This is a very good video which describes how mesothelioma develops in the lining of the lungs.

http://tinyurl.com/yhqsdzd

 

 

Just click on the “You Are Never Alone” tab to access recent videos of patients who are living with mesothelioma, as well as their caregivers.  PHLBI can put you in contact with any of these patients, so feel free to contact us at (310) 478-4678 for more information.

Senator Patty Murray (WA) and Representative Betty McCollum (MN) achieved a milestone last week in their ongoing efforts to promote mesothelioma awareness at a national level.  ”National Mesothelioma Awareness Day”, passed in the Senate and now moves to the House of Representatives.  You can help get this bill passed in the House by contacting your Representative and asking them to co-sponsor H. Res. 771. 

 

 

To read the text of H. Res 771, go to:

http://www.govtrack.us/congress/bill.xpd?bill=hr111-771

 

 

For a listing of House Representatives and their contact information, go to: https://writerep.house.gov/writerep/welcome.shtml

OF NOTE:  The Pacific Heart, Lung & Blood Institute would like to express their heartfelt thanks to David and Pilar Vanderhyde for their gift of $100,000 in support of mesothelioma research at the Punch Worthington Research Laboratory, funded by PHLBI.

Diagnosis and Treatment 

David Vanderhyde was diagnosed with pleural malignant mesothelioma (epithelial type – epithelium are tissue membranes that line the internal organs),  in October 2006, and  was instructed by his oncologist to begin chemotherapy right away.  A month later, he began the standard regimen of Alimta with Cisplatin, however, his oncologist included a non-standard targeted therapy drug as well called Avastin (Bevacizumab), which is not a chemotherapy drug but rather an anti-angiogenesis therapy.  Anti-angiogenics are drugs that inhibit blood vessel formation, and blood vessel formation is critical for tumors to grow — it’s like their food supply.  Research has shown that in some instances, Avastin may prevent blood vessel formation in some types of tumors.

ANTI-ANGIOGENIC DRUGS:  Anti-angiogenics are drugs that inhibit blood vessel formation, and blood vessel formation is critical for tumor to grow — it’s like their food supply. 

After his six rounds of chemotherapy, PET scans revealed that the chemo was effectively reducing the size of the tumors in David’s chest.  His oncologist extended treatment for two more rounds, but without Cisplatin, due to a bad reaction after round six.  David finished in May 2007, and starting researching mesothelioma treatments on the web.  After noting repeated references to the expertise and skill of Dr. Robert Cameron, Executive Medical Director of Pacific Heart, Lung & Blood Institute, David made an appointment with Dr. Cameron.

Dr. Robert Cameron performs Pleurectomy with Decortication

Dr. Cameron informed David that while chemotherapy helped reduce the size of his tumors, a surgical procedure to remove the remaining tumor, known as a Pleurectomy with Decortication (P/D), might both extend his life and give him a better quality of life. 

Dr. Cameron’s ”Less is More” approach to surgery:  Perform Pleurectomy with Decortication, and resect (remove) the pleural lining around the lung, without disturbing tumor-free organs inside the chest, as opposed to the radical, highly invasive Extrapleural Pneumonectomy, a surgery that removes the entire lung, part of the membrane lining the thoracic wall, the diaphragm and the pericardium.

On June 7, 2007, David underwent the eight hour procedure with Dr. Cameron.  Once inside, Dr. Cameron saw tumor growing around the heart, so the lining of the pericardium (heart sac) was also resected. 

Approximately three weeks after his surgery, David was feeling so good, he took a long walk along the Santa Monica Pier.   Later that night he woke up with a fluttering heart and high blood pressure.  Doctors put him on Lopresor to restore his normal heart rate. 

In July 2007, David inhaled for a deep cough to clear the phlegm causing his scratchy throat.  Phlegm occasionally occurs after surgery for mesothelioma patients and can range from moderate to severe congestion.  David coughed with such force that he opened the surgical stitches on his left side.

David’s wife Pilar immediately drove him to a nearby San Diego emergency room where doctors attempted to put steristrips over the wound.  Within minutes of leaving the ER, David could feel the strips loosening, so the Vanderhydes drove straight to UCLA. 

