Below are all of the questions asked during our six-part Cancer and COVID-19 Wellness Webinars, answered by our expert guest speakers.
Week One: Keeping a Healthy Weight and Diet
All questions answered by Dietician, Ms Aveen Bannon
Q1: I have been put into the menopause as a part of my treatment. I struggle to keep a healthy weight, my weight keeps increasing and it’s very hard to lose. I have sore joint, so impact exercise is not really available to me. Also, what foods are good for joint pain?
Including omega-3 rich foods in your diet is good for our joints e.e. oily fish, walnuts, chia seeds and linseed. If you have noticed weight change look at portion sizes and ensure that you are getting some fibre and protein at each meal. Try low impact exercise at first and build up gradually as your joints allow. If concerned check with your GP or dietitian.
Q2: I continue to lose weight no matter what I eat. I add full fat milk and cream to dishes as suggested. Everyone says I look great but I don’t see the same image. In my dreams years ago I would have loved to show off my size 8 figure. Now I see a skeleton and don’t like to look in the mirror. Any dietary advice welcome.
If experiencing continued weight loss it is a good idea to mention this to your team. With food, the most important thing is to eat little and often to encourage appetite and include protein-rich foods to help maintain lean muscle mass and carbohydrates for energy. It can be a good idea to link in with a dietitian if concerned with weight loss.
Q3: If I am dairy intolerant, how do I keep my calcium levels up?
Opt for plant milks that are fortified with calcium. Also tinned fish is a good source of calcium along with nuts, tofu and anything made with fortified flour.
Q4: What is your advice re: juicing and making soup rather than eating the fruit and veg directly?
It is always considered best to eat the whole fruit or vegetable but that is not to say that juices or soups aren’t beneficial! So generally the rule of thumb is whole fruit or vegetable is first choice, then a smoothie of soup that has the pulp or fibre still present. Then a juice which will have vitamins but little or no fibre.
Q5: Struggling with smells of certain foods I once loved like broccoli etc. Any tips for other ingredients that mask smell? I tried a stock cube but not masking it enough.
It seems that raw vegetables or roasted don’ give off as much as a smell as boiling or steaming vegetables so it is worth trying that. Also parsley can help absorb smells so could be worth adding to your dishes.
Q6: What are the best foods for Vitamin D?
Oily fish are highest in vitamin D, eggs contain some in the yolk of the egg. Mushrooms are the only vegetable with vitamin D and then there are fortified foods.
Q7: Do you recommend that everyone take a vitamin D supplement? My daughter is asthmatic and seems to get a lot of chest infections despite eating a healthy diet and being active.
It is advisable to take vitamin D during winter months in Ireland. We get vitamin D from the sunlight between the months of March and October. More recent research has recommended to take vitamin D daily during this pandemic.
Q8: Would you recommend taking dietary supplements while staying home/cocooning to help balance the diet as fresh fruit and veg doesn’t always last the week.
That can be a personal choice. A multivitamin can complement a healthy diet. Always check with a pharmacist if taking other medications.
Q9: Is it okay for me to take supplements while on Chemo? Can they interact negatively with the treatment?
Best thing is to check with your team and pharmacist.
Q10: During my treatment I became very constipated due to medication, regardless of diet. What is your advice for counteracting that?
Sometimes this can occur as a result of medication and it may be a good to talk with your GP or dietitian. Ensure adequate water intake, include some fibre rich foods at each meal. Walking or movement can help. Chia seed or linseed can be added to your breakfast or yogurt and are high in fibre.
Q11: What foods would you suggest to help cope with the side effects of cancer treatment? I have heard that things like ginger can help?
This is really individual. Ginger can help some with nausea, alongside with eating little and often and opting for plain foods. Nausea can be made worse by poor intake and not drinking enough also. It is a good idea to discuss this with your team.
Q12: In relation to sugar, is Stevia natural or is it just another sugar?
Stevia is natural but we use much less of it than regular sugar as it tastes sweeter.
Q13: What is the best source of protein for a vegan diet?
Tofu, tempeh, sietan, beans, pulses and lentils are good sources of protein alongside nuts and seeds. Nut butters and humous can be good options for snacks too. The main I recommend with vegan diets is to try and include a protein food with each meal and a couple of snacks.
