Living With Myelofibrosis: Fatigue, Appetite and Activity Planning Between Visits

The hardest part of the week, one patient told her hematology nurse, was not the blood test. It was the grocery store. Twenty minutes of pushing a cart left her legs heavy, her left side aching under the ribs, and her plan for cooking dinner quietly abandoned for toast. Nothing on the lab report had changed. Everything in her afternoon had.

That gap, between what the numbers say and what a Tuesday actually feels like, is where most people living with myelofibrosis fatigue spend their time. Clinic visits are spaced weeks or months apart. In between, you are the one deciding whether to walk, what to eat when your stomach feels full after three bites, and whether that new ache is worth a phone call.

This explainer is about those in-between weeks. It covers what the disease is doing, why tiredness and appetite loss are so common, how to plan movement without paying for it the next day, and which signs should never wait for the next scheduled appointment.

What actually happens in myelofibrosis, and why fatigue follows

Myelofibrosis is a rare, chronic blood cancer in which the bone marrow, the spongy tissue inside bones that makes blood cells, gradually fills with scar-like fibrous tissue. It belongs to a family of conditions called myeloproliferative neoplasms, or MPNs, in which the marrow makes blood cells abnormally. Mayo Clinic describes it as a form of chronic leukemia that disrupts normal blood cell production.

Scarred marrow is poor at its job. Red cells, which carry oxygen, often fall short, producing anemia. White cells and platelets may be too few or too many. The body compensates by shifting blood production into the spleen and sometimes the liver, and the spleen, normally about the size of a fist, can grow large enough to press on the stomach and cause a dragging ache under the left ribs.

Underneath this sits a driver most patients never see: inflammation. Mutations in genes such as JAK2, CALR or MPL keep signaling pathways switched on. The result is a steady release of cytokines, the chemical messengers the immune system uses to coordinate a response. The same messengers that make you feel wiped out during flu are circulating at low levels all the time.

Fatigue therefore arrives from three directions at once. Anemia means less oxygen reaches muscle and brain. An enlarged spleen makes eating uncomfortable, so fuel intake drops. Cytokines act directly on the nervous system to produce the heavy, flu-like tiredness that sleep does not fix. Understanding which of the three is dominant for you, something your team can often judge from blood counts and examination, is the first step in planning realistic days.

Living with myelofibrosis fatigue: why it feels different from ordinary tiredness

People new to the diagnosis often apologize for being tired, as though a good night’s sleep should have sorted it. It rarely does, and the evidence backs that experience. When researchers built the Myeloproliferative Neoplasm Symptom Assessment Form, a validated questionnaire published in the Journal of Clinical Oncology in 2012 and available through PubMed, fatigue emerged as the most common and the most severe symptom reported by patients with myelofibrosis and related MPNs.

Cancer-related fatigue has a recognizable texture. It is disproportionate to effort: a short walk can cost an entire afternoon. It is unrefreshed by rest. It affects thinking as much as muscle, so that reading a paragraph twice becomes normal. Mayo Clinic lists feeling tired, weak or short of breath among the earliest signs of myelofibrosis, usually because anemia develops slowly enough that the body adapts until it cannot.

There is also a rhythm to it. Many patients describe a reliable window of energy in the morning that closes by early afternoon. Night sweats, another core MPN symptom, fragment sleep and deepen the next day’s deficit. Itching after a warm shower, bone pain and low-grade fevers each chip away at reserves in their own way.

None of this is weakness of character. It is physiology. Naming it clearly matters for a practical reason: the strategies that help are different from the ones healthy people use. Pushing harder, drinking more coffee or forcing an early bedtime tends to backfire. Pacing, protecting the good hours and treating anemia when it is present are what the evidence supports, and each is worth raising with your team.

Is walking good for myelofibrosis?

For most people, yes, and it is often the single most useful thing to do between visits. Walking is low-impact, adjustable minute by minute, and carries almost no risk of a blow to the abdomen, which matters when the spleen is enlarged. It also addresses one of the quiet drivers of fatigue: deconditioning. Muscles that are not used lose strength quickly, and weaker muscles demand more oxygen for the same task, which is exactly the resource anemia has already made scarce.

