International Waldenstrom’s Macroglobulinemia Foundation:

Hope, Outreach, Support, Research

HEALTHY LIVING

Mission Statement:

To offer mutual support and encouragement to the Waldenstrom’s

macroglobulinemia community and others with an interest in the disease.

To provide information and educational programs that address patients’ concerns.

To promote and support research leading

to better treatments, and ultimately, a cure.

Published by the International Waldenstrom’s Macroglobulinemia Foundation

This information has been provided by IWMF at no cost to you. Please consider

joining and/or contributing to IWMF to enable us to continue to provide materials

like these to support research toward better treatments and a cure for

Waldenstrom’s macroglobulinemia. You may join and/or contribute at our

website, www.iwmf.com or you may mail your contribution to:

IWMF Business Office

6144 Clark Center Ave.

Sarasota, FL 34238

Ph: 941-927-4963

Fax: 941-927-4467

IWMF is a 501(c)(3) Tax Exempt Non-Profit Organization

Fed ID # 54-1784426

HEALTHY LIVING – A RESOURCE GUIDEBOOK FOR THE

WALDENSTROM’S MACROGLOBULINEMIA PATIENT

INCREASE YOUR POTENTIAL OF LIVING A LONGER AND

MORE HEALTHY LIFE THROUGH

NUTRITION, EXERCISE AND STRESS MANAGEMENT

TABLE OF CONTENTS

PREFACE................................................................................ 4

SECTION I

OVERVIEW..............................................................................6

SECTION II

NUTRITION........................................................................... 9

SECTION III

EXERCISE.............................................................................. 25

SECTION IV

STRESS MANAGEMENT.......................................................30

SECTION V

REFERENCES......................................................................... 36

PREFACE

This resource guidebook provides a brief review of selected scientific

literature in the areas of nutrition, exercise and management of stress

and anxiety for cancer patients. The following lifestyle

recommendations for Waldenstrom’s macroglobulinemia (WM)

patients are proposed in order to optimize one’s health in all stages of

treatment for this disease, whether the patient is on “watch and

wait”, undergoing treatment, or after a prescribed course of

treatment.

The primary objective of this guidebook is to assist the WM patient in

making informed lifestyle decisions resulting in a longer and

improved quality of life, and optimizing the body’s ability to cope

with WM and complications thereof. Ample references are provided

for more detailed information on nutrition, exercise, stress and

anxiety relevant to survivorship for the cancer patient.

The International Waldenstrom’s Macroglobulinemia Foundation

(IWMF) expresses its gratitude to Tony R. Brown, a WM patient

and past member of the IWMF Board of Trustees, as principal

author and leader in the development of this guidebook. The IWMF

also wishes to expresses its gratitude to IWMF volunteer member of

the IWMF Board of Trustees, Guy R. Sherwood MD, for his

extensive review and editing of the manuscript, and appreciation to

Carolyn Katzin for her professional review of the nutrition sections.

Carolyn Katzin is a licensed nutritionist and serves on the American

Cancer Society 2006 Nutrition, Physical Activity and Cancer

Survivorship Advisory Committee.

4

This guidebook was produced by the International

Waldenstrom’s Macroglobulinemia Foundation (IWMF), a

nonprofit organization founded in 1994. The mission and purpose

of the IWMF includes the provision of encouragement and support to

patients and their families with WM and to promote medical

research to find better treatments and a cure for this disease. Tax

deductible donations for education and research are welcome and

greatly appreciated. If you would like to make a donation, use the

IWMF website www.iwmf.com, email at www.info@ iwmf.com, or

send your donation to IWMF Office, 6144 Clark Center Ave.,, Sarasota,

FL 34238. For further information call the home office at 941-927-

4963.

5

SECTION I - OVERVIEW

Many Waldenstrom’s macroglobulinemia patients are told at

diagnosis that immediate treatment is often not necessary. We

are reassured by our physicians that the state of our health will

be monitored and treatment will be recommended when clinical

symptoms and laboratory tests warrant intervention. For some

of us, this period of “watch and wait” (W & W) can be anxiety

provoking, often more so than when we eventually begin active

treatment. Many of us will ask ourselves: “What do I want to do

with the rest of my life? What changes do I want to make? What

are the important lifestyle modifications that will maximize

health and treatment outcomes?” The answers will be

different for each of us. One guiding principle for many

patients is the need to feel in control of our lives, to rethink

what is truly important to us and our families, and to take the

required steps toward a good quality of life.

We can take control of our lives by becoming better informed

about our disease, by mentally and physically preparing to live

with WM until such time as a cure is found, and by obtaining

the latest information about treatment options. In order to take

charge of our lives, we need to take action.