Q14: What are some foods that help with fatigue?
Your overall diet can affect energy levels. Getting enough sleep, fluid and moving are the first things to look at. Then ensuring you are eating a regular mealtimes and including some colourful fruit or vegetable at each meal. Check with your doctor if it continues but don’t forget to rest and listen to your body too.
Q15: What is your advice re: supplements during chemo? Eg. Centrum?
Always discuss this with your team.
Q16: I juice every day and add turmeric and cinnamon. Is this a good addition to my diet and does it suffice as my five a day?
It’s a great addition and depending on the size it will account for 1 or 2 of your six a day.
Q17: Can you please advise on the amounts of calcium required per day and how to achieve this as a vegan? I am now in menopause and am already breaking bones.
This will require medical input from GP and dietitian
Q18: Any recipes or food plans you could recommend as examples to give ideas for achieving a balanced diet throughout the day?
The best approach is to include a protein food at each meal, some colour from a fruit or vegetables and fibre rich carbohydrates. There are great resources out there for experimenting with new recipes. The INDI or BDA have good resources that might be useful.
Q19: What is your view on soy intake in terms of breast cancer? The research out there is divided.
This is something that is a personal choice and you can discuss with your team.
Q20: My cancer is oestrogen related, is it ok to drink milk? And do wheatgrass smoothies help boost the immune system?
Dairy is something that is a personal choice and you can discuss with your team. Wheatgrass is a nutrition supplement that can complement a healthy diet. No food can boost your immune system but a healthy diet can help support your immune system.
Full Week One Wellness Webinar recording:
Week Two: Keeping Physically Active while at Home
All questions answered by Dr Lauri McDermott from Exwell Medical
*Disclaimer for all individuals wanting to start exercise:
It’s very important to talk with your doctor before starting any exercises so that you can decide on a program that’s right for you. Your doctor might suggest you see a physical therapist or occupational therapist
Q1: Can you advise what exercise I could do following mastectomy – I’ve also had lymph nodes removed.
This depends on how far down the road you are post-surgery – I am assuming you have no drains/stitches and have finished any post-surgery physiotherapy.
The biggest thing you need to work on is mobility of your shoulders and upper body – this means movement with no weights. Some great exercises here https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html
Once you have pain free range of movement then start using very light weights to build up your strength.
Q2: What exercise is suitable if I have lymphedema in my arm following my breast cancer?
Exercise is very good for lymphodema, you want to help the body ‘pump’ the lymph and prevent swelling that limits mobility. Here is a great video of gentle exercises https://youtu.be/zcQB6pZmdN0
Some people find compression sleeves helpful. I would recommend little to no weights on the effected arm but still, move that arm in the same way when doing exercises. You can essentially still do all the movements, just slower or without a weight/dumbbell. Don’t ever be put off by having 2 different weights if you have a stronger and a weaker or affected side.
Q3: What do you think of fitbits to monitor activity level
I think all activity monitors are fantastic!!! I would highly recommend them. They don’t have to be FitBit brands or expensive – you can get them for as little as €10 in sports shops. They give you an idea of your exercise levels and are a great motivating tool – we all need all the help and motivation we can get!
Q4: Can you tell me what moves you recommend for someone with bone metastasis?
Simply put, my 2 big recommendations are to avoid ballistic activity (i.e. jumping/high-intensity work that strains the bones) and heavy weights. Light weights and light exercise have been proven to be extremely beneficial for those with boney mets as it can help strengthen the muscles, reduce your weight and boost your mental health. If you have mets in your spine be very careful when exercising – I would recommend a lot of chair-based work. You can do aerobic, strength and core work all from a chair! Here are some of our ExWell videos that you might benefit from that are all chair-based;
Q5: Can you give some examples of moderate exercise?
Any exercise where your heart rate is between 50-70% of max. To calculate your max heart rate just minus your age from 220. So if you are 50 years of age that is;
- 220 – 50 = 170
- 50% of 170 = 85
- 70% of 170 = 145
Therefore heart rate range is 85-145 bpm.
If you are on blood pressure medication then your heart rate will be lower than your predicted max.
