When dealing with any illness, it may be difficult to maintain a positive outlook. We have provided information below that may help you keep a positive approach so that you can not only cope with your illness but also thrive regardless of it.
Managing Side Effects
Taking an Active Role in Your Care
Seeing multiple doctors at multiple locations may begin to seem overwhelming, but by participating actively with your physicians to make sure that each has the most complete and up-to-date set of your medical records, you can take some of the stress out of the process. These steps to help you stay on top of your care can also help your physicians make more informed decisions.
Stay Informed
Make sure that you always know what tests are being done. If you are unsure as to why you are undergoing these tests, do not be afraid to ask – and keep asking – until you feel comfortable that you understand. You should also keep a note of when the results of these tests will be ready.
Keep a Copy for Yourself
Since you may be seeing more than one physician, it is a good idea to always keep a copy of all your diagnostic tests, such as labs, X-rays, or any other test you may have undergone. Read these reports for yourself and ask for an explanation of anything you may not understand. Also, you should make a note of any follow-up tests or appointments recommended in a report to make sure that the follow-up action is taken.
Always Fill in the Gaps
Diagnostic test results do not make up your complete medical record, so it is a good idea to request that you receive a copy of any correspondence to or from your doctors in regard to your care. In addition, it is a good idea to complete an up-to-date medication list to be kept not only with your records but also on your person at all times. Finally, you should take the records from each of your doctors and combine them into your very own copy of your complete medical records.
Positive Principles
When dealing with any illness, the benefits of a positive attitude are hard to measure but impossible to overlook. Below we offer you advice and tips you may find useful when choosing the perspective that will shape your attitude.
Patient Communication Suggestions
1. First, take a deep breath. You don’t have to decide on the best treatment the second you are diagnosed. Take a moment to collect your thoughts. Getting all of the information at once might be difficult to digest. Therefore it is a good idea to take a friend or family member with you to help take notes and ask questions.
2. Speak up if you have questions or concerns, and if you don’t understand, ask again. It’s your body and you have the right to know. Write down questions and go over them with your doctor on your next visit.
3. Pay attention to the care you are receiving. Make sure you’re getting the right treatments and medications by the health care professionals. Don’t assume anything.
4. Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. Write down the important facts.
5. Ask a trusted family member or friend to be your advocate.
6. Know the medications you take and why you take them. Keep a list of all medicines you take. Report any pain or any symptoms you have to your health care team. Write them down; keep a diary.
7. Participate in all decisions. Remember, you are the center of your health care team. Talk to your doctor about your options regarding tests and treatment. Don’t be afraid to request a second opinion.
8. Ask about clinical trials. Clinical trials are studies examining new ways to treat cancer. Some experimental drugs or techniques will only be available to patients who are participating in a clinical trial. Talk to your insurance company. Avoid surprises during treatment by learning what cancer treatments are covered by your plan. Get involved. Cancer support groups are available to help patients and gamily members cope. Ask your nurse for recommendations of groups in your area.
9. If you wish, ask your physician to request a second opinion. In some cases more than one treatment may be right for your cancer. Request a copy of your test results and keep them. Keep a notebook with all of your medical reports and a list of your medications. Keep a calendar to write down your schedule of appointments and tests.
Do’s and Don’ts for a Positive Attitude
1. Don’t believe the old adage that “cancer equals death”.
2. Don’t blame yourself for causing your cancer.
3. Do rely on ways of coping that helped you solve problems and handle crises in the past.
4. Do cope with cancer “one day at a time”.
5. Don’t feel guilty if you cannot keep a positive attitude all the time, especially when you don’t feel good.
6. Don’t suffer in silence.
7. Don’t be embarrassed to seek counseling with a mental health professional.
8. Do use any methods that aid you in getting control over your fears or upset feelings.
9. Do find a doctor who lets you ask all your questions and for whom you feel mutual respect and trust.
10. Don’t keep your worries or symptoms (physical or psychological) secret from the people closest to you.
11. Do re-explore spiritual or religious beliefs and practices, such as prayer, that may have helped you in the past.
12. Don’t abandon your regular treatment in favor of an alternative or complementary treatment.
13. Do keep a personal notebook with all your treatment dates.
Positive Principles
1. Count your blessings, not your worries.
2. Express your feelings honestly.
3. Learn to laugh and laugh to learn.
4. Endure what is necessary.
5. Be open and flexible. Go with the flow.
6. Remain in charge by networking with your family and your doctors.
7. Accept and face your mortality.
8. Treasure each day and each new experience.
9. Exercise body, mind, and spirit as much as you are able.
10. Live remembering that life is a mystery to be lived, not a problem to be solved.
11. Invest in your inner resources: courage, effort, determination, faith, hope, and love.
12. Find the future in your “now”.
13. Emerge as a winner, not a victim or mere survivor, but truly a thriver!
Shoulder Burdens With Positive Attitude
by Sue MacDonald – from Gannett News Service
In case you haven’t noticed, the world is changing.
George Manning has been noticing for years, and the Northern Kentucky University psychology professor sees it everywhere he goes. Change happens, and change causes stress.
“Generally, the biggest cause of stress is change, and attitude is the key to coping with stress,” says Manning, author of Stress: Living and Working in a Changing World.
Resisting change, he says, sets up a cycle of anxiety, apathy and constant frustration, because nothing ever seems to go right or the way someone expected.
“If you’re dealing with change, you want to be in a state of openness, exploration, responsibility and commitment,” he says.
“I think there’s an art in dealing with stress, and it comes with practice,” he says. Some stress is necessary and good, he points out. Stress can inspire people to flee from things that are harmful, and it can inspire creativity, hard work, dedication and self-fulfillment.
George Manning offers these tips for dealing with change and stress.
- Seek out a hardy personality, one in which you feel in control of your environment, your time, your output and results.
- Mesh your values with how you allocate your time each day.
- Keep a positive attitude. Staying optimistic stimulates energy, hones focus and increases your ability to do your job well.
- Don’t deny reality. “See change for what it is.”
- Maintain healthy relationships. “Surround yourself with people who lift you up. Relationships produce definite physiological responses and positive relationships are the key.”
- Use positive self-talk to keep yourself inspired. Surround yourself with positive books, magazines and information – any input that goes into your brain.
Sometimes writing about what is happening to you can have many benefits. You can organize your thoughts, examine your feelings, preserve your memories, and soothe your soul. Keeping a journal gives you a private place to record and reflect upon both your ordinary routines and your extra-ordinary challenges. You can write anywhere at any time about anything you want. You can write as brief or as long as you wish. Be sure to date your entry. You can record your feelings, impressions, memories, and reactions. You may wish to record your goals and accomplishments.