We need to mentally and physically prepare our bodies to cope

with this illness. Any plan would include several areas for

action; (1) optimize our nutrition, (2) exercise (after

consulting our doctor about what is safe for us) and (3)

lower stress and anxiety levels so our body can concentrate on

fighting WM. The first two actions also effect the latter action.

6

A recommended action plan follows:

1. Join and support the IWMF patient organization and educate

yourself through the many information resources about WM.

2. Join and participate in a local WM support group.

3. Find an oncologist knowledgeable about WM. Ensure that

your family physician or internist participates actively in your

care. Second opinions are routine and recommended for the

WM patient. If you do not have confidence in your physicians,

change physicians until you do. Local WM support groups are

excellent sources of information about oncologist who have an

interest in WM.

4. Educate yourself about nutrition, exercise, and stress and

anxiety reduction.

Diet guidelines from the American Cancer Society and the Ameri-

can Institute for Cancer Research (AICR) are listed below:

a. Choose a diet rich in a variety of plant-based foods.

b. Eat plenty of vegetables and fruits.

c. Maintain a healthy weight and be physically active.

d. Drink alcohol only in moderation, it at all.

e. Select foods low in fat and salt.

f. Prepare and store foods safely.

g. Do not use tobacco in any form.

7

5. Consider finding a nutrition expert to help you improve your

diet. Experts include Registered Dietitians (www.eatright.org ) and

Certified Nutrition Specialists (www.cert-nutrition.org).

6. Implement a physician-supervised exercise plan designed

to keep your body in optimum condition given the status of your

health.

7. Make a list of what causes you stress and anxiety and

develop a plan to minimize each one of them. Most cancer

centers have psychologists who are extremely helpful in

helping you reduce stress and anxiety.

8

SECTION II - NUTRITION

According to the American Cancer Society, up to a third of

all cancer deaths each year can be attributed to diet,

whereas an additional third are due to smoking. The

Harvard School of Public Health states quite succinctly:

“Aside from not smoking, the most important determinants

of good health are what we eat and how active we are.”

A list of selected references is included in Section V. The

American Cancer Society (ACS) in particular has excellent

publications and information on nutrition available on

their website: caonline.amcancersoc.org.

The guiding principles of good nutrition as recommended by

the American Cancer Society are as follows:

• Choose most of the foods you eat from plant sources.

Fiber-rich foods such as fruits, vegetables, whole grains,

and legumes are loaded with antioxidants, phytochemicals,

vitamins, and minerals known to reduce the risk of cancer.

Five servings of fruits and vegetables a day (2½ cups) is

thought to reduce the risk of cancer, notably colon and lung

cancer.

• Limit your intake of high fat foods, particularly from

animal sources. High-fat diets have been associated with an

increased risk of cancers of the colon, rectum, prostate,

and endometrium.

9

Be physically active: achieve and maintain a healthy weight. As

little as 30 minutes a day, even in divided segments, can exert a

profound influence on one’s state of health.

• Limit consumption of alcoholic beverages, if you drink at all.

Excessive alcohol consumption increases the risk of cancer of the

head and neck, esophagus, and liver in men and women, and breast

cancer in women. The ACS notes that the cardiovascular benefits

of moderate drinking outweigh the risk of cancer in men over age

50 and in women over age 60. Nonetheless, it is recommended

that adults weigh the relative risks of cancer and heart disease

and discuss with their physician appropriate alcohol consumption.

PROTEINS, CARBOHYDRATES, FATS AND

CALORIES

Protein: The ACS recommends that 10 to 35% of calories

(energy), come from protein. Protein provides for growth and

repairs of the body, maintains a healthy immune system as well as

other vital functions. Good sources of protein include animal

foods like lean meat, fish, poultry, eggs and dairy products, as

well as plant foods like nuts, dried beans, peas, lentils, and soy

products.

Carbohydrates: The ACS recommends that 45 to 65 % of

calories come from carbohydrates. Carbohydrates constitute the

body’s primary source of energy. Foods high in carbohydrates

include breads, pasta, grains and cereal products, dried beans,

peas, lentils, fruits, and vegetables.

10

Fats: The ACS recommends that about 20 to 3% of calories come

from fats. Fats provide the body with calories for physical activity,

help the body grow, produce hormones, transport some vitamins

and help build new cells. Saturated fats (from meats and

whole-milk products) have the potential t o increase cancer

risks due to their interaction with hormones. Trans saturated fats

(from margarines, vegetable shortenings, and packaged breads,

cakes, cookies, and crackers) are also considered to have the

potential of increasing cancer risks and should be avoided.

