Are there any specific lifestyle changes patients should make before or during treatment?

Are there any specific lifestyle changes patients should make before or during treatment?

I would say there's really just one main lifestyle modification that a lot of Americans could benefit from. I cannot say this is absolutely necessary for patients to start therapy, but patients just in overall good physical health do better with every therapy. And even though these medicines are safe for most patients, every medicine can have side effects. Tylenol, ibuprofen. They can have side effects. And patients who are healthy tolerate side effects much better and have much lower risks of serious problems. So what does that mean? It's just the commonsense stuff. You know, reasonable, healthy diet, reasonable, healthy physical activity. I don't focus too much on the diet side of it because I feel like Oprah Winfrey and a thousand other people will opine on that on the Internet. But this physical activity half you know, I work in America and I don't think Americans are doing the best on this. And we all could be doing a bit better. But I say to my patients, you know, if we're going to be doing this for your health, then we should be doing all the basic things. You know, if you go to the car and wear a helmet but not your seatbelt, you know, it's not consistent. So we say to our patients they should be doing physical activity. And I encourage my patients, be doing 30 minutes of some real physical activity at least four days a week, preferably six days a week. And because the CLL usually does so well with therapy, we have lots of times to encourage that as patients go along. I think that's the main lifestyle modification that would really help patients and not just because of general health, but really it's been shown in many ways that physical activity actively fights cancer. And patients always say, can I can I use green tea, blueberries, dark chocolate, ginseng? Yeah, you can use any of those things. But one thing has been actually shown to fight cancer, and that's physical activity. And it doesn't cost a penny, really. So we would like to endorse it wholly. So fundamental, of course, as a healthy living. Many of the healthy living options for CLL is the ones which for for a typical any other healthy person not to smoke, not to drink heavily and having a good exercise filled well diet. Think this is especially important for CLL patients though because the healthier one CLL patient is, the more likely they'll be able to tolerate a more substantial chemotherapy, even if it is more toxic drug therapy. So a better lung function for example, renders them more easy to treat CLL which might need more toxic drugs. So smoking cessation is helpful from that perspective. They should also make sure that they are being screened regularly for other cancers because you don't want the second cancer to be an issue. Now coming, specifically relative to CLL and the drugs. Some drugs have actually shown to work better with certain kind of dietary arrangements. For example, in breast cancer, for example, we have some evidence that the PIK inhibitors work better with ketogenic diet keto, as we call it. We don't have such evidence at CLL, especially because the longer drawn disease is the patient population is a lot more complex and fewer. We don't have as many CLL patients as breast cancer patients, but we do use similar kind of small molecular therapies and one can still look at inspiration from those and think of healthy living and healthy diet being important for CLL. Another thing to remember is that CLL is often treated with steroids in addition, and steroids can lead to rapid glucose intolerance and diabetes or can lead to weight gains and so on. And so having a moderate diet can also help the patient from those kind of side effects.

How does having CLL change my daily life?

Right. And I think that's a very fundamental question to ask. And I think that is where understanding the type of person they are and the type profiling, the disease that is being addressed is fundamental. If a disease is slow growing, not really affecting, causing any toxicities, although the numbers may be very high, the numbers of blood count can be very high. But if it doesn't really affect the other subsets of the blood or it doesn't affect anything else, doesn't cause undue tiredness or loss of appetite or anything else, it's fine to just keep watching it. But that itself can sometimes cause a lot of anxiety to a patient just thinking that there's a cancer inside growing and we are not doing much about it. So having that conversation is fundamentally important.