If you would like a free subscription to the magazine ‘Cure’, call 800-210-Cure (2873). The website is http://www.curetoday.com.
Coumadin Therapy and PT/INR Monitoring
Coumadin is frequently prescribed for thrombotic disorders such as deep venous thrombosis (DVT) and pulmonary embolism (PE), as well as cardiovascular disorders such as atrial fibrillation (AF), heart valve replacement and peripheral vascular disease or cerebrovascular disease (stroke). This medication has the ability to prevent blood clots which can be damaging to these various bodily organ systems. However, Coumadin has a very narrow therapeutic index. At too low a dose there is no benefit from taking the medication, and at too high a dose there is a distinct risk of bleeding complications and possibly death.
Your cooperation and knowledge about this medication makes it’s use much safer and more effective. In the practice of Space Coast Medical Associates, Coumadin monitoring requires close attention to detail and cooperation with patients in the following items.
1. You must know the reason why you are taking Coumadin. You may state this in common, ordinary, everyday language, or you may memorize the medical term for why you are taking this medication, and for how long you are to take Coumadin.
2. You must know, without error, how much Coumadin you are taking. You must know how many tablets you are taking each day, what the strength of the tablets are, and the total number of milligrams per day that you are taking of Coumadin.
3. You must come to the office or laboratory for a pro time and INR measurement (blood test) to measure the effect of Coumadin on your blood as ordered by your physician.
4. At your meeting with the physician or nurse, is an opportune time for you to ask any questions about Coumadin therapy, plan it’s management around any other surgical or medical procedures that you are to receive, discuss potential interactions with your other medications. Any other changes in your health could effect the safety of your Coumadin and it’s use should also be discussed at this time.
Protocol for Coumadin Monitoring
1. Â The patient’s indication and duration of Coumadin therapy, as well as the target INR, is to be stated on the encounter document and the patient education is to include knowledge of the reason for treatment, as well as the patient’s knowledge of the number of milligrams and tablets that he is taking.
2. The purpose of anticoagulation indicates the therapeutic index.
A. Prophylaxis against deep venous thrombosis would be 1-2 mg of Coumadin per day and the INR is to be normal or not less than 1.5.
B. Deep venous thrombosis, pulmonary embolism, intermittent atrial fibrillation, cerebrovascular disease, or peripheral vascular disease are to have an INR of 2-3.
C. Valvular heart replacement is to have an INR of 2.5 to 3.5.
D. Recurrent or refractory deep venous thrombosis, pulmonary embolism, or thrombotic events would indicate an INR of 3-4, or as high as is otherwise instructed by your physician.
3. The patient’s doses are to be at the same dose every day, without different sized doses to be given on alternating days. The patients are to report all their medication changes and this is to be compared to a list of medications which can change the patient’s response to Coumadin.
4. The patient is to stop Coumadin before surgery, as instructed by your doctor, i.e. Infuse-A-Port placement, biopsy procedures, or dental extractions. For more invasive procedures, such as thoracotomy or exploratory laparotomy, Coumadin should be stopped further in advance, i.e. five days, with a pro time check two days before the intended procedure. Coumadin does not need to be discontinued for dental cleaning, fillings, and noninvasive surgical procedures.
5. The patient’s Coumadin dose, pro time and INR are to be kept on a flow sheet for ready reference and dosage adjustment.
Protocol
1. Prophylaxis: To prevent catheter-associated deep vein thrombosis (DVT)
1 – 2 mg Coumadin per day
INR less than 1.5
2. Deep venous thrombosis (DVT)
Pulmonary embolism (PE)
Atrial fibrillation (AF)
Cerebrovascular disease (stroke)
Peripheral vascular disease.
INR 2 – 3
3. Valvular heart replacement
INR 2.5 – 3.5
4. Recurrent or refractory deep venous thrombosis
Pulmonary embolism
Thrombotic events
INR 3 – 4 or higher or as otherwise instructed by the physician
Instructions
1. Doses are to be the same every day. No alternate dosing schedule.
2. Report all medication changes.
3. Stop Coumadin before surgery as per your physicians recommendations.nbsp; Do not stop for dental cleaning or fillings, only for extractions.
4. Coumadin dose and PT/INR are to be kept on a flow sheet in your office chart.
Report any Problems
If any of the following occur, call your physician or go to the emergency room of your local hospital immediately:
- Fever or illness, including vomiting, diarrhea, or infection
- Pain, swelling, discomfort, or any other unusual symptoms
- Prolonged bleeding from cuts or nosebleeds
- Unusual bleeding from gums when brushing teeth
- Increased menstrual flow or vaginal bleeding
- Red or dark brown urine
- Red or black stools
- Unusual bruising for unknown reasons
- Patient becomes pregnant, plans to become pregnant or intends to breast feed
- Chest pain or shortness of breath.
- If you have a bad fall, hit your head, or injure your back.
Helpful Suggestions
1. Do not start, discontinue or change other prescription or nonprescription medicine without your health care provider’s advice.
2. Always tell other doctors, dentists, pharmacists, or nurses that you are on Coumadin.
3. You should keep the same general diet from day to day.
4. You should avoid alcohol.
5. If you forgets to take a tablet, let the doctor know. You should take the missed dose as soon as possible on the same day, but you should NOT take a double dose of Coumadin the next day.
6. Wear a Medic Alert bracelet or carry an information card in your wallet to indicate that you are taking a blood thinner.
7. Do not participate in any activities that may increase your risk of significant head or body injury.
8. Do not stop taking your blood thinner without telling your doctor.
9. Do not take over-the-counter preparations that contain aspirin or non-steroidal anti-inflammatory drugs without first checking with your doctor.
The most common side effect and serious risk of oral anticoagulation therapy with Coumadin is bleeding in any tissue or organ.
TO: Patients on Coumadin Therapy
RE: Management Protocol
If you are on Coumadin at 1 mg daily (low dose therapy), your INR is expected to be in the normal range. No adjustment of medication is indicated if it is in the normal range. If the INR is greater than 1.4, please follow-up with your physician.
For patients on therapeutic Coumadin because of venous thrombosis (blood clots in leg or lung, etc.) the therapeutic INR is recommended to be between 2.0 and 3.5. If your INR is in this range, no adjustment of your medication is indicated and you can leave and return for your next blood test or doctor visit. If your INR is less than 2 or greater than 3.5, then please go to the Merritt Island office to see your physician or nurse for Coumadin dosage adjustment, as well as possible change in the blood testing schedule.
If you have any unusual bleeding at any time while on Coumadin, please call the office 24 hours a day.