Monounsaturated and polyunsaturated fats from vegetables,

nuts and grains and their oils: (e.g. olives, canola, soybean oil)

and some fish oils (particularly omega-3 fatty acids) are considered

to be good for you in limited quantities.

Calories: The calorie is the basic measure of energy.

Carbohydrates contain 4 calories per gram, proteins contain 4

calories per gram, fat contains 9 calories per gram and alcohol

contains 7 calories per gram.

To avoid weight gain one needs to balance caloric intake with

physical activity. A significant amount of physical activity is

required to burn one pound of body fat (3500 calories).

FOODS

As we enter our kitchens, grocery stores, restaurants, specialty

food stores, and other establishments we are faced with many

choices. Many foods contain, in addition to energy, nutrients that

support our body’s ability to resist and fight colds and diseases such

as heart disease and cancer.

11

The table below lists foods with the highest cancer

fighting attributes:

Foods with the Highest Cancer Fighting Attributes

Fruits Vegetables Whole. Grains

Nuts Meats

Blueberries Broccoli Barley Walnuts Wild Salmon

Strawberries Beans Brown Rice Almonds Lean Turkey

Cranberries Peas Whole Wheat Pecans Lean Chicken

Blackcurrants Watercress Bulgur Hazelnuts

Loganberries Tomatoes Rye

Bilberries Legumes Oats

Red Water- melon

Red Cabbage Bran

Oranges Asparagus Couscous

Pumpkin Spinach Quinoa

Dried prunes & raisins

Tomato Paste

Pink Grape- fruit

Kale

Boysenberries Avocado

Marionberries

Using colorful fruits and vegetables to replace other foods in your

diet typically adds nutrients and removes calories. Dark colored

fruits and vegetables contain antioxidants and phytochemicals

helpful in preventing and fighting cancer.

Some foods that are good sources of protein, carbohydrates and

fat but may not have as many cancer prevention or fighting

attributes as those with color are listed in the following table:

12

Foods to Add Protein, Carbohydrates and Fat

Proteins Carbohydrates Fat

White poultry meat More fruits Olive Oil

Soy More vegetables Avocado Oil

Low fat milk More whole grains

Egg whites

The next table lists some foods we should minimize because they

lack some of the desired nutrients or contain some ingredients

known to increase the risk of cancer:

Foods to Minimize

Proteins

Carbohydrates

Fats

Other

High fat red meats

Refined sugars

Saturated animal

Junk foods

Fried meats

Syrups & honey

Trans-fats

BBQ grilled

Smoked meats

Molasses

Corn oil

Whole eggs

Snack crackers

Safflower oil

Gelatin

White bread

Cottonseed oil

Farmed salmon/ trout, tuna, shrimp

Cakes and pastries

Hydrogenated soy oil

Most salad dressings

Refined grains

Margarine

Pickled foods

Potato Chips

Mayonnaise

French Fries

Butter

Pasta

13

Most nutritional guidelines suggest the minimal use of simple

refined sugar since it often becomes a replacement for foods with

high nutritional value. Avoiding trans-fats and limiting foods

containing saturated animal fats such as butter, cheese and fatty

or processed meats is desirable.

Of all the various foods covered, increasing vegetable and fruit

intake have the only convincing evidence of probable benefit for

the reduction of risk for developing all types of cancers. There is

little to no data on foods relative to Waldenstrom’s

macroglobulinemia.

OTHER FOODS OF INTEREST

Mushrooms: The American Cancer Society states that there exists

no evidence to support the claim that eating mushrooms fights

cancer in humans. At a recent American Association for Cancer

Research meeting there were several papers indicating a potential

benefit from consuming mushrooms by raising natural killer cell

levels. If true, this would be of benefit to those with WM.

Flaxseed oil: Most of the evidence of flaxseed oil’s ability to pre-

vent cancer from occurring or growing has come from studies

done in animals. Flax has potential hormone-modulating factors

which may be beneficial in prostate cancer prevention.

Garlic: Garlic may reduce the levels of Helicobacter pylori,

bacteria found in the stomach of infected individuals. This

bacteria has been linked with stomach cancer. Garlic is a

traditional food with potential for blood thinning and lowering

cholesterol.

14

Ginger: Ginger has no proven cancer benefit but is a traditional

anti-nausea remedy. In large doses ginger may interfere with

blood clotting and blood thinning medications.

Green tea: Phytochemicals present in both green and black

teas (Camellia sinensis) are thought to be beneficial in prevent-

ing many forms of cancer.

