Weight Gain w/ Cancer - for 2nd Stem Cell Transplant - Lymphoma

[askthetrainer]

Okay, so my father has been battling Non-Hodgkin's Lymphoma for 2 years now. He is very frail and weak (5'7" 140 pounds) and already had a 1st stem cell (bone marrow) transplant which nearly killed him and that was when he weighed 20 pounds heavier.

In a few weeks they want to perform the 2nd stem cell transplant

What obviously troubles me about the situation is the doctors (who I assume are top notch being at Stanford Medical) have offered very little help when it comes to nutrition, supplements, etc. I feel that this stem cell transplant and the associated chemo is a death sentence unless he can gain some weight.

What are some nutrition strategies any experts out there would recommend?

Keeping in mind that palatability is a major factor I think any tasteless maltodextrin powder mixed in his water, and/or carbo gain fruit punch to add calories to the diet and maybe an isopure drink for easily digestible protein? His diet currently sucks, eating garbage but sometimes that's all he can take, he's not like our new generation who like the taste of chugging weight gainers.

I would be totally willing to try anything with him to gain some weight before the transplant but I'm worried for drug reactions (i.e. some foods really do lower the effectiveness and counteract w/ chemo).

RANT: It is purely frustrating and shocking to me that they place so little focus on nutrition for cancer patients. They offer seminars but everything from the food they offer in the hospital stinks.

[Emma-Leigh]

Okay, so my father has been battling Non-Hodgkin's Lymphoma for 2 years now. He is very frail and weak (5'7" 140 pounds) and already had a 1st stem cell (bone marrow) transplant which nearly killed him and that was when he weighed 20 pounds heavier.

In a few weeks they want to perform the 2nd stem cell transplant

What obviously troubles me about the situation is the doctors (who I assume are top notch being at Stanford Medical) have offered very little help when it comes to nutrition, supplements, etc. I feel that this stem cell transplant and the associated chemo is a death sentence unless he can gain some weight.

What are some nutrition strategies any experts out there would recommend?

Keeping in mind that palatability is a major factor I think any tasteless maltodextrin powder mixed in his water, and/or carbo gain fruit punch to add calories to the diet and maybe an isopure drink for easily digestible protein? His diet currently sucks, eating garbage but sometimes that's all he can take, he's not like our new generation who like the taste of chugging weight gainers.

I would be totally willing to try anything with him to gain some weight before the transplant but I'm worried for drug reactions (i.e. some foods really do lower the effectiveness and counteract w/ chemo).

RANT: It is purely frustrating and shocking to me that they place so little focus on nutrition for cancer patients. They offer seminars but everything from the food they offer in the hospital stinks.
I think this is something you need to ask the dietitians/ nutritionists that will be working with your father's treating team... << there are many things to consider in treatment of diseases such as increasing tumour growth (ie: http://www.journals.elsevierhealth.com/periodicals/yclnu/article/S0261-5614(09)00046-6/abstract) and interactions with chemo or other drugs/ therapies... [eg: you need to be careful about supplements as high doses of things such as antioxidants can decrease the effectiveness of the chemo].


Chemo drugs the intestines will also be more 'fragile' and may not be able to digest a lot of food all at once... And you may increase risk of diarrhoea or gastric upset.... And there is also a very real risk of issues such as graft-v-host disease in stem cell transplants which can also impact the function of the intestines and absorption of nutrients... So 'easily digested' and 'non-irritative' foods are going to be needed if this is the case... Some chemo drugs can also increase risk of things like gastric ulcers - which can also be irritated by certain foods...


When adding foods ->> High carb foods is also not necessarily a good thing... Although 'palatable' it can also increase his risk of refeeding syndrome (if he has not been eating much lately). So moderate carbs may well be better... In fact, there is also growing evidence for the use of ketogenic diets in the treatment of many types of cancers: http://www.communityoncology.net/journal/articles/0501022.pdf
[note: for this, MCT have been shown to help with weight gain in those with wasting diseases - so increasing these would be useful if it were ok with the doctors involved[.


Basically - although I agree you need to get guidance - here is not the right place.

There is some good info:
http://www.cancer.gov/cancertopics/types/non-hodgkins-lymphoma
http://www.marrow.org/PATIENT/Undrstnd_Disease_Treat/Lrn_about_Disease/NHL/index.html

^
Good luck, I wish you and your family all the best.... :)

[Wowzer]

Okay, so my father has been battling Non-Hodgkin's Lymphoma for 2 years now. He is very frail and weak (5'7" 140 pounds) and already had a 1st stem cell (bone marrow) transplant which nearly killed him and that was when he weighed 20 pounds heavier.

In a few weeks they want to perform the 2nd stem cell transplant

What obviously troubles me about the situation is the doctors (who I assume are top notch being at Stanford Medical) have offered very little help when it comes to nutrition, supplements, etc. I feel that this stem cell transplant and the associated chemo is a death sentence unless he can gain some weight.

What are some nutrition strategies any experts out there would recommend?

Keeping in mind that palatability is a major factor I think any tasteless maltodextrin powder mixed in his water, and/or carbo gain fruit punch to add calories to the diet and maybe an isopure drink for easily digestible protein? His diet currently sucks, eating garbage but sometimes that's all he can take, he's not like our new generation who like the taste of chugging weight gainers.

I would be totally willing to try anything with him to gain some weight before the transplant but I'm worried for drug reactions (i.e. some foods really do lower the effectiveness and counteract w/ chemo).

