_ Should I Take Probiotics After Appendix Cancer Surgery?

Today’s question comes from Brian in the USA:

“I am recovering from CRS and HIPEC and have had several organs removed from my digestive system. I have an ileostomy, which may be ‘reversed’ in the future. I am just beginning to eat solid foods again. Like any surgical patient, I have been receiving antibiotic therapy.

Should I take probiotics?”

PMP Pals responds:

“Patients like you have specific nutritional needs. Your question is best answered by your professional healthcare team, including your surgical oncologist, and specifically, your registered dietician.

Since you have an ileostomy, you may experience a “rapid transit” of contents from your stomach and small intestine, out through your stoma. This phenomenon is also referred to as “dumping syndrome.”

If you experience this, the benefits, if any, of probiotics, or any other supplement, may be negligible as the supplement may not remain in your digestive system long enough to be absorbed and to be effective.

Ask your registered licensed dietician to review your specific needs with you. Provide your dietician with a copy of your operative report so s/he can read exactly which portions of your digestive system have been removed and “re routed” (for lack of a better description!) to determine which foods and/or supplement may be beneficial to you.

Please refer to the Nutrition pageand the Blog Library on www.pmppals.org for numerous articles pertaining to the nutritional needs of Appendix Cancer, PMP and PSM patients."

 






Articles posted in PMP Pals and on www.pmppals.org are written from the perspective of patients and their families and are not intended to substitute for licensed, professional, legal or medical advice. Patients should seek the counsel of their licensed healthcare providers.

 Copyright © 2012 by Gabriella Graham/PMP Pals’ Network/All rights reserved.

Visit us on the web at www.pmppals.org We have HOPE for YOU!

_ Solutions for Weight Loss During Chemotherapy

Today’s question has been submitted by DG in Mumbai, India who seeks solutions for his father’s weight loss.

DG says: “My father has lost seventy pounds since his surgery and chemotherapy treatment began nine months ago. Originally his weight was 180 lbs.  Now he weighs 110 lbs.

He is halfway through a 12 cycle chemotherapy regimen for the treatment of Signet Ring Cell cancer (appendiceal.) Based on his recent CT scans, his oncologist believes the chemotherapy treatment is helping my dad. However, due to my father’s weight loss, the chemo treatment has been suspended until my father can gain at least five pounds. Although my father is trying to maintain his caloric intake, he does not have an appetite.

Do you have suggestions for how my father can gain weight?”

GG responds: “Thank you for submitting your question. We will share your question with participants in the PMP Pals’ Network who have experienced similar situations and will ask for their suggestions. In the meantime, we offer the following suggestions:

These are the three most common reasons "Pals" lose weight during and after medical treatment (surgery and chemotherapy)

-         1. Digestive distress (eg vomiting)
-         2.  Anorexia (loss of appetite, typically post surgery, and/or during chemotherapy)
-         3.  Inability to absorb nutrition (due to ileostomy, gastrectomy, or other surgical removal of critical portions of the digestive system)

From what you describe, your father may suffer from reasons #1 and #2

Reason #1 (digestive distress, vomiting) may be addressed/corrected through prescription medication to relieve nausea, as prescribed by your father’s oncologist.

Non prescription remedies for nausea include ginger tea, dry crackers, and limited, unseasoned, bland foods served in small portions.

Reason #2 (anorexia, loss of appetite) may be addressed by offering a variety of small meals and "snacks" throughout the day and noting which, if any of those foods offered, appeal to your dad.

Here are resources provided by the PMP Pals’ Network to assist patients in understanding their nutritional needs:

Review our NUTRITION page carefully for the following…

BeneCalorie: ask your father’s physician whether this may be a beneficial supplement for your dad

Lactose Intolerance :often overlooked by family caregivers, but very important for GI cancer patients, as many of us are lactose intolerant following surgery and cannot tolerate sugars, sweeteners, caffeine, chocolate, canned  commercial nutritional supplements, like Boost and Ensure, milk and other dairy products) and read the

Malabsorption diet.

These articles may also be helpful:

How can I gain weight?
and
How can I gain weight...I already drink Ensure

Please keep in mind that every patient is unique; what works for one patient may not work for another. This is why it is important to incorporate a team of healthcare providers in the coordination of your father’s care. In this case, your father may benefit from the inclusion of a licensed clinical dietician and an endocrinologist, to be included in his healthcare team.

The articles posted in “PMP Pals” and on www.pmppals.org are written from the perspective of patients and their family caregivers, and are not intended as a substitute for professional medical or legal advice. Patients should seek the counsel of their licensed professional healthcare providers. Copyright© 2011 by Gabriella Graham/PMP Pals’ Network/All rights reserved.



 

JL from the USA asks:

“I am about 11 months post-CRS, and feeling great! My weight had stabilized at a pretty good number. However, recently my weight seems to be dropping again. Perhaps my body is not making efficient use of the food I eat, because portions of my digestive system were removed during surgery. I don't know what else to eat, or how to eat much more than I am eating.

