NUTRITION DURING CHEMOTHERAPY DR. KELLY SALVADOR, MEDICAL ONCOLOGIST SUSAN VILLAROMAN, NUTRITIONAL ADVISOR

GRACE CUENCA (GC): This afternoon we want to share with you what we do in Petals of Hope, that ah, we practice integrative medicine. That means traditional treatment; you know that is your chemotherapy, radiation plus proper nutrition to help people cope with the oncological treatments. And I’m sure after this talk; you’ll go home with this new set of lessons that you can use with your fellow cancer patients. Okay, we shall begin.

Ah, the discussion is not aimed to replace recommendations provided by the medical practitioners but to complement them in patient’s health care in living with cancer. It was only a decade ago, the importance of diet in cancer treatments was given very little importance but lately researches and clinical studies see the benefit of incorporating proper diet with treatments and a growing number of oncologists are advising their breast cancer patients to eat properly during such time. Your diet is an important part of your treatment for cancer. This information has been prepared to help you learn about your diet needs during treatment and to help you cope with side effects that may affect eating. It is design for cancer patients and their families and other caregivers.

The information here has been gathered from many sources and reflects the experiences of cancer patients and the caregivers who worked with them. Eating the right kinds of foods during and after treatment can help you feel better and stay stronger. Good nutrition strengthens the body’s defenses and can result in a quicker recovery period. Researchers have found that people eat well during their treatment, especially those whose diets are high in protein and calories, are better able to tolerate side effects. A good diet helps to promote healing, maintains strength, prevents body tissue from breaking down, and rebuilds those normal cells that have been affected by the treatment.

The body’s needs for nutrients are altered because of the decrease in activity, exercise, and a change in how the body metabolizes food. The diet that is promoted to prevent cancer such as a Vigan Diet, or juice fasting may not be a desirable diet during treatment or in many cases even after. This is the time to nourish the body with all the nutrients needed to stay strong and fight the disease. The number one nutrient needed is calories and the major source of concentrated calories is the right kind of fats.

Each of these terms, calories and fats has a bad name but they will be crucial in combating decreasing appetite or other problems affecting eating. No one food can supply all the nutrients each day. Vitamins and minerals are central dietary nutrients to your diet. The nutritionist will help to activate, regulate and control many of the functions that take place in the body.
Dr. Kelly.

DR. KELLY SALVADOR (KS): Hello and good afternoon! Friends, ah, Susan, once in a while when a person is diagnosed with cancer more often than not your doctors will sit down and plan a treatment with you. Your treatments may consist of surgery, chemotherapy, radiation therapy, biologic immunotherapy, or somehow a combination of all of these treatments. But as we all know that all of these methods of treating cancer kill the cells. In the process of killing the cancer cells, some healthy cells are also damaged.

And because of this, this is what causes these side effects of cancer treatment. Recommendations about food and eating for cancer patients can be very different from the usual suggestions for healthful eating. This can be confusing for many patients because this new suggestions may seem to be the opposite of what they’ve always heard.

SUSAN VILLAROMAN (SV): That’s true. Nutrition recommends usually stress eating lots of fruits, vegetables and whole grain breads and cereals, including a moderate amount of meat and dairy products, and cutting back on saturated fat, sugar, alcohol and salt. I know some of you may have gone to alternative means… sinasabi don’t eat meat but during treatment you need protein, you need the amino acids to repair. So okay… saka na lang natin ia-adjust uli after the treatment.

Okay, nutrition recommends for cancer patients to focus on eating higher calorie food that emphasize on protein. Recommendations may include eating or drinking more during treatments. Sometimes it may be best to eat less of certain high fiber foods because these foods can aggravate problems such as diarrhea or sour mouth. Nutrition for cancer patients are different because they are designed to help build up your strength and help you withstand the effects of your cancer and its treatment. When you are healthy, eating enough food to get the nutrients is usually not a problem. But during cancer treatment, however, this can become a challenge especially if you have side effects or simply don’t feel well.

Prepare yourself for cancer treatment. Here it is. Until your treatment actually starts, you will not know exactly if any side effects you may have or how you will feel. One way to prepare is to think of your treatment as a time for you to concentrate on yourself and on getting well. Here are some ways to get ready. Eat a healthy diet. Plan ahead. Think positive. Eat a healthy diet. A healthy diet is vital for everybody’s blood or for every body to work its best. This is even more important for cancer patients.