Ways to get your heart rate in this range – walking, aerobics (from a chair or standing), cycling, swimming, dancing, boxing, weighted exercises – basically anything, it’s just all about the effort you put in.
Q6: Would you recommend climbing stairs on a regular basis as a form of strengthening exercise, would this be a good alternative to a 30 minute walk? (3 flights x 10 times during the day)
Short answer – yes! Climbing and going downstairs can be tough on the joints however so think about some step aerobics using your first step as seen here.
Stairs are a great way to get an aerobic workout as it is very demanding on the heart and lungs. Also great resistance work for the legs. Just make sure you keep your posture and technique correct and do not over-rely on one side.
Q7: If you have never done much exercise, is it harmful to your muscles and bones to start running after cancer treatment?
I would recommend to walk before you run. Start with walking and increase the pace to a brisk walk (you should look like you’re late for an appointment!). Try intervals than when you are comfortable – for example, run for 10 seconds and walk for 1 minute, gradually over time increasing the running and decreasing the walking. Running can be tough on the joints and so make sure you have good appropriate runners and run on grass if you can. There are plenty of ways to get fit however like dancing and aerobics so if running doesn’t suit you don’t give up!
Q8: My chemo has given me a heart condition. What exercises are suitable for me now? I have had Adriamycin.
Having a heart condition due to cancer and its treatments is very common. I would recommend you take a long gradual warm-up before all exercise to help get your heart up slowly. Click here for a good video by ExWell.
Your warm-up should be at least 10 min long. My other recommendation is for you to avoid things that will cause your heart rate to spike and drop quickly – for example, if you run fast and then stop suddenly. This sudden change could make you feel dizzy and faint. Instead gradually increase and decrease speeds. Otherwise, exercise is so important to keep your heart healthy, try some of the RTE work out videos linked above.
Q9: Appreciate home exercises to help replace muscle where muscle mass has shrunk?
Muscle wastage is very common as we age and then is worsened by cancer and its treatment. Resistance training is the best way to combat this. If you have balance issues, do the exercises in a chair (bicep curl, shoulder press, frontal raise etc). Use a light weight to begin with (0.5kg or 1kg) and try complete 10 repetitions and repeat this 2-3 times if you can. Gradually increase the weight and/or the reps.
Weights do not need to be dumbbells – use tins of beans, water bottles, shopping bags full of household items.
Q10: What is good exercise to manage osteoporosis? Is it possible to reverse by exercise alone?
Osteoporosis cannot be reversed but it can be managed and improved by exercises. The best exercise for this is weight bearing – namely walking and weights. As stated above use light weights to being with and higher repetitions. Everyone, but especially women over 55 and cancer patients/survivors should be mindful of osteoporosis and try to incorporate weight training into their week. The goal is at least 2 weight sessions a week.
Q11: Post-treatment any recommendations for good home starter gym kits ie. what to get dumbbell etc? Also where can I source these?
It is easy to use things around the home such as tins, water bottles, shopping bags with items. Roughly 1litre of water is 1kg. Dumbbells can be more comfortable to hold however so if you are looking to invest I would get a set of 1kg and 2kg to start off with. Resistance bands are also fantastic as they take up minimal space and there are tonnes of exercises you can do if you search YouTube. These can be found in sports shops, Argos, Tesco and sometimes Aldi/Lidl.
Q12: Can you give some examples of gentle exercises that I could do sitting in the chair or lying on the bed for the days that I feel really wiped? Thank you.
Absolutely. Don’t ever underestimate the work out you can do sitting on a chair. On the tough days play your favourite music and exercise along to these;
Q13: I have had one lung removed due to cancer, what exercises would you recommend for me?
The same as most people, at least 150 mins of moderate-intensity aerobic work (walking/dancing/aerobics) and at least 2 sessions of resistance work a week with light weights. Having 1 lung means you need to focus on keeping the remaining lung as healthy as you can. You might become breathless quicker than others so be mindful of this and take plenty of breaks.
Q14: What exercise would you recommend with palmer planters, sore feet and hands?
