Help for a Poor Appetite

Unfortunately, one of the side effects of cancer and/or the treatment of cancer is a poor appetite which leads to unwanted weight loss and overall physical decline. There are some simple steps to take to help get you through this situation.

Eat small frequent meals instead of 3 larger meals, and eat every couple of hours.
Make eating more enjoyable by setting the table with pretty dishes and flowers, use candlelight, and/or play music while eating.
Eating is a social event, try to have family or friends present when you eat.
Consume high calorie and high protein foods and include these in meals and snacks throughout the day. Use foods that are easy to eat as snacks, such as ice cream and pudding.
Add sauces and gravies to meat, and cut meat into small bite-sized pieces to make it easier to chew and swallow.
Avoid low-calorie foods–use real butter and cream to add calories.
Avoid liquids with meals as they can fill you up faster. Instead, reserve your liquids to in-between meals and add-in liquid meal supplements like Ensure or Carnation Instant Breakfast between meals, too.
If the smell of food bothers you, trying eating bland food or eat your food cold or at room temperature.
If you are bothered by a metallic taste, use plastic eating utensils.
Check with your doctor about medication to help relieve constipation, nausea or pain to increase your appetite.
Keep snacks on hand to eat when your are hungry. Try hard boiled eggs, nutritional, drinks, Greek Yogurt, nuts, protein smoothies.
Ginger tea and green tea are natural appetite stimulants.

Most important, tell your doctor about your decreased appetite. If needed, she may prescribe you a medication to help stimulate your appetite.

Need help? Schedule your appointment with ICS today.

Mom was Right–Eat Your Veggies

Eating a variety of vegetables is important for maintaining and achieving a healthy body. Why? Vegetables are a great source of many nutrients including potassium, folic acid, vitamin A, vitamin C, and dietary fiber.

According to the USDA:

Eating a diet rich in vegetables and fruits as part of an overall healthy diet may reduce risk for heart disease, including heart attack and stroke.
Eating a diet rich in some vegetables and fruits as part of an overall healthy diet may protect against certain types of cancers.
Diets rich in foods containing fiber, such as some vegetables and fruits, may reduce the risk of heart disease, obesity, and type 2 diabetes.
Eating vegetables and fruits rich in potassium as part of an overall healthy diet may lower blood pressure, and may also reduce the risk of developing kidney stones and help to decrease bone loss.
Eating foods such as vegetables that are lower in calories per cup instead of some other higher-calorie food may be useful in helping to lower calorie intake.

There are three types of vegetables: Leafy Greens, Colorful, and Cruciferous

Leafy Greens:

Loose leaf greens are the most nutritious and iceberg lettuce is probably the least nutritious of the green leafy vegetables. The darker the color of the green, the more nutrition as well.

Deep green, leafy vegetables are notoriously rich in beta-carotene, vitamins, and minerals. Types: beet, Swiss chard, collards, dandelion, kale, lettuce – romaine, spring greens, butternut, spinach, and turnip.

Serving Size: 1 cup

Colorful:

A fun way to eat more vegetables is to eat a rainbow of vegetables.

The skins of vegetables contains phytonutrients, which are natural compounds that are promoters of health. Specifically, phytonutrients stimulate enzymes that help the body get rid of toxins, boost the immune system, improve heart health, promote healthy estrogen metabolism and stimulate death of cancer cells.

Red fruits include apples, blood oranges, cranberries, cherries, goji berries, grapes, plums, pomegranate, raspberries, strawberries, watermelon, and rhubarb

Red Vegetables: radish, tomatoes, potatoes, sweet red peppers, beets, beans

Blue/purple/black fruits include a wide variety of berries: blueberries, blackberries, boysenberries, huckleberries, and figs, grapes, prunes, plums and raisins.

Blue/purple/black vegetables listed are purple bell pepper, purple cabbage, purple carrots, purple cauliflower, eggplant, purple kale, black olives, purple potatoes.

Green fruits listed here are apples (Granny Smith), avocado, limes, olives, and pears.