You’ll go into treatments with reserves to help keep up your strength, prevent body tissues from breaking down, rebuild tissue and maintain defenses against infection. People who eat well are better able to cope with side effects. You may even be able to handle higher doses of certain treatments, for example. We know that some cancer treatments are actually much more effective if the patient is well nourished than getting enough calories and protein in his or her diet. Don’t be afraid to try new foods. Some things that you may have never liked before may taste good to you during treatment.

(KS): Okay. So now we plan ahead. How to prepare for cancer chemotherapy and radiotherapy. Yes, you might be diagnosed with a disease called cancer and right away you’ll feel numb. Many of you may get very depressed. Some of you may actually yell and say why me? For heaven’s sake, why me? Of course, you may just cry on or a few days, some of them even a few weeks later, you still cry. My friends, that is normal. That is very normal. You have to undergo that. Okay?

But then all, once you’ve felt all the ranges of emotions you still have to deal with the treatments of the dreaded C word called cancer. Depending on the type and stage of your diagnosis, you might need surgery, chemotherapy and/or radiation. Every step is scary. But you don’t have to be helpless. While cancer treatment is exhausting, there are sensible easy steps you can take to help yourself endure it. You must first decide you want to make the best of the worst situation. No doctor can make the cancer go away magically but you can help achieve the best results by doing your part.

(SV): Okay. Doing your part is to get healthy before treatment. No matter the course of treatment, you can prepare by getting yourself in the best shape possible. This does not mean you should train for marathon right before surgery. But it does mean following common health advises. You usually have one to two months from the diagnosis to the first treatment. This time is critical. You sit to shape up and to strengthen your mind to fight.

Okay. First do not binge. It’s common to reach for comfort foods in times of trouble. And no one will disagree with you that these are trying times. But before you devour a pint of ice cream, remind yourself that the more in shape and health conscious you are before the treatment, the easier it will be for your body to recover. Don’t diet.

While some of us over eat, others go into shock and forget how to chew. So you must eat sensible, balanced meals to keep up your stamina. Or if you were following some fad diet before diagnosis, stop. Just eat what you know is good for you. Lots of leafy greens, salads, two servings of protein a day, moderate amount of fruits, nuts and seeds, cheese. Stay away from sugar and white flour products, though. We all know how and what to eat. We just don’t… we just don’t do it all the time. But now is the time.

Now, also keep exercising or start walking. Whatever your exercise regimen before diagnosis, keep it up. This is asking a lot especially with a cascade of doctor’s appointments and new information, but do it. Exercise will rejuvenate your spirits and prepare your body to endure the next six months, which is the average length of cancer treatment. If you have never exercised, it’s not too late to start. Actually, it’s crucial that you start. Don’t over do it. Simply walk with friends after work or appointments. You need to get lots of things off your mind, so you just as well go on swinging your arms and quickening your pace as you do.

You want to go to the mall, go malling, but you know, brisk walking you don’t stop at every clothes store that you see. But after you’ve done it for like 20 to 30 minutes of brisk walking you pace down slowly then you can stop by the shops and… Drink lots of water. It keeps your organs, particularly your skin, hydrated thus easing the shock of surgery. That’s true. I’ve proven it myself. Also your system will heal more quickly and easily. Read. Read everything you can about your particular type of cancer. The more informed you are the more questions you can ask your doctors. Don’t be intimidated by doctors. There are here to help you. And C Network is here. You can read also, you know. There’s so much things that the cancer community can offer you now.

Sleep. Of course you’re stressed but missing sleep can weaken the body. You’re trying too hard to upkeep. If you are getting less than 6 hours of sleep, consider asking your doctor for a sleeping medication. Of course, if you’re exercising this will help you sleep, too.

(KS): Thank you, Susan. These next 2 parts are on chemotherapy and radiotherapy. Okay. Chemotherapy often scares patients much more than surgery, especially with the side effects of hair loss and nausea. Know that both can happen, depending on the line of drugs used, but neither has to be catastrophic. You will best endure these symptoms if you plan ahead. You will have time because it’s customary to wait almost a month after surgery to start your chemotherapy, thus, allowing your body to recover.