Peripheral neuropathy is a common side effect of cancer and can affect the hands and feet. Different people experience different things from numbness to tingling and sometimes pain. This can eventually go away or may remain for some time. The main thing is to try to keep all the joints moving. For the hands simply rotate the wrists, move the fingers, move in every direction your hand can to keep the joints and muscles supple. The same goes for feet – try to wiggle the toes and rotate the ankles whenever you are sitting. For muscles, if you don’t use it you lose it so keep working them. If your balance is affected due to your feet, exercise with a support like a chair or a wall nearby. If you find it tough to hold weights, try wrist weights or a shopping bag on your wrist with items inside for weight.
Q15: I had an anterior resection for rectal cancer one month ago with temporary ileostomy formation, I was advised not to do any pulling, pushing or heavy lifting due to risk of hernia. I’m still healing internally following abdominal surgery so would like some advice regarding exercise?
Definitely no heavy weights, also nothing that causes intra abdominal pressure to increase which would be lifting weights (even light ones) whilst holding your breath – ALWAYS breath continuously when doing weights. Also, avoid anything that contracts your tummy such as sit-ups and crunches. You are not long after surgery so very light exercise. Main thing is to avoid inactivity so gentle aerobic work, stretching, movement of the joints all very important now. Eventually, build things up to more moderate intensity a few weeks later. Keep checking in with your health care professionals if you have any other queries.
Q16: How can you counteract heavy muscles especially in legs which makes stooping down to get something very difficult.
For the stooping I demonstrated how I teach people in classes – essentially, have your feet shoulder-width apart at least, keep your head looking to the ceiling and try touch the floor or as low as you can – you will sort of look like a sumo wrestler! What this will do however is keep your back straight. Bending your back when picking something up can be very damaging.
Heaviness in the legs can be lots of things, make sure you rule out any swelling. Otherwise, it might be fatigue and muscle wastage. Try exercising from a chair. Kick the legs when you are sitting as if you are swimming. Gradually build things up to then exercising standing. Videos above in Q12 of chair-based work.
- Avoid inactivity (stand up regularly and move)
- Make being an active part of your routine
- Set small goals
- Try chair-based workouts and gradually build-up
- Consult your GP or cancer care team if you have specific queries
- Check out exwell.ie for more info
You can watch Lauri’s full presentation below:
Week Three: How to ensure you’re getting enough sleep and good sleep hygiene
All questions answered by Sleep Physiologist Breege Leddy
Q1: After getting my chemo treatment, the following two night I can not sleep. Thank You.
Chemo can play havoc with our sleep, all medications can alter out sleep plus you have the anxiety surrounding the treatment. If you have a bad night sleep its important to try to not make up for the lost sleep by having lie ins etc. Forming bad habits can make this short term problem into a more long term problem. If you are struggling to get through the following day after a particularly bad night sleep you can have a scheduled nap of 20 minutes and have it earlier on in the day (before lunch) so you can still build up a sleep debt before that nights sleep.
Q2: I wake up to go to the loo 3/5 times during the night. Do you have any suggestions for this?
Limit fluid intake in the evening. It could be a habit, when you wake try a short relaxation or mindfulness technique. If you fall back to sleep without thinking about having to go to the toilet, its more than likely a habit. If you do genuinely have to go to the toilet excessively during the night its knows as nocturia. Do you have any other things going on while you sleep, do you snore, do you have changes in your breathing, do you wake with a dry mouth, are you sleepy during the day? If so these symptoms along with nocturia may be suggestive of a sleep disorder called obstructive sleep apnea. Speak to you GP, in order to get a referral to a sleep consultant.
Q3: I fall into a deep sleep quickly but wake often at about 4:30 and then cant get back to a proper sleep. I try mindfulness but it doesn’t always work.
Ensure you are not going to bed too early. Mindfulness is a good tool to have for awakenings but should only last 20 minutes or so. If you are still awake after 20 minutes you should get up out of bed, go to a living area and relax and only go back to bed when sleepy. This helps strengthen the connection between bed and sleep.
Q4: Is there a risk of negative interaction between sleep medication and chemotherapy or other cancer treatment?
There can be, always speak to your GP for advice and never take sleeping medication without being prescribed it by your GP.