Soy products: Recent studies have advised caution with the

overuse of soy-based foods. Concerted efforts in research are

now underway to better delineate risks and benefits of soy con-

sumption in cancer patients.

Alcohol: Moderate consumption of alcohol prior to meals may

help increase appetite in appetite-suppressed individuals. Red

wine contains resveratrol which may be beneficial in lowering

cholesterol and improving health.

Sweeteners: Sweeteners continue to be an area of significant

controversy. Many nutritional experts favor minimizing the use

of all sweeteners.

Culinary herbs: Eaten in amounts typically used for culinary

purposes many herbs contain beneficial antioxidants and anti-

carcinogens. Rosemary, thyme, oregano, marjoram, and cumin

are examples of such plants that have been used for centuries for

their health and flavor properties.

15

IMPACT OF FOOD PREPARATION ON NUTRITIONAL VALUE

Fresh produce: Fresh produce should be washed with large

amounts of cold water prior to eating to remove any surface dirt

and bacteria, particularly if the skin is to be ingested. In hard-to-

get to places on fruits and vegetables consider scrubbing with a

clean dish brush. For leafy vegetables like cabbage peel off the

outer leaves and discard. The American Cancer Society notes

that the low levels of pesticides and herbicides on fruits and veg-

etables do not pose a danger of cancer or its recurrence. Organic

foods should be carefully inspected to assure that pests such as

molds are not on the surface and have not penetrated the skin of

the fruit or vegetable. Always choose fresh undamaged produce

for optimal health.

Raw versus cooked produce: The American Cancer Society states

that raw foods are usually considered to be more nutritious than

cooked and the less produce is cooked the more nutrients it

retains. Boiling vegetables for a long period of time can leach

out vitamins B and C. The American Cancer Society

recommends steaming or microwaving as the best way to

preserve most of the nutrients in food.

Certain nutrients are better absorbed when cooked however.

Lycopene in tomatoes is better absorbed when cooked and

consumed together with fat or oil. Some vegetables lose their

bitter- ness when cooked and produce less gas. Examples of

beneficial heat-stable vegetables of the cruciferous family include

cabbage, broccoli, cauliflower, kale and watercress. These

may be eaten cooked or fresh.

16

Frozen fruits: Frozen fruits may be more nutritious because

they are normally frozen quickly at peak ripeness. You may wish to

check the calorie content as some are prepared with additional

sugar. Fresh or frozen fruit should be consumed at every meal.

Meats: Baking, broiling or poaching lean cuts of meat is healthier

than frying or charbroiling. Charbroiling meat may cause the

formation of carcinogens and is discouraged.

VITAMINS

Vitamins are by definition essential to health and life. Food

provides the best source of most vitamins. For most people a

multivitamin and mineral supplement that contains the

recommended amounts is a good insurance policy. For

additional supplemental recommendations you should check with

a nutrition expert and inform your oncologist and other

physicians who treat you of your vitamin and supplement intake.

This is important as some supplements (and herbs) may react

with or interfere with the actions of chemotherapeutic drugs and

may be contraindicated in certain treatment protocols.

Supplemental vitamins and minerals are not strictly regulated in

the U.S., relying primarily on voluntary “industry good

manufacturing practices”. The American Cancer Society presents

the following statements regarding specific vitamins:

17

1. High doses of vitamin A are toxic and long term use of high

doses (in conjunction with beta-carotene) may cause lung cancer.

High doses of beta-carotene may also increase the rate of

colorectal cancer in people who smoke cigarettes, consume

alcohol, or both.

2. Current scientific evidence has not found any beneficial

effects of vitamins B1, B3, B4, B5, B6, or B12 supplementation on

the growth or spread of cancer.

3. Diets adequate in Vitamin C were associated with fewer

delays in treatment related to low blood counts.

4. There is emerging evidence that a vitamin D supplement may

play a role in decreasing the proliferation of prostate cancer cells, and

may be required together with calcium supplements in cancer patients

in general who experience bone loss secondary to treatments.

5. There is no evidence that vitamin E significantly affects the

growth of cancer in doses over 400 IU per day. Diets with sufficient

vitamin E were associated with lower risk for infection. Excess

vitamin E may increase the effect of the blood thinner warfarin

(Coumadin).

6. There is no evidence that vitamin K is an active anticancer agent

in human patients.

7. Folic acid may protect against certain cancers, including

breast, esophageal, prostate, bladder and colon cancer.

