The Treatment Ends, But Does the Cellular Impact?

When we talk about a stem cell transplant for multiple myeloma, we usually talk about the big things: high-dose chemotherapy, transplant day, waiting for our counts to recover, and eventually going home.

But what happens inside our cells after all of that?

The melphalan leaves the body fairly quickly. That doesn't necessarily mean every biological effect starts and disappears just as quickly.

That is where mitochondria become interesting.

First, What Does Melphalan Actually Do?

Before an autologous stem cell transplant, patients usually receive high-dose melphalan, a powerful chemotherapy drug. I like to explain its job simply: melphalan destroys the myeloma cells and severely damages the bone marrow, and then our stem cells come back in to rescue us. Melphalan damages DNA and kills rapidly dividing cells, but healthy cells can also be affected. That's why we may experience hair loss, mouth sores, stomach problems, and extremely low blood counts. On transplant day, our previously collected stem cells are returned to us and eventually begin rebuilding the bone marrow and producing new red blood cells, white blood cells, and platelets. We call it a stem cell transplant because those stem cells are transplanted back into our bodies, but their real job is to rescue our bone marrow after the high-dose chemotherapy.

The Drug Leaves. What About the Damage?

Mitochondria are like tiny power stations inside our cells, helping produce the energy our bodies need. Melphalan damages cells and can disrupt their mitochondria, potentially triggering cell death. That's exactly what we want it to do to myeloma cells. Unfortunately, healthy cells can get caught in the crossfire too.

Melphalan itself doesn't stay in the body very long, but that doesn't mean all of its effects disappear when the drug does. Think of a sunburn. The sun exposure may have ended hours ago, but the damage to your skin remains. Chemotherapy is much more complicated, but the idea is similar.

Some damaged cells die, while others survive but may not function as well as before. Researchers call one of these changes cellular senescence, where a cell remains alive but no longer grows or functions normally. Scientists are also studying how chemotherapy affects our mitochondria and whether these cellular changes may play a part in why some people feel like treatment aged them.

This doesn't mean every transplant survivor has permanently damaged mitochondria. It simply means that what happens to our cells during treatment may last longer than the chemotherapy itself.

Why am I still so tired?

Not two weeks after transplant.

Not two months.

Sometimes years later.

If mitochondria aren't working efficiently, cells may have more difficulty producing and managing the energy the body needs. Mitochondrial dysfunction has therefore become one area researchers are investigating in cancer-related fatigue and survivorship.

But we have to be careful here.

We cannot say that mitochondrial damage from melphalan is the reason someone is fatigued years after transplant.

Post-transplant fatigue can have many causes, including anemia, medications, chronic inflammation, pain, poor sleep, hormonal changes, loss of muscle mass, deconditioning, infection, nutritional problems, the underlying cancer, and other medical conditions.

Mitochondrial dysfunction may be one piece of a much bigger puzzle.

Mitochondria and Our Muscles

Mitochondria are particularly important in muscle because muscles require a tremendous amount of energy.

When mitochondrial function is impaired, it can be associated with things like reduced endurance, exercise intolerance, muscle weakness, and slower physical recovery.

Sound familiar?

Again, that doesn't prove melphalan caused someone's muscle weakness years later. There are plenty of other possible causes, but it does help explain why researchers are interested in mitochondria when studying long-term cancer-treatment fatigue and physical decline.

"I feel like treatment aged me."

There may actually be some science behind that feeling.

Intensive chemotherapy creates enormous stress on the body. It damages rapidly dividing cells, forces tissues to rebuild, and can contribute to processes associated with biological aging, including cellular senescence and changes in mitochondrial function.

Researchers are beginning to look more closely at whether cancer treatment can actually accelerate the body's aging process. That doesn't mean receiving melphalan suddenly makes you ten years older, but intensive chemotherapy puts an enormous amount of stress on our cells and tissues. This may help explain why some people come out of treatment feeling as if their bodies have aged much faster than the calendar suggests they should have. So, when a patient says, "I feel like treatment aged me," there may actually be some science behind that feeling.

What About the Long-Term Risks We Already Know About?

High-dose melphalan has known potential late effects. One of the most serious is the increased risk of secondary blood cancers, particularly myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). These can develop years after treatment.

Some patients can also experience prolonged or persistent problems with blood counts or organ function after intensive therapy, although the cause may involve more than melphalan alone.

Melphalan can also affect other parts of the body. In rare cases, it has been linked to lung damage, while kidney and liver function are usually monitored closely during treatment and afterward. Neuropathy is a little different and worth explaining because although it is common among myeloma patients, melphalan may not always be the cause.

Numbness, tingling, and burning in the hands and feet are certainly familiar to many myeloma patients, but melphalan isn't usually the first drug we blame. Other myeloma treatments—particularly drugs such as bortezomib—are much better known for causing peripheral neuropathy. The disease itself and other medical conditions can also contribute.

When we've been through several different drugs plus a transplant, figuring out exactly which treatment caused a symptom isn't always easy.

But Aren't Mitochondria Able to Repair Themselves?

Thankfully, our cells have ways of cleaning up and recovering from some of this damage. One of those natural processes is mitophagy, the cell's own housekeeping system. It recognizes mitochondria that have become damaged or aren't working properly and removes them, helping the cell get rid of what is no longer useful or healthy.

Our cells also have a way of making new mitochondria, called mitochondrial biogenesis. In simple terms, the body can replace some of the mitochondria that have been damaged with new ones. This means that mitochondrial damage from chemotherapy doesn't necessarily last forever. Our bodies continue working to clean up, repair, replace, and adapt long after treatment is over. It may also help explain why recovery from a stem cell transplant can take much longer than we expect. Even years later, the body may still be adjusting and recovering from everything it went through.

Can We Improve Mitochondrial Health?

There isn't a magic "mitochondria reset button" after transplant.

However, several things associated with overall metabolic and mitochondrial health are also the same boring things our doctors keep telling us to do.

When medically appropriate, they include:

• Gradually increasing physical activity.
• Resistance or strength exercise
• Eating adequate protein and balanced nutrition
• Getting good-quality sleep
• Managing other health conditions
• Avoiding smoking
• Discussing persistent fatigue, weakness, or exercise intolerance with the medical team

Exercise is particularly interesting because physical activity can stimulate mitochondrial biogenesis and improve the body's ability to produce and use energy.

Of course, "just exercise" isn't very helpful advice when someone is dealing with severe cancer-related fatigue. Activity has to match the person's health, abilities, blood counts, bone health, and recovery stage.

And please be cautious with products marketed as "mitochondrial support." A supplement labeled with the word "mitochondria" on the bottle doesn't mean it has been proven to repair chemotherapy-induced damage. Supplements can also interact with cancer treatments and other medications.

Talk to your medical team before taking them.

What Researchers Still Don't Know

This may be the most important part of this entire discussion.

We know quite a bit about how melphalan damages cells during treatment.

We know mitochondria participate in some of those cellular pathways.

We also know mitochondrial dysfunction, oxidative stress, cellular senescence, inflammation, and biological aging are being studied in cancer survivors.

What we don't yet know is exactly how much persistent mitochondrial dysfunction from high-dose melphalan contributes to a particular person's symptoms five, ten, or twenty years after transplant. That connection is still being investigated, and I think that's an important distinction.

There is a difference between saying, "Scientists are studying whether this contributes to long-term symptoms" and saying, "Melphalan damaged your mitochondria, and that's why you're tired six years later."

Science isn't at the second statement yet.

Surviving Treatment Is Only Part of the Story

High-dose melphalan and a stem cell transplant have given many myeloma patients years they may not have had otherwise. For some of us, it has meant a long and deep remission and more time with the people we love. But making it through transplant doesn't mean everything suddenly goes back to normal. Treatment may be over, but our bodies can continue dealing with the effects long after transplant day.

Cancer survivorship research also needs to ask what happens to the body five, ten, fifteen, and twenty years after intensive treatment.

Why do some people bounce back while others struggle with fatigue?

Why does one person regain their strength while another never quite returns to their old baseline?

How much does it come from cancer?

How much does it come from chemotherapy?

How much comes from aging, inflammation, medications, immune changes, mitochondrial health, or a combination of all of them?

We still don't have all those answers.

The melphalan may have left our bodies years ago. Our stem cells rebuilt our bone marrow, our hair grew back, and our blood counts eventually recovered. We went from counting the days after transplant to celebrating the years since it happened. But that doesn't mean our bodies forgot what they went through. Researchers are still learning just how long some of the changes caused by such intense treatment may last and what they could mean for us years down the road.