If you have any symptoms or signs of a recurrence of blood clot (progressive swelling of an extremity, arm or leg) or increasing shortness of breath or coughing up blood, please call our office immediately (and/or go to the emergency room of your hospital).
Potential drug interactions with Coumadin (Warfarin Sodium) are listed below by specific drugs.
The following factors, alone or in combination, may be responsible for
Increased PT/INR Response:
| acetaminophen alcodol allopurinol amiodrone HCI aspirin azithromycin cefamandole cefazolin cefoperazone cefotetan cefozitin ceftriaxone chenodiol chloramphenicol chloral hydrate chlorpropamide cholestyramine cimetidine ciprofloxacin cisapride clarithromycin clofibrate cyclophosphamide danazol danshen (chinese herb) dextran dextrothyroxine diazoxide diclofenac dicumarol diflunisal disulfiram doxycycline erythromycin ethacrynic acid 5-FU fenofibrate fenoprofen feverfew fluconazole fluorouracil |
fluoxetineflutamide fluvastatin fluvoxamine garlic ginkgo glucagon halothane heparin ibuprofen ifosfamide indomethacin influenza virus vaccine itraconazole ketoprofen ketorolac levamisole levothyroxine liothyronine lovastatin mefenamic acid methimazole methyldopa methylphenidate methylsalicylate ointment (topical) metronidazole miconazole moricizine hydrochloride nalidixic acid naproxen neomycin norfloxacin ofloxacin olsalazine omeprazole oxaprozin oxymetholone panax ginseng paroxetine penicillin G pentoxifylline phenylbutazone |
phenytoin piperacillin piroxicam prednisone propafenone propranolol propylthiouracil quinidine ranitidine salycylate-rich herbs cramp bark, willow, wintergreen sertraline simvastatin stanozolol streptokinase sulfamethizole sulfamethoxazole sulfinpyrazone sulfisoxazole sulindac tamoxifen tetracycline thyroid ticarcillin ticlopidine tissue plasminogen activator (t-PA) tolbutamide tramadol trimethoprim/sulfamethox azole urokinase valproate vitamin E xeloda zafirlukast zileuton |
The following factors, alone or in combination, may be responsible for
Decreased PT/INR Response:
| alcohol aminoglutethimide amobarbital atorvastatin azathioprine butabarbital carbamazepine chloral hydrate chlordiazepoxide chlorthalidone cholestyramine corticotropin |
feverfew ginkgo garlice methimazole moricizine hydrochloride nafcillin panax ginseng paraldehyde pentobarbital phenobarbital phenytoin prednisone |
primidone propylthiouracil ranitidine rifampin secobarbital spironolactone sucralfate trazodone vitamin C (high does) vitamin K |
Vitamin K can reverse the effect of Coumadin (decrease PT/INR). Vitamin K can be found in many foods.  Vitamin K content of food is not known with a high degree of accuracy. Foods high in vitamin K are green leafy vegetables, but milk meats, eggs, cereal, and fruits do contain small amounts of vitamin K. Additional foods to avoid are green and herbal tea, fish oil supplements, soybean oil, cotton seed oil, cannola oil, olive oil, coriander leaf, mint leaf, seaweed (lava, purple). Listed below is the amount of vitamin K in a 3-1/2 ounce serving.
800-830 mcg Swiss chard, kale
500-540 mcg Parsley
400-440 mcg Spinach, Brussel sprouts
300-380 mcg Purslane
200-270 mcg Broccoli, turnip greens, watercress, endive, lettuce leaves, spring onions
100-170 mcg mustard greens, cabbage, red cabbage, avacados, asparagus, dry roasted peas, dill pickles, kiw fruit, saurkraut, pea pods, abalone, lentils, kidney beans, cucumbers, carrots, sweet peppers, pumpkin, leeks, artichoke, celery, plums, mayonnaise, peanut butter, coffee, cauliflower, pinto beans, potato chips
Bone Marrow Biopsy and Aspirate
Here we have provided some basic information in the event that your oncologist has recommended he perform a bone marrow biopsy and/or aspirate to help evaluate and manage your medical condition. The procedure is scheduled by the office to be performed at your local hospital in its outpatient ambulatory surgery department. The office/hospital staff will review the procedure with you and obtain your signed informed consent.
You should not take anything by mouth (NPO) for at least 6 hours prior to your procedure. You should have someone available to drive you home, because you will receive medication that may make you sleepy. In the surgical area you will be asked to change into a hospital gown and be placed on a stretcher. An IV will be started in one of the veins in your arms.
You will then be transferred into the procedure room. You may be given oxygen by nasal cannula at the request of your oncologist. Medication will be given by vein to make you sleepy, as well as decrease discomfort. The skin overlying your posterior hip bone will be cleaned with Betadine (iodine) swabs. Sterile drapes will be placed. Local anesthetic will be administered using 1% Xylocaine. A small incision in the skin will be made in the anesthetized tissue with a scalpel. The bone marrow sample will be obtained and placed in the biopsy site. You will be asked to rest after the procedure, and your vital signs will be taken. You then can change into your clothing and you will be transported by wheelchair to your car to be driven home by a friend or family member.
The dressing should stay in place until the next morning. This can then be removed and a sterile bandage placed at the biopsy site. You may take a shower the next morning.
If you have any pain or bleeding of concern to you, please call the office at any time and ask for your doctor to be paged. He or his covering physician will return your call.
If you are on a blood thinner (Coumadin, aspirin, Plavix, etc.), please make sure that your oncologist is aware of this and he may ask you to hold your medication for a few days prior to the procedure to help avoid bleeding, if it will be medically safe to do so.
You will have an appointment to return to the office to review the results with your oncologist. This will usually be 3 to 7 days after the procedure. Sometimes specialized tests are ordered on the bone marrow sample, which are sent out to outside laboratories. The results of these sent-out tests may take 1 to 2 additional weeks.
If you have any questions regarding the indications for the bone marrow biopsy with respect to your medical or regarding the procedure itself, please talk to your oncologist.
Depression
1. Recognizing the difference between a normal emotional reaction to cancer and a more severe depression is important for patients and their families, friends, and caregivers because appropriate treatment can significantly reduce the suffering caused by depression and improve quality of life.
2. Everyone deals with a diagnosis of cancer differently, and not all patients will become depressed.
3. Certain individuals with cancer may be more likely than others to become depressed. Risk factors include a history of depression, alcohol or substance abuse, poorly controlled pain, social isolation, socioeconomic pressure, and advanced-stage cancer.
4. If you or someone you love is having difficulty dealing with cancer or the daily stress of life, it may be time to try something new. Don’t be afraid to talk about your feelings with friends and family members and to encourage them to talk about theirs in return.
5. If five or more of the following symptoms last for more than two weeks, or if they disrupt normal day-to-day functioning, consult a professional.
