Nutrition for Appendix Cancer and Pseudomyxoma Peritonei Patients
Question of the Day from the PMP Pals
Are Probiotics Safe for Gastroenterology Patients?
Longtime Pal and Advisory Council member, Sandra J Rhoades, RDH, MDH, shares this quotation from an abstract posted in Therapeutic Advances in Gastroenterology/Sage Journals
"Although probiotics appear to be generally safe in an outpatient setting, the situation may be different in immunocompromised, hospitalized patients who may be at a greater risk of developing probiotic sepsis.
No studies exist addressing the issue of safety specifically.
Many questions regarding use of probiotics in GI disorders remain to be answered in future studies, such as most optimal doses, duration of treatment, physiological and immunological effects, efficacy of specific probiotics in specific disease states, and safety in debilitated patients."
Nutrition News for Appendix Cancer and Pseudomyxoma Peritonei Patients and Their Families!
Patients diagnosed with Appendix Cancer,Colorectal Cancers, Gastric Cancer and Pseudomyxoma Peritonei, may experience specific nutritional needs following surgery.
Always consult with a registered dietician/nutritionist for specific information regarding your personal nutritional needs; provide him/her with a copy of your operative report(s.)
To quote Dr Paul H Sugarbaker, "Digestion begins with the chewing motion!" As we chew, foods are broken into smaller particles so they can be processed in the stomach and intestinal track. The purpose of digestion is to extract vital nutrients that our bodies need to maintain health and recover from illness and surgery.
Vital nutrients include calories, protein, carbohydrates, fats, vitamins and minerals, in addition to water. Nutrients are primarily absorbed through the small intestine into the blood stream where they are carried throughout the body and put to work keeping out organs functioning properly. On average, we consume about 2 liters of food and liquid daily. Nutrients our bodies don't need are excreted through the urinary track and large intestine.
For detailed information regarding post operative nutrition, including post op weight gain and weight loss, diets for ostomates, etc, read the PMP Pals' Handbook:Preparing for Surgery.
This week's article of interest:
Cancer Patients Have Special Nutritional Needs
Source: CDC
Anemia
Basic information about Anemia, causes and remedies
Anorexia is the loss of appetite or lack of desire to eat, and can lead to weight loss. Anorexia can be due to a variety of factors relating to the diagnosis and treatment of Appendix cancer and pseudomyxoma peritonei patients in the midst of chemotherapy and post operatively, with or without HIPEC.
B-12 Vitamin
Some Appendiceal Cancer and Pseudomyxoma Peritonei patients may require supplements of
Vitamin B 12 (see below) following surgery, especially if surgery includes a gastrectomy.
Benecalorie Supplement
Benecalorie Low Volume Calorically Dense Supplement
Benecalorie Concentrated Liquid Nutrition
Source: Walgreens
Body Mass Index
Calculate your body mass index (BMI)
Source: National Heart and Lung
Celiac Disease (includes gluten sensitivity and gluten free foods)
Dehydration, importance of preventing
Video slideshow: Cancer Patients Need to Avoid Dehydration
Diet, exercise and lifestyle
Can Diet and Exercise Help to Prevent Cancer?
Source: Web MD, Feb 15, 2011
Top Ten Cancer Fighting Foods
Source: Web MD
Oncologists' Recommendations: Excercise vs Supplements
Source: American Association for Cancer Research, 2009
Diet, Nutrition and Cancer: Findings from the AACR
Source: American Association for Cancer Research, 2009
Digestion
Digestion: How Food Moves Through the Bowel
Source: Anne Collins
Iron
Iron Absorption, Storage and RDA
Source: Iron Disorder Institute
Flatulence, Foods Causing Distress
Foods Contributing to Flatulence
Source: Nexium
Gastrectomy Care
Special needs of Gastrectomy patients
Source: Cleveland Clinic
Dietary needs of Gastrectomy patients
Post operative care of Gastrectomy patients
Nutritional needs of Gastrectomy patients
Are you scheduled for, or have you experienced a Gastrectomy?
The PMP Pals' Network Gastrectomy Resource Group shares a wide variety of information to assist you in returning to eating the foods you love and maintaining the calories you need!
Are you an Appendix Cancer or Pseudomyxoma Peritonei patient in of a Gastrectomy Pal Mentor?
Join "Gastrectomy Pals" and learn how to maintain your nutrition while enjoying your favorite meals!