RANT: It is purely frustrating and shocking to me that they place so little focus on nutrition for cancer patients. They offer seminars but everything from the food they offer in the hospital stinks.

I'm very surprised that there isn't a Dietitian seeing your father in hospital at every chemo cycle.

Don't go for any of the common bodybuilding supplements. They are completely inadequate in this situation. You want to get something that is specifically designed for hospital use. There are 3 main companies, Abbott Nutrition, Pharmatel Fresenius Kabi and Nutricia.

These are some nutrition supplements that we commonly use with our haem patients:
Ensure Plus:
http://abbottnutrition.com/Products/ensure-plus

Two Cal HN:
http://abbottnutrition.com/Products/twocal-hn

There are many from Abbott nutrition that taste quite good. Buy a couple and check preference for taste and go from there. You can get ensure plus in a neutral flavour which can help if he has a lot of taste changes.

Fortisip:
http://www.nutritionincancer.co.uk/en/forti-range/milkshake-style.html (not sure if this is available in the US).

Fortisip and Two cal are the ones that most patients seem to like and use regularly. 1 can of two cal is ~480 Cal in 237ml. It is very useful if he has a lot of nausea or poor appetite as the volume is very small. We commonly give two cal as 4 doses over a day of ~60ml (or 120ml 4 times daily if more cals are needed).

They are all nutritionally complete (ie all vits and minerals needed to live) and people can and do live off them, especially two cal (we also use it as a naso-gastric feed). None will prevent the chemo drugs doing their job. In fact good nutrition improves the outcome of chemo treatment.

As Emma-Leigh mentioned there is a risk of refeeding syndrome, however he would have to have been eating very little (ie less than 500Cal/day) for the last few weeks for it to be a real danger. Also the risk of refeeding from oral intake alone is small. It more commonly occurs when NG feeding or with parenteral nutrition.

How much weight has he lost in the past 4 weeks?

[justboo2u]

I am very sorry to hear that your dad is having such a time with his lymphoma...
Do you happen to know what they're giving him for it?

I have been treated for B-cell (NH) lymphoma since the beginning of the year... or more accurately, about June (diag began the prev Jan)... by the time it was realized it had invaded the marrow and was generally systematic...

I was initially on Rituximab for the specific lymphoma as well as the 'kitchen sink' drugs (names I apologize that I dont have) that (I presume) were to work on the WBC/marrow issue(s)...

I have never really been 'sick' from the treatment(s)... initially once-every-3wks of 2 days, with the Ritux on day 1 and the 'sink' on day 2... so one could say I have been 'lucky'... that Im having to work on LOSING 'chemo-fat' rather than struggling to keep weight on.
Fortunately for me, neither was it necessary to receive marrow... I had a bad-enuf time putting up with the marrow-biopsies, which grew more intolerable each time they did it! :eek:

While I agree that 'professional' help would be best I can only offer info that I received...

Because the drugs I took (by infusion) 'mostly' targeted immature, fast-growing cells, I was advised to reduce the intake of carbs... and I did sometimes find myself wanting to 'gorge' on sweets.... but I do that anyway. :rolleyes:

I apologize that I cannot offer any 'useful' help except that if he can keep food down to eat what he likes/can as often as possible... the typical multi-feeding mode 'we' use here.

My best to you and your dad... I hope things improve for him SOON! :D

Edit: After re-reading Emma's and Wowzer's input I see that Ensure entry... Tho I never needed it myself it is/was often used by some of the others... excellent info from them both, IMO. Perhaps if I had been more 'diligent' I wouldnt be working on dumping this regained 'insulation' :p

2nd Edit: Are they infusing blood to keep his RBC count up? Altho I was injecting Naproxen (?) for the WBC I was fortunate that the RBCs never dropped enuf for that... :)

[AbAbber2k]

I have a client with Hodgkin's who is currently going through chemo, and I mentioned to him that he should ask his doctor(s) about diet and nutritional supplementation to optimize his recovery and improve energy levels... they basically brushed him off. It's absurd that something so incredibly important gets no coverage. Something every patient needs to work on outside the doctor's office. I basically tell him to get plenty of protein, eat a lot of micronutrient dense foods, and sleep A LOT. He's doing really well so far (what he can do... chemo DESTROYS your strength) and even though his outlook is very good, I want it to be better... the best it can be. If I knew a good dietitian that didn't just parrot FDA standards I'd happily refer him, but alas, I do not.

Personally, in my very humble, very non-registered-dietitian opinion, I would try to get him to eat more red meat (lots of vitamins, zinc, iron... very important), eggs (yolks have tons of nutrients, and cholesterol is important for hormone production and restorative growth I believe) and lots of dark, leafy greens. For pure weight gain, if he's not lactose intolerant, whole milk + whey for an effective gainer. At his weight, despite the toll chemo takes on the body, I would think it wouldn't be too hard to put those 20lbs back on with a concerted effort.

[AndrewWard123]

Hey mate,

Although I am not experienced or qualified to answer your question, I just wanted to say how sorry I am that this is happening...

My prayers are with your father and family.

[trance__dreamer]

Hey mate,

Although I am not experienced or qualified to answer your question, I just wanted to say how sorry I am that this is happening...

My prayers are with your father and family.

^^ ditto. my dad had bone marrow/blood cancer. (i forgot what it's called...myeloma? (sp)) he, too, got really frail & weak. it was above & beyond devastating to see. he was given no nutritional guidance at.all; whatsoever.

i wish your dad a speedy recovery.