- Persistent sad or ‘empty’ mood
- Loss of interest or pleasure in ordinary activities
- Decreased energy or fatigue
- Sleep disturbances (insomnia, early waking, or oversleeping)
- Eating disturbances (loss of appetite or weight gain or loss)
- Difficulty concentrating, remembering, or making decisions
- Feelings of guilt, worthlessness, or helplessness
- Irritability
- Excessive crying
- Chronic aches and pains that don’t respond to treatment
- Thoughts of death or suicide or suicide attempts
Caregiver Suggestions
If the person you care for is an adult:
It is important to remember that he or she has the right to make decisions about his or her life. You should respect that right unless your loved one has lost the capacity to make decisions for himself or herself or could put others in danger through his or her behavior.
Whenever possible, offer choices.
The ability to make choices is a basic freedom, so provide choices whenever possible – from where to live to which cereals to eat at breakfast to what to wear. Choices enable us to express ourselves. As your loved one’s options become more limited, through health losses, financial constraints or social losses, you have to work harder to provide choices.
Do only those things your loved one cannot do.
If your loved one is still capable of performing certain activities, such as paying bills or cooking meals, then encourage him or her to do so. Helping your loved one maintain a feeling of independence will make him or her feel better about being in a care-receiving situation.
Be sure to do what you promise to do.
Many care recipients find it emotionally difficult to have to depend on others, and many worry about being a burden. So, with all these mixed feelings, your loved one will need to be able to rely on you. Do what you promise. Remember that your loved one needs you, even if he or she doesn’t say so.
Take care of yourself
This may seem obvious, but caregivers often exhaust themselves by trying to handle caregiving responsibilities on top of normal daily routines. Providing care for a loved one while holding down a job, can lead to exhaustion. If you do become exhausted, you’re more likely to make bad decisions or to take out your frustrations on your loved one. So, take care of yourself; take time out to do things you enjoy even if it means saying no to your loved one. Caregivers who refresh themselves can be there for the long haul.
Your family is your first resource.
There can be deep emotional currents when a loved one becomes ill. Some family members will want to do everything, while others will do very little unless they’re asked. Yet spouses, brothers and sisters, children and other relatives can do much to ease your caregiving burden.
Caregiver Suggestions
1. Family members should not make an invalid of a person with cancer who is otherwise fully capable of physical activity and responsible participation in the family.
2. Family members should not equate physical incapacity with mental failing. It is especially important that an ill patient feel a necessary part of the family.
3. Families must guard against ‘rehearsing’ how they will act if the patient dies by excluding him or her from family affairs now.
4. Caregivers have the right and obligation to take care of their own needs as well as those of the person with cancer. Even though they may be accused of being selfish, they must do what is needed to maintain their own peace of mind in order to better minister to the needs of the person with cancer.
5. Caregivers may need help from outsiders in caring for the patient. Although the patient may object to this, caregivers have the tight to assess their own limitations of strength and endurance and to obtain assistance when required.
6. If the patient attempts to use the illness as a weapon, caregivers have the right to reject that and to do only what can reasonably be expected of them.
Nine Core Care-giving Process
1. Monitoring (ensuring changes in the patient’s condition have been noted).
2. Interpreting (making sense of what is observed).
3. Making decisions (helping select a course of action).
4. Taking action (carrying out decisions and instructions).
5. Providing hands-on care (carrying out nursing and medical procedures).
6. Making adjustments (progressively refining care givers’ actions).
7. Accessing resources (obtaining what is needed).
8. Working together with the patient (sharing illness-related care in a way that is sensitive to the personalities and individuality of both patient and caregiver).
9. Negotiating the health care system (ensuring patient’s needs are adequately met).
Communicating With Your Children
Advice for all Ages
1. Never lie to a child
2. Answer their questions
3. Don’t hide your grief. You can let your children see you crying
and pulling yourself back together.
4. Allow them to express themselves in whatever way they can.
5. Use the word ‘cancer’, don’t avoid the facts
by presenting a fairytale-like story.
6. Don’t panic, but don’t minimize the seriousness either.
7. Telling the type of cancer, where it is located and how it is treated,
helps demystify the disease.
8. Tell children how this may affect their day-to-day life,
but try to maintain as much normalcy as possible.
9. Reassure your children that they are safe.
10. Don’t forego discipline.
11. Keep communication open.
12. For children who are not talking yet,
the most important thing is providing continuity of care.
Try and keep your routine with them and be available.
13. Emotional regression is common in preschool children.
They may become clingy, may start to resume baby talk
or have bedwetting.
14. For teenagers, give them the information they request
or they will become angry when they find out on their own.
You can be frank and direct by stating the situation as it is.
One example would be to say “We are not looking for a cure
at this point. We are looking to keep Dad comfortable.”
Consider taking the trial to a support group for kids who have lost someone important to them. To find a center near you or to order books, go to website http://www.grievingchild.org.
Intimacy and Sexuality After Cancer
You may have changes in your sex life after cancer treatment – many people do. About half of women who have had long-term treatment for breast and reproductive organ cancers and more than half of men treated for prostate cancer report long-term sexual problems. Many cancer survivors say they were not prepared for the changes in their sex lives.
Sexual problems after cancer treatment are often caused by changes to your body from surgery, chemotherapy, radiation, or the effects of pain medicine. Sometimes these problems are caused by depression, feelings of guilt about how you got cancer, changes in body image after surgery, and stress between you and your partner.
People report four main concerns:
Losing interest in sex.  Some may struggle with their body image after treatment. Even thinking about their partners seeing them without cloths is stressful. Others are worn out or in pain, and sex is the last thing on their minds. Chemotherapy and some cancer medicines can also reduce sex drive.
Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that also change your sex life. Some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis, or cancer of the testes. Some treatments can also weaken a man’s orgasm or make it dry. Some women find it harder, or even painful, to have sex after cancer treatment. Some cancer treatments, like chemotherapy, surgery, or radiation, can cause these problems; sometimes there is no clear cause for these problems.
Having menopause symptoms. Â When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or other problems that can affect their desire to have sex.
Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for cancer survivors to have children. Depending on the type of treatment you had, your sex and age, and the length of time you’ve been out of treatment, you may still be able to have children.
Getting Help With Sexual Problems From Your Doctor or Nurse
Often, sexual problems will not get better on their own. To get help with many of these problems, it is important to talk to your doctor. Ask about any medical problem that may be causing changes in your sex life. You may be able to get treatment for the problems you are having.
These may include:
Erection problems. Medicines, counseling, finding ways to please yourself, surgery, or other approaches may help.
