Wednesday, November 2, 2011

Quality of Life

Yesterday, I had my 'last' round of chemo. The doctors will re-evaluate in a month and decide based off my labs, tests, and symptoms, if I need more treatments.  The last 3 weeks for me have been a bit tiresome. Chemo therapy, plus lupus nephritis (kidney disease) can inhibit the production of red blood cells, leading to low hemoglobin and iron levels. Last treatment my hemoglobin was down to 7 (normal is >11). You can imagine how my body felt-run down, sleepy, and every bit of energy went to chasing around Liam, who by the way is getting into every drawer in my bedroom and knows how to 'help' me with laundry by dismantling it, but he makes me smile and laugh every time he does it!  During my the last treatment they gave me an injection, Aranesp, which helps by stimulating the bone marrow to produce more red blood cells in order to raise my hemoglobin and iron levels.  It worked! My hemoglobing is now up to 8.6!

Once again, my husband was amazing too! With all the work he does in the home office and manages to make my child safe, happy, and also able to feed myself and my child healthy food during meal times-he amazes me every time. One night last week, I had NO appetite, and this really brought me down.  I know we are suppose to "eat to live", but "I live to eat"! I love food-everything about it!  I said to my husband, "I just want to crave something, want to eat something, have an appetite" and in order to stimulate my appetite, we decided to walk around the grocery store to get ideas. It worked! I started craving a 'thanksgiving' dinner. It may have not been the most lengthy and a little more processed thanksgiving meal, but the most important thing at the time was that I make sure I get some calories and nutrients into my body.

As a dietitian, I always stress to my cancer patients and those who are facing appetite loss: if you are having trouble with the 'health foods' and they are making you nauseous or sick, then look at the foods that comfort you and foods you can tolerate! Having additional nausea and throwing up your food is only going to cause you to lose the nutrients and hydration you need!  It is best you are able to digest the food and obtain some calories! You need to weigh the pros and cons when you have an acute illness, and it is most important to receive the calories! I often have patients, who can only tolerate living off ice cream and milk shakes. They have calories and protein too!

I worked in a nursing home for a few years, and often my patients would refuse to eat anything that wasn't sweet!  I am a very liberal dietitian and I strongly feel that at the end of life or when disease process inhibits appetite, it is important to focus on the quality of life, quantity may follow! As I said before it is better that they receive optimal calories, rather than skip and refuse meals. There are 2 goals for older-adults in long term care: maintenance of health through medical care and maintenance of quality of life. When medical nutrition therapy prescribes a 'therapeutic diet' such as a diabetic diet or a low fat/low salt diet, these diets often restrict certain foods and portions of food in order to help control the patients 'disease process', However, when an older-adults or patient has been affected by cancer or the side effects of cancer, they may fail to comply with the 'therapeutic diet' and additionally refuse to eat, causing a decline in medical status and additionally hinder their quality of life.

I'll leave you with an amazing picture of the 'thanksgiving meal' my husband made for me: portabella mushroom stuffed with low sodium stuffing mix, topped with lightly sauteed red peppers and parmesan cheese. On the side: canned whole cranberries, peas, and whole wheat toast with apricot jam! Sounds amazing, right? I was able to taste the food, and not left with a 'metallic' flavor in my mouth- a side affect from chemo. The best part about this meal was not only that it tasted and looked amazing, but the man that prepared it, and the love that went into it! In my next blog, I plan to discuss: coping with cancer during the holidays and the 'care taker' role.

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