Green vegetables on this list are numerous: artichoke, bamboo sprouts, bean sprouts, bitter melon, bok choy, broccoli, broccolini, Brussels sprouts, cabbage, celery, cucumber, edamame/soy beans, green beans, green peas, greens of all types (beet, chard, collards, dandelion, kale, lettuce, spinach, and turnip), okra, snow peas, and watercress.

Yellow fruits to choose from such as Golden Delicious apples, Asian pears, lemons, pineapple, and starfruit.

Yellow vegetables include yellow bell peppers, corn, and potatoes.

Orange fruits include apricots, cantaloupe, mango, nectarine, oranges, papaya, persimmon, and tangerines.

Orange vegetables on this list are acorn squash, orange bell pepper, butternut squash, carrots, pumpkin, and sweet potatoes.

Serving Size: 1/2 Cup

WHITE/TAN/BROWN

White/tan/brown fruits are fairly sparse on this list, but include apples and applesauce (the non-skin part of the apple), coconut, dates, lychees, and peas.

White/tan/brown vegetables include cauliflower, garlic, mushrooms, onion, sauerkraut, and shallots. Mushrooms encompass more than just the standard white mushroom as there are several types that are considered to have significant medicinal benefit because of their ability to help the immune system. Examples of mushrooms to try include: Shiitake, button, portabello, crimini, and chanterelle.

Cruciferous:

Cruciferous vegetables are known to help detoxify the body should be eaten every day. Cruciferous vegetables have a phytonutrient which has been shown to be anti-cancer. These phytonutrients change the way estrogen is broken down in the body. As a result, eating these vegetables is associated with the decreased risk of hormone or estrogen related cancers such as breast and uterine cancer. Eating these vegetables either raw, lightly sautéed, or steamed is best. Cruciferous vegetables are also known as important sources of fiber, vitamins, and minerals.

They include Arugula, Broccoli, Cauliflower, Cabbage, Kale, Brussels sprouts, broccoli, and watercress, are considered to be excellent anti-cancer foods.

Serving Size: 1 cup

HOW TO EAT MORE VEGETABLES

Try Cauliflower Rice: you can find it in the frozen food section already riced or you can easily make your own with a food processor–just cut head of cauliflower into smaller pieces and pulse till cauliflower is in size of rice grains. Sauté onion, garlic in olive oil or coconut oil and then add rice to cook. Frozen cauliflower rice can be microwaved. Add cilantro for Mexican flavor or ginger for Asian.

Try Spaghetti Squash: easy to make in the microwave. Halve and put in microwave dish with a little water, clean out seeds first. Microwave 4-8 minutes. Use a fork to make into angle hair fine strands that can be used instead of spaghetti.

Keep a bowl or container of fresh cut vegetables on the top shelf of refrigerator, within easy reach.

Keep a fruit bowl on kitchen counter, table, and desk at work.

Pack fruit and vegetables in purse/briefcase to eat as a snack. Bring moist towelettes to clean them off before eating if you do not have time to wash.

Choose fruit for dessert (fruit kabobs, berry compotes, fruit salads, etc.).

Have dishes with lots of vegetable variety (e.g., soups, stir-fry).

Toss in red pepper, tomatoes, garlic, onions or broccoli to omelets.

Add some greens into your morning smoothie.

Make grilled Brussels sprouts and drizzle with olive oil.

By adding more vegetables into your diet, you will be on your way to a healthier lifestyle.

Supplied by Dr. Linda Jager, MD Iowa Cancer Specialist

Guest Post from an ICS Patient!

Henry Ford said, “You can’t build a reputation on what you are going to do.” We at Iowa Cancer Specialists are proud to have a built a reputation on what we do everyday–provide quality healthcare in a warm environment with a caring and knowledgeable staff. But you don’t have to take our word for it. Here is what one of our patients had to say:

“The new building for Iowa Cancer Specialists is designed with attention to excellent parking and functional features as you study the floor plan of the building interior. Selection of color tones with attention to artistic painting and objects create a warm welcoming environment. I have appreciated the fact that though office hours are 8:00 a.m. to 5:00 p.m., when I arrive on an early morning, doors are unlocked and allow me to step into the comfort of the waiting area. Individuals involved with scheduling, managing telephones, and greeting of arrivals are positive
and within a few short weeks know patients by name. In fact, all the employees are energetic and reach out to patients with greetings for the day.