Vaginal dryness.  Dryness or tightness in the vagina can be caused by menopause. Ask whether using a water-based lubricant during sex, using vaginal dilators before sex, and/or taking hormones or using a hormone cream are options for you.
Way you can gain muscle control by doing Kegel exercises. You can help strengthen muscles in your genital area by doing these exercises. Practice by controlling your muscles to stop the flow of urine. You can do these exercises even when you are not urinating. Just tighten and relax the muscles as you sit, stand, or go about your day.
Concerns about having children and what you can do. Discuss family planning concerns with your doctor.  If you are a women, ask if you still need to use birth control even if you are not getting your period.
Seeing a sex therapist. Â He or she may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.
Source: National Cancer Institute
Meditation
1. Wear loose clothing.  Sit or lie down in a quiet place.
2. Close your eyes.
3. Concentrate on a single word, object, or calming thought,
such as the word ‘calm’ or ‘peace’.
4. Don’t worry if other thoughts or images pop into your
mind while you are doing this. Just relax and return to
what you were focusing on.
5. Continue until you feel relaxed and refreshed.
Constipation
Many prescription medications can cause constipation, particularly opioid analgesics. Bowel function may also be impaired by decreased physical activity, inadequate fluid intake, and pain. Regular doses of opioid pain medications frequently cause constipation. In patients with chronic pain, who require regular doses of opioid analgesics, laxatives are almost always necessary to avoid constipation.
A daily bowel regimen should be followed, with the goal being to have a bowel movement every one to two days. It is important to keep in mind that if the dosage of pain-relieving medication is changed, you may need to also increase your daily dosage of laxatives.
1. Take one or two stool softeners twice daily (Senokot-S or Colace).
2. Take two tablespoons of Milk of Magnesia every evening, unless you have had a bowel movement that day.
3. If there is no bowel movement within 48 hours, try three Dulcolax tablets or a Dulcolax suppository.
4. Cathartics that can be used include Milk of Magnesia, Lactulose and citrate of magnesium.
5. Consider eating high fiber, high bulk foods such as prunes or prune juice, raisins, etc.
6. If no results, contact your physician for additional instructions.
7. It may be necessary to take more than four stool softener tablets a day for some pain medication regiments. Discuss this with your doctor.
Hot Flashes
1. Hot flashes can occur in men and women.   This is usually due to hormonal changes due to disease and/or treatment.  This is usually seen in women with breast cancer and in men with prostate cancer.
2. In women with breast cancer, they are advised to avoid estrogen-containing medication and products because there is concern that this may increase the risk of recurrence or progression of breast cancer. Medications that can be prescribed by your physician include antidepressants (Effexor, Zoloft, Paxil, etc.) or antidepressant, Neurontin. These medications have central nervous system effect in decreasing hot flashes to a degree in some patients.
3. In men treatments include estrogens, progesterones, or the antidepressants and antiseizure medication as described above.
4. Additional therapeutic options include counseling, acupuncture, as well as the possibility of being enrolled in clinical trials.
Non-Hormonal Management of Hotflashes
(Estrogen and estrogen containing substances are not recommended in Breast cancer patients)
Foods the may help with hot flashes
1. Soy - (Not recommended in breast cancer patients) some soy products contain high levels of isoflavones (genistein and daidzein), which are weak estrogen-like substances from plants – phytoestrogens. The weak estrogenic effects of soy may improve some menopausal symptoms. Whole or lightly processed soy products are preferred to high processed derivatives or supplements. Avoid soy supplements (genistein and isoflavone powders) as high levels can stimulate breast tissue. Up to 50 grams of soy protein per day is considered safe. In a recent study, postmenopausal women who consumed 45 grams of soy flour daily experienced about a 40 percent reduction of hot flashes.
2. Flaxseed - (Not recommended in breast cancer patients) contains a high concentration of lignins, which act like a very weak estrogen. The lignins are concentrated in the hull of the seed.
Information for #1 and #2 from:
Marisa C. Weiss MD, and Ellen Weiss in
Living Beyond Breast Cancer, 1998.
Herbs of interest
1. Black Cohosh Root – many of the clinical trials have been conducted using a proprietary formula, Remifemin, and demonstrated good effect in relieving menopausal symptoms, such as vasomotor instability (hot flashes/flushes) with little or no toxicity in postmenopausal women. The recommended dose of Remifemin is 1 tablet, standardized to contain 20 mg of herbal drug, twice daily. It is not recommended that this be taken for more than 6 months, because of the lack of long term safety data.
2. Evening Primrose Oil – has demonstrated relief of mastalgia (breast tenderness). It has also been tried for management of menopausal symptoms, but its use for this indication has much less data to recommend it.
3. Don Quai – is not an effective herbal medicine for menopause, despite its popularity for this use in the West.
Herbs of Interest information taken from:
Women’s Health Series: Herbs of Special Interest to Women
Mary L. Hardy, in the Journal of the American Pharmaceutical Association
General Considerations
Wear layered clothing, avoid spicy foods and avoid excessive alcohol.
Food and Herbal Therapy
Phytoestrogens – Phytoestrogens (plant estrogens) are isoflavone compounds present in such foods as soy products, sweet potatoes, pumpkin, and legumes, carrotts and a variety of other vegetables.
Herbal Therapies – A large variety of herbal treatments are available. A review of clinical studies that have evaluated the efficacy and safety of specific herbal medications was recently published in the Journal of the American Pharmaceutical Association. The authors concluded for the relief of menopausal symptoms, only black cohash demonstrated efficacy for this indication. Although this herb has a good safety profile, we lack long term safety data. Safety data are still largely lacking for many herbal medications, and recommendations for usage and dosage vary.