18

The American Cancer Society states in the Nov/Dec 2006 paper

Nutrition and Physical Activity During and After Cancer

Treatment: An American Cancer Society Guide for Informed

Choices:

“During and after cancer treatment, there is a probable benefit of

taking a standard multiple vitamin and mineral supplement that

contains approximately 100% of the Daily Value because, during

these times, it may be difficult to eat a diet with adequate amounts of

these micronutrients. The use of very large doses of vitamins, and

other dietary supplements is not recommended because some

evidence exists that high-dose supplements can increase cancer

risks.”

MINERALS

Minerals in small amounts are essential and eating a wide variety of

fruits, vegetables and grains provides us with the minerals we need.

It is best to follow your physician and dietician’s advice regarding

specific minerals during treatment and in cases where your body is

noted by laboratory testing to be deficient in specific minerals.

Mineral supplements are not strictly regulated in the U.S. and may

contain impurities. Mega-doses are not recommended unless there

are government regulated clinical claims to support their use.

The American Cancer Society presents the following statements

regarding specific minerals:

19

1. Calcium supplements will not slow the growth of most

cancers but is being studied in slowing the growth of polyps

which may predispose individuals to colorectal cancers.

2. The role of copper, iron and molybdenum in the control of

cancer is unknown.

3. There is no evidence that magnesium supplements affect the

incidence or development of cancer.

4. Studies of the effects of a high-potassium diet on cancer have

not shown a positive link between potassium intake and the prevention

or development of cancer. Excess potassium in the body can be life-

threatening.

5. Some studies have shown that people with head and neck

cancer or childhood leukemias have low zinc levels in their blood

and/or in their white blood cells. High doses of zinc can cause some

serious side effects.

6. High levels of selenium in the body may lower risk of lung,

colon, prostate and bladder cancer. Selenium can be toxic in high

doses.

As is the case in vitamins, excessive mineral supplementation can

be harmful.

20

HERBS

Eaten in amounts typically used for culinary purposes most herbs are

harmless. These herbs are typically different than the medicinal herbs

used to treat illnesses. The American Cancer Society has stated

“Herbal supplements do not slow or reverse the spread of cancer.

Herbs do not affect or control the growth of cancer or cancer cells”.

Herbal products are not strictly regulated in the U.S. and may

contain impurities, particularly herbs from Asia. Some herbs may

interfere with cancer treatments. Mega doses are not

recommended unless there are government regulated clinical

claims to support their use. The NIH’s National Center for

Complementary and Alternative Medicine is doing extensive research

in herbal medicine as it relates to cancer treatments in particular.

www.nccam.nih.gov.

The following websites also contain information about medicinal

herbs:

www.mskcc.org/aboutherb

www.canceralternatives

mednet.ucla.edu

www.naturalstandards.com.

NUTRITIONAL MODIFICATIONS PRIOR, DURING AND AFTER TREATMENT

Caution should be used in taking vitamins, minerals and herbs

during treatment as they may interfere with the cancer treatment.

21

Only those supplements taken in the doses recommended by a

cancer nutrition health professional and agreed to by your

oncologist and other physicians should be considered.

“Eating Hints for Cancer Patients: Before, During and After

Treatment” is available from the following website:

www.cancer.gov/cancertopics/eatinghints.

Food safety is important when your immune system is compromised.

The American Cancer Society provides recommendations in kitchen

hygiene, the preparation of foods and the refrigeration and storing of

food for cancer patients. Main issues include cleanliness and cooking

of foods at adequate internal temperatures. Over-cooking food,

especially charring, should be avoided.

The Environmental Working Group Food News Letter October 2003

issue www.ewg.org lists the 12 most pesticide contaminated fruits

and vegetables: apples, bell peppers, celery, cherries, imported

grapes, nectarines, peaches, pears, potatoes, red rasp- berries,

spinach and strawberries. For these fruits and vegetables one can

consider switching to properly certified organic versions of the same

fruit or vegetable. The 12 least contaminated fruits and vegetables

are asparagus, avocados, bananas, broccoli, cauliflower, sweet corn,

kiwi, mangos, and onions.

22

DIETS PROMOTED AS CURES FOR CANCER

There is no current evidence to support diet therapies for any form

of cancer apart from the nutritional recommendations from the

American Cancer Society (ACS). Indeed many of these treatment

protocols may lead to significant weight loss which in itself is

harmful. Electrolyte abnormalities have also resulted in the death of

individuals engaged in these controversial diets. Below are some of

the more common controversial diets:

Gerson Therapy: This therapy requires following a strict low- salt,

low-fat vegetarian diet, drinking juice from approximately

20 pounds of freshly crushed vegetables and fruits, and coffee

enemas. The ACS states: “There is no scientific evidence that the

Gerson therapy effectively reduces cancer progression or improves

survival, and it can be very harmful to the body.”