At UCLA, doctors found an infection had developed, so they couldn’t re-stitch his side.  Instead, David had a “wound vac” attached to his side for over four months.  A “wound vac” gently and continuously drains the open wound so that it can heal quickly — without the machine, healing could have taken up to a year. Pilar became an expert at packing the wound with sponges, then bandaging the top until it eventually healed.

David continued his regular visits to Dr. Cameron who recommended radiation with Dr. Michael Selch, also at UCLA.  David’s PET scans in November 2007 showed good results, though David was concerned about the four month delay in radiation due to the blown stitches.

David completed his radiation, then began nightly injections of interferon alpha as maintenance therapy beginning April 24, 2008. David usually keeps a very positive attitude and outlook on all aspects of life, however, while he was on interferon, he noticed that he felt extremely fatigued, which caused depression. He did not want to get out of bed. David found it difficult to summon the optimism he often relied upon during his treatments.

Depression and fatigue are common side effects associated with interferon alpha. Usually these symptoms (and possibly flu-like side effects) disappear after a few days. David continued the interferon treatments, but after three weeks of worsening depression and fatigue, David and Dr. Cameron decided to stop the drug. Two days later, David noticed that he was feeling better and was a little more upbeat.

In October, 2008, a CT scan revealed some micronodules in David’s right lung, however, after four rounds of chemotherapy, Dr. Cameron says the nodules look fainter, and may be receding.

When David is finished with chemotherapy, he is going to try the interferon injections again, but at a lower dosage. 

“Never Surrender”

Despite the hardships during treatment, David plans to set an example by continuing to fight the good fight and never surrender.  He often says he can’t wait to share his story about being a 10 year survivor!  He hopes to inspire others to donate their time and money to the efforts of the Pacific Heart, Lung & Blood Institute, as “[they] believe in trying to find a cure for this so-called incurable disease.”

——————————————————-

 

Pilar Vanderhyde’s Tips for stress reduction: 

 

*Draw on your personal relationship with God, in whatever form you perceive God to exist.

 

*We watched a video called ‘The Secret’, which is all about positive thinking, and positive thinking is why David is alive today.  A thoracic surgeon in San Diego told us that David’s cancer was inoperable, and there were no options.  We decided to do some research on our own, and an interesting thing happened: Dr. Cameron’s name kept coming up, not only on the web, but also from the daughter-in-law of a friend, an attorney, and other oncologists.  Be sure to explore your options, even if someone tells you “nothing can be done.”

 

  *Find things that make you smile, and, if you really like the rain, like I do, make a fool out of yourself and go dance in the rain… 

 

 

 

Please take a look through the new PHLBI Video Library, and learn more about mesothelioma and treatment options from Dr. Robert Cameron.  Be sure to check back — we will be adding more videos shortly.

Dr. Cameron appeared on the television program “Extra” this evening in a segment about lung cancer and mesothelioma.  Click link below to watch!

http://extratv.warnerbros.com/2008/12/lifechangers_the_facts_about_l.php

Congratulations to Linda Reinstein and ADAO for a job well done!

ADAO Celebrates Introduction of Fifth Annual Senate Resolution that Establishes

“National Asbestos Awareness Week”

Senator Max Baucus Praised for Leadership in Introducing Resolution that Increases Awareness of

Asbestos Dangers

Washington, DC … February 27, 2009 —

 

The Asbestos Disease Awareness Organization (ADAO), the leading

organization serving as the voice of asbestos victims, today celebrates the introduction of S.RES.57, a resolution that

declares the first week of April as “National Asbestos Awareness Week” and urges the Surgeon General to warn and

educate Americans on the severe hazards of asbestos exposure.

ADAO praises Senator Max Baucus (D-MT) for his work in introducing the important resolution. Additional cosponsors

and key supporters of S.RES.57 include: Senator Richard Durbin (D-IL), Senator Dianne Feinstein (D-CA), Senator

Johnny Isakson (R-GA), Senator Edward Kennedy (D-MA), Senator Patrick Leahy (D-VT), Senator Patty Murray (DWA),

Senator Harry Reid (D-NV), and Senator Jon Tester (D-MT).