Care and concerns for my health are foremost in the minds of those who have been attentive to my needs. Professional treatments are with both an efficient use of time and the efforts to develop a personal relationship. Lab results, medications suggested, and recommended
actions are shared with clarity. Good skills are practiced in listening to my questions. Professional communication with other physicians and University of Iowa Hospitals demonstrate a team approach in sharing thoughts regarding treatments. Dr. Susannah Friemel has created a culture where positive energies lead to staff being an integrated team working with each of us as patients. And Dr. Friemel has addressed each of my questions, demonstrated an in-depth knowledge of her field, and has given me complete confidence that she knows who I am and what the continuous changes in my health program should entail.” David Fairweather

See what all the talk is about–schedule your appointment at ICS today!

Coping With a Sore Mouth

Mouth sores (oral mucositis) are a common side of cancer treatment. Mouth sores may develop with chemotherapy or radiation therapy either alone or combined and usually appear 7-10 after the start of treatment. The mouth sores, also called ulcerations, can be mild or severe and cause treatment to be delayed. Symptoms of mouth sores include swollen gums, burn-like sores, a coating on the tongue, painful swallowing, chewing, or painful breathing.

Mouth sores occur because cancer treatment is intended to kill rapidly growing cancer cells. Some cells in your body, like those in your mouth, grow rapidly and the treatment mistakes those cells for cancer cells and tries to eliminate them, which causes the ulcerations. However, there are ways to reduce your risk getting mouth sores as well as treating them if they develop.

One way to reduce your risk is to maintain good oral hygiene. It is important to keep your mouth clean so bacteria will not build up. See your dentist before you begin treatment to ensure your mouth/teeth are in good condition.

Here are some other ways to ensure good oral hygiene include and to minimize the discomfort of mouth sores:

Use a mouth rinse mixture with ½ tsp salt to 8 oz of water, or ½ tsp of baking soda and 8 oz of water Use after eating and prior to bed.
Avoid mouth washes with alcohol as can cause dryness and may sting.
Choose lukewarm or cool foods that are soothing. Extremely hot or cold foods cause mouth distress.
Carry a water bottle when away from home and sip water frequently. Try drinking through a straw.
Blend and moisten foods that are dry or solid sue soups or with sauces, and casserole.
Choose soft, creamy foods.
Use a soothing lip balm to keep lips moist.
Use a soft toothbrush or, if needed, disposable sponge swabs.
Avoid flossing if platelet count is low or gums are bleeding.
Don’t wear dentures.
Avoid alcohol and alcohol.
Avoid tobacco as smoking inhibits healing.
Avoid rough textured foods .
Avoid tart, acidic, or salty beverages and foods, such as citrus fruit juices, pickled and vinegary foods, tomato based foods.
Avoid strong spices such as chili powder, cloves, curry, hot Sauces, nutmeg, peppers.

In addition to the above recommendations, your doctor may prescribe a topical pain reliever.

It is important for you to manage your mouth sores as they can delay treatment due to infection and the pain/discomfort may cause you reduce caloric intake and lose weight.

If you develop mouth sores, please notify your physician at Iowa Cancer Specialists for further recommendations.

The Dos and Don’ts of Diarrhea

“Never give in, and never give up.” Hubert Humphrey.

Everyone suffers from diarrhea from time to time, and usually it’s from an infection. However, loose watery stools are also a common side effect of cancer treatment medications. But, being common doesn’t mean it can’t be serious. Persistent diarrhea causes the body to lose needed water and nutrients. Left untreated, diarrhea may cause dehydration which can be life threatening.

Ways to manage your diarrhea

There are steps you can take to avoid dehydration and control diarrhea:.