Kelly Treatment/Gonzalez Treatment: Includes up to 150 daily

dietary supplements (enzymes and large doses of vitamins, minerals,

and amino acids), fasting, exercising and prayer. Again the ACS states:

“There is no scientific evidence that this metabolic therapy is

effective in treating cancer or any other disease, or that the therapy is

safe or effective.”

Vegetarian Diet: Population studies have linked vegetarian diets

with a decreased risk of heart disease, diabetes, high blood pressure,

obesity, and colon cancer.

23

Current evidence does not suggest that a vegetarian diet prevents

cancer recurrence. Vegans, strict vegetarians who eat no animal

products at all, must be careful to consume adequate amounts of

protein, vitamin B12, zinc, and iron, as well as vitamin D and

calcium.

Macrobiotic Diet: A macrobiotic diet is generally vegetarian and

consists largely of whole grains, cereals, and cooked vegetables.

Eating dairy product, eggs, coffee, sugar, stimulant and aromatic herbs,

red meat, poultry and processed foods is discouraged. Of all the

above-mentioned diets, the macrobiotic diet is felt to be the least

harmful.

24

SECTION III - EXERCISE

Exercise is fundamental to one’s health. Not only does exercise

help burn calories, but it is helpful in digestion, reducing stress,

combating fatigue and insomnia, and maintaining a healthy

and competent immune system. The benefits of exercise are

significant in cancer patients, contributing to better treatment

outcomes and overall quality of life.

A brief summary of the benefits of exercise in cancer patients

are:

1. Moderate exercise boosts the activity of lymphocytes and

macrophages, which destroy cancer cells.

2. A lean body mass, coupled with physical activity, lowers

insulin and glucose levels. Insulin can suppress immunity and

stimulate tumor growth.

3. Exercise can make the body more sensitive to insulin,

helping the body use energy from foods more effectively. This

may help lessen the severity of cancer cachexia, a detrimental

malnourished state common in cancer patients.

4. Physical activity may stimulate bowel movements, reducing

the amount of time cancer-causing agents or toxins reside in

your colon.

5. Exercise may help prevent hormonally-based cancers by

decreasing estrogen production.

25

With all of the benefits of exercise, we often still do not exercise

at the level we should. It requires willpower and determination

to make a commitment to a daily exercise program, one which

many of us avoid until a life-threatening event occurs. We need

to take action to exercise to the level that is appropriate for our

body and state of health.

Regardless of one’s current level of exercise a consultation with

a physician is recommended prior to beginning an exercise

program or prior to making any significant changes to an exist-

ing exercise program. This is particularly important for anyone

who has a heart condition. The American Cancer Society (ACS)

recommends that for people largely inactive or just beginning

an exercise program a gradual increase to 30 minutes per day of

moderate-to-vigorous physical activity at least five days per week

is appropriate. Those who are already exercising at 30 minutes

per day five days per week should strive toward 45 minutes on

most days of the week.

The ACS notes that regular physical activity can reduce anxiety

and depression, improve mood, boost self-esteem, and reduce

symptoms of fatigue, nausea, pain, and diarrhea in the cancer

patient. The ACS also provides helpful tables relevant to exercise

in their publications, such as:

26

Types of Physical Activity

Type of Physical Activity

What’s Involved

Examples

General Physical Activity

Muscle movement that uses energy, including exercise and daily activities

Swimming, dancing, mowing the lawn

Aerobic Activity

Improving cardiovascular fitness

Walking the dog, jogging, bicycling, jumping the rope

Resistance Training

Strengthening muscles and protecting joints

Lifting weights or using resistance training equip- ment, push-ups, carrying and lifting

Flexibility Training

Stretching muscles to improve range of motion, balance and stability

Stretching and yoga

The ACS suggests simple ways to increase physical activity:

1. Use stairs rather than an elevator.

2. Exercise with your family, friends and coworkers.

3. Take a 10 minute exercise break to stretch or take a quick

walk.

4. Walk to visit nearby friends or coworkers instead of send-

ing an e-mail.

5. Plan active vacations rather than driving-only trips.

6. Wear a pedometer every day and increase your daily step

totals. Aim for 10,000 steps per day if possible.

7. Use a stationary bicycle while watching TV.

8. Plan your exercise routine to gradually increase the days

per week and minutes per session.

27

Guidelines from the ACS on the amount of exercise

suggested each week for adults:

“Engage in at least moderate activity for 30 minutes or

more on five or more days of the week; 45 minutes or

more of moderate- to-vigorous activity on five or more

days per week may further enhance reductions in the risk

of breast and colon cancer”.