Now what to do during treatments? Like what Susan said a while ago, it’s better to plan ahead and, more often than not, your oncologist sits down with you and plans ahead with you so that what we call we will walk with you through chemotherapy.

1. Know what you’re getting.

There are more than 50 chemotherapy drugs around the world, which can be administered in numerous ways. Each can have its own side effects. So before you’ve read about hair loss, do your own research on the drugs you get. You might not lose hair at all. That’s good news, no? Cancer is one of the most studied diseases today. A monumental amount of data is available on everything from ingredients, reactions, dosages and toxicities.

2. Know your terminologies.

At times, it seems like everyone in the doctor’s office is speaking a secret language or a quote in German, noh? Teach yourself common terms related to cancer care. Start a vocabulary list in a notebook and carry the notebook with you to appointments. The more you can keep up with the lingo, the more in control you feel about your treatment. Some examples are what is an oncologist? Doctor who prescribes and monitors the cause of your chemotherapy, or better known as a medical oncologist. Now there are also surgical oncologists, radiation oncologists.

Adjuvant therapy. I’m sure many of you have heard about that. These are chemotherapy treatments that follow surgery or radiation therapy to hopefully prevent cancer recurrences.

Antiemetic – medicine that controls nausea.

Systemic Therapy – describes how chemotherapy works. The drugs affect the whole body by flowing through the blood stream, the purpose of which is to destroy cancer cells that may have spread from the original site.

Metastasis - I’m sure many of you have heard of this word. Describes the condition where cancer cells have spread beyond the original site such as from the breasts to the liver, breast to the bone, etc. This occurrence may call for more strenuous drugs, larger doses and of course more rounds of chemotherapy.

Lymph node is a surrounded masses lymphatic tissue through which cancer spreads through out the body. A telling sign of metathesis is when one or more of the lymph nodes have enlarged. Okay?

3. Once in a while expect weight gain.

Even as little as 5 years ago chemo patients severely lost weight during treatment because of nausea, vomiting. But with new anti-nausea medications, you will be able to eat much better. What’s more, your body will force you to eat because chemotherapy drugs are strong and demanding, so that the average weight gain maybe as much as 20 pounds for some people, during the course of treatment, of course. Don’t worry about the weight gain, you will lose it anyway. That’s why it is especially important to be in shape before treatment and to eat healthy foods throughout your entire regiment.

4. Prepare as much as possible.

Once you know what to expect, visualize what life is like during and after treatment. If you know you will lose your hair, buy a wig, or prepare for one. Wear it to get used to it, to get used to the looks of it, make your favorite healthy nurturing foods and freeze them. Of course, cancel unneeded trips and appointments. Try to keep busy. Chemotherapy might last three months, okay, or every week for a year. If you’re up to it, keep working and follow your routine. Of course, your level of activity is waited against the severity and frequency of your treatment. Even if you’re weak, try to join yoga sessions or Tai Chi or class meant for soothing and nurturing, okay. Bring a pal during your chemotherapy.

Chemotherapy drugs can be given orally, by injections, through a catheter or port, or topically. Any way you get it, it’s unpleasant. Bring someone fun to sit with, sit with as you go through the course of chemotherapy. If you must to have a needle jabbed into the back of your hand for half an hour, it’s best to be laughing with a pal to pass time. Of course, some drugs can leave a metallic taste, okay, have a candy in your mouth. And be super clean. Wash your hands fastidiously. Use soap. Always wash your hands after toilet use and before preparing or consuming your food.

Shower everyday and do not share your towel, toothbrush, razor and other personal items with anyone. Try to use a soft toothbrush to prevent bleeding of gums. And use antiseptic mouthwashes after meals and before bed. If you do get an infection, it can best be treated with antibiotics if caught early. Better, tell your doctors about it, especially when you’re starting to have fever. Drink plenty of water. This cannot be emphasized enough. Water keeps your mouth moist and flushes wastes from your kidneys and bladder. All these will try to prevent infections. Avoid risky foods. When your immune system is low, do not eat foods that could be contaminated or filled with bacteria, some of which may include inorganic salad greens, raw or lightly cooked eggs, shellfishes, soft cheeses, sushi and sashimi, okay. Of course, try to look your best. A change in your appearance doesn’t mean you have to look (inaudible). Organizations like ‘Look Good’, ‘Feel Better’, are dedicated to help you find the right wig, draw new eyebrows, and keep color in your cheeks.