Gastric Cancer Post Op Diet
Stomach Cancer Diet Video: Registered Dietician, Charlotte Lawson
Gain weight, post op
Anorexia
Malabsorption
Source: MedScape 2008
Malabsorption Diet (opens as pdf file)
Source: Ohio State University
Post Operative Weight Loss and Nutrition
Source: PMP Pals' Network
Quick Tips for Post Op Weight Gain
Source: PMP Pals' Network
G Tube or Gastrostomy Tube
G Tube explanation and instructions
Source: UPMC
Government Assistance
SNAP: Supplemental Nutrition Assistance Program
Nutrition awareness website
Source: US government
Inflammation: Anti Inflammation Diet
The Anti Inflammation Diet Book
Source: Jessica Black RD
J Tube or Jejunostomy Tube
Jejunostomy Tube
Source: Roswell Park Cancer Center
Jejunostomy Tube
Source: Duke Medical
Lactose Intolerence
Isopure:Lactose Free Protein Beverage
Lactose Intolerence: Symptoms and Remedies
Source: Symposier 2010
Cooking Without Milk: Milk-Free and Lactose-Free Recipes
Lactose Intolerance: Symptoms and Remedies
Source: Dr Pin Wang
Lactose Intolerance and Human Evolution
Source: Dr Katherine Pollard, UCSF
Low Residue Diet
Low Residue Diet: Some GI cancer patients must avoid high fiber food, post surgery
Source: Mayo Clinic
Malabsorption
Malabsorption may be experienced by patients who have undergone colon resections gastrectomies, ileostomies, etc. Some patients discover they are lactose intolerant following surgery.
Metabolic Acidosis
Causes and treatments for metabolic acidosis
Source: NIH NCI
Nutritional Info for All
Nutritional Issues in Cancer Care
American Dietetic Association
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/index.html
Study on using broccoli sprouts to prevent Gastric Cancer
Source: Medscape, 2009
Nutrition Essentials and Diet Therapy
Source: Elsevier, 2009
Obstructions
Tips to prevent intestinal blockages and obstructions caused by diet
Source: PMP Pals' Network
Pancreas Enzymes
Pancrease Microtablets
Post Operative Osteoporosis
Osteoporosis may occur when Pseudomyxoma Peritonei and Appendix Cancer patients experience a total or partial gastrectomy and/or ileostomy.
Osteoporosis: Are you at risk due to post op malnutrition?
Source: National Osteoporsis Foundation
Reclast treatment for osteoporosis
Probiotics
Probiotics
Source: Mayo Clinic
Recommended Reading
Risks of eating raw fish
Video of tapeworm disovery during colonoscopy
Source: Symposier 2010
Short Bowel Syndrome or Short Gut Syndrome
Short Bowel Syndrome Guidelines
Source: Memorial Sloan Kettering
Supplemental Beverages and Products
Isopure: Low carb, lactose free, high protein beverage
Nutritional Supplements for Cancer Patients
Source: Nestle
Enteral Nutritional Formulas
Source: Drugs.com
Unjury Medical Quality Protein Beverages
Resource Fruit Flavored Supplemental Beverage by Novartis
Juven nutritional supplement beverage
Source: Abbott Laboratories
Enlive Supplemental Beverage
Source: Abbott Laboratories
Nutrition Product Comparision Chart Among Supplemental Beverages
Source: Abbott Laboratories
TPN
The Oley Foundation** provides helpful information about IV nutrition for patients with unique digestive needs
http://www.oley.org
Total Parenteral Nutrition (TPN)** via IV or Central Line
http://www.merck.com/mmpe/sec01/ch003/ch003c.html
Prognosis for Peritoneal Carcinomatosis Patients with TPN administered at home
Source: Pub Med 2006
Some patients may require intravenous or "tube fed" nutrition or TPN while they recuperate from surgery. The Oley Foundation (scroll below) provides helpful information for patients and their family caregivers.
Many patients recuperating from surgery receive "TPN"(see below) nutritional feedings via a Central Line or IV, during the post operative days and weeks in the hospital, and/or at home.
Vitamin B 12
Vitamin B 12 Needs and Sources
Source: NIH
Vitamin B 12
Source: Mayo Clinic
Enteral Supplements of Vitamin B 12 Post Gastrectomy
Source: Annals of Surgery, 2000
Post Gastrectomy Issues, including Vitamin B Deficiancy
Source: Cleveland Clinic
Vitamin B Deficiency and Depression
Vitamin B deficiency may be linked to depression
Vitamin D Deficiency
Vitamin D deficiencies may occur in patients who have experienced a total or partial gastrectomy. These patients should be monitored periodically for folic acid and B 12 levels. Consult with an endocrinologist regarding specific needs.
Vitamin D receptor may play a key role in development of inflammatory bowel diseases
Source: American Journal of Pathology and Check Orphan
Vitamin D deficiency in adults
Source: Merck
PMP Pals' Articles About Nutrition
Are commercially prepared high calorie beverages appropriate for you?