The ACS examples of moderate and vigorous intensity

physical activity are as follows:

Examples of Moderate and Vigorous Intensity Physical

Activities

Moderate Intensity Activities

Vigorous Intensity Activities

Exercise and

Leisure

Walking, dancing, leisure bicycling, ice skating, roller skating, horseback riding, canoeing, yoga

Jogging or running, fast bicycling, circuit weight training, aerobic dance, martial arts, jumping rope, swim- ming

Sports

Volleyball, golfing, softball, baseball, badminton, doubles tennis, downhill skiing

Soccer, field or ice hockey, lacrosse, singles tennis, rac- quetball, basketball, cross-country skiing

Home Activities

Mowing the lawn, general lawn and garden maintenance

Digging, carrying and hauling, masonry, carpentry

Occupational Activities

Walking and lifting as part of the job, custodial work, farming, auto or machine repair

Heavy manual labor (forestry, construction work, firefighting)

Numerous fitness and nutritional experts offer additional

recommendations:

28

1. Aerobic exercise most days (30-60 minutes)

2. For those not currently exercising, begin with walking a

minimum of one hour per week.

3. Resistance exercises (weight training) 2-3 times per week.

4. Stress management practice (15 minutes most days).

5. Hydration: Drink 8 or more 8-ounce glasses of water daily

(may include tea and/or 100% fruit/vegetable juice).

6. Sleep (7-8 hours for most people).

Gordon and Curtin in their book “Comprehensive Cancer Care,

Integrating Alternative, Complementary, and Conventional

Therapies,” recommended evaluating your physical status,

finding an exercise that fits you now, exercising within your

capacity and include walking as a significant part of an exercise

plan. They also recommend experimenting with yoga, tai chi,

and qi gong; systems of gentle moving, meditation, stretching,

breathing and imagery.

29

SECTION IV - STRESS MANAGEMENT

One of the first emotions we experience when diagnosed with

Waldenstrom’s macroglobulinemia (WM) is the over-

whelming desire to rid ourselves of the disease as quickly as

possible. After educating ourselves about this illness we may

appreciate that treatment may not be required immediately and

we should perhaps consider taking greater control of our life.

Taking control means (1) becoming knowledgeable about WM

and its treatments and consulting a knowledgeable physician,

(2) optimizing our body’s ability to fight the disease through

exercise, rest and nutrition, (3) minimizing the other battles our

body has to fight such as infections, harmful foods, stress and

anxiety and (4) cultivating a spiritual practice and enlisting the

support of prayer/meditation, family, friends and community

resources.

One of the most difficult situations newly diagnosed patients on

watch and wait have to deal with is the stress and anxiety

associated with learning they have cancer. This section covers

personal experiences as well as a review of recent literature on

how best to deal with the stress and anxiety you face when you

have been diagnosed with Waldenstrom’s macroglobulinemia.

The same principles apply to your spouse, loved ones and

caregivers who also face stress and anxiety, sometimes more

intensely than we do.

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Stress is a term applied to the physiologic response you

experience when you feel threatened, out of control because of

some change in your life, or overloaded by too many events that

are happening at once. Some of the biggest event stressors

include marriage, separation, divorce or death of a spouse, and

major injury or illness such as WM. Small and repetitive changes

in your life may add up to create major stress that can be harmful

to your health.

Anxiety is defined as the feeling of fear or helplessness against an

unidentifiable danger or a sense of loss of connection.

Following are several techniques found to be helpful in dealing

with stress and anxiety:

1. Accept the fact that you have WM. Denial is an ineffective

strategy to reduce stress and anxiety. We need the support of

loved ones and others who have WM to cope with the

uncertainty of the disease. The decision to involve business

associates, co-workers and our boss is a personal one we each must

decide for ourselves.

2. Become knowledgeable about WM and the management of

stress and anxiety. Considerable information is available from the

IWMF’s website and in its DVDs and publications, especially its

quarterly newsletter, The IWMF Torch.

Information is also available at major cancer treatment centers, as

well as numerous websites and publications available from

cancer organizations such as the American Cancer Society.

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3. Optimize your body’s ability to fight WM. After the initial

period of shock, stress, anxiety and possibly even depression

associated with the diagnosis of WM, we need to take action to

optimize our body’s ability to fight this slow-growing cancer in

order to prolong the time between treatments and to enjoy as

much high-quality life as possible. Candidly assess your disease:

What helps fight it? What aggravates it? Then decide what you are

going to do about it.