Drink plenty of clear liquids throughout the day. Liquids at room temperature are better tolerated.
Eat small, frequent meals and snacks throughout the day
Limit or eliminate milk products except yogurts
Drink and eat foods that higher sodium such as bone broth or broth soups
Eat high-potassium foods such as bananas, potatoes, avocado
Eat foods high in pectin, such as bananas, apples or low sugar apple sauce
Drink at least one cup of liquid after each loose bowel movement
Limit use of sugar free gums and foods with sorbitol.
Use Imodium AD or Kaopectate for diarrhea. You may begin by taking 2 tabs. Continue 1 tab after each loose stool up to 8 times max per day.
Avoid foods and drinks which produce gas, such as carbonated drinks, cruciferous vegetables (cauliflower, broccoli, cabbage).

When to call a doctor

Be sure to call your doctor if :

Diarrhea persists more than three days.
Your stool have an unusual color or there is blood in the stool.
If you have a fever.
If you are weak or dizzy
If you are having more than 6 loose stools a day and medication is not working.

We at Iowa Cancer Specialists are committed to your health. Call our office today to schedule your appointment.

Linda Jager, M.D.

Create a Vibrant Life With A Functional Medicine Approach

Life Style Intervention

Dr. Linda Jager believes that we all deserve a vibrant life and that we each have the potential to
create this for ourselves. We know that the root cause of many of chronic diseases can be
helped with lifestyle intervention. By that we mean changes in what we eat, how
much we move, and our attitudes and outlook on life.

Dr. Jager uses a Functional Medicine approach to help you achieve your health goals.
Functional Medicine is a systems-oriented approach that engages both the patient and doctor
in a therapeutic partnership. Instead of treating just the symptoms of disease, Functional Medicine addresses the whole person. Many diseases have genetic, environmental and lifestyle factors that can influence long term health and disease progression. Most doctors are not adequately trained to apply strategies such as nutrition, diet and exercise to prevent or treat chronic illness. Functional Medicine practitioners are specially trained in these areas.

Principles of Functional Medicine

Patient-centered care
Health promotion, beyond just the absence of disease
Individual, not protocol-driven, treatment plans
Integrative, science-based approach to healthcare
Attention to internal (mind, body, spirit) factors
Attention to external (physical and social environmental) factors
Integration with best medical practices

The Vibrant Health Approach

When treating cancer, a Functional Medicine doctor would agree that both radiation and other
conventional approaches are required, but then would also ask what else we can do as a patient-doctor partnership? And, how can we promote the patient’s underlying health issues? MostAmericans diets full of sugar and other unhealthy items, lack exercise, and are under chronic stress. Dr. Jager helps her patients implement changes to have the best chance of healing. A critical part of this type of care is to develop a health plan that the patient will embrace and adhere to.

Science is now proving what we all knew intuitively – that how we live, the quality of our
relationships, the food we eat and how we use our bodies determines much more than our
genes ever will. There are numerous strategies to combat or prevent cancer, including eating
well, exercising regularly, getting sufficient sleep, and controlling stress levels.

Interested? On Sunday, February 3rd from 4-5 pm Dr. Jager will be offer a free introduction to her Functional Medicine approach by reviewing the principles and strategies used in Functional Medicine. This class is located at the Genesis West Medical Center in the Borromeo Conference Room. If you cannot make this event, please call ICS at 563-421-1960 for future dates. Of, note, Dr. Jager also teaches a six-week lifestyle modification class on Sunday evenings. The last class for this session is February 10th. Call ICS for more details.

We look forward to seeing you.

Therapy Options For Nicotine Addiction

Written by Dr. Linda Jager.

Quitting tobacco is the number one way to improve your health. If you would like help quitting smoking, ICS offers clinical consultations for smoking cessation.

Stopping tobacco use is often described as a journey because it sometimes takes more than one attempt to quit. It has been reported that over 70% of smokers want to quit, and as many as 50% attempt to quit every year. Unfortunately, only 5-10% of smokers who try to quit “cold turkey” are successful in the long term because smoking is not just a habit, but an addiction. The addiction is real and difficult to overcome, and even more so without support.

To be successful, it is best to think of it as a stepwise process. The U.S. Department of Health and Human Services recommend that, unless contraindicated, people who smoke ten or more cigarettes a day will consider the use of a drug therapy in every attempt to quit.

