Myeloma Today speaks with Heather-Ann Younker, RD, CNSD
Myeloma Today: Please tell us about your work with myeloma patients.
Heather-Ann Younker, RD, CNSD: I am a transplant nutritionist working specifically with the transplant program at Hackensack University Medical Center (HUMC) in New Jersey. It is mandatory for each patient who enters the HUMC transplant program to attend one of our weekly Nutrition and Food Management Program educational sessions. There are separate sessions for patients undergoing autologous and allogeneic transplants, but each includes a class on nutrition. In addition, their nurse clinician or physician will often refer them to me for individualized counseling to help maintain a sound nutritional plan and reduce treatment side effects.
MT: What does your first meeting with a myeloma patient encompass?
HY: Basically, it is a screening process. I go through a series of detailed questions designed to assess the patient's nutritional status. For example, I need to know about any weight loss or dietary changes that patients may have experience since the onset of their disease. With myeloma, patients who are on a chemotherapy regimen in preparation for their transplant are likely to be experiencing gastrointestinal distress (such as nausea, vomiting, diarrhea, constipation), as well as poor appetite and weight loss.
MT: How are you able to help such patients?
HY: A common approach is to experiment with different foods and to structure a diet with smaller but more frequent meals. The dietary programs I design are tailored to each individual patient. This could be as simple as adding nutritionally balanced milkshakes to the patient's existing dietary practices. But, of course, some cases are more challenging.
MT: How do you approach a challenging case?
HY: Patients who have renal difficulties or are on dialysis present a number of challenges. There are foods that such patients are not allowed to have. This may be a big adjustment for a patient who previously never had to limit his or her dietary intake in any way. Now, all of a sudden, the patient must adhere to a strict high-protein, low-potassium, low-phosphorus, low-sodium diet. The renal diet has many restrictions, which must be taught to both the patient and the caregiver or other family members.
MT: What is your most frequent dietary recommendation?
HY: If there are no renal problems, then I would say that a high-protein diet would benefit many patients, whether or not they are planning to undergo a transplant. Cancer patients often experience loss of muscle mass, and increasing their intake of protein helps curtail this. Conversely, patients I work with who have renal issues but are not on dialysis must be carefully supervised when it comes to protein intake. To maintain good nutrition, small meals and regular snacks are a good rule of thumb. Drinking plenty of water is important.
MT: Are there any restrictions that would apply to all transplant patients, whether or not they have renal issues?
HY: Yes. Before the transplant takes place, and for several months after, I strongly recommend that patients adhere to the Low Microbial Dietary Guidelines. This is due to the suppression of the immune system. The low-microbial diet reduces a patient's exposure to bacteria and prevents food-borne illness. It is important to avoid foods that are likely to have a high bacterial count, such as unwashed fruits or vegetables, and rare meats or raw fish. If food is prepared in advance, it must be immediately frozen (and thawed only when you are ready to eat). All leftovers should be discarded after 24 hours. Dining out is problematic because you can't control food preparation. Adhering to these restrictions is very important, and I recommend that a transplant patient follow these dietary guidelines for a minimum of three months.
MT: How often do you see a newly referred patient?
HY: Teaching patients a new way of eating usually requires several sessions. There's just too much information to be taken in at once. And when it comes to patients who are on dialysis, I try to see them even more frequently until their nutritional status has stabilized.
MT: Do you follow patients after they have had their transplants?
HY: Yes, of course. Either their nurse clinician or physician refers them back to me, or the patients will call me on their own when questions or issues arise. One common issue is that, after a transplant, patients often develop aversions to food they previously liked. So, once again, I must help them learn a new way of eating. Each patient's journey is unique, and I am here to assist in whatever way I can before, during, and after a transplant. And I love my job. Recently I saw a patient who was referred to me in preparation for a transplant. I met him when he was in a wheelchair and on a feeding tube. We continued to work together for six months following his transplant. When I saw him last, he was walking down the hospital corridor, looking as healthy as anyone. That's what it's all about for me.