4. Stay active and engaged. Use the diagnosis of WM as a

wake-up call to think through what is and is not important in

your life and what you want to do with the remainder of your

life. Besides developing and following a plan to fight WM, we

can stay active and engaged in finding and pursuing a purpose in

our life.

5. Take control. Eliminate unnecessary tasks. Is the need to

buy more to replace what we already have so important? Does

every minute of the day have to be filled with some activity?

6. Join a WM support group and participate in the IWMF

Talklist. We can get great comfort by asking what others with

WM have done to deal with the illness.

7. Avoid caustic situations and toxic support characters.

Martin L. Rossman M.D. in his 2003 book Fighting Cancer From

Within, How To Use The Power Of Your Mind For Healing

defines “toxic support characters” as “badgers” (do something

now), “doom and gloomers” (sorrowful and already have you in

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the grave), “projectors” (no sincere interest in your feelings, think

you are not dealing with cancer the way they would), “users”

(need you to make them feel better), “new agers” (ask what you

did wrong to get cancer) and “cancer fascists and fundamentalists”

(think they know all there is to know about WM without any

training).

8. Use imagery to relax, reduce stress and give your body a

chance to repair. There are many guided imagery techniques

used for mind-body healing. Relaxation techniques, meditation,

biofeedback, hypnosis and mind-body exercises such as yoga, tai chi

and qi gong can all be helpful. Dr. Rossman’s book mentioned

above highlights four forms of guided imagery to deal with

stress associated with cancer. The first are the relaxation

techniques which include meditation. These techniques allow

your mind and body to conserve energy, refresh and repair. The

second form, called “evocative imagery,” is a re-connecting to

past events so that you can use them effectively in “emotional

bodybuilding” to fight your cancer. To help with evocative

imagery, Dr. Rossman recommends keeping a personal Healing

Journal.

The third kind of imagery is akin to a prayer to influence the

“mystery” in your life. Dr. Rossman defines the mystery as “what

you might call God, destiny, fate, karma, and the things that

happen to you that do not seem to be under your control.” The

fourth kind of imagery involves “inviting an image (called the Inner

Healer) that can represent the immense healing intelligence

within you and finding out how you can support each other.” Dr.

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Rossman recommends using a Healing Journal with this form of

imagery. His book provides tools for using these imaging

techniques.

1. Seek professional help. Depression is a natural reaction when

diagnosed with a serious illness. Should the depression

persists for greater than 4 months, you may require

professional help from your physicians and from

psychologists that specialize in cancer-related mental

health issues. The best way to assess your depression is

to seek professional support. Often, just talking to a

professional may be all you need!

2. Exercise and get fit! Although addressed earlier, exercise is also an

aid to stress management. Benefits of a healthy body and

psyche include:

a. Greater self-esteem due to feeling fit and feeling

good about your body.

b. Being more positively perceived by others, as a

more at- tractive physical appearance leads other people

to consider you more poised, sensitive, kind, sincere, and

more socially and occupationally successful.

c. Feeling more alert and able.

d. Become more productive. Healthy women and men

miss fewer days of work, have fewer illnesses, are

involved in fewer accidents, and have a better attitude

toward work in general.

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e. Decreased feelings of depression and anxiety.

f. Increased ability to manage stress, with a resulting

decrease in stress related behaviors.

3. Use a self-help stress management handbook to reduce

stress. MindBody Cancer Wellness, A Self-Help Stress

Management Manual by M. Edwards explains the stress

response, offers relaxation strategies and provides

additional reference sources.

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SECTION V - REFERENCES

The International Waldenstrom’s Macroglobulinemia

Foundation (IWMF) provides educational resources to patients

and caregivers. Numerous booklets are available on a wide range

of topics, and the IWMF website www.iwmf.com can offer

important links to other reputable organizations and sources of

information.

The American Cancer Society’s “Nutrition and Physical

Activity During and After Cancer Treatment: An American

Cancer Society Guide for Informed Choices”, current as of

December 2006, is the definitive article on cancer nutrition at:

caonline.amcancersoc.org/cgi/content/full/56/6/323

The American Cancer Society published in 2004 an excellent

comprehensive and inexpensive book: “Eating Well, Staying

Well During and After Cancer”

The American Institute for Cancer Research is a non-for-profit

organization offering reliable information about nutrition and

cancer. www.aicr.org/index.lasso

Harvard School of Public Health website: www.hsph.harvard.edu/nu

tritionsource

The National Institute of Health’s National Center for

Complementary and Alternative Medicine has an up-to-date

listing of clinical trials and other studies on integrative medicine.

www.nccam.nih.gov

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