The treatment ends. Survivorship doesn't.

 

 

A Note About Research

Some of what we know about the long-term effects of chemotherapy is well established, while research into mitochondrial dysfunction, cellular aging, and long-term fatigue after cancer treatment is still developing. This article is meant to help explain what researchers are learning, not to suggest that mitochondrial damage is the cause of every symptom someone experiences after a stem cell transplant.

Resources & Further Reading

National Cancer Institute (NCI)
International Myeloma Foundation (IMF)
Multiple Myeloma Research Foundation (MMRF)
Blood Cancer United
PubMed — National Library of Medicine

Research & Further Reading

Shafqat S, et al. “The Achilles' Heel of Cancer Survivors: Fundamentals of Accelerated Cellular Senescence.” Journal of Clinical Investigation, 2022. https://www.jci.org/articles/view/158452

Wang S, et al. “Accelerated Aging in Cancer Survivors: Cellular Senescence, Frailty, and Possible Opportunities for Interventions.” International Journal of Molecular Sciences, 2024. https://pubmed.ncbi.nlm.nih.gov/38542292/.

Wang S, et al. “Cancer Treatment-Induced Accelerated Aging in Cancer Survivors: Biology and Assessment.” Cancers, 2021. https://pubmed.ncbi.nlm.nih.gov/33498754/

Filler K, et al. “Association of Mitochondrial Dysfunction and Fatigue: A Review of the Literature.” BBA Clinical, 2014. https://pmc.ncbi.nlm.nih.gov/articles/PMC4136529/

Saligan LN, et al. “The Biology of Cancer-Related Fatigue: A Review of the Literature.” Supportive Care in Cancer, 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4484308/

My Heart Aches: Navigating the Pain of Losing My Second Mom

 

Holidays can bring both happiness and deep sadness. They remind us of the joy of being with loved ones, but also make us feel the pain of those who are gone. Some people have time to prepare for holidays without someone special, while others face that loss right in the middle of the season. My heart aches for my ex-husband, his family, and my children as we grieve the loss of my "ex-mother-in-law", who passed away just days before Christmas.

Carolyn was a truly remarkable woman. One of my favorite memories is a long, 14-hour drive we took together, just the two of us. As we drove, we talked about life, family, love, and what matters most. During that quiet time, I promised her I would never stop loving her son, Scott, and that I would always be there for him, no matter what happened. She told me how much that meant to her, and I felt the importance of that moment. I meant that promise when Scott and I said our wedding vows 40 years ago. I meant it when our marriage ended. And I still mean it today, because love that deep does not just disappear.

Our family has changed, but the love has stayed strong. Scott and I have stayed close friends, even after being divorced for 13 years. I remarried, and from the start, my husband understood that my children and their father would always be important to me. That understanding made my love for Lance even stronger. He knew we came as a package. What we have now is a family that may be different, but it is built on respect, compassion, and commitment. It works for us, and in its own way, it is a win for everyone.

Carolyn may not have fully understood our family situation, but she accepted it, and that meant a lot. She never held my new marriage against me. Instead, she welcomed my husband, Lance, into the family, which he still finds hard to believe. His own family did not accept me, and I am estranged from my own family, so Lance and I were left without the mothers we needed. But my ex-mother-in-law showed us kindness instead of judgment. She kept loving me as a daughter, reminding me that family is not just about blood, but about the people who choose to stay.

Carolyn really was a remarkable woman, and loving her for more than forty years has been one of the greatest gifts of my life. She often showed me what grace looks like in everyday life, even without saying a word. She made people feel accepted, no matter their flaws or past, and she did it with a quiet strength that stayed with me. Our relationship was not perfect—no real relationship is. But even when we disagreed, she never stopped loving me, and that meant more than she knew.

She supported Scott and me in a way I had never known before: steady, respectful, and selfless. I know she had her own opinions about the changes I made in her family, but she always chose love over control. She accepted those changes without resistance or judgment. When she gave advice, it was because we asked for it, and when she stayed quiet, it was thoughtful and kind. That rare support shaped me as a mother. Because of Carolyn, I learned to stand beside my children, trust them, and love them without conditions.

I am so grateful for my wonderful adult children, and I know Carolyn was very proud to be their grandmother. Maybe she stayed close to me after Scott, and I divorced because she loved them deeply. Maybe she remembered the promise I made to always love her son and knew I meant it. Or maybe it was just who she was—a woman with a heart big enough for complexity, change, and forgiveness. She never explained her reasons, never wanted recognition, and never made me feel like I had to earn my place. Instead, she gave me love, respect, and a sense of belonging. I will always be grateful that she allowed me to remain part of the family, and I will carry her example with me for the rest of my life.

Her death is hard for everyone, but few people really know how hard it is for me. I feel like an orphan. My pain and grief for her are as real and deep as any daughter’s grief for her mother. Our relationship never fit a simple title. Ex-mother-in-law sounds distant and cold, which is nothing like what she was to me. Legally, I can’t call her Mom anymore, but in my heart, she has always been my mom. She was, and always will be, my mom.

Carolyn was a woman of strength—quiet strength. The kind that didn’t demand attention, but held everything together. She was a true matriarch, the backbone of the family. She worked hard her entire life and loved her family with that same fierce devotion. She was someone my children could look up to, but just as importantly, she was someone I looked up to—even though, by height alone, I stood above her.

She loved our children unconditionally and with pride. She was always there for them, always involved. She celebrated their successes as if they were her own. I know how proud she was when my daughter graduated from Purdue and when she made Carolyn a great-grandmother. I am so grateful that my children grew into responsible, loving, and giving adults, and I know that didn’t happen by accident. Their grandmother helped shape them into the adults they are today, people everyone is proud of.

My heart aches with the loss of my mom, who was not my flesh and blood, but was my mother in every way that mattered. Losing a mother is unlike any other loss. It goes deeper than words and touches places we didn’t know existed. Carolyn made me feel safe and understood, both in my proud moments and my flaws. With her gone, the world feels less steady, as if something important is missing. No matter how old we are, part of us will always long for our mother’s presence, her voice, and her reassurance. I still long for Carolyn’s.

Grief for a mother is not a straight path. It comes in waves, sometimes gentle and sometimes overwhelming. Ordinary moments can suddenly feel heavy: a holiday, a memory, or a simple question I wish I could ask her. Even when a relationship is complicated, the loss brings a special kind of pain. I grieve not only who she was, but also what she stood for: home, history, belonging, and unconditional love.

Even with this loss, her lasting influence remains. Her lessons, values, and love live on through us. We carry her in the way we love, care for, and support others. A mother may leave this world, but her presence never really goes away. She becomes part of who we are, quietly guiding and shaping us, even when she is gone.

Carolyn was that woman in my life.

My heart will always ache.

I love you, "Mom."

Bleeding Wallets: The High Cost of Blood Cancer Treatment Compared to Other Cancers

The financial burden of cancer treatment is a significant concern for patients and their families; among all the various types of cancer, blood cancers—particularly multiple myeloma and leukemia—surface as some of the most expensive to treat. The costs of treating blood cancers go beyond the initial diagnosis and treatment phases, resulting in excessive healthcare expenditures that many families find hard to manage.

The average cost of blood cancer treatment exceeds $150,000 in the initial year, with acute leukemia patients incurring the highest expenses across all age groups. On average, these patients can accumulate costs nearing $450,000 in their first year of treatment. Patients diagnosed with multiple myeloma also exceed the average cost, totaling just over $200,000 in the first year.

Comparing Costs Across Cancer Types

When evaluating the costs of treating different types of cancer, blood cancers, particularly multiple myeloma, consistently emerge as the most expensive. This is mainly due to their unique treatment requirements, which often involve complex and ongoing therapies. However, lung and thoracic cancers have the highest annual costs. Lung/thoracic cancer has high total yearly costs, often with shorter or less complicated treatment timelines. At the same time, multiple myeloma is the most expensive cancer to treat annually per patient. It is important to note that the nature of blood cancer treatments, including advanced therapy protocols, significantly contributes to higher overall treatment costs.

High Initial Costs

Blood cancer treatments are generally more expensive when compared to other cancer types. For instance, patients newly diagnosed with multiple myeloma can incur costs exceeding $200,000 within the first year of treatment. This expense is primarily because the treatment regimens are complex and often require a combination of therapies. There is a need for specialized care and frequent monitoring during the initial treatment phase. The costs of medications, such as maintenance lenalidomide, are high. Moreover, the high initial costs are just the beginning. The financial implications often extend into subsequent years, amplifying the burden on patients and their families.

