Living with Multiple Myeloma
Multiple myeloma patients can follow a normal lifestyle in terms of family, work and social interaction. However, they must adapt some of their daily habits to the rhythm defined by the disease and side effects of the treatment.
Smoking. If you smoke, it is very important that you quit as it aggravates the side effects associated with the treatments, such as loss of appetite and decreased lung capacity.
Alcohol. As with smoking, you should not consume large amounts of alcohol, although drinking is not prohibited.
Diet. There is no scientific evidence to suggest you should avoid eating proteins or sugars if you have cancer. No particular food is contraindicated, except on rare occasions due to interactions with certain drugs. Eat whatever you want but in small amounts and several times a day. It is important to maintain your muscular body mass and avoid losing too much weight.
Physical activity. Unless your doctor tells you otherwise, you should try to follow your normal routine and take part in physical exercise if possible. It will help minimise treatment-related side effects and accelerate recovery. Practising physical activity tends to produce a greater feeling of well-being. Ask your doctor about the most appropriate level of activity for you.
A good night’s sleep. Do not stay up too late and make sure you sleep at least 7–8 hours every night so you can tackle each day with more energy.
Sex. As long as you generally feel well enough, then you can still practice sex. It is important for women of childbearing age to take contraceptive measures, as you should not get pregnant during treatment.
Travel. You should discuss travel preparations with your medical team.
Emotional support. Good social and emotional support is always important when trying to overcome an illness. In other words, it is both positive and therapeutic to surround yourself with people close to you (friends and family) and to carry out activities together.
How can I alleviate the side effects of multiple myeloma treatment?
Although other treatments are available for multiple myeloma, chemotherapy is one of the most common. It is therefore a good idea to be familiar with the symptoms of the treatment-related side effects.
Nausea and vomiting. These are the most common side effects and can even appear despite taking medicines to prevent them. It is important to remember that each course of chemotherapy is specific to each patient. Accordingly, the hematologist will inform you about the likelihood of experiencing these side effects and which medicines are bested suited to preventing them before you start treatment. In addition to drugs used to prevent vomiting and nausea (antiemetics), the use of antianxiety agents and relaxation techniques can also help by reducing the patient’s overall level of anxiety.
Mucositis. Mucositis is inflammation of a mucous membrane and can produce painful sores and ulcers. It usually affects the oral mucous membrane, particularly the lips, tongue, palate and throat; although it can also occur in other areas, such as the anal, vulvar or virginal mucous membranes. If you notice pain or changes in your mouth during the cancer treatment, then you should discuss it with your doctor. Alleviation of the side effects is an important aspect of your cancer care and treatment.
Constipation. Constipation is defined as defecating less than twice per week, wherein the consistency of stools changes as they become hard and cause pain when expelled from the body. You should increase your fibre intake, reduce the consumption of astringent foods, e.g., rice, drink plenty of fluids, exercise or take laxatives. Constipation may highlight a more serious problem that could require further tests and therefore it is a good idea to discuss any symptoms of constipation or changes with your healthcare team.
Diarrhoea. If the chemotherapy affects the cells lining the intestine, then it may start to function differently. Consequently, the intestine loses its ability to absorb water and different nutrients, which gives rise to diarrhoea. Your healthcare team will prescribe medicines that prevent the onset of diarrhoea or cut it off as soon as possible. Following an astringent diet based around low-fibre foods (e.g., rice, boiled fish, baked apples, etc.), drinking fluids slowly, avoiding milk and dairy products, and abstaining from irritating drinks such as coffee or alcohol can all help control this symptom. Diarrhoea may sometimes be significant in terms of its duration and the number of bowel movements per day. In such cases, to avoid dehydration, it is vital that you contact your healthcare team so they may prescribe the most appropriate treatment.
Fever. Fever can appear as a direct side effect of the drugs administered during chemotherapy. It generally appears in the first few hours after they are administered and disappears quickly. Fever may also be associated with an infection that arises due to the reduction in your defences induced by the actual treatment (immunosuppression); this requires antibiotic therapy. If you experience a fever of above 38 °C, especially if it is accompanied by a cough with purulent phlegm, fatigue, pain or bleeding when urinating, catheter insertion site inflammation or any other associated symptom, then you should discuss it with your healthcare team as a matter of urgency.
Skin, nails and hair follicles. Chemotherapy can affect the skin, nails and hair follicles. Even though the level of toxicity is not usually very severe and the effects are reversible, its management is still very important as it affects the patient’s quality of life and impacts on their body image.
Hair loss (alopecia). Alopecia occurs due to the action of the different drugs on the hair follicles, causing their destruction and subsequently hair loss. Hair loss is not always a side effect of chemotherapy since it depends on the type of drugs being used. There is also a chance that hair loss will be generalised, i.e., it not only affects the scalp but other parts of the body as well, such as the armpits, arms, legs, eyebrows, eyelashes, etc. It is a reversible side effect, but your hair may grow back with different characteristics than before (colour, texture, etc.).
Itchiness (pruritus), redness (erythema), dryness and flaking skin. These symptoms are not usually very significant, but they should still be monitored. If you notice sudden or intense itchiness on your skin, rashes, hives or difficulty breathing, then these could be signs of an allergic reaction that requires immediate medical attention.
Nails sometimes develop a very dark colour and become brittle, they break easily and vertical stripes may appear.
Incompatibilities with other medicines
You must inform your healthcare team about any other treatments you are following as they could interact with the chemotherapy. Patients taking digoxin (a drug used to treat heart diseases) must receive special attention as it can interfere with the absorption of other medicines. Oral anticoagulants (medicines used to treat heart diseases) can increase the toxicity or decrease the effectiveness of chemotherapy drugs that are eliminated. Antivirals (medicines used to treat people infected with HIV) can interact with some of the drugs used during chemotherapy. Interactions have also been observed with antiepileptic drugs.
Port-a-Cath® and peripherally inserted central catheters (PICC line)
Chemotherapy is usually administered intravenously. Different devices are available for patients with poor venous access so that the nursing team can avoid repeatedly puncturing and damaging peripheral veins. A Port-a-Cath® and a peripherally inserted central catheter (PICC line) are the most used devices in cases of multiple myeloma.
A PICC line is a catheter introduced through a vein in the upper arm. The end of the catheter finishes in a large vein close to the heart. It is inserted by making a small incision in the skin under local anaesthesia. Once inserted, the catheter is fixed to the arm to keep it in place. The healthcare team will then take an X-ray to ensure it is in the correct position. After the PICC has been placed, the patient can go home without any further ado. The catheter is protected with a waterproof dressing, but it is still a good idea to avoid wetting it directly as it could fall off. Your healthcare centre will replace the dressing once a week.
The Port-A-Cath® is a plastic disc introduced beneath the skin on the chest or arm which subsequently connects to the blood stream through a catheter. Port-A-Cath® placement involves a minor surgical procedure under local anaesthesia. Once the Port-A-Cath® and catheter have been positioned correctly and the incision has healed, wearers only notice a slight lump under their skin. There is no reason why they should cause discomfort, but it is a good idea to discuss any activities that involve excessive or repetitive physical movements with your healthcare team beforehand. When you are not receiving treatment there is no needle in place, so the system does not require any special care and patients can wash and bathe as usual. When receiving treatment, the needle is covered with a dressing to hold it place and keep the puncture site clean. The dressing must be kept clean and dry. The injection site must be examined on a regular basis. If it moves, swells or redness/bruising appear, then you should inform your healthcare team.
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