The general adult target from the Centers for Disease Control and Prevention is 150 minutes of moderate activity a week plus muscle-strengthening work on two days. That figure is a population benchmark, not a prescription for someone with low hemoglobin, and the CDC itself notes that any amount of movement is better than none. For many people with myelofibrosis the realistic starting point is ten minutes at a pace where you can still talk, repeated once or twice a day.

A few adjustments make walking safer and more sustainable:

• Walk at your best time of day rather than when the schedule says.
• Stop while you still have something left; the goal is to finish able to repeat it tomorrow.
• Sit down if you feel light-headed, and mention this to your team, as it may signal that anemia needs attention.
• Choose flat routes with places to rest when counts are low.

Before increasing intensity, or adding anything involving contact or heavy straining, ask your hematologist. Platelet levels, spleen size and any history of clots all shape what is sensible for you specifically.

How to plan activity between visits: pacing, not pushing

Pacing is a technique borrowed from chronic illness rehabilitation, and it turns the boom-and-bust cycle upside down. Instead of doing as much as possible on a good day and then collapsing for two, you set an activity level you can sustain on an average day and hold it steady, adding small increments only when several days in a row feel manageable.

Start with an honest baseline. For one week, note what you did and how you felt the next morning, using a simple 0 to 10 scale for tiredness. Patterns usually appear fast: the day after a long drive, the morning after a late dinner, the reliable slump after standing to cook.

Then divide effort into blocks. A load of laundry is not one task but three: sorting, moving to the machine, folding. Placing a rest between blocks, even five minutes seated, often lets the whole job get done without the crash that follows doing it in one push.

Protect the good hours for things that matter to you. If mornings are your window, that is when to see a friend or tackle the paperwork, not when to vacuum. Chores can be delegated, postponed or shrunk; connection and purpose are harder to replace and are part of why the MPN symptom questionnaire measures inactivity as a symptom in its own right.

Finally, plan for variability. Counts change, transfusion cycles change, treatment side effects come and go. A pacing plan is a draft that gets revised at each visit, ideally with your nurse or a rehabilitation professional who knows your blood results. Bring your week’s notes; they are more useful to the team than a general report of feeling tired.

Myelofibrosis appetite loss: the spleen, early fullness and weight

Appetite loss in myelofibrosis is usually mechanical before it is anything else. The spleen sits high on the left side of the abdomen, tucked behind the stomach. When it enlarges, a condition doctors call splenomegaly, it takes up room the stomach needs to expand. The result is early satiety: feeling full after a small amount of food. Cleveland Clinic lists this sense of fullness, along with pain or discomfort under the left ribs, among the recognized symptoms of the disease.

Cytokines add a second layer. The same inflammatory messengers that drive fatigue also suppress hunger signals and can alter taste, so food that used to appeal now seems flat or metallic. Night sweats and low-grade fevers burn calories the body then struggles to replace. Unintended weight loss appears on the MPN symptom questionnaire for this reason, and it is one of the items your team watches most closely.

Two consequences deserve attention. First, losing weight means losing muscle as well as fat, and lost muscle feeds straight back into fatigue and unsteadiness. Second, a shrinking appetite can mask changes in the disease itself, since a rapidly growing spleen and worsening constitutional symptoms sometimes show up first as a drop on the bathroom scale.

Treatments that reduce spleen size, discussed later, often improve appetite as a side benefit, which is one reason your team may ask about eating at every visit. Until then, the practical goal is not a perfect diet but steady intake: enough protein to protect muscle, enough total energy to hold weight, and enough fluid to avoid the dizziness that dehydration layers onto anemia.

Eating when you feel full after three bites: practical approaches

Meal size is the lever most people can pull immediately. Six small meals spread across the day fit around a crowded abdomen far better than three large ones, and they also smooth out the energy dips that come from long gaps without food. Think of a plate the size of a saucer rather than a dinner plate, offered often.

Density matters more than volume. When every mouthful counts, choose foods that pack protein and energy into small portions: eggs, yogurt, nut butters, cheese, beans, fish, and smoothies made with milk or a fortified alternative. Liquids leave the stomach faster than solids, so a nourishing drink between meals can add intake without adding fullness at mealtimes.

Timing can be adjusted around the spleen. Many patients find they tolerate more in the morning before the day’s discomfort builds, and less late in the evening when lying down afterwards worsens the pressure. Eating the largest meal early and keeping supper light is a reasonable experiment.