Women’s Health Series: Herbs of Special Interest to Women
Mary L Hardy, in the Journal of American Pharmaceutical Association
| Medication | Usual Dose | Side effects | Precautions |
| Bellergal-S | One tablet at bedtime | Dry mouth, dizziness, drowziness | Do not take if there is a history of glaucoma, coronary artery disease, peripheral vascular disease, impaired renal or liver function. Has addictive potential. |
| Clonidine patch or oral | One 0.1 mg patch weekly or One 0.05 mg tab twice a day. May increase to 0.1 mg twice a day if hot flashes persist. | Hypotension (low blood pressure), dizziness, fatigue | Caution in patients with severe coronary insufficiency, recent MI, cerebrovascular disease, chronic renal failure or impaired liver function. |
| Available Over the Counter (OTC) | |||
| Vitamins | Usual Dose | Side effects | Precautions |
| Vitamin E | 800 IU daily | none at this dose | |
| Vitamin C 200 mg and bioflavinoids (Peridin C) | 2 tablets three times a day | Perspiration may have an unpleasant odor | |
| Prescription Medications | |||
| Medication | Usual Dose | Side effects | Precautions |
| Paxil | 10 mg daily for 1 week, then 20 mg daily | Decreased appetite, weakness, sleepiness, dry mouth, insomnia, tremor, nervousness, nausea, constipation, diarrhea | Do NOT take with alcohol or MAO inhibitors. Use with caution with impaired liver or kidney function. Caution if on lithium or digoxin. |
| Zoloft | 50 mg daily | Headache, tremor, dizziness, insomnia, sleepiness, dry mouth, nausea, diarrhea, dyspepsia, sweating | Decreased clearance of diazepam, tolbutamide. Avoid use with MAO inhibitors. Monitor closely if on Warfarin (Coumadin). |
| Prozac | 20 mg daily Max dose 80 mg daily |
Nervousness, anxiety, insomnia, headache, drowsiness, tremor, dizziness, weakness, nausea, diarrhea, dry mouth, anorexia, dyspepsia, rash, weight loss. | Interactions possible with insulin, oral diabetic agents, Flecamide, carbamazepine, vinblastine, lithium, phenytoin, tryptophan, warfarin (Coumadin). |
| Effexor | 75 mg daily | Anxiety, nervousness, insomnia (minimal at this dose) |
Potential interactions with MAO inhibitors. |
Diarrhea
Guidelines for the treatment
of Chemotherapy induced diarrhea
1. Report diarrhea to your physician.
2. Avoid:
- Food products
- Milk and dairy products (particularly in lactose-intolerant individuals)
- Hot or spicy foods (pickles, relish, curried foods, hot pepper)
- Alcohol
- Sodas with carbonation
- Caffeine-containing products (coffee, tea, chocolate)
- Certain fruit juices (prune juice, orange juice with pulp)
- High fiber foods (raw vegetables, whole grain products, dried legumes)
- High-fat foods (fried foods, high fat spreads or dressings) - Medications
- Bulk laxatives (Metamucil, methylcellulose)
- Magnesium-containing medications (Maalox, Mylanta, Ascriptin A/D)
- Stool softeners (Peri-Colase, Dulcolax)
- Promotility agents (Metoclopramide, Propulsid)
- Herbal supplements
(Milk thistle, aloe, cayenne, saw palmetto, Siberian ginseng, and others)
3. Replace fluids with:
- Water
- Decaffeinated beverages (decaffeinated tea, coffee, and sodas)
- Clear broths (chicken or beef)
- Noncarbonated drinks, such as clear fruit juices (apple or cranberry juice)
- Pedialyte, Gatorade, and other electrolyte-replacement drinks
- Lactose-free beverages such as soy milk or lactose-free dairy products (Lactaid)
- Nonalcoholic beverages
- Drink 8 to 10 glasses of clear liquids per day (water, Pedialyte [Ross], Gatorade [Quaker], broth)
- Eat frequent small meals (bananas, rice, applesauce, Ensure, toast)
4. Treatment:
- Administer standard dose of loperamide (Imodium)
- Initial dose 4 mg, followed by 2 mg every 4 hours or after every unformed stool 12-24 hours later.
5. Skin care
Uncontrolled diarrhea can cause pain and soreness to the skin around your anus. Try these tips to protect your skin and relieve pain.
- Clean the area often with unscented baby wipes or baby oil.
- Use warm sitz baths several times a day to soothe the skin. Available at your pharmacy, a sitz bath is a small tub that fits on the toilet seat. Fill it with warm water and sit in it for about 5 to 10 minutes.
- Gently pat the area dry after cleaning.
- Spread Desitin, Balmex, or A+D Ointment over the skin after each bowel movement. These ointments help to heal and protect your skin. Stop using them if they make your skin worse.
- Be sure to tell your doctor or nurse if your skin feels tender or sore.
- Clear broths (chicken or beef)
6. Be prepared for accidents
- If you are experiencing diarrhea, you may want to wear a pad.
- Use nightlights in your bedroom, hallway, and bathroom so you can safely find your way to the bathroom during the night.
7. If diarrhea is unresolved in 24 hours, you may require
hospitalization. Call your physician.
Mouth Sores
Mouth Symptoms of Cancer Treatment
(Chemotherapy and/or Radiation Therapy)
It’s common for patients receiving these treatments to experience painful mouth sores. Cancer treatment is used to kill cancer cells, but it may also harm normal cells. These treatments may cause your mouth to become dry or sore. Some patients develop mouth sores similar to cold or canker sores that often make it difficult to eat, drink, swallow, talk or sleep. Sometimes mouth sores result in a delay of cancer treatment.
Eating and drinking fluids are essential to your overall health; therefore, it is important to take good care of your mouth and throat.
Things you can do to help your mouth heal and to make it feel better:
1. Examine your mouth at least once a day.
A. Look for ulcers, pimples, sores, red areas,
patches or other changes in your mouth.
B. Report any changes to your doctor or nurse.
2. Keep your mouth clean and moist.
A. Clean your teeth; use a soft toothbrush; be careful not to damage
your mouth by brushing too hard. If it hurts to use a soft toothbrush
use an oral swab, cleaning stick or soft tip sponge.
B. Do not floss when it causes pain or bleeding
or when you platelet counts are low.
C. Keep your dentures in only during meals.
D. Don’t use common mouthwashes that contain alcohol,
which can dry and irritate your mouth.
E. Rinse your mouth with salt solution (1/2 teaspoon of salt in 8 ounces of water)
or baking soda (1 teaspoon with 1 cup water). Rinse with this solution
for 1 to 2 minutes every 2 to 3 hours.
F. Keep your lips moist with lip balm.
Mouth Sores (Oral Mucositis) a new product, Gelcair may help.
If you develop sores inside your mouth
the suggestions below should help you feel better.
1. Avoid foods and juices that are highly acidic
(oranges, tomatoes and grapefruits).
2. Try not to use too many spices, especially salt,
because they may sting your mouth..
3. Avoid cigarettes and alcohol.
4. Drink water and other fluids throughout the day.
Chew sugarless gum or suck on sugarless candies.
5. Work with your health care professional to control pain;
ask them to recommend treatment for your sore mouth.
A. May use Magic mouthwash or viscous Xylocaine, Gelcair
(contact physician for prescription). If there is white coating in the mouth,
you may have a yeast infection. Please contact your physician
for an examination and possible prescription.
Chemotherapy and Your Mouth
It is important to know that side effects in the mouth can be serious.
- The side effects can hurt and make it hard to eat, talk, and swallow.
- You are more likely to get an infection, which can be dangerous when you are receiving cancer treatment.