“We applaud Senator Max Baucus and the cosponsors of S.RES.57 for their leadership and support in successfully

introducing this significant resolution that declares the first week of April as National Asbestos Awareness Week,” said

Linda Reinstein, Executive Director and Co-Founder of the Asbestos Disease Awareness Organization. “Since 2005,

ADAO has worked with the Senate to raise awareness through the passage of asbestos awareness resolutions. We

continue to honor individuals and their families who have suffered from diseases caused by asbestos exposure through our

efforts to increase awareness and prevention. ADAO will continue to work with Congress to educate Americans until we

finally ban the deadly fibers once and for all.”

FYI: A simple resolution (H.Res. or S.Res.) like this one in the U.S. Congress is a legislative proposal that does not require the approval of the other chamber or the signature of the President and does not have the force of law. Simple resolutions are used only to change the internal rules of one of the chambers of Congress or to express the sentiments of one of the houses. Bill numbers restart from 1 every two years. Each two-year cycle is called a session of Congress. This bill was created in the 111st Congress, in 2009-2010.

TO TRACK THE RESOLUTION, GO TO:  www.govtrack.us

 

CLICK  TO SEE THE TEXT OF RESOLUTION S.RES.57 :

 www.asbestosdiseaseawareness.org/eLibrary/2009_AAD_Files/ADAO_2009_Senate_Resolution.pdf

You may have come across this article on the internet.  When asked about the efficacy of the test, Dr. Robert Cameron had the following comment:  “Any test that helps doctors better diagnose and treat mesothelioma is of benefit. This test has not been approved in the US and it is not yet clear how much, if any, impact it would have on the current standard of immunohistochemical stains done in this country.“

——————————————————————————————————————–

New Mesothelioma Test Improves Diagnosis

Since introducing miRview^TM meso in December 2008, Rosetta Genomics has already begun distributing the breakthrough test in Israel and Turkey.

miRview^TM meso is a microRNA-based molecular diagnostic test that differentiates malignant pleural mesothelioma from other carcinomas in the lung. Malignant mesothelioma is a rare form of cancer that is almost exclusively caused by asbestos exposure. Those who are typically at risk of contracting the disease have either worked in the shipyard, construction, electrical, or automotive industry.

The test uses up-to-date molecular technologies for the processing and measuring of microRNAs. MicroRNAs, which are a newly-discovered family of genes in protein complexes, have been shown to be very specific to different types of tissues and tumors.

During the test, two separate scores are calculated to indicate the amount of mesothelioma and non-mesothelioma microRNAs in the sample. The scores are then analyzed to determine whether or not the sample is a mesothelioma or non-mesothelioma sample.

Although miRview^TM meso is only being distributed to the public in Israel and Turkey, Rosetta Genomics has made the test commercially available to the United States through its Philadelphia-based CLIA-certified lab.

The test, which can only be ordered by a physician, simply requires a formalin-fixed, paraffin embedded (FFPE) tumor tissue sample to be shipped to Rosetta Genomics’ Philadelphia-based lab. Once the sample is received, results can be available within 10 business days.

This test is a critical breakthrough for diagnosing mesothelioma. Currently, there is no single marker that is entirely conclusive for either malignant mesothelioma or metastatic tumor, which often makes it difficult for physicians to make a complete diagnosis. However, Rosetta Genomics’ miRview^TM meso test applies microRNA biomarkers and molecular technology to address this clinical need. High confidence cases have already shown 100 percent accuracy in determining the presence of mesothelioma.

Through the duration of 2009, Rosetta Genomics expects to conduct about 2,000 miRview^TM meso tests in its laboratory in Philadelphia, Pennsylvania.

Montana Asbestos Trial Opens

A federal prosecutor told jurors Monday that W.R. Grace & Co. knew for years that its products posed serious health hazards to residents of Libby, Mont., but the company hid the risks from workers and government regulators.