Now what happens after? Okay, after chemotherapy, many things may happen. Your doctors may tell you, you’re in absolute remission which is, we just monitor you for recurrences. You’re in partial remission or are about, you’re, you’re fifty percent treated or reduce in your, tumor has shrunk, but did not disappear completely, so your doctors will most likely recommend more chemotherapy and at times may even change drugs. You’re (inaudible), that means there’s no increase or decrease in the size of the tumor so that altogether your doctors may change your chemotherapeutic drugs or regimen.

Wow, you’re in progression. Your tumor continues to grow, therefore more aggressive therapy may be launched by your doctors, and of course, you may developed secondary malignancy which means that cancer has spread to another area and you developed a second cancer for that matter. And of course, a whole new course of regiment maybe advised for you. For radiotherapy, these treatment uses radiation to kill cancer cells and shrink tumors at a specific site. It is considered the least invasive of cancer treatment options. It is often the last step in your regiment if it’s needed at all. Now radiotherapy does not usually cause nausea or to greatly weaken the immune system. But once in a while you may see a decrease in your white blood cells so your doctors may order a complete blood count or your CBC from time to time. Okay?

Now for those who are treated after the radiotherapy, you may be advised to use aloe vera gel after every treatment to help regenerate damaged skin. Okay, but not before the therapy itself. Now, although these treatments target the fast growing cancer cells in your body, healthy cells can also be damaged. Therefore healthy cells that normally grow and divide rapidly, such as those in the mouth, digestive track and hair, are often affected by cancer treatment. These damaged to healthy cells is what was used to be the unpleasant side effects that cause eating problems also. The good news is that there are many things the patients can do about them and not everyone has side effects during treatment. But most side effects go away anyway when treatment ends. Side effects can be well controlled with new drugs. Okay? And talk to your doctor about a possible side effects from your treatment, what can be done about them even before the treatment itself. You know, when a person understands what may or may not happen before the therapy itself, it usually helps a lot for you to be prepared. And eventually, if the side effects come in hopefully it would be controlled or it would be just for a few days. Okay.

Some eating problems are caused by the treatment itself. Losing your appetite or feeling nauseated are two normal responses which is part and parcel of being nervous or fearful about the treatment itself. You may want to talk to a dietician, of course to your doctors or to your nurses. Remember, there aren’t any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don’t feel like eating at all. Even the thought of food, they make them feel sick already. There is much that you can do to help yourself, a friend or loved one through the period of cancer treatment.

Breast cancer, chemotherapy side effects and their nutritional or personal management. Side effects associated with chemotherapy may vary from person to person. Some patients may experienced significant side effects while others may experience very minimal side effects. It is not possible to predict who’s going to have more side effects. All the side effects described here would not affect everyone. But most patients will have the common side effects like hair loss, while some other effects may affect few patients and may not trouble some others. Here will we show you the most common side effects of chemotherapy.

Speak to your doctor if either of these symptoms in severe or may last for several hours: pain in the joints, of the arms or the legs which may last 2 to 3 days, changes in the color of the nails, tingling in the hands or toes. If you experienced any of the following symptoms, call your doctor immediately. Unusual bruising or bleeding, pain, redness or swelling at the injection site, changes in normal bowel or bladder for more than 2 days, fever, chills, cough, sore throat, difficulty in swallowing, dizziness, shortage of breathe, severe exhaustion, skin rash or chest pain.

(SV): Apart from poor appetite and loss of weight, some people with cancer have other difficulties with eating. Some of these problems may be related to the cancer itself while others maybe temporarily side effects of treatment. We suggest that you discussed the matter with your oncologist, and your nutritionist to assist you to plan a healthy diet that can help you handle the treatment better.

Next is, one of the tips that we have given you is to think positive. And here’s seven ideas that really work:

1. Teach yourself a lesson. In counseling this technique is called reframing. You take cancer and try to define it for what you can learn from this experience and that will make your life better. It is a way of turning pain to gain.