- If the side effects are bad, you may not be able to keep up with your cancer treatment. Your doctor may need to cut back on your cancer treatment or may even stop it.
What Mouth Problems Does Chemotherapy Cause?
You may have certain side effects in your mouth from chemotherapy. Another person may have different problems. The problems depend on the chemotherapy drugs and how your body reacts to them. You may have these problems only during treatment or for a short time after treatment ends.
- Painful mouth and gums
- Dry mouth
- Burning, peeling, or swelling tongue
- Infection
- Change in taste
You can see or feel most of these problems. Check your mouth every day.
Why Should I See a Dentist?
You may be surprised that your dentist is important in your cancer treatment. If you go to the dentist before chemotherapy begins, you can help prevent serious mouth problems. Side effects often happen because a person’s mouth is not healthy before chemotherapy starts. Not all mouth problems can be avoided, but the fewer side effects you have, the more likely you will stay on your cancer treatment schedule.
It is important for your dentist and cancer doctor to talk to each other about your cancer treatment. Be sure to give your dentist your doctor’s phone number.
When Should I See a Dentist?
You need to see the dentist at least two weeks before chemotherapy begins. If you have already started chemotherapy, ask your cancer doctor when it is safe to go see a dentist.
What will the Dentist and Dental Hygienist Do?
- Check your teeth.
- Take X-rays.
- Take care of mouth problems.
- Show you how to take care of your mouth to prevent side effects.
What Can I Do To Keep My Mouth Healthy?
Keep your mouth moist.
- Drink a lot of water.
- Suck ice chips.
- Use sugarless gum or sugar-free hard candy.
- Use a saliva substitute to help moisten your mouth.
Clean your mouth, tongue and gums.
- Brush your teeth, gums, and tongue with an extra-soft toothbrush after every meal and at bed time. If brushing hurts, soften the bristles in warm water.
- Use a fluoride toothpaste
- Don’t use mouthwashes with alcohol in them.
- Floss your teeth gently every day. If your gums bleed and hurt, avoid the areas that are bleeding or sore, but keep flossing your other teeth.
- Rinse your mouth several times a day with a solution of 1/4- teaspoon baking soda and 1/8- teaspoon salt in one cup of warm water. Follow with a plain water rinse.
- Dentures that don’t fit well can cause problems. Talk to your cancer doctor or dentist about your dentures.
If your mouth is sore, watch what you eat and drink.
- Choose foods that are good for you and easy to chew and swallow.
- Take small bites of food, chew slowly, and sip liquids with your meals.
- Eat soft, moist foods such as cooked cereals, mashed potatoes, and scrambled eggs.
- If you have trouble swallowing, soften your food with gravy, sauces, broth, yogurt, or other liquids.
- Avoid tissue irritation (physically irritating and high temperature foods, tobacco, alcohol, or spices).
Call your doctor or nurse when your mouth hurts.
- Work with them to find medications to help control the pain.
- Topical anesthetics may be beneficial (viscous Xylocaine, Magic mouth wash).
- If the pain continues, talk to your cancer doctor about stronger medicines.
- Examine your mouth to see if there is any bleeding, coating lesions, or blisters.
Remember to stay away from:
- Sharp, crunchy foods or acidic foods, like citrus fruits and juices, which can irritate your mouth.
- Sugary foods, like candy or soda that could cause cavities.
- Toothpicks, because they can cut your mouth.
- Tobacco products.
- Alcoholic drinks.
Oral – Balance Mouth Moisturizer
1-800-922-5856
http://www.laclede.com
GelClair
- Requires prescription
- Instructions: 1 sachet added to 15 – 45 ml of water, rinse or gargle for approximately 1 minute then spit out. Avoid food or drink for 1 hour after using GelClair. May administer three times a day or as needed.
Lymphedema
18 Steps to Prevention of Lymphedema for Upper Extremities
For the patient who is at risk of developing lymphedema,
and for the patient who has developed lymphedema.
(National Lymphedema Network Recommendations)
1. Absolutely do not ignore any slight increase of swelling in the arm, hand, fingers, neck or chest wall (consult your doctor immediately).
2. Never allow any injection, IV, or a blood drawing in the affected arm(s).
3. Have blood pressure checked in the unaffected arm.
4. Keep the edemic arm or at-risk arm spotlessly clean. Use lotion (Eucerin) after bathing. When drying, be gentle, but thorough. Make sure it is dry in any creases and between the fingers.
5. Avoid vigorous, repetitive movements against resistance with the affected arm (scrubbing, pushing, pulling).
6. Avoid heavy lifting with the affected arm. Never carry heavy handbags or bags with over-the-shoulder straps.
7. Do not wear tight jewelry or elastic bands around affected fingers or arm(s).
8. Avoid extreme temperature changes when bathing or washing dishes (no sauna or hot tub). Keep the arm protected from the sun.
9. Avoid any type of trauma (bruising, cuts, sunburn, or other burns, sports injuries, insect bites, cat scratches).
10. Wear gloves and long sleeves while doing housework, gardening, or work that could cause even minor injuries.
11. When manicuring your nails, avoid cutting your cuticles (inform your manicurist).
12. Exercise is important, but consult with your therapist. Do not overtire an arm at risk: if it starts to ache, lie down and elevate it. Recommended exercises: walking, swimming, light aerobics, bike riding, and specially designed ballet or yoga. (Do not lift more than 15 lbs.).
13. When traveling by air, patients with lymphedema (or at risk) must wear a compression sleeve. Additional bandages may be required on a long flight. Increase fluid intake while in the air.
14. Patients with large breasts should wear light breast prosthesis (heavy prosthesis may put too much pressure on the collarbone/shoulder area). Soft pads may have to be worn under narrow bra straps. Wear a well-fitted, supportive bra; not too tight; no wire support.
15. Use an electric razor to remove hair from axilla. Maintain electric razor properly, replacing heads as needed.
16. Patients with lymphedema should wear a well-fitted compression sleeve during all waking hours. At least every 4-6 months, see your therapist for a follow-up. If the sleeve is too loose, most likely the arm circumference has reduced or the sleeve is worn. Unfortunately, prevention is not a cure. But, as a cancer and/or lymphedema patient, you are in control of your ongoing cancer checkups and the continued maintenance of your lymphedema.
17. Warning: If you notice a rash, blistering, redness, increase of temperature or fever, see your physician immediately. An inflammation or infection (lymphangitis) in the affected arm could be the beginning or a worsening of lymphedema.
18. Maintain your ideal weight with a well-balanced, low-sodium, high-fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid – rather, this will weaken the connective tissue and worsen the condition. The diet should contain protein that is easily digested, such as chicken, fish, or tofu.
