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After a quick trip to the doctor’s office for my Neulasta injection (the drug that fights the chemo drugs’ suppression of white blood cells), I return home for a meeting with Lynn, a member of our church who’s a licensed dietician and counselor. She’s offered to help me look at some dietary issues.
Lynn sits down with me in our living room, takes out a pad and begins asking questions about my dietary habits and preferences – both before I began treatment, and in the last day or two as I’ve been starting to experience the chemotherapy side effects.
I confess some of my past sins – too much fast food, a fondness of potato chips and late-night ice cream snacks, and overeating generally. These have led to problems with obesity that have plagued me all my life. I’ve never been a binge eater, but as a baby-boomer child I so internalized my Depression-era parents’ strictures about cleaning my plate that I’ve tended to keep eating till well past the point of fullness. But now is not the time to address those problems. The goal of a chemotherapy diet is to maintain weight, because unhealthy weight loss is such a common result of the chemo medicines themselves (not to mention the feelings of nausea that suppress appetite).
Actually, if I do manage to lose some weight as a result of all this, that would probably be the only thing that could be said in favor of undergoing the rigors of chemotherapy. (I remember reading somewhere about a cancer survivor who used to joke about her very successful $30,000 diet program.) But Lynn and I are agreed – the immediate health concerns of maintaining caloric intake, protein and vitamins are paramount.
Vanessa, the nurse in Dr. Lerner’s office who gave Claire and me our orientation to chemotherapy, touched on some dietary issues – mostly around subjects like preventing mouth sores and avoiding infections. I’ve been following her instructions of using a homemade salt, baking soda and water mouthwash six times daily, and am ready to cut out orange juice and other acidic foods at the first sign of sores. I’m also avoiding all mouthwashes that contain alcohol, and have switched to a soft-bristled toothbrush. Vanessa also instructed that, in times when my white blood cell count is down, I should follow standard traveler’s instructions for eating raw fruit in tropical countries – eat only what fruit you can peel. In times of severe stomach upset or diarrhea, Vanessa recommends the “BRAT” diet – bananas, rice, applesauce and toast.
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In times when eating is very difficult, she encourages me to try making some fruity blender shakes, with soy milk, honey, fruit juices, banana and a little wheat germ.
Tomato-based foods are out, because of mouth-sore issues and also because they can cause stomach upset. I should also avoid very spicy foods.
In times of nausea, it’s a good idea to stay out of the kitchen while food is being cooked, as food odors can cause lack of appetite. Better to have some pre-prepared meals that can be heated up quickly in a microwave.
I show Lynn a booklet Vanessa gave us, published by the National Cancer Institute. It’s called Eating Hints for Cancer Patients: Before, During and After Treatment (U.S. Department of Health and Human Services, 1997), and is also available online. Lynn pages through this, and gives it her seal of approval.
Because she’s also a member of the church, Lynn offers to get some volunteers together to bring our family some prepared meals. While it feels odd to be on the receiving end of this sort of kindness, I put my pride aside and agree. Because of my flexible schedule, I’ve been doing nearly all the grocery-shopping, and have also taken my place in our weekly family cooking rota. Now that I’m sick, I won’t be able to help in these ways, and Claire’s hospice-visitation schedule often keeps her busy into the late afternoons and sometimes evenings. Yes, some ready-to-cook meals would be a help.
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She leaves me with her list of written suggestions, and encourages me to stay in touch. It’s good to know I’ve got an ally like her, who can help us chart a simple and healthy course.
I go into the kitchen and make lunch – scrambled eggs and toast. I’m feeling tired, but I also feel inspired by Lynn’s suggestions, so I decide to head off to the supermarket. I know I could just make Claire a shopping list and she’d cheerfully pick up whatever I need, but somehow I feel the need to push the cart up and down the aisle myself, look at what’s on the shelves with a new eye, and think carefully about what sorts of foods appeal to me now. Besides, I know that once I’m into that second week after treatment – the “nadir,” they called it, back in Dr. Lerner’s office, when I’m watching my blood counts fall (and my hair, besides) – I probably won’t have the inclination or energy to walk down a supermarket aisle. So, it’s now or never.
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The supermarket looks very different to me now. I’ve always been very aware that we Americans have an absurdly large range of food choices in general, compared to the Third World – but now I feel a little like I’ve joined a sort of chemo Fourth World. It’s just one more way that cancer can be an isolating experience.
1 comment:
Just wait till the Steroids kick in, you'll eat anything at arms length! Ha! Ha!
It's true, watching / smelling others cooking kills your appetite. If I went into the kitchen while someone was cooking, I'd skip the meal!
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