By NICHOLAS K. GERANIOS

Associated Press Writer

MISSOULA, Mont. -
A federal prosecutor told jurors Monday that W.R. Grace & Co. knew for years that its products posed serious health hazards to residents of Libby, Mont., but the company hid the risks from workers and government regulators.

In opening statements at a major environmental crime trial, Assistant U.S. Attorney Kris McLean said the company and its executives conspired to keep those hazards a secret.

“The company and individual executives chose profits at the expense of people’s health and chose avoiding liability over disclosing health hazards to the government,” McLean told a U.S. District Court jury in Missoula. “They endangered the health of hundreds, if not thousands.”

Attorney David Bernick of Chicago, who is representing Grace, sought to blunt the emotional nature of the prosecution’s presentation. Grace did not conspire to hide an asbestos contamination problem that was already widely known in the community and to regulators, he said.

Grace, which bought the mine in 1963, will contend that asbestos contamination was much worse under its predecessor, Zonolite. Asbestos-related disease can take decades to appear after exposure, Bernick said.

“If people are getting sick today, it’s not because of conditions today or recently,” he said.

Grace and five of its former executives are on trial on charges that from 1976 to 1990 they knowingly allowed workers to be exposed to asbestos from the vermiculite mine the company had operated near Libby, in northwestern Montana. The company and some executives also are charged with hampering the federal investigation of contamination.

Lawyers for residents of the Libby area say asbestos exposure has killed more than 200 people and sickened some 2,000, and the toll is rising because the diseases can take years to appear.

McLean contended the company did its own research and learned decades ago that even low levels of asbestos in the vermiculite became dangerous when disturbed. Even so, Grace donated dangerous mine waste for Libby schools to use in building tracks for runners, he said.

McLean said Libby suffers 40 to 80 times the national average in its rate of death from asbestosis, and lung-cancer mortality is 30 percent higher than health officials would expect the town to experience. Bernick said the figures are based on flawed studies.

Libby is a town of about 2,600 people in a forested valley of the Cabinet Mountains, about 100 miles northwest of Missoula.

Kevin Cassidy, a lawyer for the Justice Department in Washington, D.C., focused his opening statements on the individual executives, some of whom were in the courtroom. He said many were long aware of dangers, but took active steps to conceal them from workers and regulators. Even when the mine was closed and the land was being sold, executives did not disclose the dangers to the buyers, who included small-business people, Cassidy said.

 ”As a result of that concealment, people in Libby, Mont., including unsuspecting families, were put in danger,” Cassidy said.

Bernick said allegations of public endangerment and conspiracy to defraud the government relate not to the time when the mine was operating, but to the period after 1999 when the U.S. Environmental Protection Agency arrived for cleanup. The mine closed in 1990.

“There is no charge in this case that the defendants, Grace or the individuals, acted criminally to cause injury to miners and their families,” Bernick said.

No one disputes that miners were exposed to asbestos dust and then carried it home on their clothes, he said.

“There is no question that miners and their families suffered tragic losses as a consequence of the operation of this mine,” Bernick said. But he noted that Grace took active steps that reduced asbestos exposure after the company bought the mine.

Bernick ridiculed the notion of a conspiracy by executives to hide existence of asbestos that already was widely known and studied for decades.

“This was a mine that everyone knew had asbestos in the material,” Bernick said. “It was not a secret.”

After the mine closed and was reclaimed, there was a period of quiet until news articles the Seattle Post-Intelligencer published in 1999 raised new concerns, Bernick said.

“Almost all of it was old news,” Bernick said. “You know what papers are like: old news becomes new news.”

The news coverage brought the EPA back to Libby and that investigation led to the charges. The trial is expected to last several months.

In addition to Grace, a chemical company based in Columbia, Md., the defendants include former executives Henry A. Eschenbach, Jack W. Wolter, William J. McCaig, Robert J. Bettacchi and Robert C. Walsh.

A federal indictment unsealed in February 2005 charged Grace and its former executives with violating the federal Clean Air Act and obstructing an EPA investigation into the asbestos contamination.