Why am I losing weight? How can I maintain my weight, and perhaps gain additional weight?”


GG responds:

“There could be many reasons for your weight loss. The first place to begin is by consulting with your medical team, which should include your surgical oncologist, an endocrinologist and a registered, licensed dietician.

Among other tests and examinations, your surgical oncologist will investigate any possible recurrences of cancer; your endocrinologist will test you for diabetes, hormonal imbalance, pancreatic malfunction, and other possible reasons for your weight loss. After all of your tests and examinations have been completed, the dietician can assist you in developing a diet for your specific needs.

Have you changed/increased your level of physical activity recently?

Do you maintain a food diary and notate your daily intake of protein, carbohydrates, fats and overall calories?

Click here to read “Do you need to keep a food diary?”

Have you been tested for lactose intolerance?

Many “Pals” attempt to regain calories by consuming high fat/high sugar content beverages and foods including commercial products like Ensure or Boost, or smoothies and milkshakes made with milk products, without realizing that post-surgery, some patients are unable to tolerate lactose, dairy, or simple sugars including corn syrup (found in many processed foods.) These “foods” can actually contribute to weight loss, as they often cause or contribute to diarrhea symptoms.

NUTRITION pageincludes articles about the Malabsorption Diet and about Lactose Intolerance.

When you schedule a consultation with a licensed dietician, give him/her a copy of your operative report so that s/he can clearly read the portions of your digestive system that have been removed. Diets for GI cancer patients are not “one size fits all” and must be developed for each individual patient.

Our NUTRITION page includes information about a protein supplement sold under the name of BeneCalorie. Some “Pals” have found this product to be helpful in supplementing your diet. Ask your licensed dietician whether the BeneCalorie product is appropriate for you.

In conclusion, consult with your medical team of specialists, as noted above, to determine

1) the cause of your weight loss and

2) methods to maintain and perhaps gain additional weight.

 

Articles posted in PMP Pals and on www.pmppals.org are written from the perspective of patients and family caregivers and are not intended to substitute for licensed, professional legal or medical advice. Patients should seek the counsel of their licensed healthcare professionals regarding their specific medical needs. Copyright © 2011 by Gabriella Graham/PMP Pals’ Network. All right reserved.

_

Q: "Are processed sugar and honey metabolized in the same manner?"

A: "Simple sugars are used, or metabolized, in the body the same way. Molasses is added to brown sugar, hence it's color and flavor.
Their are no significant differences in the nutritional profile of honey and white or brown sugar.

Honey can be a reservoir for Clostridium botulinum spores, which have been linked to the development of infant botulism, a serious disease.
Infants under 12 months of age should never be given honey or foods containing or flavored with honey."

This response was provided to the PMP Pals' Network by Sandra Rhoades, PMP Family Caregiver, Bachelors of Science in Dietetics,Master of Public Health in Nutrition

Many abdominal cancer patients discover varying degrees of digestive distress during the weeks and months following surgery.

Although appendix cancer, colorectal cancer and pseudomyxoma peritonei patients may experience similar CRS including the partial or total removal of particular segments of the digestive system, each patient is truly unique.

Nausea, diarrhea and bowel obstructions are the most common post operative digestive problem that patients (and their family caregivers/spouse) voice concerns about.

Indeed, these are serious symptoms as they can contribute to weight loss, malnutrition and painful blockages (obstructions.)

The PMP Pals' Network has posted numerous articles on the topic of obstructions and their prevention.

Likewise our NUTRITION link provides a variety of resources and menu plans with those patients who experience special needs, among them, low fiber, lactose intolerance and malabsorption diet plans.

We suggest that:

1. patients schedule a consultation with a licensed, clinical nutritionist to develop a personalized diet plan, after providing the nutritionist with a copy of the patient's operative report(s) in order for the nutritionist to be made aware of the specific segments of the digestive system that have been removed/altered and

2. patients maintain a daily "food diary" by noting any food or beverage they consume during a 24 hour period, and maintaining this diary for at least one week at a time.

"Diaries" may be simply maintain on a memo or note pad. By use of a food diary, the patient can note when digestive distress (ie nausea, diarrhea, obstructions, etc) occur, then can "track" back to what they have consumed (food or beverage) during the past hour, day or past few days.

For most patients, the food diary quickly becomes a helpful tool in determining which foods and beverages are tolerated well, and which may be problematic.

Patients should note that foods or beverages which are not well tolerated during the early stages of post operative recovery, may eventually become well tolerated.

Likewise, in the future, foods that are initially  well tolerated by some patients, including fibrous foods, may problematic in the future if scar tissue/adhesions occur.

As with any medical symptom, always discuss changes in your symptoms, which your licensed healthcare professional.