2. Interrupt your negative thoughts. Research shows that if you continue to think negatively, you will feel more negative. Interrupting those thoughts and replacing them with positive memories can be extremely helpful in creating more positive energy.

3. Set realistic goals. Positive thinkers have learned how to meet their objectives. They set standards that are neither too high nor too low. They feel a sense of accomplishments when they complete their tasks on daily to-do list. Realistic goals must be specified and they must be achievable.

4. Be good to yourself. You need to define those things that make you feel good. And as often as you can, incorporate them in your daily life. We know that positive-reinforcement works. You can, need to reinforce yourself with the things that you value and enjoy. Even if it’s just stroking your breast, you know.

5. Be glad it’s not worst. This technique simply put says one ‘my situation maybe bad it indeed could be worst.’ While sometimes our situation is as bad as it gets, usually most of our situation, we can find things that are worst.

6. Look for the Silver Lining. While it is true that negative things do happen, such as cancer, and there are times when we seemed to be overwhelmed by them. It is important that positive things do in fact happen. Take time each day to write down or think about the positive things that occurred in your daily life. It could be as simple as looking at the beautiful cloud or hearing a song that you really enjoy.

(KS): Thank you, Susan. Finally, after cancer treatment ends, and you’re feeling much better you may want to think again about the traditional guidelines for healthy eating. Just as you wanted to go into treatment with all the resurge that such a diet could give you, you want to do the best for yourself at this important time. There’s no current research that suggest that the food you eat will prevent your cancer from recurring, but we do know that eating right will help regain your strength, rebuild tissue, and help you feel and live well with cancer. Thank you.

(SV): Thank you, very much for having us.

MODERATOR: I’d like to open the floor now for questions. Yes, Ma’am. Meron po tayo dun sa likod. Introduce lang po natin ang sarili natin and then para naman po makilala kayo ng mga ka-sisters natin dito.

(Q1): Good Afternoon to the, ‘Batman and Robin’. I am very much honored to meet the two of you.

(SV): Likewise.

(Q1): And, I would like to ask, what is this extra fat that we have under our arm and how can we eradicate this because it, it really irritates us, or myself.

SV: Ah, I can answer that, no. The irritating fat, as you put it, are actually excess fat that ah, comes from our food intake. Our body already makes cholesterol by itself, so we don’t need to put too much extra in through our food. So I will suggest that you check your diet, you know, your food groups that you eat. Kasi sometimes mali yung amount, too much fat with very little vitamins and mineral-enriched food you know. So mali yung proportion ng ano ng plato. (inaudible due to simultaneous talking) Yung dapat ano ganito lang, ilang ounces lang, yung ang marami, tapos yung dapat ganun karami yun ang konti. Kaya ang nangyayari ang distribution sa katawan natin nung nutrients na yun hindi na healthy. Kaya yun yon, kaya ang suggestion ko, I-check niyo muna yung diet nyo kung ano. Sa isang lingo, pwedeng gawin yun, eh. I suggest that. Ano kinain niyo, gano karami, dapat alamin niyo yung food group.

Kung mayroon kayong kilalang duktor o nutritionist, pwede niyong tanong, ‘ano ba yun food group?’ Para araw-araw ma-monitor mo gano karaming kanin o pasta o ganun. Gano karaming karne, gano karaming taba? And then once na-figure out mo na yun, balikan mo yung nutritionist after a week. And then sasabihin niya sa yo kung anong tamang proportion. Pag ginawa niyo yun, 6 to 8 weeks makakakita na kayo ng improvement pero hindi lang diet kasi ang sagot diyan, eh. Exercise pati, para hindi nakalawlaw pag nawala yung taba. That’s it.

(KS): Before we go to other, ah, drugs or medicines or what, you check your diet again. Often than not, many of us have forgotten even myself about the good proper diet, no. Baka, taking too much something you thought would help you defecate everyday or regularly but actually you did not, kulang po sa fiber, no. Madalas ganun po. O yung tubig na intake po ninyo noh, which very often happens in women, no. Now, as far as the other one is concerned, I’ll give it to Susan for her answer.