The case stems from the vermiculite mining on Zonolite Mountain near Libby, mining that began around 1920 and continued until 1990. Vermiculite could be processed into products used for plumbing insulation, fireproofing and gardening. Zonolite brand insulation is in some 35 million homes in the United States.

Vermiculite from the Libby mine was contaminated with naturally occurring asbestos mineral fibers, which can be inhaled and can cause mesothelioma, asbestosis and lung cancer.

Particles of the ore entered the homes of miners because it clung to their clothes. Ore also was taken to processing plants in Libby, where a smokestack released up to 24,000 pounds of dust a day. Asbestos-contaminated mine tailings were used to build running tracks at local junior high and high schools, and lined an elementary school skating rink.

The town was declared a Superfund cleanup site in 2002.

The five retired executives, who are free on recognizance, face up to 15 years in prison and fines totaling millions of dollars if they are convicted. A verdict against Grace could lead to millions in fines against the company.

Copyright © 2009 The Seattle Times Company

When side effects of cancer treatment interfere with normal eating, adjustments can be made to ensure the patient continues to get the necessary nutrition.  Medications may be given to stimulate the appetite. Eating foods that are high in calories, protein, vitamins and minerals is usually advised. Meal planning, however, should be individualized to meet the patient’s nutritional needs and tastes in food.

Anorexia

Anorexia (lack of appetite) is one of the most common problems for cancer patients.

The following suggestions may help cancer patients manage anorexia: 

         Eat small high-protein and high-calorie meals every 1-2 hours instead of 3 larger meals.

      Have help with preparing meals.

      Add extra calories and protein to food (such as butter, skim milk powder, honey, or brown sugar).

      Take liquid supplements (special drinks containing nutrients), soups, milk, juices, shakes, and smoothies when eating solid food is a  problem.

      Eat snacks that contain plenty of calories and protein.

      Prepare and store small portions of favorite foods so they are ready to eat when hungry.

      Eat breakfasts that contain one third of the calories and protein needed for the day.

      Eat foods with odors that are appealing. Strong odors can be avoided by using boiling  bags, cooking outdoors on the grill, using a  kitchen fan when cooking, serving cold food instead of hot (since odors are in the rising steam), and taking off any food covers to release the odors before entering a patient’s room. Small portable fans can be used to blow food odors away from patients. Cooking odors can be avoided by ordering take-out food.

      Try new foods. Be creative with desserts. Experiment with recipes, flavorings, spices, types, and consistencies of food. Food likes and dislikes may change from day to day.

The following high-calorie, high-protein foods are recommended:

      Cheese and crackers.

      Muffins.

      Puddings.

      Milkshakes.

      Nutritional Supplements.

      Yogurt.

      Ice cream.

      Powdered milk added to foods such as pudding, milkshakes, or any recipe using milk.

      Finger foods (handy for snacking) such as deviled eggs, cream cheese or peanut butter on crackers or celery, or deviled ham on crackers.

Taste Changes

Changes in how foods taste may be caused by radiation treatment, dental problems, or medicines. Cancer patients often complain of changes in their sense of taste when undergoing chemotherapy, in particular a bitter taste sensation. A sudden dislike for certain foods may occur. This may result in food avoidance, weight loss, and anorexia, which can greatly reduce the patients’ quality of life. Some or all of the sense of taste may return, but it may be a year after treatment ends before the sense of taste is normal again. Drinking plenty of fluids, changing the types of food eaten and adding spices or flavorings to food may help.

The following suggestions may help cancer patients manage changes in taste:

     Rinse mouth with water before eating.

     Try citrus fruits (oranges, tangerines, lemons, grapefruit) unless mouth sores are present.

     Eat small meals and healthy snacks several times a day.

     Eat meals when hungry rather than at set mealtimes.

     Use plastic utensils if foods taste metallic.

     Try favorite foods.

     Eat with family and friends.

     Have others prepare the meal.

     Try new foods when feeling best.

     Substitute poultry, fish, eggs, and cheese for red meat.

     Find nonmeat, high- protein recipes in a vegetarian or Chinese cookbook.

     Use sugar-free lemon drops, gum, or mints if there is a metallic or bitter taste in the  mouth.