“Unlike [other hematologic cancers] such as large B-cell lymphoma or Hodgkin lymphoma, where you give 6 months of treatment and you’re done for most patients, in myeloma, treatment is pretty much lifelong, continuous therapy, for 7 or 8 years or more, which is the median survival of the disease,” said Dr. Rajkumar. “And we don’t use these drugs alone; we use them in combination, which then increases the cost even more…. Quadruplets are up-and-coming options now, very similar to R-CHOP [rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone] for the cure [of non-Hodgkin lymphoma]. You are talking about a four-drug combination of monoclonal antibodies costing between $350,000 and $600,000 for 1 year of treatment.” (Cavallo, How to Treat Patients With Multiple Myeloma Cost-Effectively Without Compromising Outcome)

Ongoing Treatment and Relapses

One of the staggering realities of myeloma treatment is that nearly all patients will experience relapses or develop cancers that become refractory to existing therapies. This inevitability leads to some critical factors. Multiple myeloma patients often require indefinite, long-term maintenance therapy, which can include a combination of doublet or triplet therapies. This ongoing treatment approach is necessary to manage the disease. Still, it amplifies financial toxicity, as patients must bear additional costs for extended periods.

Patients diagnosed with acute leukemia often face significant out-of-pocket expenses, leading to immediate financial burdens. In contrast, those diagnosed with multiple myeloma tend to accumulate significantly higher total out-of-pocket costs over a three-year period. Patients' higher costs can often be traced back to numerous relapses and a range of treatment plans.

The Emotional and Financial Toll

Beyond the straightforward financial analysis, the strain of high medical costs can have profound emotional and psychological implications for patients and their families. Prolonged treatments can lead to high levels of stress and anxiety related to financial issues and a decline in quality of life due to ongoing health problems and the side effects of treatment. Financial limitations, not just medical factors, may significantly influence care decisions.

These factors underline the importance of addressing the clinical aspects of cancer care and the financial and psychological challenges arising from the high treatment costs. The costs associated with blood cancer treatment, particularly for diseases like multiple myeloma and leukemia, reflect a complex landscape where financial toxicity is an almost unavoidable reality. Patients often bear the brunt of high initial expenses and ongoing treatment costs, which accumulate over the years, leading to increased financial strain and emotional distress. As healthcare continues to evolve, it is imperative for stakeholders to address these spiraling costs and to ensure that financial barriers do not impede access to crucial, life-saving therapies. Understanding the financial impact of blood cancers—especially compared to other cancers—highlights an urgent need for systemic changes to improve patient outcomes and alleviate economic burdens in the future.

References

Cavallo, J. (2020, August 25). How to treat patients with multiple myeloma cost-effectively without compromising outcome. The ASCO Post.

Dieguez, G., Ferro, C., & Rotter, D. (2018, October). The cost burden of blood cancer care. Leukemia and Lymphoma Society.

Team, R. (2024, February 1). The true cost of multiple myeloma. Resolve Wordmark.

Shielding Myeloma Warriors: 7 Strategies for a Safer Flu and COVID Season

Flu and COVID-19 can be serious for anyone, but for people living with multiple myeloma, respiratory virus season deserves extra attention. Myeloma itself can weaken the immune system, and some treatments can further reduce the body's ability to fight infection.

That doesn't mean you have to spend the season afraid to leave your home. A few practical precautions, along with guidance from your healthcare team, can help reduce your risk while allowing you to continue living your life.

Here are seven strategies to consider during flu and COVID season.

1. Talk to Your Healthcare Team About Vaccines

Vaccination remains an important tool for reducing the risk of severe illness from influenza and COVID-19.

Because myeloma and its treatments can affect how strongly the immune system responds to vaccines, talk with your oncology team about which vaccines are appropriate and the best timing for receiving them. This can be particularly important around treatments such as stem cell transplantation, CAR-T therapy, or other therapies that significantly affect immune function.

Your healthcare provider can also tell you whether additional or updated vaccine doses are recommended based on your treatment and current health.

2. Know the Symptoms—and Act Early

Flu and COVID symptoms can overlap and may include fever or chills, cough, sore throat, congestion, fatigue, body aches, headache, and sometimes shortness of breath.

People with weakened immune systems may not always develop the "classic" symptoms of infection. For example, the absence of a high fever doesn't necessarily mean an infection isn't serious.

If you develop symptoms or know you've been exposed to influenza or COVID-19, contact your healthcare team promptly. Timing matters because antiviral medications for influenza and COVID-19 generally work best when started early.

Your oncology team can also check for possible interactions between antiviral medications and your cancer treatments or other prescriptions.

3. Practice Good Hygiene

Simple precautions can still make a difference.

Wash your hands regularly with soap and water, especially after being in public places and before eating. Alcohol-based hand sanitizer is a useful alternative when soap and water aren't available.

Try to avoid touching your eyes, nose, and mouth with unwashed hands. Regularly cleaning frequently touched surfaces can also be helpful, particularly when someone in the household is sick.

Because influenza and COVID primarily spread through respiratory particles, good ventilation and cleaner indoor air are also important tools for reducing exposure.

4. Be Strategic About Crowds and Sick Contacts

Living with myeloma doesn't necessarily mean avoiding every public place. Instead, think about your individual risk and the environment you're entering.

During periods of high respiratory-virus activity, consider avoiding close contact with people who are sick and limiting time in crowded, poorly ventilated indoor spaces.

A well-fitting, high-quality mask can provide another layer of protection in higher-risk situations such as crowded stores, airports, public transportation, medical facilities, or gatherings where you don't know whether others are ill.

And don't feel guilty about asking someone who is sick to postpone a visit. Protecting your health is reason enough.

5. Have a Plan Before You Get Sick

The middle of an illness isn't the ideal time to figure out what you need.

Keep an adequate supply of your regular medications and basic necessities at home. Consider having masks, a thermometer, hand sanitizer, and COVID tests available as well.

More importantly, know who to call and what to do if symptoms begin. Ask your oncology team ahead of time whether they want you to contact their office immediately if you develop a fever, test positive for COVID, or have been exposed to influenza.

Having a plan can eliminate uncertainty when you're already feeling sick.

6. Pay Attention to Your Breathing—and Other Warning Signs

Respiratory infections can become serious more quickly in people whose immune systems are compromised.

Contact your healthcare provider if you develop new or worsening symptoms. Severe difficulty breathing, persistent chest pain or pressure, new confusion, inability to stay awake, or other signs of a medical emergency require immediate medical attention.

Myeloma patients should also pay attention to dehydration. Fever, vomiting, diarrhea, and poor fluid intake can be particularly concerning when kidney function is already compromised.

Don't assume that a worsening symptom is "just the flu." When you're living with myeloma, it's better to ask.

7. Support Your Immune System—Without Falling for "Immune-Boosting" Claims

There is no food, vitamin, herb, or supplement that can magically "boost" an immune system affected by multiple myeloma.

What you can do is support your overall health.

Eating a balanced diet, getting appropriate physical activity, sleeping adequately, staying hydrated, managing other health conditions, and following your prescribed treatment plan all contribute to your body's ability to handle illness.

Before taking vitamins, herbal products, or supplements, talk with your healthcare team. Some supplements can interact with cancer medications or may not be appropriate for people with kidney problems or other medical conditions.

For some patients with recurrent or severe infections, physicians may recommend additional medical strategies based on immune function and treatment history. Those decisions should be individualized.

Protection Without Isolation

Living with multiple myeloma already requires enough adjustments. Protecting yourself during flu and COVID season shouldn't mean putting your entire life on hold.

Think of infection prevention as layers of protection rather than one perfect solution: appropriate vaccination, cleaner air, good hand hygiene, avoiding close contact with people who are sick, masking when circumstances warrant it, recognizing symptoms early, and having a plan with your healthcare team.

Perhaps most importantly, don't wait until you're seriously ill to make that phone call.

When your immune system is compromised, early communication and early treatment can matter.

You can't eliminate every risk. But you can understand those risks, prepare for them, and make informed choices that allow you to protect your health while continuing to live your life.