A few points are worth checking with your team rather than assuming:

• Iron and vitamin supplements are not automatically helpful in myelofibrosis; anemia here is usually caused by marrow failure rather than deficiency, and some people who receive regular transfusions accumulate iron rather than lack it.
• Alcohol can irritate the stomach and interact with medicines, and is best discussed openly.
• Food safety becomes more important when white cell counts are low; thorough cooking and careful handling of raw produce reduce infection risk.

If weight keeps falling despite these steps, ask for a referral to a dietitian who works with hematology patients. Persistent loss is information your team needs, not a personal failure.

How does myelofibrosis affect the brain? Understanding myelofibrosis brain fog

Myelofibrosis does not usually invade the brain itself. What patients call brain fog, that sense of slowed thinking, misplaced words and difficulty holding a train of thought, is real, common enough that the MPN symptom questionnaire includes concentration problems as one of its ten core items, and comes from several indirect routes.

Oxygen delivery is the most direct. Anemia reduces the amount of oxygen the blood can carry, and the brain is the organ least tolerant of shortfall. Many people notice that concentration improves within days of a transfusion or once hemoglobin rises with treatment, which points to how much of the fog is circulatory rather than structural.

Inflammation is the second route. Cytokines cross into the nervous system and alter how neurons signal, producing the same mental heaviness people recognize from a bad cold. This is thought to be a large part of why fatigue and poor concentration travel together in MPNs.

Sleep disruption is the third, and it is often underestimated. Night sweats, itching and bone pain wake people repeatedly. Fragmented sleep degrades memory consolidation and attention the next day regardless of blood counts.

Less commonly, blood clots and bleeding can affect the brain, because platelet numbers and function may be abnormal in MPNs. This is why sudden confusion, severe headache, weakness on one side or trouble speaking are emergencies rather than symptoms to note in a diary.

For everyday fog, the practical approach mirrors fatigue management: schedule demanding mental work in your best window, write things down, break tasks into steps, and tell your team, since a change in thinking may be the first sign that anemia or the disease itself has shifted.

What to avoid with myelofibrosis

The honest answer is that the list is shorter than most people fear, and most items are about protecting an enlarged spleen, fragile blood counts and a body with little reserve.

Blows to the abdomen head the list. When the spleen is enlarged, it sits lower and less protected than usual, and a hard impact can injure it. Many teams advise against contact sports, heavy lifting that strains the abdomen, and activities with a high risk of falls while the spleen is large. Walking, swimming, cycling on quiet paths and gentle strength work with light resistance are generally more suitable, but the specific boundary depends on your spleen size and platelet count, so ask.

Unsupervised over-the-counter painkillers are a second area for caution. Some common anti-inflammatory pain relievers affect platelet function, which matters when counts are already low or already high. Ask your team which options are appropriate before treating bone pain or headaches yourself.

Infection exposure deserves thought when white cell counts are low. Hand hygiene, avoiding people who are acutely unwell, staying current with vaccines your team recommends, and treating fever as urgent are more useful than isolating yourself, which carries its own costs.

Smoking increases clot risk and damages blood vessels, both of which compound the risks MPNs already carry. Heavy alcohol use strains the liver, which may be doing extra blood-forming work, and interacts with several medicines.

Finally, avoid unverified supplements or diets marketed as marrow-healing. There is no mainstream evidence that any food or supplement reverses marrow fibrosis, and some products interact with prescribed treatment. If something interests you, bring it to your team rather than starting it quietly.

How treatments aim to ease symptoms, and who is usually asked to wait

Treatment in myelofibrosis is organized around two questions: how much are symptoms and spleen size affecting daily life, and how high is the risk of the disease progressing? The National Cancer Institute’s patient guide to chronic myeloproliferative neoplasms describes an approach that ranges from observation through symptom-directed medicines to stem cell transplant, chosen according to risk category and individual circumstances.

People with low-risk disease and few symptoms are often asked to wait, with regular monitoring rather than active treatment. This can feel counterintuitive, but every treatment carries side effects, and starting one before it offers a clear benefit is not neutral. Watchful waiting is an active decision revisited at each visit, not an absence of care.