(SV): Ah, para dagdagan yung sinabi ni Doc, tama yun, eh. Kulang ka ng fiber. Yun ang isa sa reason. And the second reason is yung importante nga, tubig. No kasi dapat sa atin ano, lalo na if we are aging, ah, kailangan yung fiber intake natin is 30 to 35 grams a day, noh nananggagaling sa mga gulay, ganun ano. Tapos yung tubig at least mga 2 liters day. Kasama na yung sabaw dun o kung ano, no. Basta total ng liquid ano, a day, two liters a day. So tama si Doctor Kelly, palagay ko kulang ka ng fiber saka yung choice ng food mo, kailangan review.

(Q1): Thank you, Ma’m.

(SV): Yung Slimming Tea pala, mayroon akong sasabihin dun, no. Ah, kasi yung slimming tea, ah, ang nawawala kasi niyo dun yung bodily fluids, hindi yung fats.

(Q1): Ay, hindi fats.

(SV): Oo. Talagang pag nag timbang ka, saka lagi kang naka-slimming tea, regular ka dumudumi di ba pag naka slimming tea, tapos magtimbang ka, mababana ang timbang mo. Pero it doesn’t mean healthy ka. Saka kung laging ganun, naini-is-stimulate ng laxative, hindi natural na peristalsis ng intestines mo ang pagdumi, ah, yung minerals na kasama sa vitamins natatanggal yun, eh. Noh, kailangan mo yun, tapos natanggal. Tapos hihina buto mo. Tapos kukulubut ang balat, pagkatapos malalagas pa buhok. Di saying lang lahat. Ang talagang answer ay proper diet, hindi yung mga instant gratification.

MARITONI FERNANDEZ (MF): Yah, I’d like to add if you don’t mind. Siguro importante din po yung pag-exercise. Kasi when you exercise talagang you go more regular. And sleep, di ba? Matulog ka ng maayos and then basta kasi tayo mga cancer survivors or the ones undergoing treatment, kailangan po we take care more in everything. We have more sleep, we eat better, we exercise more regularly. Lahat po nung dapat gawing ng normal na tao satin exaggerated. Thank you, po.

(GC): Okay? More Questions? We have some more time for questions. Side, please come forward quicker. Kasi konti na lang ang time natin. Hold on. Sige po, Ma’m, diretso lang po.

ANITA ENRIQUEZ (AE): Good afternoon everybody, I’m Mrs. Anita Enriquez from Dasmarinas, Cavite from PGS-VCC. I want to tell you that opposite of Mrs. Maria (lastname inaudible), opposite that, every time I eat, after a few hours, I remove my bowel. Why is it like that?

(SV): Ah, watery ho ba? Matubig?

(AE): Hindi naman ho.

(SV): Buo pa rin siya.

(AE): Oo, pero little by little. Konti, konti lang.

(SV): Ganito kasi siguro ang amount ng pagkain nyo hindi rin yung regular ang amount. Hindi uniform. Kasi pagkaganun, yung nga reklamo rin ng iba yun sa amin, eh. Kasi erratic yung pagkain hindi yung tamang regular meals ba. No, na ibing sabihin ngayon ganito ang amount ng meals ko kasi ganito ang tamang amount. Mamaya iibahin ninyo na naman yung amount, iba ang amount ng carbohydrate, iba ang amount ng protein. Kasi para sa atin like sabi ng ni Maritoni, yung ginagawa ng normal na tao medyo exaggerated sa atin. Parang ibig sabihin, hindi naman mahirap planuhin pero parang mas aware tayo sa plato natin hindi basta inano lang. Kaya minsan ang dami-daming kinain. Yung ibang times naman, masyadong konti naman. Kaya hindi rin regular. Kasi may tao na kung talagang naplano niya ng maayos, regular din yung times more or less kung kailan siya dudumi. Kahit dalawang beses mangyari yun sa isang araw maganda nga yun, eh. (inaudible due to simultaneous talking) O meron din. Saka hindi uniform. Hindi uniform sa tao. Mabuti nga kayo nakaka-remove, di ba mas maganda yun keysa naka-stockup, no Maritoni?

