Published on January 22, 2019
How can multiple myeloma patients prepare for a transplant with their diet? Oncology dietitian Alexa Welch, from University of Iowa Health Care, gives expert recommendations on how to maintain optimal nutrition and wellness pre-transplant. Alexa also discusses some common side effects patients experience post-transplant and ways to adjust your diet accordingly. Watch now to learn more.
This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc., Celgene Corporation, and Takeda Oncology for their support.
Transcript | Is There a Pre-Transplant Diet for Myeloma Patients?
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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 etc.
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?
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.
But you're sick going into transplant, so is this like – I don't want to say force-feeding – but if there's a care partner there, are they saying, “George, eat your vegetables, you're 72 years old?” You have to make an effort, I guess.
Yeah. So, actually, most of the time when I see patients present on day one of hospital admission, they are usually feeling pretty well and have been eating well at home and actually have not been losing weight usually.
So, sometimes when they're first diagnosed they've lost some weight, they weren't eating well, they were tired, they didn't know why. That is usually behind them before they come in for transplant. So, typically, actually, when they get here they are feeling pretty good and have been eating pretty well. It's going into their admission where they're getting the chemo and they're getting the transplant that they start to not feel very well again.
Let’s talk about that. So, for people – and Chris, we have groups in myeloma going through different kinds of treatment. Let's talk about transplant for a second. If they're on your unit, how do you help them with their diet, when, let's face it, this is a rough business? And Jim's been through it four times, he'll talk to me about it. But from your point of view, how do you help people say strong?
Yeah. Nutrition is very individualized, just like Melanie was saying for exercise. You just kind of have to figure out where the patient is and what they’re struggling with most. Some of the most common side effects are gonna be loss of appetite, mouth sores, nausea, vomiting.
We kind of take each of those individually. So, loss of appetite, typically I recommend doing smaller meals more often throughout the day instead of forcing yourself to eat three big meals when you don’t have an appetite you’re not hungry and you’re forcing food down.
Sometimes it's easier to force a smaller amount and try that every couple hours instead of sitting down to a big overwhelming meal that you can barely even get three bites down and then you just feel hopeless because there's no way you can finish all that food at once.
So, sometimes just having snacks like peanut butter and crackers or fruit and cottage cheese, or something small like that and breaking that up throughout the day helps to get in enough calories and protein so that you're not losing weight or losing strength. So, usually, that is what we do for loss of appetite when you are kind of force-feeding.
And then when you get to that point, we’re not really super worried about eating from all the food groups. So, if you’re not able to get your fruits or your veggies in for those few days, I’m not gonna be super concerned. Or if a milkshake is the only thing that sounds good, then absolutely once you get in your calories and getting protein in that way.
I’m glad to hear you say that because my little kid when I went through chemo would bring me a great chocolate milkshake, so I didn’t feel guilty at all. So, that’s okay. You’re giving us permission?
Absolutely, yes. Absolutely. And I think most of my doctors and team agree with that, that if that’s the only thing that they can get down, then we’re definitely not telling them that they cannot have that.
For nausea and vomiting, usually, our pharmacists and our doctors have medications that they can get onboard to help anti-nausea, anti-vomiting medications that help control that. And then from my end, I just make sure my patients know that right after they get a dose of that medication is when they should try to order some food or eat some food. So, that that's fully kicked in and they can try to get as much food down and keep it down as possible.
Because obviously, if you're force-feeding yourself and it's gonna come back up, it doesn't do any good. So, medication does usually help control nausea, we’ve just got to make sure that we find the right cocktail for them.