     Add spices and sauces to foods.

        Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

**Taking Zinc Sulfate tablets during radiation therapy to the head and neck may speed the return of normal taste after treatment.  BE SURE TO CONSULT YOUR DOCTOR FIRST.

 

Dry Mouth

Dry mouth is often caused by radiation therapy to the head and neck. Some medicines may also cause dry mouth. Dry mouth may affect speech, taste, ability to swallow, and the use of dentures or braces. There is also an increased risk of cavities and gum disease because less saliva is produced to wash the teeth and gums.

The main treatment for dry mouth is drinking plenty of liquids, about ½ ounce per pound of body weight per day.

Other suggestions to manage dry mouth include the following:

     Eat moist foods with extra sauces, gravies, butter, or margarine.

     Suck on hard candy or chew gum.

     Eat frozen desserts (such as frozen grapes and ice pops) or ice chips.

     Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).

     Keep water handy at all times to moisten the mouth.

     Choose foods and drinks that are very sweet or tart, to stimulate saliva.

     Avoid mouth rinses containing alcohol.

     Drink fruit nectar instead of juice.

     Use a straw to drink liquids.

Mouth Sores and Infections

Mouth sores can result from chemotherapy and radiation therapy. These treatments target rapidly-growing cells because cancer cells grow rapidly. Normal cells inside the mouth may be damaged by these cancer treatments because they also grow rapidly. Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier.

Suggestions to help manage mouth sores and infections include the following:

Eat soft foods that are easy to chew and swallow, eg:

            Soft fruits, including bananas, applesauce, and watermelon.

Peach, pear, and apricot nectars.

   

Cottage cheese.

 

Mashed potatoes.

 

Macaroni and cheese.

 

Custards; puddings.

 

Gelatin.

 

Milkshakes.

 

Scrambled eggs.

 

Oatmeal or other cooked cereals.

 

TIP: Use the blender to process vegetables (such as potatoes, peas, and carrots) and meats until smooth.

     Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.

     Avoid foods that are spicy or salty. Avoid foods that are acidic, such as vinegar, pickles, and olives.

     Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.

     Cook foods until soft and tender.

     Cut foods into small pieces.

     Use a straw to drink liquids.

     Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth.

     Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).

     Add gravy, broth, or sauces to food.

     Drink high-calorie, high-protein drinks in addition to meals.

     Numb the mouth with ice chips or flavored ice pops.

Using a mouth rinse that contains GLUTAMINE may reduce the number of mouth sores. Glutamine is a substance found in plant and animal proteins. BE SURE TO CHECK WITH YOUR DOCTOR FIRST.

Nausea

Nausea caused by cancer treatment can affect the amount and kinds of food eaten. The following suggestions may help cancer patients manage nausea:

     Eat before cancer treatments.

     Avoid foods that are likely to cause nausea. For some patients, this includes spicy foods, greasy foods, and foods that have strong odors.

     Eat small meals several times a day.

     Slowly sip fluids throughout the day.

     Eat dry foods such as crackers, breadsticks, or toast throughout the day.

     Sit up or lie with the upper body raised for one hour after eating.

     Eat bland, soft, easy-to-digest foods rather than heavy meals.

     Avoid eating in a room that has cooking odors or that is overly warm. Keep the living space at a comfortable temperature and with plenty of fresh air.

     Rinse out the mouth before and after eating.

     Suck on hard candies such as peppermints or lemon drops if the mouth has a bad taste.

Diarrhea

Diarrhea may be caused by cancer treatments, surgery on the stomach or intestines, or by emotional stress. Long-term diarrhea may lead to dehydration (lack of water in the body) and/or low levels of salt and potassium, important minerals needed by the body.

The following suggestions may help cancer patients manage diarrhea:

      Eat broth, soups, sports drinks, bananas, and canned fruits to help replace salt and potassium lost by diarrhea.

      Avoid greasy foods, hot or cold liquids, and caffeine.

      Avoid high-fiber foods–especially dried beans and cruciferous vegetables (such as broccoli, cauliflower, and cabbage).