When symptoms or spleen size become troublesome, the most widely used class of medicines is the JAK inhibitors. These block Janus kinase signaling, the overactive pathway that drives both cell production and cytokine release, and they are prescribed with the aim of shrinking the spleen and easing constitutional symptoms such as fatigue, night sweats and itching. Effects on appetite often follow spleen shrinkage. They do not remove the fibrosis, and they can lower blood counts, so monitoring is close in the early months.

Anemia is addressed separately, with options that may include transfusions, agents that stimulate red cell production, or other medicines, depending on the pattern of the anemia and the person’s other conditions.

Stem cell transplant, in which the patient’s marrow is replaced with a donor’s, is the only approach that aims to change the disease itself rather than its symptoms. It carries substantial risks and is usually considered for people at higher risk who are fit enough to tolerate it. Whether it is appropriate, and when, is a judgment your treating team makes with you.

Tracking symptoms between visits: what the evidence says to measure

Doctors cannot see your Tuesday afternoons. They see a snapshot on clinic day, when adrenaline and a good night’s sleep often make you look better than you have felt all month. A symptom diary closes that gap, and there is a validated template to borrow from.

The Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score, published in the Journal of Clinical Oncology in 2012, asks patients to rate ten symptoms from 0 (absent) to 10 (worst imaginable), giving a total out of 100. It was developed across an international group of MPN patients and is now widely used in clinical trials and clinics. You do not need the official form to benefit from its structure; rating the same ten items once a week gives your team a trend rather than an impression.

Symptom tracked	Why it matters in myelofibrosis
Fatigue	Most common and most severe symptom; reflects anemia and inflammation
Early satiety	Signals spleen pressure on the stomach
Abdominal discomfort	Often tracks spleen size
Inactivity	Measures functional impact, not just feeling
Concentration problems	Captures brain fog
Night sweats	Inflammatory symptom; disrupts sleep
Itching	Common in MPNs, often worse after warm water
Bone pain	May reflect marrow activity
Fever	Low-grade fevers are a constitutional symptom; new high fever is urgent
Unintentional weight loss	Marker of disease burden and nutrition risk

Add two lines of your own: what you did that day, and roughly what you ate. A single page per week, brought to each appointment, turns vague reports into data your team can act on.

What the weeks between appointments usually look like

Between visits, life with myelofibrosis tends to settle into a rhythm shaped by blood tests, treatment cycles and the disease’s own slow pace. Knowing the typical shape helps you spot when something is off.

Monitoring intervals vary widely. Someone under observation with stable counts might be seen every few months; someone starting a JAK inhibitor is usually checked more often in the early period because counts can fall. Someone receiving transfusions lives by a shorter cycle, and many notice a predictable curve: energy and clarity lift in the days after a transfusion, then drift downwards as hemoglobin falls again. Mapping your own curve onto a calendar makes it easier to schedule demanding tasks near the top of it.

Symptoms fluctuate without necessarily meaning progression. Night sweats may come in clusters; itching may flare in hot weather; appetite may vary with spleen discomfort. What matters is the trend across weeks, not any single bad day, which is where the diary earns its keep.

Side effects from treatment, when treatment has started, often appear in the first weeks and are frequently manageable with adjustments made by the prescriber. Report them rather than stopping a medicine on your own; abrupt changes to some MPN medicines can cause symptoms to return sharply, and only your team can judge how to adjust safely.

Emotionally, the between-visit weeks are where anxiety tends to live. Many patients find a routine of weekly self-rating, a fixed contact route to the nursing team for questions, and one enjoyable activity protected each week does more for peace of mind than any amount of reading. Ask your team how they prefer to be contacted between appointments and what threshold should trigger a call.

Life expectancy and the stage 3 question: what the evidence actually shows

This is the question typed into search engines late at night, and it deserves a straight answer about what can and cannot be known. Myelofibrosis is not staged the way solid tumors are, so there is no formal stage 3. What clinicians use instead are risk scores. Tools such as the Dynamic International Prognostic Scoring System, known as DIPSS, and its successors combine age, blood counts, symptoms and, in newer versions, genetic findings to sort patients into risk categories from low to high. These categories guide decisions about observation, medicines and transplant.

Published survival estimates for each category exist in the medical literature, and your hematologist can discuss them with you. This article deliberately does not quote them, for reasons that are clinical rather than evasive. The figures are averages drawn from groups of patients, often diagnosed years ago before current treatments were widely available. They cannot tell any individual what will happen, and the range within each category is wide. The National Cancer Institute’s patient guide notes that prognosis depends on factors including age, blood counts, symptoms and genetic changes, and that it is individual.