Making it easier to kick the habit:

There are a number of medications to make quitting easier. A variety of nicotine replacement therapy (NRT) products are available without a prescription (patches, gums, lozenges). Other nicotine replacement therapy products (inhalers and nasal spray) require a prescription. Other helpful prescription medications include Zyban and Chantix, both of which curb your desire for tobacco. Research shows that patients who use a combination of therapies are the most successful.

Many different support systems are also available–including online, telephone consultation, phone apps, personal counseling, group therapy, acupuncture and hypnosis.

Why is it even more important to stop smoking with a cancer diagnosis?

Continuing to use tobacco during treatment can make treatments difficult to tolerate, increase side effects, and even undermine treatment effectiveness. Cancer patients already have an increased risk of a secondary cancer and smoking further increases this risk.

Let ICS help you develop a personalized stepwise approach to assist you on your journey to be tobacco free. Call ICS today to schedule your smoking cessation consultation.

When Smokers Quit:
20-30 minutes	Blood pressure and pulse rate drop to normal; body temperature of hands and feet increase to normal. Blood flow returns to skin.
8 hours	In the blood carbon monoxide drops to normal and oxygen increases to normal
24 Hours	Chance of heart attack decreases
48 hours	Nerve ending start to regrowing and ability to smell and taste is enhanced.
2 weeks- 3 months	Circulation improves, walking is easier and lung function efficiency increases.
1-9 Months	Coughing, sinus congestion, fatigue and shortness of breath decrease
1 year	Excess risk of coronary artery disease is half that of a smoker
5 years	Lung cancer death rate ( 1 pack per day smoker) decreases almost half. Stroke risk is reduced to that of a nonsmoker after 5-15 years. Risk of cancer of mouth, throat and esophagus is half that of smoker’s.
10 Years	Lung cancer death rate similar to nonsmokers, precancerous cells replaced, risk of cancer of bladder, kidney and pancreas decreases.
15 years	Risk of Coronary heart disease is that of a nonsmoker.

Mitochondrial Health–The Power House of Your Cells

Today’s post was written by Iowa Cancer Specialist’s newest physician, Dr. Linda Jager.

Just the title of this article might scare you off if you have nightmares from you 10th grade biology course where they taught you the parts of the cell. But don’t be afraid, this little
organelle of the cell is central to your health. Mitochondria also called the “power house” of
the cell are the part of the cell that makes your energy. They take oxygen and nutrients from
food and make energy. When mitochondria work well they help reduce fatigue, pain, and
memory problems while supporting muscles and burning excess fat.

Damaged mitochondria can result from eating foods that encourage generalized inflammation
and pain. Mitochondria are damaged by toxins in our environment.
If you were to look at a mitochondria under an electron microscope you would see that it looks
a little like a bacteria, it is bean shaped organelle made up of folded membranes, and it even
has its own DNA. You know how mom’s are always to blame for anything that goes wrong?
Well it may be right when you talk about your mitochondria. For it is from your mom that you inherit your mitochondria.

Mitochondria are in all cells, but cells that need a lot of energy like
muscles, including the heart, and nerves have largest concentrations of mitochondria. Mitochondria need certain things in the diet to stay healthy, since most of their structure is made up of cell membrane. Cell membranes are made up of fat. So to keep thier
power houses happy they need healthy fat.

Healthy Fat:
Is there such a thing as healthy fat? Yes there is! In particular we need (DHA) Omega 3 fatty acids for healthy mitochondria.

Where can we find these? Fatty fish like salmon, mackerel, cod and sardines.

Other healthy fats that are needed are medium chain triglycerides (MCTs). Coconut oil is a source of MCTs.

Avocados and advocated oil supply the body with heart healthy monounsaturated fats. The
remarkable avocado had 20 different minerals, vitamins and phytonutrients, and is natural
antioxidant.

Extra virgin olive oil: high quality oil rich in polyphenols which are also antioxidants.