More than Family: The Incredible Bond and Lifelong Lessons of Cousins

Cousins are like having built-in best friends who are there for you through thick and thin. They're not just part of the family; they're the ones who uniquely understand you. Sometimes, our connection with our cousins can be stronger than with our siblings because of this unique mix of love and shared experiences. What's great about cousins is that they bring a fresh perspective to the table - coming from different backgrounds, they can open our minds to new ideas and ways of seeing the world. This diversity adds so much spice to our lives, helping us grow in empathy, strength, and acceptance. While we often focus on our immediate family circle, let's recognize the treasure trove of love and friendship that cousins can bring into our lives.

Cousins are like stars in the same sky, distant but always there.

Cousins bring a unique blend of family ties and friendship that makes them special. They go beyond just being relatives and become our lifelong companions, sharing in our family stories and understanding our unique family dynamics. Whether lending a hand in times of need, offering a listening ear during challenging moments, or simply being there to celebrate life's milestones, cousins provide unwavering support and a sense of belonging. From childhood to adulthood, their presence in our lives adds richness and depth to our experiences, creating lasting memories and cherished, invaluable relationships.

Cousin relationships are extraordinary and can grow into lasting friendships that enrich our social and emotional well-being. The trust, loyalty, and companionship that cousins share can be a cornerstone of support and understanding throughout our lives. Through shared experiences, memories, and traditions, cousins form a unique bond that can shape our values and perspectives. What's especially remarkable is how cousins from diverse backgrounds and life paths can offer each other valuable insights and life lessons. From empathy to resilience, cousins have the power to inspire and teach each other, making this relationship a source of growth and enrichment.

Cousins play a crucial role in our lives as they are family members and carriers of our ancestors' legacy. They embody our roots, history, and heritage as powerful reminders of our origins. By exemplifying the values and traditions passed down through generations, cousins motivate us to uphold and cherish our familial heritage, fostering a deep sense of pride, inner fortitude, and resilience. In essence, cousins are a vital connection to our past, guiding us toward a promising future filled with rich traditions and enduring values. Moreover, they offer us a profound sense of belonging within a supportive network, standing by us through thick and thin. In a world often marked by feelings of isolation, having cousins who are ever-present and unwavering in their support provides us with a comforting stability that brightens even the darkest days.

Cousins are built-in friends who sneakily teach us all the essential life lessons we need while having fun hanging out. They're more than just family; they're mentors in communication, teamwork, and problem-solving, equipping us with skills that come in handy off the playground, too. As cousins share jokes, secrets, and countless memories, their bond can blossom into lifelong friendships that sprinkle our lives with joy and emotional support. Research even backs it up - these connections don't just bring a smile to our faces; they boost our mental well-being and overall happiness. So, cheers to our cousins for being the unsung heroes of our social and emotional growth, giving us a solid foundation of love and security that stays with us for years.

In wrapping up, it becomes evident that cousins hold a special place in our lives, extending far beyond mere family ties. They are the ones who stand by us, offer guidance, and become our trusted companions in the journey of life. Their impact on our growth and character development is profound, molding us into more resilient, compassionate, and understanding individuals. Therefore, let us embrace and celebrate our unique connection with our cousins, recognizing the invaluable support, history, and wisdom they bring into our lives. So, the next time we gather with them, let's take a moment to honor the beautiful bond and appreciate their profound influence on shaping who we are today. After all, cousins are a cherished gift that continues to enrich our lives in countless ways.

My dear, cousins. you are greatly missed.

Navigating Intimacy: How to Maintain Connection While Living With Multiple Myeloma

Intimacy is about much more than sex. It can be the way your partner reaches for your hand, the comfort of lying beside someone you love, a private conversation at the end of a difficult day, or the physical closeness that reminds you that you're still partners—not simply patient and caregiver.

Multiple myeloma can change that connection in ways people don't always talk about.

Cancer affects the body, but it also affects how we see ourselves and how we relate to the people closest to us. Pain, fatigue, treatment side effects, changes in appearance, anxiety, and uncertainty can all influence sexual desire and physical intimacy.

There is no single definition of a "normal" sex life. What matters is finding a form of intimacy that feels comfortable, safe, and meaningful for you and your partner.

How Myeloma Can Affect Intimacy

Myeloma and its treatments can create very real physical barriers to intimacy.

Pain, fatigue, nausea, neuropathy, bone damage, weakness, and medication side effects can make sexual activity uncomfortable or simply unappealing. Treatments and other medications may also contribute to problems such as erectile dysfunction, vaginal dryness, changes in sensation, or reduced sexual desire.

Bone disease deserves particular consideration. When bones or vertebrae have been weakened by myeloma, certain movements or positions may cause pain or potentially place additional stress on vulnerable areas. Talk with your healthcare team if you're unsure which activities are safe for you.

But physical limitations are only part of the story.

Hair loss, weight gain or loss, surgical scars, loss of height from spinal compression, or other changes in appearance can affect how attractive or confident someone feels.

Then there are the invisible changes.

Fear of relapse. Financial worries. Medical appointments. Uncertainty about the future. Concerns about children and family. The exhaustion of living with a disease that never entirely leaves your thoughts.

It's difficult to feel romantic when your mind is occupied with surviving.

Your Partner May Be Struggling Too

Cancer changes relationships for both people.

A partner may become frightened of hurting you or causing a fracture. They may hesitate to initiate sex because they don't want you to feel pressured. They may feel guilty for wanting physical intimacy while you're dealing with cancer.

And when a partner becomes a caregiver, roles can begin to blur.

Suddenly the person who was your romantic partner may also be organizing medications, driving you to appointments, helping with household responsibilities, or caring for you when you're sick. Switching between caregiver and romantic partner isn't always easy.

Stress and exhaustion affect caregivers, too.

Neither person's feelings are wrong. The important thing is making room to talk about them.

Start With an Honest Conversation

One of the most valuable things couples can do is talk openly about what has changed.

That conversation doesn't need to happen in the bedroom or immediately before sex. Choose a quiet time when neither of you feels pressured.

You might talk about what hurts, what you're afraid of, what you miss, what still feels good, and what you would like to try.

Sometimes both partners are waiting for the other person to say something.

One person may be thinking, They don't find me attractive anymore.

The other may be thinking, I'm afraid I'll hurt them.

Without a conversation, both people can quietly arrive at completely different conclusions.

When Talking to Your Doctor Feels Awkward

Sexual health is part of your health.

Still, bringing it up during an oncology appointment can feel uncomfortable—especially when you're already discussing blood counts, scans, medications, infections, kidney function, and treatment decisions.

Healthcare providers may not automatically ask about sexual health, so you may need to start the conversation yourself.

If saying it aloud feels awkward, write your question down before your appointment or send it through your healthcare system's patient portal.

Depending on the problem, your healthcare team may recommend lubricants or vaginal moisturizers, medications for erectile dysfunction, medication adjustments, physical therapy, counseling, or referral to another specialist.

Don't assume a sexual side effect is something you simply have to live with.

Redefining What Intimacy Means

One of the biggest adjustments may be realizing that intimacy doesn't have to look exactly the way it did before cancer.

If intercourse is painful, exhausting, or medically difficult, closeness can take other forms.

Holding hands, kissing, cuddling, massage, lying together, showering together, affectionate touching, meaningful conversations, or simply spending uninterrupted time together can preserve physical and emotional connection.

Removing the expectation that every affectionate moment must lead to sex can also reduce pressure on both partners.

Sometimes intimacy begins to return when neither person feels responsible for making something happen.

Work With Your Body, Not Against It

Timing can make an enormous difference.

If treatment leaves you exhausted at night, intimacy doesn't have to happen at bedtime. If you know certain days after treatment are particularly difficult, choose another time.

Pay attention to when your energy, pain, nausea, and other symptoms are usually at their lowest.

Comfort matters too. Pillows and positioning can reduce pressure on painful areas. Lubricants or moisturizers may help with vaginal dryness. Less physically demanding positions or other forms of sexual activity may be more comfortable.

With significant bone disease, fractures, spinal problems, or severe pain, ask your healthcare team about physical limitations before experimenting with activities that could put stress on affected bones.

Rebuilding Sexual Confidence

Cancer can change the way you see your body.

You may look in the mirror and see scars, weight changes, hair loss, or other reminders of everything you've been through. Feeling differently about your appearance doesn't make you shallow. Body image and sexuality are closely connected.

Small things can sometimes help you reclaim a sense of yourself.

Wear clothes that make you feel good. Experiment with a hairstyle or makeup if that's something you enjoy. Return to hobbies and activities that remind you what your body and mind can still do.