(MF): I was going to say. Ang sarap ng problema mo. Sana lahat kami ganun. (laughing)

(AE): Saka Ma’m before, slim ho ako. Payat ako. But nagtataka ako ngayon lumaki ang tiyan ko kaya nagpa-ultrasound ako. Eh, tumaba ho ako. Wala ng magkasyang damit ko. Kaya ngapa-ultrasound ako. Pero naman ho pati yung lungs ko, x-ray lahat. Natatakot ho ako kasi lumaki yung tiyan ko. Baka buntis ho ako. (audience laughing).

(SV): Kasi nga sabi ni Maritoni,ano eh, kasi hindi pwedeng diet lang talaga, eh. Kasama yung exercise.

(AE): Thank you.

(MF): Tita, kahit lakad lang po. Kahit maglakad lang kayo ng konti sa mall or kung saan man. I wanted to say something also about the nutrition. Hindi po naming ma-stress enough kung gano kaimportante ang paglinis, yung kailangan malinis lagi yung pagkain ninyo. Ah, as much as possible kapag nag-a-undergo chemo kayo, huwag po kayo yung magpre-prepare ng pagkain, kasi fresh po yun, super delikado sa mga chemo patients dahil sa mga bacteria. We’re very prone to bacteria, yung immune system natin super mababa. Yung white blood cells natin almost zero yan kapag nag-che-chemo tayo. So talagang, this is the time po to really ask other people in your family, yung mga kapatid or kung may asawa kayo talagang gamitin nyo muna yung asawa nyo ‘kayo muna ang magluto’. Kailangan talaga po. That’s very, very important.

(GC): We have one more question and then one more after.

(Q2): How valid is the recommendation na pag during the course of chemotherapy, huwag daw kumuha ng mga vitamin supplements, mga Vitamin C, mga B-complex and avoid those other oxidants yung mga ganun, yung plain lang na balanced diet.

(SV): Ok, ahm, actually yan topic na yan kung idi-discuss natin isa-isa ano yan, eh, mahigit 3 hours. Pero in a nutshell sasabihin ko kung why. No, I work along with Dr. Kelly who is an oncologist. We exchange knowledge and researches. Kaya binabawal minsan ng duktor yung anti-oxidants pagka yung nag-tri-treatment no, kagaya ko non, nag-radiation stop muna lahat ng anti-oxidant kahit mabuti sa katawan ko yun kasi it gives ano eh, false results. Halimbawa hindi pa la nagreceive kung ano man yung cancer na yun, hindi makita masyado kasi sa dami ng anti-oxidant tinatakpan yung results no. Nadadaya yung results, no.

At saka mayroon mga vitamins na habang nagche-chemo ka, halimbawa yung, CMF, ano ba yung M nun, ah methotrexate, no, pagka nagvi-vitamin B na may folic acid, nagkakalaban. So yun dalawang example lang, No, kung ibibigay ko lahat sa’yo ang haba-haba. So pagkahalimbawa natapos ka nang, basta during chemo, kainin niyo yung mga sinabi naming ni Dr. Kelly dito, no. And then after chemo, pwede na I-ano yun, i-reinstate yung mga vitamins mo.

Kaya lang hihingi pa rin tayo ng go signal sa oncologists. O tapos na mag chemo to,’pwede na ho ba ibigay yung vitamins?’ Pagsinabi ng dok na, ‘sige na’ o di sige na. Pero during treatment, I would rather you talk to your oncologist. Hindi kasama, that’s it.

(MF): Pwede mag dagdag ng tanong? Ahm, hindi lang sila mga vitamins no. Kasi naalala ko yung ako yung nagche-chemo, ah, pati mga Tylenol, mga ganyan, mga over-the-counter drugs bawal lahat di ba? Kasi, that’s ah, sabi nila it will masked certain things na it could mean already that you’re having a different effect or another problem and then pag nag-tylenol ka nawawala yung headache sandali, pero maya-maya nandiyan na naman. Can you expand on that please?

(KS): Yah, you’re exactly right, Maritoni. Remember, we as oncologists, your doctors, we want our patients to get well. As much as possible, every one. So when we are focus on that line in killing the cancer cells, true, we are also introducing side effects to the patients ourselves. But when we put in any additional things like, even as light as Tylenol, as with things is harmless, there might be some interactions or masking of the therapy itself. Akala po natin ay effective, yung pala hindi, o akala natin hindi po effective, yung pala , ay, ah neutralizing effect ang ibang gamot or whatever. So it may make our judgment, ah, become parang confusing in a way. Baka kami eh, ah, mag-recommend ng changing of the therapy altogether where in fact it was already, it was starting to work, no, but we could not see it. Or we may do additional treatments which sana hindi pa naman dapat kasi you’re still, you’re still working on the new one that baka it may work, no. What we are trying to say is, please try not to mix many things together. It makes our judgment even more difficult.

