70M with multiple myeloma remission looking for alternative/unconventional therapy/dietary Ketosis

Inputs

Keywords-Multiple myeloma, stress pulse therapy, nutritional ketosis, dexamethasone.

Review around effects of dexamethasone(steroid) and the patient's apprehension on achieving ketosis. Is it a scientific apprehension or apprehension due to informational poverty and lack of continuity of care?

adopting a "low carb" diet that will better manages my BGLs on non-dex days (I definitely want to get my BGLs to lower levels without insulin, they're too high at the moment)

modifying the diet to better manage my BGLs during my dex days

and when the time is right going into full ketosis

History

2005- T2 diabetes

2016- Clear cell Renal cell carcinoma (RCC) followed by radical nephrectomy

2017- Multiple Myeloma (MM) followed by stem cell transplant

Remission till 2022

June 2022 – Covid – usage of dexamethasone- increased blood glucose level (BGL) – Insulin therapy

March 2023 – recurrence of MM – started on Revlimid

July / Aug 2023 – lesion in coronary sinus, paranasal sinus and supraorbital(between skull and dura mater) – diagnosed as plamacytoma – radiation therapy x5 for coronary sinus lesion.

January 2024- bacterial sinus infection, fragmented left clavicle by plasmacytoma

Currently on – dexamethasone + carlifozimib + promalidomide

Plan

To receive another stem cell transplant

Explore unconventional treatment plans

Patient status

Post radical nephrectomy, Multiple Myeloma, Type 2 Diabetes Mellitus

Challenges

Unable to have proper sleep on - dexamethasone consumption days

Trying to manage BGL without going for insulin therapy by attaining physiological ketosis

Exploring unconventional methods to treat MM

AND

Exploring adjuvant/complementary therapies for better quality of life

Literature review

Main headings

1. Multiple Myeloma

a. Managing MM with unconventional treatment plans

2. Dexamethasone and Type two diabetes

a. Dexamethasone and BGL

b. Tackling sleep related side effects caused by dexamethasone and chemo drugs

3. Plasmacytoma

a. Starving cancer cells to kill tumour

4. Ketosis diet

a. Low carb diet or alternative methods to reach ketosis stage.

5. Lifestyle changes

1. Persons with acquired solitary kidney, including those who have had a unilateral nephrectomy for living kidney donation, renal malignancies, or trauma, have decreased renal mass that leads to increased intraglomerular pressure and glomerular hyperfiltration. We recommend avoidance of excessively high dietary protein intake (>1 g/kg per day) and high dietary sodium intake (>4 grams/d), adequate dietary fiber intake from plant-based foods, a target body mass index of <30 kg/m2 (in non-athletes and non-bodybuilders), and judicious management of risk factors of progressive chronic kidney disease (CKD), and future studies should help to better determine optimal care practices for these persons.[1]

2. Keto diet is one of the most widely accepted weight loss regimens. Few cases exist in the literature regarding the keto diet causing acute kidney injury. Our patient presented with acute kidney injury without an underlying kidney condition. Studies show that individuals with prior kidney disease are at a higher risk of complications. In light of these findings, the ketogenic diet for weight loss should be considered with care, especially in those at high risk of developing kidney disease. [2]

3. Mind–body therapies [3]

These combine mental focus, breathing, and body movements to help relax the body and mind. Some examples are

• meditation: focused breathing or repetition of words or phrases to quiet the mind and lessen stressful thoughts and feelings.

• biofeedback: using special machines, the patient learns how to control certain body functions that are normally out of one's awareness (such as heart rate and blood pressure).

• hypnosis: a trance-like state in which a person becomes more aware and focused on certain feelings, thoughts, images, sensations or behaviors. A person may feel more calm and open to suggestion in order to aid in healing.

• yoga: ancient system of practices used to balance the mind and body through stretches and poses, meditation, and controlled breathing

• tai chi: a form of gentle exercise and meditation that uses slow sets of body movements and controlled breathing

• imagery: focusing on positive images in the mind, such as imagining scenes, pictures, or experiences to help the body heal

• creative outlets: interests such as art, music, or dance

4. Dexamethasone (DXM) is a synthetic corticosteroid developed as a drug with relatively few side effects and strong anti-inflammatory properties. However, one of its most frequently reported adverse effects in patients is sleep disturbance [5]. Sleep disturbance causes other health issues such as cardiovascular disease [6]; therefore, it is important to address these adverse effects in daily clinical practice. Steroid pulse therapy with DXM causes more complaints of sleep disturbance than in the case of prednisolone [7], one of the long-established synthetic steroids [8]. Moser et al. [9] showed that 3 mg of DXM administration every eight hours (total 48 h) caused an increase in the REM sleep latency and percentage of time spent in arousal, as well as a decrease in REM sleep and the number of REM sleep periods in healthy humans. Demisch et al. [10] showed that acute administration of DXM (1 mg) changed the production of nocturnal melatonin (sleep-wake cycle regulator), indicating that steroid-induced sleep disturbance requires only one dose of DXM induction. In the animal model, an administration of 0.5 mg/kg DXM once daily for 21 consecutive days causes an increase in the power of slow EEG frequencies during wake state and decreases the time spent in REM sleep. [4]

5. Noise and Light Reduction [5]

Question: Should noise and light reduction strategies (vs not using these strategies) be used at night to improve sleep in critically ill adults?

Recommendation: We suggest using noise and light reduction strategies to improve sleep in critically ill adults (conditional recommendation, low quality of evidence).