Most importantly, remember that you are more than the physical changes cancer has created.

You are still a partner. You are still capable of giving and receiving affection. And you are still allowed to want closeness.

Don't Forget About Infection and Treatment Safety

Depending on your treatment and blood counts, there may be times when additional precautions are necessary.

Very low white blood cell counts can increase infection risk, while low platelet counts can increase the risk of bleeding or bruising. Certain treatments may also require temporary precautions involving sexual activity, contraception, or exposure to medications through bodily fluids.

Pregnancy prevention may be particularly important with some myeloma medications because certain drugs can cause severe birth defects.

These recommendations vary by medication and individual circumstances, so ask your oncology team what precautions apply specifically to you.

Connection Can Change Without Disappearing

Your intimate relationship after a myeloma diagnosis may not look exactly like it did before cancer.

That's okay.

Relationships evolve throughout life because of aging, illness, stress, parenthood, caregiving, and countless other changes. Myeloma simply forces some of those conversations sooner and more abruptly than anyone expected.

The goal isn't necessarily to recreate your old sex life.

It is to discover what closeness means now.

Talk to each other. Be patient with each other. Experiment with what feels comfortable. Ask for professional help when you need it. And remember that intimacy isn't measured by how often you have sex.

Sometimes the most intimate thing two people can do is simply remain emotionally present while life is changing around them.

Myeloma may change your body and your relationship, but it doesn't have to take away your ability to love, connect, touch, and be close.

Navigating the Emotional Rollercoaster: Coping With the Impact of a Myeloma Diagnosis on Your Mental Health and Well-Being

Receiving a multiple myeloma diagnosis can turn your world upside down.

One moment, you're living your ordinary life. The next, you're learning a new language filled with blood counts, bone marrow biopsies, treatments, scans, medications, and words like remission and relapse.

And somewhere in the middle of all that medical information is you.

The emotional impact of myeloma can be every bit as complicated as the physical one. Shock, fear, sadness, anger, hope, gratitude, frustration, guilt, and even numbness can appear—sometimes all in the same day.

There is no "correct" way to feel after a cancer diagnosis. Your emotions may change from day to day or even hour to hour. You may feel strong one morning and overwhelmed that afternoon.

That doesn't mean you're coping badly. It means you're navigating something extraordinarily difficult.

When Cancer Begins to Change Your Identity

Myeloma can affect parts of life you never expected cancer to touch.

Appointments and treatments may begin determining your schedule. Activities you once enjoyed may become harder because of pain or fatigue. You may need help with things you previously handled independently.

Before long, it can feel as though you've gone from being a spouse, parent, grandparent, employee, friend, traveler, gardener, musician—or simply yourself—to being "the cancer patient."

Financial concerns can add another layer of stress. Reduced work hours, medical expenses, insurance worries, and uncertainty about the future can create anxiety for both patients and their families.

Recognizing these losses matters. You aren't simply adjusting to an illness. You may also be adjusting to changes in independence, identity, relationships, finances, routines, and expectations for the future.

Diagnosis: When Everything Is New

The period immediately following diagnosis can be particularly overwhelming.

Many people know very little about multiple myeloma before they're told they have it. Suddenly, they're expected to understand complicated test results and make treatment decisions while still trying to process the words you have cancer.

Shock and disbelief are common.

Some people cry. Others research everything they can find. Some become angry. Others feel strangely calm or emotionally numb.

You may even move between these reactions.

Give yourself permission to process the diagnosis in your own way and at your own pace.

During Treatment: Living From Appointment to Appointment

Treatment can create its own emotional cycle.

There may be anxiety before blood tests and appointments, followed by the wait for results. Good numbers can bring tremendous relief. Unexpected results can quickly replace that relief with disappointment or fear.

Physical side effects can also wear down emotional resilience.

Pain, insomnia, nausea, neuropathy, fatigue, infections, fractures, and changes in appearance can affect mood, independence, relationships, and your ability to participate in everyday life.

You may also become more dependent on a spouse, family member, or friend.

Accepting help isn't always easy. Some patients feel guilty watching someone they love take on additional responsibilities.

But needing support during cancer treatment isn't a personal failure. Cancer changes what your body can handle, sometimes temporarily and sometimes permanently.

Steroids Can Affect More Than Your Myeloma

Steroids such as dexamethasone are commonly used in multiple myeloma treatment and can have significant effects on mood and sleep.

Some people experience increased energy, irritability, anxiety, agitation, emotional sensitivity, or insomnia while taking steroids. Others experience an emotional or physical "crash" as the steroid wears off.

These changes can be confusing for patients and the people around them.

If steroid-related mood changes become difficult to manage, tell your healthcare team. Don't change or stop your medication on your own. Your doctor may be able to adjust your treatment or recommend strategies to help manage the side effects.

It can also help to explain these patterns to the people closest to you so they understand that some changes in mood may be related to treatment.

What Happens When Treatment Works?

You might expect reaching remission or a deep treatment response to erase the emotional burden of cancer.

Sometimes it doesn't.

During active treatment, you're focused on getting through the next appointment, infusion, medication cycle, or procedure. When treatment slows down, emotions that were pushed aside can suddenly surface.

Then another fear may appear:

What if it comes back?

This is sometimes called fear of recurrence or, with myeloma, fear of progression or relapse.

Friends and family may assume that successful treatment means everything has returned to normal. They may say you're "all better" without understanding that multiple myeloma is generally considered a treatable but incurable disease and that continued monitoring remains part of life.

That difference between how you feel and how others expect you to feel can be isolating.

It can help to explain that remission doesn't necessarily erase the emotional effects of what you've experienced.

When Myeloma Relapses

Hearing that myeloma has returned or stopped responding to treatment can bring back many of the emotions experienced at diagnosis.

Fear. Anger. Disappointment. Frustration. Grief.

You may immediately think about everything ahead—more tests, new medications, side effects, appointments, expenses, and changes to plans you hoped to make.

Some people also try to protect their families by hiding their fears.

But carrying everyone else's emotions while suppressing your own can become exhausting.

Fortunately, treatment options for multiple myeloma have expanded considerably, and a relapse doesn't necessarily mean you've run out of options. Your myeloma specialist can help determine the next treatment strategy based on your previous therapies, disease characteristics, overall health, and other factors.

It is possible to be frightened and hopeful at the same time.

Your Emotional Health Can Affect Your Physical Well-Being

The relationship between emotional and physical health works in both directions.

Pain and fatigue can affect your mood, while prolonged stress, anxiety, and depression can contribute to sleep problems, appetite changes, difficulty concentrating, exhaustion, headaches, and other physical symptoms.

This doesn't mean that physical symptoms are "all in your head."

It means your mind and body aren't separate systems.

Emotional health deserves attention just as pain, kidney function, blood counts, and treatment side effects do.

Recognizing When Sadness May Be Depression

Feeling sad, frightened, angry, or overwhelmed after a cancer diagnosis doesn't automatically mean you're experiencing clinical depression.

But sometimes sadness becomes something more.

Talk with your healthcare team if feelings of hopelessness, emptiness, or sadness persist or interfere with everyday life. Other warning signs may include losing interest in things you once enjoyed, withdrawing from others, significant sleep or appetite changes, difficulty concentrating, overwhelming guilt, or feeling that life isn't worth living.

Sometimes friends or family recognize the change before you do.

Depression and anxiety are health conditions, and effective treatments are available. Counseling, support groups, medication, or a combination of approaches may help.

If you are thinking about harming yourself or feel that you may not be able to keep yourself safe, seek emergency medical help immediately.

Give Yourself Permission to Practice Self-Care

Self-care doesn't have to mean expensive vacations, spa days, or pretending everything is positive.

Sometimes self-care means taking a nap.

Sometimes it means saying no.

Sometimes it's sitting outside, calling a friend, turning off your phone, listening to music, working on a hobby, or allowing yourself to have a bad day without apologizing for it.

Try to preserve pieces of the life you had before myeloma.

Cancer may occupy part of your life, but it doesn't deserve ownership of every part of it.

Talk About What You're Feeling

Talking can prevent emotions from becoming isolating.

You may find comfort in your spouse, family, friends, another myeloma patient, a support group, counselor, social worker, psychologist, or member of your healthcare team.

Not everyone needs the same kind of support.

Some people want to talk frequently. Others process their emotions privately. Some find enormous value in connecting with people who have experienced cancer themselves because they don't have to explain every feeling.