The more useful conversation is about your own risk category, what is driving it, and whether anything in it can change. Anemia can sometimes be treated. Symptoms can often be reduced. Fitness can be protected. Transplant eligibility is reassessed over time.

If you want numbers, ask your team directly and ask what they are based on. Many people find that a frank discussion, with the caveats explained, is less frightening than an unexplained figure found online at two in the morning. The decision about how much to know, and when, is yours to make with them.

What people often get wrong about living with myelofibrosis fatigue

Some myths cause real harm because they push people towards the wrong strategy. Here are the ones hematology nurses hear most, corrected against the evidence.

Rest more and the fatigue will lift. Prolonged rest weakens muscle, and weaker muscle needs more oxygen for the same task, which deepens fatigue in an already anemic body. Gentle, regular activity is what rehabilitation evidence supports, provided it is paced and cleared by your team.

Iron tablets will fix the anemia. The anemia of myelofibrosis is mostly a production problem in scarred marrow, not an iron shortage. People who receive regular transfusions may actually have too much iron. Supplements should only follow blood tests and a conversation with your prescriber.

Feeling full early means I am eating too much. More often it means the spleen is crowding the stomach. Smaller, more frequent, denser meals are the response, not skipping food.

My blood counts were fine, so the tiredness must be in my head. Counts capture only one driver. Cytokine-related fatigue can be severe with reasonable hemoglobin, which is precisely why symptom questionnaires were developed alongside blood tests.

Brain fog means the disease has spread to my brain. Myelofibrosis does not usually involve the brain directly. Fog reflects oxygen delivery, inflammation and broken sleep, and often improves when these are addressed.

Watchful waiting means nothing is being done. Observation is an active choice to avoid side effects until treatment offers clear benefit, reviewed at every visit.

A special diet can reverse marrow scarring. No mainstream evidence supports this claim. Good nutrition protects muscle and energy; it does not remove fibrosis.

Questions to ask your care team about fatigue, appetite and activity

Appointments are short and memory is unreliable when you are tired. Writing questions down beforehand, and asking whether a nurse or pharmacist can answer some of them by phone later, tends to produce better conversations. These are the ones that most often change what people do between visits.

• Which of my symptoms do you think is driven by anemia, which by the spleen, and which by inflammation? How would each be addressed?
• What is my current risk category, what is it based on, and what would change it?
• How large is my spleen now, and are there activities you would advise me to avoid because of it?
• Is walking appropriate for me at my current counts, and how would I know if I am doing too much?
• Are there over-the-counter medicines I should not take without checking, given my platelet count?
• Should I be tested for iron overload or iron deficiency before taking any supplement?
• Could a referral to a dietitian or a rehabilitation professional who works with blood cancers help me?
• If treatment is being considered, what is the aim: spleen size, symptoms, anemia, or the disease itself? What side effects should I watch for in the first weeks?
• If I notice a new symptom between visits, who do I contact, how quickly, and what should never wait?
• How often will my plan be reviewed, and what would prompt an earlier review?

Bring your symptom diary and a list of everything you take, including supplements and herbal products. Consider bringing someone with you, or asking permission to record the conversation, so that the answers survive the drive home. There is no such thing as a question too small when the answer shapes how you spend your energy for the next two months.

When to call your doctor: red-flag signs that should not wait

Most days with myelofibrosis are managed with pacing, food and patience. A small number of situations are different, and knowing them in advance removes the temptation to wait and see. Contact your team the same day, or seek emergency care, if any of the following occur.

• Fever, especially with shivering, a new cough, painful urination or a sore mouth. When white cell counts are low, infection can escalate quickly and needs prompt assessment.
• Bleeding that does not stop with pressure, blood in urine or stool, black tarry stools, vomiting blood, or a sudden spread of small red or purple spots on the skin. These may reflect low or dysfunctional platelets.
• Sudden, severe pain under the left ribs, particularly with light-headedness or pain spreading to the left shoulder. An enlarged spleen can be injured or lose its blood supply, and both are emergencies.
• Breathlessness at rest, chest pain or a racing heartbeat, which may signal worsening anemia, a clot in the lung or a heart problem.
• Signs of a clot: a swollen, warm or painful calf, or sudden one-sided weakness, facial drooping, slurred speech, severe headache or confusion.
• Rapid, unexplained weight loss, drenching sweats that are new or much worse, or bone pain that suddenly intensifies. These can indicate a change in the disease that your team will want to evaluate.
• Fainting, or dizziness on standing that is new, which may point to a sharp fall in hemoglobin.