Recommended Reading
The Cancer Lifeline Cookbook. Kimberly Mathai, with Ginny Smith.
Seattle, WA: Sasquatch Books, 2004, 234 pages, $19.95.
The Cancer Lifeline Cookbook could be described as a combination cookbook and nutrition guide for patients with cancer, caregivers, and survivors who want to adopt a healthy lifestyle after treatments have been completed. This well-organized, informative, and up-to-date nutrition and cancer book has wonderful recipes, each with a nutritional analysis.
The text is easy to read and divided into seven sections, including resources for cancer- and nutrition-related information and an index. Each section provides an overview of the cancer-fighting properties of foods, how to incorporate these foods into patients' diet, and tips on menu planning, preparing and storing foods, and recipes. Although few limitations can be found in this book, some of the recipes require ingredients that are not typical in certain regions of the United States (e.g., nori, a sea vegetable that is a rich source of protein). On the other hand, cooking is all about being adventurous and trying unusual ingredients.
The Cancer Lifeline Cookbook addresses nutritional management issues in cancer therapy that are well organized and easy to understand. The chef's and nutritional tips throughout the recipe section are a strong addition to the book. The authors did a great job in discussing cancer and nutritional benefits and implementing them into mouthwatering recipes. Illustrations are sparse; however, the cookbook does provide a glossary of terms.
The uniqueness of this publication lays in its upbeat approach to promoting healthy eating during cancer therapy without compromising flavors, variety, or good nutrition. The section on 10 super foods is very practical. This cookbook would be a great addition to patients' libraries.
This book was reviewed by:
Joyce Diacopoulos, RD, CNSD, LDN
Nutrition Coordinator
Hillman Cancer Center
University of Pittsburgh Cancer Institute
Pittsburgh, PA
Gut- Check: Your Prime Source for Bowel Health and Colon Cancer Prevention
by Jeffrey M. Aron, Harriette E. Aron
Be Good to Your Gut: Recipes and Tips for People With Digestive Problems
by Pat Baird
The Culinary Couple's Creative Colitis Cookbook
by Denise Weale, Ross Weale
Mayo Clinic on Digestive Health:Enjoy Better Digestion With Answers to More Than 12 Common Conditions
by John E., Md. King (Editor),
Mayo Clinic
The New Eating Right for a Bad Gut:The Complete Nutritional Guide to Ileitis, Colitis, Crohn's Disease,
and Inflammatory Bowel Disease
by James Scala
The What to Eat if You Have Cancer Cookbook
by Daniella Chace,
Maureen Keane (Contributor)
PMP Pals' Nutrition Advisory Council
Sandra Rhoades, PMP Family Caregiver
Bachelors of Science in Dietetics
Master of Public Health in Nutrition
Articles of Interest:
Low Carb, High Protein Diet May Reduce Both Tumor Growth Rates and Cancer Risk
Source: AACR 06.14.11
"Nutrition Plate" Replaces the "Food Pyramid"
Source: NY Times
Immune Boosting Foods Slideshow: Learn which foods boost your immune system
Source: Web MD
Guidelines for the Diagnosis and Management of Food Allergies
Source: NIH NIAID
"Food allergy is a public health problem that affects children and adults and may be increasing in prevalence."
Nutrition Tips for Chemotherapy Patients
Source: Web MD 04.12.11
Study shows strawberries may protect against esophageal cancer
Source: Web MD 04.06.11
Heavy beer drinkers may be at risk for gastric cancer, if they have this gene variant
Source: US News and World Report 04.04.11
Fruits and Vegetables May Help Prevent Colorectal Cancer
Which fruits and vegetables are the most effective in preventing colon cancer?
Source: Web MD 10.04.11
Question of the Day
How Can My Father Re Gain Weight?
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?”
PMP Pals 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, it sounds like your dad suffers 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.
Question of the Day from the PMP Pals
Why am I losing weight?
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?”
PMP Pals 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 "How to Start a Food Diary"
Have you been tested for lactose intolerance?
Scroll below to read articles about "Malabsorption Diet" and "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.
Click here to read Post Operative Weight Loss and Nutrition.
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 © 2012 by Gabriella Graham/PMP Pals’ Network. All right reserved.
“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?”
PMP Pals 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 "How to Start a Food Diary"
Have you been tested for lactose intolerance?
Scroll below to read articles about "Malabsorption Diet" and "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.
Click here to read Post Operative Weight Loss and Nutrition.
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 © 2012 by Gabriella Graham/PMP Pals’ Network. All right reserved.