The important thing is knowing where you can turn when carrying everything alone becomes too heavy.

Take Care of Your Body, Too

Basic physical needs can become surprisingly easy to neglect during cancer treatment.

Eating as well as you're able, staying appropriately hydrated, getting adequate sleep, and participating in physical activity that's safe for your condition can support both physical and emotional health.

Exercise doesn't have to mean going to a gym. Depending on your bone health and physical abilities, gentle walking, stretching, or other activities approved by your healthcare team may help reduce stress and improve mood.

With myeloma-related bone disease, always ask your healthcare team what types of exercise are safe.

Mindfulness and Meditation

Mindfulness isn't about pretending frightening thoughts don't exist.

It's about learning to notice thoughts and emotions without allowing every one of them to carry you away.

Meditation, breathing exercises, guided relaxation, prayer, or simply sitting quietly and focusing on the present moment can help some people manage anxiety.

Even a few minutes can provide a mental break from constantly thinking about the next appointment, test result, or treatment decision.

Give Your Emotions Somewhere to Go

You don't always have to talk about your feelings to process them.

Write.

Paint.

Draw.

Play music.

Work in the garden.

Create something.

Cry when you need to.

Keeping a journal can be particularly useful because patterns may begin to emerge. You might notice that anxiety increases before appointments, irritability follows steroid treatment, or sadness appears when you're exhausted.

Recognizing patterns gives you an opportunity to prepare for them rather than feeling blindsided every time.

Finding Meaning Without Forcing Positivity

Cancer doesn't have to become a "gift."

You don't have to be grateful for it.

And you don't have to find a silver lining in every difficult experience.

But some people eventually discover that cancer changes what they value.

They may spend more time with people they love, let go of relationships that drain them, return to forgotten interests, advocate for others, travel when they're able, create something meaningful, or simply become more protective of their time.

That isn't about pretending cancer was worth it.

It's about deciding what you want to do with the life that still belongs to you.

You Don't Have to Ride the Rollercoaster Alone

Living with multiple myeloma can mean living with uncertainty.

There may be wonderful test results followed by frightening ones. Long periods of stability may be interrupted by new symptoms or relapse. Hope and fear may exist side by side.

Emotional strength doesn't mean remaining positive every day.

Sometimes strength means admitting you're scared.

Sometimes it means asking for help.

Sometimes it means crying, resting, getting angry, talking to someone who understands, and trying again tomorrow.

Your mental health is part of your cancer care—not something separate from it.

You are allowed to care for your mind with the same seriousness that you care for your body.

Fueling Your Fight: How Diet Can Support Myeloma Treatment

When you're living with multiple myeloma, food can suddenly become much more complicated than deciding what's for dinner. Patients often wonder whether there are foods they should eat, foods they should avoid, or a special diet that might slow the disease.

Unfortunately, myeloma also attracts its share of claims about restrictive diets, supplements, and foods said to "starve" or cure cancer. There is currently no diet proven to cure multiple myeloma. Instead, nutrition should be viewed as part of supportive care—helping your body maintain strength, manage treatment side effects, protect overall health, and recover.

And during treatment, the "perfect" diet isn't always realistic. Sometimes the most important nutritional goal is simply finding foods you can tolerate and getting enough calories, protein, and fluids.

Build Your Diet Around Balance

For most people with myeloma, the foundation is similar to that recommended for the general population: a varied diet containing vegetables and fruits, whole grains and other nutritious carbohydrates, protein-rich foods, and healthy fats.

However, there isn't one myeloma diet that works for everyone.

Kidney problems, diabetes, weight changes, gastrointestinal symptoms, treatment side effects, infections, and other medical conditions can dramatically change nutritional needs. That's why advice from your oncology team or an oncology dietitian can be especially valuable.

Carbohydrates: Your Body Needs Fuel

Carbohydrates sometimes get an undeservedly bad reputation in discussions about cancer. Claims that eliminating carbohydrates or sugar can "starve cancer" oversimplify how the human body works.

Carbohydrates are an important source of energy.

When you can tolerate them, choose nutrient-rich options such as whole-grain bread and pasta, brown rice, oatmeal, potatoes, beans, fruits, and vegetables.

Higher-fiber foods can also support digestive health and help you feel satisfied longer. However, treatment-related diarrhea, constipation, nausea, or mouth sores may temporarily make some high-fiber foods difficult to tolerate. Your needs may change from one treatment cycle to another.

Protein: Helping Your Body Repair and Recover

Protein is particularly important during cancer treatment because your body uses it to maintain muscle and repair tissues.

Good sources include fish, poultry, eggs, lean meats, beans, lentils, dairy products, soy foods, nuts, and seeds.

If your appetite is poor, adding protein to foods you're already able to eat can help. Eggs, yogurt, nut or seed butters, cheese, smoothies, or other protein-rich snacks can provide nutrition without requiring a large meal.

People with significant kidney impairment may need individualized recommendations regarding protein intake, so don't drastically increase protein without discussing it with your healthcare team.

Fill Your Plate With Color

Fruits and vegetables provide vitamins, minerals, fiber, and a wide range of naturally occurring plant compounds.

Instead of searching for one supposed cancer-fighting "superfood," concentrate on variety. Different colors generally represent different nutrients and plant compounds, so mixing things up is more useful than relying heavily on one particular food.

Fresh, frozen, and canned fruits and vegetables can all be nutritious choices.

Food safety may become especially important when your immune system is significantly suppressed. Wash produce thoroughly and follow your care team's recommendations regarding foods to avoid during periods of severe immunosuppression.

Don't Forget Bone Health

Because multiple myeloma can damage bones, bone health is an important part of overall care.

Dairy foods such as milk, yogurt, and cheese provide calcium, protein, and other nutrients. Fortified nondairy alternatives can also be useful if you don't consume dairy.

However, more calcium isn't automatically better for someone with myeloma.

Myeloma-related bone destruction can sometimes cause dangerously high calcium levels in the blood. Kidney problems can further complicate calcium and vitamin D needs.

Before taking calcium or vitamin D supplements, ask your healthcare team whether they're appropriate for you.

Choose Healthy Fats

Fat is an essential nutrient and an important source of energy.

When possible, emphasize unsaturated fats from foods such as olive oil, nuts, seeds, avocados, and fish while limiting excessive amounts of saturated fat and heavily processed foods.

But there is an important exception: if you're losing weight or struggling to eat during treatment, adding calorie-dense foods may be exactly what your body needs.

Nutrition during cancer treatment isn't always about eating fewer calories. Sometimes the priority is preventing malnutrition and maintaining strength.

Be Careful With Supplements

The supplement aisle can be particularly confusing for cancer patients.

Products are frequently marketed as "immune boosting," "detoxifying," or even cancer fighting. Those claims don't necessarily mean a product is safe or effective for someone undergoing myeloma treatment.

Herbal products, vitamins, concentrated extracts, and dietary supplements can interact with medications or create additional problems for people with impaired kidney or liver function.

Laboratory research showing that a substance affects cancer cells is also not the same as proving that taking the supplement treats cancer in humans.

Curcumin, green tea extracts, high-dose vitamins, and other supplements are frequently discussed within cancer communities. Some are being researched, but they should not replace established myeloma treatments.

Always tell your hematologist or pharmacist everything you're taking—including vitamins, powders, herbs, teas, and supplements.

"Natural" does not automatically mean harmless.

Hydration Matters—Especially for the Kidneys

Staying adequately hydrated is often particularly important in myeloma because abnormal proteins produced by myeloma cells can damage the kidneys.

Water is generally an excellent choice, but soups, milk, smoothies, and other beverages can also contribute to fluid intake.

How much you need depends on your individual circumstances.

Someone with normal kidney and heart function may receive very different advice from someone with significant kidney disease, heart problems, swelling, or who requires dialysis. Follow your healthcare team's recommendations rather than forcing yourself to meet an arbitrary number of glasses each day.

Alcohol should also be discussed with your healthcare provider because it may interact with medications, worsen dehydration, or increase side effects such as dizziness and drowsiness.

When Treatment Makes Eating Difficult

Knowing what constitutes a healthy diet doesn't help much when chemotherapy makes everything taste like metal.

Cancer and its treatments can cause loss of appetite, nausea, vomiting, diarrhea, constipation, dry mouth, mouth sores, altered taste, fatigue, and difficulty swallowing. High-dose chemotherapy and stem cell transplantation can make eating particularly challenging.

During these periods, the rules change.