      Drink plenty of fluids through the day. Room temperature liquids may cause fewer problems than hot or cold liquids.

      Limit milk to 2 cups or eliminate milk and milk products until the source of the problem is found.

      Limit gas-forming foods and beverages such as peas, lentils, cruciferous vegetables, chewing gum, and soda.

      Limit sugar-free candies or gum made with sorbitol (sugar alcohol).

      Drink at least one cup of liquid after each loose bowel movement.

Low White Blood Cell Count

Cancer patients may have a low white blood cell count for a variety of reasons, some of which include radiation therapy, chemotherapy or the cancer itself. Patients who have a low white blood cell count are at an increased risk of infection.

The following suggestions may help cancer patients prevent infections when white blood cell counts are low:

     Check dates on food and do not buy or use the food if it is out of date.

     Do not buy or use food in cans that are swollen, dented, or damaged.

     Thaw foods in the refrigerator or microwave. Never thaw foods at room temperature. Cook foods immediately after thawing.

     Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.

     Keep hot foods hot and cold foods cold.

     Avoid old, moldy, or damaged fruits and vegetables.

     Avoid unpackaged tofu sold in open bins or containers.

     Cook all meat, poultry, and fish thoroughly. Avoid raw eggs or raw fish.

     Buy foods packed as single servings to avoid leftovers.

     Avoid salad bars and buffets when eating out.

     Avoid large groups of people and people who have infections.

     Wash hands often to prevent the spread of bacteria.

Fluid Intake

The body needs plenty of water to replace the fluid lost every day. Long-term diarrhea, nausea and vomiting, and pain may prevent the patient from drinking and eating enough to get the water needed by the body. One of the first signs of dehydration (lack of water in the body) is extreme tiredness.

The following suggestions may help cancer patients prevent dehydration:

     Drink 8 to 12 cups of liquids a day. This can be water, juice, milk, or foods that contain a large amount of liquid such as puddings, ice cream, ice pops, flavored ices, and gelatins.

     Take a water bottle whenever leaving home. It is important to drink even if not thirsty, as thirst is not a good sign of fluid needs.

     Limit drinks that contain caffeine, such as sodas, coffee, and tea (both hot and cold).

     Drink most liquids after and/or between meals.

     Use medicines that help relieve nausea and vomiting.

Constipation

Constipation is defined as fewer than 3 bowel movements per week. It is a very common problem for cancer patients and may result from lack of water or fiber in the diet; lack of physical activity; anticancer therapies such as chemotherapy; and medications.

The following suggestions may help cancer patients prevent constipation:

      Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Increase fiber gradually and drink plenty of fluids at the same time to keep the fiber moving through the intestines.

      Drink 8 to 10 cups of fluid each day. Water, prune juice, warm juices, lemonade, and teas without caffeine can be very helpful.

      Take walks and exercise regularly. Proper footwear is important.

If constipation does occur, the following suggestions for diet, exercise, and medication may help correct it:

     Continue to eat high-fiber foods and drink plenty of fluids. Try adding wheat bran to the diet; begin with 2 heaping tablespoons each day for 3 days, then increase by 1 tablespoon each day until constipation is relieved. Do not exceed 6 tablespoons per day.

     Maintain physical activity.

     Include over-the-counter constipation treatments, if necessary. This refers to bulk-forming products (such as Citrucel, Metamucil, Fiberall, FiberCon, and Fiber-Lax); stimulants (such as Dulcolax tablets or suppositories and Senokot); stool softeners (such as Colace, Surfak, and Dialose); and osmotics (such as milk of magnesia). Cottonseed and aerosol enemas can also help relieve the problem. Lubricants such as mineral oil are NOT RECOMMENDED because they may prevent the body’s use of important nutrients.  BE SURE TO CHECK WITH YOUR DOCTOR FIRST. 

Good food sources of fiber include the following:

4 or more grams of fiber per serving

             Legumes (½ cup, cooked).

              Kidney beans.

              Navy beans.

              Garbanzo beans.

              Lima beans.

              Split peas.

              Pinto beans.

              Lentils.

             Vegetables and fruit

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