(MF): The reason why I brought that up is kasi po na napakahilig natin mga Filipino mag self-medicate.

(KS): Correct!

(MF): Di ba? Kasi nag-chechemo ka na, sumakit ng konti yung ulo mo sabihin ng kapatid mo, “Hay, i-biogesic mo na lang yan.’ Na-biogesic mo, tapos you go to your next check-up, nakalimuta muna na nag-Biogesic ka so hindi mapapansin nung duktor.

(KS): Exactly, exactly. That’s why, Mari, in the course of the discussion a while ago, we were telling you number 1, try to sit down with your oncologist even before you start treatment. Know what are the medications you’re gonna use. Then refer to C Networks’ internet to go to see these things. Then, 2, know the side effects of these treatments. So like what Mari says, yun pala yung headache na yun was part and parcel, kasi nagka-insomnia ka hindi ka nakatulog or whatever. So these things was already pre-warned to you. No, you don’t really have to commit the same, and probably, in a few, few hours you’ll feel much better, okay. But it’s always important to plan ahead.

(GC): Thank you, Doc. We just have, ah, time for one more question before we go to the next session. Si, ah, Miss Beautiful Girl over there in stripes. There…

(Q3): Good afternoon. I just want to ask if is it safe to take, ahm, virgin coconut oil during chemo or right after chemotherapy. Because I’ve heard a lot of that.

(SV): Yah, I’m glad you asked, no. Kasi ganito yun, ah, sa pinag-aralan ko sa nutrition, palm oil and coconut oil are 92% saturated fats. Huwag akong babarilin nung nagtitinda ng Extra Virgin. Kasi, ano, molecular biology yun at saka chemistry, biochemistry yung kinuha ko. Kaya ano, hindi naman magsisinungaling yung medical books ko na 92 % saturated fat yon. Ngayon yung iba, pag sinabi kasing ah, ‘this is the cure-all oil’, ano, ah exaggerated ang use nila noon. Ganon. But you don’t know you’re having lipidosis, ang dami-dami ng taba. And ngayon, I know that ah Extra Virgin Coconut Oil has anti-bacterial properties kasi nagagamit yun sa ano dressing ng wound. Pero, then again, it depends on the kind of wound. Mamaya baka pag-fungal, hindi naman pala pwede, baka bacterial. Then I’ll, I will suggest you ask your doctor and don’t be a hilot. Kasi mahirap yun, no. I won’t, I won’t recommend something na, ano, based on testimonials, you know. I have given I Can Serve ahm, a guide. I don’t know Maritoni if you’ve seen that yung how to gauge kung ano yun ah, a quack medicine o ano ang hindi no. Yung, yung accepted ng medical community. Hindi ko sinasabi na hindi promising yun pero as of now I can tell you don’t ingest too much of a 92% saturated fat. That’s all I can say.

(GC): And si Doc, has last words to say for, for every one?

(KS): Well, in closing I’d just like to say that please do not be afraid of the dreaded C, cancer, no, especially when you have to do different treatments of surgery, undergoing surgery, or chemo, or radiation or whatever treatments. The only thing is that you have to talk to your doctors. Your doctors I’m sure are well-trained. They know what to do and they will tell you and walk half with you, okay, because our goal is to make you well, no, from cancer.

Another one, in closing, this is sort of a… next year, February 2006, magkakaroon po ang ating bansa and Second Cancer Relay for Life. This is where I’m asking everyone to join because I’m the Chairman for this coming Relay for Life, please do come and join. This Relay for Life is for all cancer survivors where we’ll have fun and we will try to disseminate information to the entire Philippines, para sa ating mga kapwa Pilipino kung ano ba talaga ang cancer, paano ba ito iiwasan to and of course to encourage our cancer survivor, our friends and their family.

(GC): With that, let us all give a round applause for Ms. Susan Villaroman and Dr. Kelly Salvador.