

Andrew Schorr:  

How long have you been in the dietitian field?

Alexa Welch:       

I worked as a dietitian for three years, and then I have worked on the same floor as Melanie with the bone marrow transplant patients now for two years.           

Andrew Schorr:  

Okay. Wow. So, well, let’s start with exercise, Melanie. So, I’ve interviewed a number of myeloma patients over the years and there’s some people who find out they have myeloma when a family member gives them a hug, and then they have like cracked ribs, and they never knew that they had this illness they never heard of. They never knew their bones were at risk, and then they go in, and they get this diagnosis, and it’s terrifying.

And so, you think, “Well gee, if somebody giving me a hug can crack my ribs and I have myeloma, how on earth can I exercise?” What do you tell people related to these bone issues?

Melanie House:   

Well, I always take time to educate my patients on where their lytic lesions or pathologic fractures may be located. In my experience, that’s actually an area where patients often don’t realize, perhaps they’ve never viewed their imaging.

And I encourage my patients to be better understand that because if you don’t realize where those lesions are, then you wouldn’t have good information to guide other activities or precautions that you might need to take.

Andrew Schorr:                  

So, at step one, know where you have lesions, step two, but that would freak me out. Now, I’m a leukemia survivor myself, and I haven’t had those bone complications. But if I did, I would be just terrified to do stuff. But yet, exercise is good for us, right?

Melanie House:

Well, I think, yes, exercise is good for you, as long as it's in the proper dose. And so, it needs to be the right intensity, the right frequency, the right load.

So, that's where you really need to work with a professional who has a good understanding of where your lesions are and understands the different biomechanical principles, how the muscles might pull on that bone, that could be good or bad, how posture or lifting technique might impact your fracture risk.

So, it's important that there is a professional who's knowledgeable working with you, a physical therapist that has access to those films or those scans to help inform them giving you the proper prescription for exercise.

Andrew Schorr:  

A couple more questions for you, now—so, some of us know my friend, Jack Aiello, who was treated with a transplant years ago. He’s doing great, also like you, Jim, a long-term survivor of myeloma, but he was left with neuropathy. So, he walks with a cane. Sometimes he uses a scooter. But yet, he’s aging like all of us and he needs exercise for his body. So, what about if you have that complication of neuropathy which some people do with myeloma?

Melanie House:   

As far as exercise, we can find some form of exercise that’s safe anywhere along that spectrum. That all depends on the person’s balance response, their tolerance for weight-bearing through their legs, because some people have not only the sensory changes, but they have more painful kinds of sensory changes with weight-bearing.

So, again, it’s very specific to the patient but the one thing I do want to emphasize about neuropathy is, it is not—I have a lot of patients who say to me, “Well, I know my balance is bad because I have neuropathy, end of story.”

And I say to them well, actually, we have the potential to improve your balance because fortunately, your brain is still connected to your muscles through your nerves and we can recruit other muscles and help them work more efficiently together to improve your balance response.

And so, I actually train my patients with neuropathy so that they can improve their balance. I’ve had countless reports back from patients who have discharged from the hospital and gone on to do outpatient therapy and recovered balance that they never thought that they could.

Andrew Schorr:  

Wow. And how do you do that? Is it like practicing standing on one foot? Give us a clue?

Melanie House:   

Well, actually, I'm a very practical person and I work with people that are laborers, you might work with a truck driver or somebody who is a farmer. These aren't individuals that are typically going to go seek out tai chi or something like that. And it isn’t that simple, but if you can challenge yourself in single-limb balance and do it safely that is really gonna force your nervous system to have to respond more quickly and efficiently.

That is actually the test that I do and the exercise that I prescribe. But I set them up to do it safely. So, if you can do this test and this exercise standing in a corner in your home, where two pieces of drywall come together with a chair in front of you, then you’ve got the walls that can catch you behind and to the sides, the chair in front of you so that you can catch your balance if you need to and when you need to.

Single-limb balance is a great way to challenge ourselves. You might get the feedback, “Well, I never stand on one leg.” And to that, I say, actually when we walk we're standing on one leg over and over. So, it does prepare a person to be better on uneven surfaces, slopes and conditions like that.

Andrew Schorr:  

Okay. And we were talking about bone complications and obviously, if you’re worried about these lesions and you fall, which you might if you don’t have the best balance, then that triggers more bone issues.

Melanie House:   

Correct.

Andrew Schorr:  

So, we don’t want to really understate balance as important and many of us and the people, typically, not always with myeloma are older, where balance isn’t as good anyway. So, balance, we’ve got to think about balance, right?

Melanie House:   

Very important. Very important.

Andrew Schorr:  

All right. Let's talk a little bit about nutrition, Alexa, for a minute. So, there you are in the transplant unit and Melanie was mentioning a number of the patients who come through there are people being treated for myeloma. When you get blasted or even with less intensive transplant, there are a lot of issues about feeling like you can't eat, maybe you have mouth issues, pain etcetera.

So, first, let's talk about somebody getting ready for a transplant because that's still used in myeloma in some quarters. How can somebody fortify themselves if they're told well, transplant is what we're recommending for you?

Alexa Welch:       

So, one of the most important things we want patients to be aware of before transplant is maintaining your weight. Try not to lose any weight. We don't want you losing muscle or losing strength at all before transplant.

So, eating a well-balanced diet while you can, while your appetite is still good. Eat from all the food groups, get your fruits and veggies in, get your proteins in, keep your muscles strong, keep your weight up. That's pretty much the coming into transplant, being prepped and as strong as possible.