What do mitochondria like for fuel?
Ketones over carbohydrates. So a low carbohydrate diet is preferred..
Mitochondria like it when you don’t eat. Fasting and caloric restriction increase the number of
mitochondrial present. It can be as simple as 12 hrs between dinner and breakfast.

What are the essential Nutrients for energy production?
CoQ10 body can make it but decreased production after 50 yrs old and statins interfere with
production. Alpha lipid acid and acetyl L Carnitine B vitamins: Riboflavin, B1, B2, B3, niacin, Magnesium

What factors that damage Mitochondria?
Aging, toxic metals, Alcohol, persistent organic pollutants.

Dr. Jager has a diverse medical background in family medicine, wound care, emergency room care, pathology, functional and palliative care. She uses her experience in functional medicine with her patients at ICS. Functional care is an individualized, science-based approach that addresses the root cause of disease. It leverages the patient’s genetics, lifestyle, and biochemical components to personalize treatment plans including lifestyle modifications, stress reduction, and dietary changes to promote optimal wellness.

ICS Welcomes Tami Sheldon, ARNP

Iowa Cancer Specialists is proud to announce the addition of Tami Sheldon, ARNP to our staff.

Tami is an undergraduate of Illinois State University with a degree in Exercise Science and Fitness. She did undergraduate work at Chamberlain University of Cincinnati graduating with a Bachelor of Science in Nursing. Tami also has a Master’s degree in Nursing from the University of Cincinnati and is a board certified nurse practitioner.

Tami always knew she wanted to be involved in medicine, but it wasn’t until after she received her degree in Exercise Science and Fitness that her interests directed toward nursing. She has expertise in labor and OB/GYN, and she served on the Open Heart Team at Trinity Medical Center. Recently, she worked in pain management intervention, but says her passion has always been for women’s health.

Being more than just another health care worker is important to Tami. She states she is excited about her new position at ICS as it will give her an opportunity to connect with patients while providing both educational and emotional support. ICS plans to primarily utilize Tami’s training in OB/GYN health with our ovarian cancer patients, and as a liaison between ICS and the University of Iowa Gyn/Onc department.

Tami was raised in the Quad City area. She enjoys watching the Chicago Cubs and the Bears with her Navy Veteran husband, Josh. She has two small children and a greater Swiss mountain dog named Gunner.

Be sure to stop in to Iowa Cancer Specialists to meet Tami. She looks forward to serving your health care needs.

Dr. Linda Jager Joins ICS

Iowa Cancer Specialists is happy to welcome Dr. Linda Jager to our team!

Dr. Jager is a graduate of the Indiana School of Medicine. Her diverse medical background in family medicine, wound care, emergency room care, pathology, functional and palliative care is an asset at Iowa Cancer Specialists.

At ICS, Dr. Jager will primarily be working with our patients who need palliative/supportive care. Dr. Jager knows this field well as she formerly was the Palliative Care Director for Genesis Family Medical Center. Palliative care is for patients who have a chronic illness and to help them manage their pain, symptoms, as well as help improve their quality of life. Palliative care also helps with advanced care planning and supports patients and families as they face a life changing disease.

Dr. Jager will also use her experience in functional medicine with her patients at ICS. Functional care is an individualized, science-based approach that addresses the root cause of disease. It leverages the patient’s genetics, lifestyle, and biochemical components to personalize treatment plans including lifestyle modifications, stress reduction, and dietary changes to promote optimal wellness. According to Dr. Jager “watching the body heal is phenomenal.”

In addition, Dr. Jager intends to utilize her skills as a medical educator derived from teaching at Mary Crest College and St. Ambrose University while working with her patients at ICS. She states that education and teaching is her passion and it is important to her that “patients be heard, and that the truth be spoken. ”

Dr. Jager is originally from Pennsylvania, but has lived in Louisiana and Indiana before settling in the Quad City Area. She has three children, a daughter and two sons, and enjoys gardening, and playing tennis. She also loves hiking and spending time in the woods. A woman of faith, one of her core beliefs is that “you should live to use the gifts God has given you to serve others.”

Dr. Jager is enthusiastic to live out this belief while serving her patients at Iowa Cancer Specialists.