Novel therapy agents are a mixed blessing. Yes, they are helping me and a number of my fellow multiple myeloma patients to live longer. And compared to the harsher cytotoxic agents that many patients with other types of cancer are forced to take, the side effects for most of us aren't so bad.
But with more of us using maintenance chemotherapy for longer periods of time, the side effects can become harder to manage. This is especially true for those of us who have had a stem cell transplant. I seem so much more sensitive to most any drug I take now.
Just because a side effect isn't life threatening doesn't mean it can't negatively affect our quality of life. Last week I focused on nausea. This week I would like to share some tips for how to control another common therapy side effect--constipation.
Isn't it funny how the same drug can have such a different effect on different people? For example, I know several patients who get diarrhea from using Revlimid®, Thalomid® or Velcade®.
But in my experience, it is much more common for patients who are using these chemo drugs to experience constipation. Mix in a variety of other medications--especially pain killers like oxycodone--and chronic constipation is almost guaranteed.
Let me share how I overcome my day-to-day constipation challenges.
Regular exercise can help. So can drinking lots of water. Yet as many of you may have already experienced, simply staying active and changing one's diet may not be enough. But it is the beginning to a long-term solution.
I start my day with a vegetable smoothie that includes spinach, tomatoes, carrots, celery, cucumbers, kale and milled flax seed. And I eat two or more vegetables at every meal.
Since I'm on a low carbohydrate diet, eating a lot of sugary fruit isn't practical for me. But blueberries, strawberries, raisins and a few prunes can also help.
But modifying what you eat by adding a wide variety of fiber-rich foods is only a start. I quickly learned that no matter how many vegetables I ate, it sometimes wasn't enough.
I never liked the idea of using a product like Metamucil or over-the-counter stool softeners for an extended period of time. Instead, I use a safe and simple substitute--magnesium.
Magnesium is the number one ingredient in a number of laxatives. It is inexpensive and has the added bonus of helping prevent cramping caused by taking Thalomid or Revlimid.
You can experiment with how many magnesium tablets to take and when. I'm not a physician, but I believe the worst that can happen to you if you take too much magnesium is a case of the "runs."
For me, a 100-mg tablet or two with each meal--along with my high fiber diet--is enough to keep me close to regular.
I already mentioned how I add milled flax seed to my morning smoothie. Flax seed is an amazing food, full of omega 3's and fiber. So is wheat germ. Sprinkling one or both of these concentrated super foods on your cereal is both good for you and can be a "constipation buster."
Over the years I have received a number of suggestions from readers about ways to overcome constipation. I would like to share a few of those with you now. Because what works for me may not work for you:
- Drink a large hot glass of water with lemon slice every morning
- 2 or 3 tablespoons of mineral oil daily
- 2 or 3 tablespoons of coconut oil as needed. They also agreed adding flaxseed can help
- Probiotics help prevent the problem before it occurs. Eating yogurt with natural cultures daily is the most common way to build up the live microbial organisms that should be active and present in everyone's digestive tract. I have been told that Kefir, sauerkraut and Asian foods like kimchee, natto, tempeh and miso can all be incorporated into your diet to help build up the natural digestive process
- Using herbal teas containing rhubarb, aloe, senna or buckthorn
Try to remember that overusing laxatives and/or stool softeners can make the problem worse. This also applies to the herbal teas I mentioned above.
Also remember, multiple myeloma patients tend to take a lot of calcium, which can cause your muscles to contract and make constipation worse. Again, magnesium helps counteract this problem.
All set? Next week, I will suggest ways to deal with side effects caused by "demon dex," or dexamethasone.
Until then, feel good and keep smiling!