Vitamin E and Prostate Cancer
NIH funded study shows increased prostate cancer risk from Vitamin E supplements
Source: NIH 10.11.11
Digestive Distress (Gas) Following Appendix Cancer Surgery
Gastrointestinal cancer patients, and the public in general, are often caught in the dilemma between eating a healthy diet and suffering from the pain, bloating, flatulence (gas) and associated distress that accompanies many common foods.
These problems may be exacerbated for Appendix cancer patients, especially following surgery and/or chemotherapy treatments.
In today's article we provide general information regarding common complaints among our fellow gastrointestinal cancer patients. Consult with your healthcare provider regarding your specific personal needs.
It is a normal condition to have air travel through the digestive system. The average adult produces up to two quarts of air (gas) daily. Gas may be produced by the foods you eat or when air is swallowed when you eat, drink or chew gum. Some medications, including antihistamines, and calcium channel blockers may contribute to gas production.
Gas Producing Foods
Confused about gas producing foods? The following foods may be some of the “culprits” that you may have overlooked!
Bagels, Beans, Bleu Cheese, Bread, (Carbohydrates) Broccoli, Brussell Sprouts, Buttermilk, Cabbage, Carbonated beverages, Cauliflower, Corn Flakes, Crackers, Fried and Fatty foods, Fructose (natural sugar) Peanuts, Peas, Potatoes, Ranch dressing, Sorbitol (artificial sweetener)
High fiber foods
Intestinal cancer patients may experience difficulties in digesting a high fiber diet
and should consult with their physician before adding or deleting foods from their meal plans.
Common high fiber foods include:
Apples, Artichokes, Asparagus, Beans, Bran, Brussell sprouts, Cabbage, Carrots, Celery, Peas, Pineapple, and whole grains
Gluten Sensitivity
Patients affected by Celiac Disease may be unable to consume whole grains. For more information about gluten sensitivity, see the Celiac Disease Nutrition page on www.pmppals.org
Laxatives
Laxatives should only be used after consulting with a physician. Bulk forming laxatives are taken with water, absorb water in the intestine and make the stool softer.
These laxatives may interfere with the absorption of some medications:
Citrucel,Metamucil,Konsyl,Serutan
Stimulant laxatives cause intestinal rhythmic muscle contractions:
Correctol,Ducolax,Feen a Mint,Purge,Senokot
Stool softeners add moisture to the stool and may be prescribed following surgery:
Colace,Dialose,Mineral Oil
Saline laxatives draw water into the colon for easier stool passage:
Citrage of Magnesia,Haley’s M O,Milk of Magnesia
Diarrhea
Diarrhea may occur following gastrointestinal surgery and may accompany chemotherapy.
Foods and beverages that may aggravate diarrhea:
Coffee, High fiber foods, Milk, Milk based foods (ice cream, yogurt) Raw vegetables, Strong tea
Foods that may ease diarrhea:
Applesauce, Bananas,Rice, Toasted bread
Medication to combat diarrhea (consult with your physician):
Immodium, Lomotil, Sandostatin
For more information about Diet, Nutrition, Malabsorption and intestinal distress, visit the
NUTRITION link at www.pmppals.org
Copyright 2011 by Gabriella Graham/PMP Pals' Network/All rights reserved
This page is sponsored in memory of Jeff Beach...
by his family, friends and community.
Visitors to www.pmppals.org are encouraged to discuss publications and information contained herein with their licensed, professional healthcare providers. The information provided on www.pmppals.org is not intended as a replacement for licensed, professional medical or legal advice.
Please respect your fellow patients and caregivers by not copying or cutting and pasting any pages from this website onto yours.
The PMP Pals Network is a volunteer patient advocacy program. We support the services that we provide, including this web page, as volunteers and through subscriptions to our publications.
We neither solicit nor receive funds from pharmaceutical companies or healthcare providers, thus maintaining our dedication to serving as patient advocates.Copyright(c)2011 by PMP Pals' Network.
Visitors to www.pmppals.org are encouraged to discuss publications and information contained herein with their licensed, professional healthcare providers. The information provided on www.pmppals.org is not intended as a replacement for licensed, professional medical or legal advice.
Please respect your fellow patients and caregivers by not copying or cutting and pasting any pages from this website onto yours.
The PMP Pals Network is a volunteer patient advocacy program. We support the services that we provide, including this web page, as volunteers and through subscriptions to our publications.
We neither solicit nor receive funds from pharmaceutical companies or healthcare providers, thus maintaining our dedication to serving as patient advocates.Copyright(c)2011 by PMP Pals' Network.
The PMP Pals' Network updates our website 364 days per year with a wide variety of new information to keep you informed about maintaining optimal health! Whether you seek information about research studies, health insurance, personal mentoring, diet and exercise, new treatment options, and so much more, the PMP Pals' Network is your "go to" place for information! This page last updated on 12.05.11