Instead of worrying about whether every meal is perfectly balanced, concentrate on getting enough nutrition and fluids in whatever form you can tolerate.

Small, frequent meals may be easier than three large meals. Soft or cool foods may help when your mouth is sore. Smoothies, soups, yogurt, eggs, nutritional drinks, or other calorie- and protein-dense foods can be useful when appetite is limited.

If food tastes metallic, experimenting with different utensils, temperatures, seasonings, or foods may help.

Most importantly, tell your care team when you're struggling to eat or drink. Persistent weight loss, dehydration, vomiting, diarrhea, or mouth sores shouldn't simply be endured.

When Treatment Causes Weight Gain

Not everyone loses weight during cancer treatment.

Steroids such as dexamethasone can increase appetite, alter blood sugar, contribute to fluid retention, and change how the body stores fat. Reduced physical activity and emotional eating can contribute as well.

If you gain weight during treatment, don't respond with an extreme diet.

Talk with your healthcare team about whether weight loss is appropriate while you're receiving treatment. A registered dietitian—particularly one experienced in oncology—can help you develop realistic strategies that protect muscle and nutritional status while addressing unwanted weight gain.

Small, sustainable changes are generally more useful than restrictive diets.

Food Is Support, Not a Cure

Nutrition plays an important role in living with multiple myeloma, but food shouldn't become another source of fear.

There is no single "myeloma diet," no superfood capable of eliminating the disease, and no supplement that can substitute for appropriate medical treatment.

Instead, think of nutrition as another tool in your treatment toolbox.

Eat for strength. Eat for energy. Eat to support recovery. And when treatment makes eating difficult, eat what you can.

Your nutritional needs may change throughout your myeloma journey. What works during remission may not work during chemotherapy, transplantation, or relapse. Kidney function, medications, blood counts, weight, appetite, and side effects all matter.

Work with your healthcare team, ask for an oncology dietitian when you need one, and be wary of anyone promising that a particular food, supplement, or restrictive diet can cure your cancer.

The goal isn't dietary perfection.

The goal is giving your body the support it needs while you fight the disease.

Stay Strong: The Power of Exercise While Living with Multiple Myeloma

When you're living with multiple myeloma, exercise may be the last thing on your mind—especially on days when fatigue, pain, neuropathy, or treatment side effects make simply getting through the day feel like a workout.

But movement matters.

Regular physical activity can support cardiovascular health, muscle strength, mobility, balance, emotional well-being, sleep, and overall quality of life. Exercise also plays a role in maintaining healthy immune function and controlling inflammation.

For people living with multiple myeloma, however, exercise isn't about pushing harder or proving how strong you are.

It's about finding ways to move safely within the limits of your body.

Exercise and Your Immune System

Physical activity affects many parts of the immune system. During and after moderate exercise, immune cells circulate throughout the body, helping with normal immune surveillance. Regular activity can also help regulate inflammation and reduce stress hormones.

That doesn't mean exercise can prevent myeloma from progressing or replace treatment. Think of physical activity as one piece of supporting your overall health while living with cancer.

Consistency is generally more important than intensity.

A short walk, gentle stretching, or a few minutes of movement may be more beneficial—and more realistic—than occasionally pushing yourself through an exhausting workout.

As Dr. Joseph Mikhael, Chief Medical Officer of the International Myeloma Foundation, has explained:

“We were built to move and to exercise, and even with the diagnosis of multiple myeloma, for the vast majority of our patients, there is a way to exercise.”

The important part is finding your way to move.

Why Exercise Can Be Especially Helpful With Myeloma

Multiple myeloma and its treatments can affect nearly every aspect of physical well-being.

Fatigue can make you less active. Less activity can contribute to muscle weakness and loss of stamina, which can make everyday activities even more exhausting.

Appropriate exercise can help interrupt that cycle.

Depending on your individual health and treatment plan, regular movement may help:

• Maintain muscle strength and mobility

• Improve balance and coordination

• Reduce deconditioning

• Support cardiovascular health

• Improve sleep

• Reduce stress and anxiety

• Improve mood

• Support healthy blood sugar control

• Maintain independence with everyday activities

• Reduce some aspects of cancer-related fatigue

• Support overall quality of life

Exercise can also help maintain bone and muscle health, but this requires special consideration in multiple myeloma.

Myeloma Bones Require Extra Care

Exercise recommendations for someone with multiple myeloma aren't necessarily the same as recommendations for a healthy person.

Myeloma can weaken bones and cause lytic lesions, fractures, spinal problems, or other skeletal complications. That means certain exercises may be unsafe depending on where your disease has affected your bones.

High-impact activities, contact sports, jumping, twisting movements, and heavy lifting may be inappropriate for some patients.

If you have bone lesions, osteoporosis, previous fractures, spinal involvement, or significant bone pain, talk with your healthcare team before beginning resistance or weight-bearing exercises. A physical therapist familiar with cancer or myeloma can be particularly helpful in determining which movements are safe.

The goal isn't to avoid movement.

It's to find safe movement.

Don't Forget About Neuropathy

Peripheral neuropathy is another consideration for many myeloma patients.

Numbness, tingling, weakness, or decreased sensation in your feet can affect your balance and increase your risk of falling.

If neuropathy affects your feet or legs, be especially cautious with exercises that require significant balance or involve slippery or uneven surfaces.

You may feel safer exercising near a sturdy chair, railing, or wall. Depending on your abilities, seated exercises may also provide an effective alternative.

There's nothing wrong with modifying an exercise.

Safe exercise is better than impressive exercise.

Exercise May Help With Treatment-Related Health Risks

Some medications used during myeloma treatment, particularly corticosteroids, can affect blood sugar, muscle strength, bone health, sleep, appetite, and weight.

Regular physical activity can improve insulin sensitivity and help the body regulate blood glucose. It can also support cardiovascular health and help preserve muscle.

People with multiple myeloma may also have an increased risk of venous thromboembolism (VTE), particularly when taking certain medications or when other risk factors are present.

Regular movement can support circulation and reduce prolonged periods of inactivity. However, exercise does not replace medications or other measures your healthcare team may prescribe to prevent blood clots.

If you develop sudden swelling, warmth, redness, or pain in an arm or leg—or sudden shortness of breath or chest pain—seek medical attention promptly rather than attempting to exercise through it.

Exercise Can Help Your Mind, Too

The benefits of movement aren't limited to your muscles.

Living with an incurable cancer can bring anxiety, depression, fear of progression, uncertainty, and enormous emotional stress.

Physical activity can provide a mental break from cancer.

It may help improve mood, reduce stress, promote better sleep, and give you something positive to focus on that isn't a lab result, appointment, medication, or treatment.

And exercise doesn't have to happen in a gym to count.

Walking your dog counts.

Gardening counts.

Stretching while watching television counts.

Dancing around your kitchen counts.

Movement is movement.

Finding an Activity That Works for You

There is no perfect myeloma workout.

Your ideal activity depends on your bone health, treatment status, blood counts, neuropathy, balance, cardiovascular health, fatigue level, and overall fitness.

Some options to discuss with your healthcare team include:

Walking

Walking is accessible, requires little equipment, and can easily be adjusted to your energy level.

You don't have to begin with 30 minutes.

Start with five or ten if that's what your body can manage.

Swimming or Water Exercise

Water-based exercise can provide cardiovascular activity while reducing stress on the joints.

However, patients with compromised immune systems, central lines, wounds, or certain treatment-related restrictions should ask their healthcare team whether swimming or public pools are appropriate.

Yoga and Gentle Stretching

Yoga and stretching can help maintain flexibility, balance, and mobility while providing relaxation and stress relief.

Some traditional yoga positions may need to be modified for people with spinal involvement, bone lesions, fractures, or balance problems.

Tai Chi

Tai Chi combines slow, controlled movements with balance, breathing, and concentration. It can be a gentle way to stay active while also supporting relaxation.

Resistance Training

Light resistance exercises may help preserve muscle strength.

Resistance bands, light weights, body-weight exercises, or other equipment may be appropriate for some patients—but resistance training should be individualized when myeloma has affected the bones.

Don't assume that "light" automatically means safe. Where your bone lesions are located matters.

Start Small

One of the biggest mistakes people make when returning to exercise is trying to do too much too quickly.

Your body has been through a lot.

Start slowly and build gradually.

You might begin with:

5 minutes of walking.

Then 10.

Then perhaps 15.

Your goal doesn't have to be running a marathon. Your goal may simply be walking around the block without needing to stop.