None of these signs means the worst has happened, but each needs a clinician’s judgment rather than a diary entry. Keep your team’s contact details and your most recent blood results where you can find them, and do not stop or change any prescribed medicine on your own while waiting for advice.

Frequently asked questions

Is walking good for myelofibrosis?

For most people, yes. Walking is low-impact, adjustable and unlikely to injure an enlarged spleen, and it counters the muscle loss that makes fatigue worse. Start with short sessions at a pace where you can still talk, stop before you are exhausted, and check with your hematologist before increasing intensity or adding activities involving contact or heavy straining.

What is the life expectancy for someone with stage 3 myelofibrosis?

Myelofibrosis is not staged like solid tumors, so there is no formal stage 3. Clinicians use risk scores such as DIPSS that combine age, blood counts, symptoms and genetic findings. Published survival figures exist for each risk category but are group averages, often from before current treatments. Your hematologist can explain your own category and what the numbers do and do not mean.

How does myelofibrosis affect the brain?

It rarely involves the brain directly. The concentration problems patients describe as brain fog come from anemia reducing oxygen delivery, inflammatory cytokines affecting nerve signaling, and sleep broken by night sweats and itching. Abnormal platelets can also raise the risk of clots or bleeding, so sudden confusion, severe headache or one-sided weakness are emergencies.

What should I avoid with myelofibrosis?

Avoid blows to the abdomen and contact sports while the spleen is enlarged, over-the-counter anti-inflammatory painkillers unless your team approves them, smoking, heavy alcohol use, and unverified supplements marketed for the marrow. When white cell counts are low, careful food handling and avoiding people who are acutely unwell reduce infection risk. Ask your team where your personal limits sit.

What is the best approach to myelofibrosis fatigue management day to day?

Pacing works better than pushing. Record your energy for a week to find your best hours, protect those for what matters most, break tasks into blocks with short rests, and keep gentle activity steady rather than alternating big efforts with collapse. Tell your team about the pattern, since anemia and inflammation are treatable drivers they can assess.

Why do I feel full after a few bites, and what helps myelofibrosis appetite loss?

An enlarged spleen sits behind the stomach and limits how far it can expand, producing early fullness. Inflammatory chemicals also blunt hunger and alter taste. Small, frequent, protein-rich meals and nourishing drinks between them usually help, as does eating your largest meal earlier in the day. Report continued weight loss, since it can signal disease change.

Should I take iron for the anemia of myelofibrosis?

Not without testing and your prescriber’s advice. The anemia here is usually caused by scarred marrow producing too few red cells, not by iron deficiency, and people who receive regular transfusions can accumulate excess iron. Your team can check iron studies and tell you whether any supplement is appropriate.

Can myelofibrosis brain fog improve?

Often, yes. Many people notice clearer thinking after a transfusion or when treatment raises hemoglobin, which shows how much fog is circulatory. Better sleep, when night sweats and itching are controlled, also helps. Practical steps include scheduling mental work in your best window, writing things down and telling your team about any change, as it can be an early signal.

What does watchful waiting mean in myelofibrosis?

It means regular monitoring without active treatment because current symptoms and risk do not yet justify the side effects of medicines. It is a decision reviewed at every visit and changed when symptoms, spleen size or blood counts shift. It is not the absence of care, and you should still report new or worsening symptoms promptly.

How do JAK inhibitors work for myelofibrosis symptoms?

They block Janus kinase signaling, the overactive pathway that drives excess cell production and the release of inflammatory cytokines. The aim is to shrink the spleen and ease symptoms such as fatigue, night sweats and itching, which often improves appetite too. They do not remove marrow fibrosis and can lower blood counts, so whether and when to use one is your prescribing clinician’s decision.

References

• MedlinePlus: Primary myelofibrosis
• CDC: Adult Activity, an Overview of Physical Activity Guidelines

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.