Q5: No matter how relaxed or tired I am, I always seem to wake at around 4am. Generally no problem getting back to sleep but never sleep the full night through. Do you have any advice?
If this awakening is for a very short period of time and you are getting back to sleep quickly its not an issue. It is normal to have brief awakenings toward the end of the sleep period. Nobody sleeps for 100% of the time in bed. As long as you are sleeping for approx. 90% of the time and have no daytime symptoms as a consequence it’s all normal.
Q6: Will my sleep be affected by the steroids I’m taking as a part of my cancer treatment?
Steroids do affect the architecture of sleep as does most medications. The patient may not be aware of any of these effects as they may not have any symptoms of disturbed sleep.
Q7: I wake up in the middle of the night and don’t have trouble falling back to sleep, but I am exhausted when I wake up in the morning. Is there anything I can do to help this?
Try some kind of short relaxation technique, imagery or mindfulness during this time to ensure there is no anxiety or stress as this can impact the quality of sleep. If you think you are getting enough sleep on a consistent regular basis and still sleepy during the day speak to your GP. There may be a sleep disorder affecting the quality of your sleep and this would need to be assessed by a medical sleep consultant.
Q8: I get anxious when it’s time to go to bed i.e.. I’m tired because I know its hit and miss if I will sleep right through. I fall asleep straight away but can wake as bright as a button 1.5/2 hours later. I have tried to listen to music, lavender oil etc but nothing works. This goes on for about 4/5 time a week. Any suggestions please?
Its important to distinguish between ‘tiredness’ and ‘sleepiness’. Ensure that ‘sleepiness’ is your cue for going to bed. This may involve going to bed at a later time than normal. The need for sleep may not be great enough for you to stay asleep. As time goes by in this pattern, the body can start to repeat this pattern and it becomes a habit. By ensuring you are really sleep you are more likely to have a greater sleep debt and the need for sleep with be greater and therefore you are more likely to sleep through. Progressive muscle relaxation techniques performed in bed can help with anxiety around sleep. If you are awake for more than 20 minutes in bed its important to get out of bed, go to a comfortable area in a living room and do something relaxing until you feel sleepy and then return to bed again. This starts to associate bed with sleep and not a place of anxiety.
Q9: I often heard when younger that the sleep you get before midnight is better quality. Is this true?
No this is one of the many sleep myths. Normal sleep follows a very strict pattern regardless of the time you go to bed. The body should enter into deep sleep approx. 1 hour after sleep onset and we get the majority of this deep sleep in the first third of the night.
Q10: Because of chemo induced menopause, I wake up sweating a lot at night and find it hard to get back to sleep. What is your advice on this?
Unfortunately, menopause can be a common trigger for insomnia. The most effective treatment is CBT-I.
Q11: I’ve heard that blue light is very damaging to sleep. Would you recommend blue light glasses while working on screens during the day or just avoiding screens an hour before bed?
Blue light during the day poses no harm. However blue light should be avoided 2 hours prior to bed as it supresses melatonin which is a sleep promoting hormone.
Q12: Would you recommend a particular type of pillow that can aid sleep e.g. Is a firm pillow better, is natural down pillow better that foam?
This is purely a personal choice. Whatever is comfortable for the individual will help sleep.
Q13: What like things like natural remedies i.e.. Kalms Night, Melissa Dream etc. Do they work?
These over the counter sleep aids should not be used long term. The scientific evidence of their effectiveness is poor. You should always consult their GP before taking these as there can be interactions with other medication that you may be on.
Q14: Would you recommend taking melatonin in tablet form – I’ve always been a bad sleeping but never wanted to take any sleep tablets?
Melatonin is not indicated for the treatment of insomnia. It is only available on prescription in Ireland. The gold standard treatment for insomnia is CBT-I which has a success rate of over 80%
Q15: Is it safe to take sleeping medication for a prolonged period of time?
Long term use of sleeping medication can cause a lot of negative effects such as memory loss and falls in older people, effect ones ability to drive, you may have a hangover effect the next day, can cause a dependence on them, can cause anxiety, and the dosage will need to be increased to have the same effect and eventually they won’t work. CBT-I is now the gold standard treatment for chronic insomnia.
Watch a full version of Breege’s webinar here