That's progress.

Pay attention to how you feel during exercise and afterward. If an activity leaves you completely depleted for the rest of the day or several days afterward, you may have pushed beyond what your body currently tolerates.

Know When to Stop

Exercise shouldn't mean ignoring warning signs.

Stop exercising and contact your healthcare team if you experience unusual or severe symptoms such as significant pain, dizziness, fainting, unusual shortness of breath, chest pain, or new weakness.

You may also need to modify or temporarily avoid exercise when you have a fever, infection, significant anemia, very low platelet counts, dehydration, severe treatment side effects, or other medical complications.

Your healthcare team can help you determine when it's safe to resume activity.

Hydration, Nutrition, Sleep, and Recovery Matter Too

Exercise is only one piece of maintaining your health.

Your body also needs adequate nutrition, hydration, sleep, and recovery.

Drink enough fluids based on the recommendations of your healthcare team, particularly if kidney function or medications affect how much fluid is appropriate for you.

Try to eat a balanced diet that provides adequate protein and nutrients to support muscle and overall health.

And don't underestimate sleep.

Recovery is part of exercise—not something separate from it.

Some Days, Rest Is the Exercise Plan

Living with multiple myeloma means your energy level may change dramatically from one day to another.

Yesterday you may have walked two miles.

Today you may need a nap after taking a shower.

That doesn't mean you've failed.

Cancer-related fatigue is real, and treatment can take an enormous toll on your body.

Listen to it.

There will be days to move and days to rest.

The goal isn't perfection. It isn't a certain number of steps, miles, repetitions, or minutes.

It's maintaining as much strength, mobility, independence, and quality of life as your individual circumstances allow.

Multiple myeloma may change how you exercise.

It doesn't necessarily mean you have to stop moving.

Start where you are.
Move in ways that are safe for you.
Rest when your body asks you to.
And celebrate what your body can still do.

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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice. Because multiple myeloma can affect the bones, kidneys, blood counts, nerves, and other parts of the body, speak with your oncologist, myeloma specialist, physical therapist, or other healthcare professional before beginning or changing an exercise program.

The Silent Intruder: How Multiple Myeloma Can Affect the Body

Multiple myeloma, often simply called myeloma, is a cancer of plasma cells that develops in the bone marrow. Although it begins in one type of blood cell, its effects can reach far beyond the marrow. Bones, kidneys, blood cells, the immune system, nerves, and other organs can all be affected.

That is part of what makes myeloma such a complicated disease. Two people with the same diagnosis may experience it very differently. Some develop significant bone disease, while others first show signs of kidney problems, anemia, frequent infections, or abnormal bloodwork.

Understanding what myeloma can do to the body isn't meant to create fear. It can help patients recognize symptoms, understand why certain tests are performed, and have more informed conversations with their healthcare team.

The Impact on Bones

Bone damage is one of the best-known complications of multiple myeloma.

Normally, our bones are constantly being remodeled. Old bone is broken down by cells called osteoclasts, while new bone is created by osteoblasts. Myeloma can disrupt this carefully balanced process, increasing bone breakdown while interfering with the body's ability to rebuild it.

The result can be lytic lesions—areas where bone has been weakened or destroyed. These lesions commonly occur in the spine, skull, ribs, pelvis, and other bones containing active marrow.

Bone involvement may cause persistent pain, fractures from relatively minor trauma, collapsed vertebrae, loss of height, and mobility problems.

As bone breaks down, calcium may also be released into the bloodstream, causing hypercalcemia. High calcium levels can cause symptoms including excessive thirst, frequent urination, constipation, weakness, confusion, and kidney problems.

Effects on the Kidneys

Kidney problems can sometimes be one of the first clues that something is wrong.

Myeloma cells may produce abnormal immunoglobulins or portions of them called light chains. When excessive amounts of these proteins pass through the kidneys, they can injure the delicate structures responsible for filtering the blood.

Kidney function may also be affected by dehydration, high calcium levels, infections, certain medications, and other complications.

Damage ranges from mild impairment to acute kidney injury or, in severe cases, kidney failure requiring dialysis. Fortunately, kidney function can sometimes improve when myeloma is brought under control and contributing problems are treated quickly.

Blood and the Immune System

Healthy bone marrow is essentially a blood-cell factory. As myeloma cells accumulate, they can crowd out normal blood-forming cells.

One common consequence is anemia, or too few healthy red blood cells. Anemia can contribute to fatigue, weakness, dizziness, shortness of breath, and reduced stamina.

Platelet and white blood cell counts can also become low in some patients, either because of the disease itself or its treatment.

Myeloma creates another unusual problem: although malignant plasma cells may produce large quantities of an abnormal antibody or antibody fragment, production of the normal antibodies needed to fight infection can decrease.

That leaves many people with myeloma particularly vulnerable to infections. Infection prevention, vaccinations when appropriate, prompt evaluation of symptoms, and careful monitoring therefore become important parts of myeloma care.

The Spine and Nervous System

When myeloma weakens the vertebrae, a vertebral compression fracture can occur. In some circumstances, a tumor or damaged vertebra can place pressure on the spinal cord or surrounding nerves.

Symptoms may include severe or worsening back pain, numbness or tingling, weakness in the arms or legs, or difficulty walking.

New loss of bladder or bowel control, significant weakness, or symptoms suggesting spinal cord compression require urgent medical attention. Early treatment can be critical to preventing permanent neurological damage.

Peripheral neuropathy can also occur in people living with myeloma, although it may result from the disease, other medical conditions, or certain myeloma treatments.

The Heart and Cardiovascular System

The relationship between myeloma and cardiovascular disease is more complicated than simply saying that myeloma damages the heart.

Anemia, kidney dysfunction, infections, electrolyte abnormalities, blood clots, and certain cancer treatments can all place additional strain on the cardiovascular system.

Some patients also develop AL amyloidosis, a separate but related plasma-cell disorder in which abnormal light-chain proteins form amyloid deposits in organs. When those deposits involve the heart, they can interfere with its ability to function normally.

Because there are many possible causes of cardiovascular symptoms, new shortness of breath, swelling, chest discomfort, fainting, or persistent heart rhythm changes should be evaluated rather than automatically attributed to myeloma.

The Mouth and Jaw

Oral health deserves special attention during myeloma treatment.

Bone-strengthening medications such as bisphosphonates and denosumab can be extremely valuable for reducing skeletal complications. However, in uncommon cases, they are associated with a serious condition called medication-related osteonecrosis of the jaw (MRONJ).

This does not mean everyone taking these medications will develop jaw problems. The risk is influenced by factors including treatment duration, dental health, and invasive dental procedures.

Ideally, patients should have appropriate dental evaluation before beginning bone-modifying therapy and maintain good oral hygiene and regular dental care afterward. Patients should also make sure their dentist knows about their myeloma medications before extractions or other invasive dental work.

Treatment and Management

There has been tremendous progress in multiple myeloma treatment. Today's options extend well beyond traditional chemotherapy and may include proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, corticosteroids, targeted therapies, autologous stem cell transplantation, CAR-T cell therapy, and bispecific antibodies.

The best approach depends on many factors, including the person's age and overall health, kidney function, disease characteristics, previous treatments, cytogenetic risk, and individual goals.

Supportive care is equally important. Managing pain, protecting bones, preventing and treating infections, maintaining kidney health, treating anemia, and monitoring treatment side effects can make an enormous difference in both health and quality of life.

An autologous stem cell transplant is an important treatment for eligible patients, but it is not currently considered a guaranteed cure for multiple myeloma. It can produce deep and sometimes very long-lasting remissions.

Living With the Silent Intruder

Multiple myeloma may begin in the bone marrow, but its reach can extend throughout the body. That is why myeloma care involves much more than watching a single laboratory number.

Doctors monitor blood counts, kidney function, calcium levels, monoclonal proteins or free light chains, bones, symptoms, and other indicators to build a picture of what the disease is—or isn't—doing.

And while multiple myeloma remains generally considered a treatable but incurable blood cancer, the outlook has changed dramatically. New treatments continue to produce deeper responses and longer remissions, and researchers continue to investigate what long-term disease control—and perhaps one day cure—might look like.

Knowledge gives patients another tool in that fight. Understanding how myeloma can affect the body can make it easier to recognize changes, ask questions, advocate for appropriate care, and participate actively in treatment decisions.

The silent intruder may be complicated, but it doesn't have to remain mysterious.