Fatigue
Some Possible Causes of Fatigue
- Medications and treatments including chemotherapy, radiation,
pain medications
- Body’s need for extra energy to repair healthy tissue after treatment
- Toxic substances released by dying cancer cells
- Anemia
- Infection
- Chronic pain
- Treatment-related changes to the nervous system
- Side effects or symptoms including anemia, fever, nausea, vomiting, diarrhea, pain, breathing difficulties, lack of sleep, poor quality of sleep
- Changes in nutrition or nutritional needs
- Lack of exercise
- Emotional factors including depression, anxiety and fear
- Diseases not related to cancer (heart, lung, musculoskeletal, etc.)
- Post operative fatigue
- Cancer burden
Symptoms of Fatigue
- Extreme weariness, lack of energy
- Leg pain, difficulty climbing stairs or walking short distances
- Shortness of breath
- Difficulty concentrating or making decisions
Tips to Fight Fatigue
- Take an active role in your treatment, ask questions.
- Keep a diary to help you identify when you have the most energy and what activities make you feel fatigued or energized. This information can help you plan your activities for the times you have the most energy. this information will also help you to communicate with your physician.
- Delegate. Ask family or friends for assistance with chores, cooking and childcare. Often, family members or friends are happy to help because it is something concrete they can do for you.
- Exercise if your doctor says it is okay for you to do so. Simple stretching and range of motion exercises or a short walk may give you more energy, not decrease the energy you have. Begin slowly and build up to the level that is right for you. Your doctor, nurse, or physical therapist can help you devise a personal exercise plan.
- Rest as often as needed and take short naps. Try not to rest more than necessary as this may decrease your energy level. Many people find that an afternoon nap helps them feel less fatigued for the rest of the day. If you are having trouble sleeping, talk to your health care team to determine why and what you can do about it.
- Control other side effects or symptoms as best you can. Work with your doctor or other health care team member to manage things like nausea, vomiting and fever.
- Speak with a professional counselor to help you cope with the stress of your illness. Learning some relaxation or stress relieving techniques may help.
- Review your diet with your doctor or a nutrition counselor. Treatment and recovery often puts extra demands on your body for calories, nutrition, and fluids.
- Join a support group or participate in a one-on-one buddy program, such as LRF’s Partners Against Lymphoma program, to speak with other lymphoma survivors.
- Drink plenty of fluids and eat as well as possible.
- Limit intake of caffeine and alcohol.
- Save energy for the most important things.
For more information, talk to your physician or call the M. D. Anderson Cancer Center information line at 800-392-1611 (option #3). You can also visit www.mdanderson.org/topics/fatigue for additional resources such as the Brief Fatigue Inventory (BFI) to help you cope with cancer-related fatigue.
Pain
Helping Your Doctor Treat Your Pain
1. Talk to your doctor about treatment as soon as you experience pain.
It is much easier to manage pain that is treated early.
2. Take your pain medication as prescribed. Don’t ‘wait it out’ until
pain is unbearable, because it will be more difficult to relieve.
3. Alternative methods, such as listening to a relaxation or guided
imagery tape or using hot or cold compresses may help.
4. Be able to report your symptoms accurately.
Keeping a pain diary can help.
5. Include reports of your functional status.
6. Accurately report all medications you take,
including over-the-counter medicine.
7. Report the characteristics of your pain.
The most important help you can give your doctor is an accurate
description of the symptoms or type of pain you are experiencing.
8. Do not exaggerate or dramatize.
9. Describe the intensity of the pain.
10. Set Goals.
Develop a set of goals to guide treatment and assess progress.
Hand/Foot Syndrome
Typical signs include swelling, pain, skin redness, skin eruptions and peeling of skin, tenderness, cracking of skin, bleeding of skin. Symptoms are manageable and in most patients the reaction is mild and resolves in one to two weeks.
In order to decrease or prevent hand/foot syndrome patients should do the following:
1. Avoid tight clothing and shoes.
2. Avoid steam or hot showers, whirlpools, baths, and spas.
3. Avoid direct sunlight on skin.
4. Avoid letting the skin of your hands and feet dry out excessively.
Avoid adhesives on your skin (tape, adhesive bandages).
Use soft bandages if necessary.
5. If symptoms do develop, treatment can include cool baths
or compresses, moisturizers, including petroleum jelly.
6. If symptoms progress and/or infection occurs, contact your doctor.
Chemotherapy dose modification may be necessary.
7. Stay in cool places, avoid heat on your skin.
8. Consider B6 50- 100 mg p.o. twice a day
(must not be on a platinum chemotherapeutic agent).
Grade 1: Â Minimal skin changes or dermatitis (erythema – redness)
without pain.
Grade 2: Â Skin changes (peeling, blisters, bleeding, edema – swelling)
or pain, not interfering with function.
9. Consider Celebrex (Cox-2 inhibitor).
Nausea & Vomiting
Many patients fear the nausea and vomiting that may accompany cancer treatment. Fortunately, antiemetics and anti-nausea drugs have become very effective in preventing these symptoms. However, no medicine works for everyone 100% of the time. The patient should continue to work with his or her doctor to find the right medication.
Here are some tips that may help.
- Eat and drink slowly.
- Chew food well, and eat food cold or at room temperature.
- Eat small meals throughout the day instead of three big meals.
- Breathe slowly and deeply or use relaxation techniques such as self-hypnosis, biofeedback, and guided imagery when nauseated.
- Avoid sweet, fatty, spicy, or fried foods, as well as bothersome odors.
- Wear loose-fitting cloths and try to stay in a well ventilated area.
- Take anti-nausea medication after chemotherapy on a preventative basis as well as on an as-needed basis.
- Do not arrive for chemotherapy hungry.
- May use lemon drops.
- Eat whatever tastes good to you.
- Try to eat foods that taste good cold. The odor of hot foods can lead to nausea in susceptible people.
- You may wish to drink ginger ale. Ginger has an anti-nausea effect.
- If you vomit up blood, call your physician immediately and/or go to the emergency room.
- Don’t lie down for one hour before or after mealtime.
- Drink cool clear beverages, such as unsweetened juices. Examples are apple juice and grape juice.
Tips to improve appetite.
- Include family members
- Eat small, frequent meals and snacks
- Serve food attractively and in a pleasant atmosphere
- Decrease liquids at mealtime to allow more room for solid foods
- Attempt to induce light exercise
- Eat the biggest meal of the day when most hungry, regardless of time of day
- Add flavoring by seasoning foods
- Ensure the consistency of food is appropriate
- Try a lollipop or hard sucking candy to stimulate saliva production
Hair Loss
If hair loss is likely, you may want to:
1. Cut your hair short.  Hair loss may seem less noticeable.
2. Be fitted for a wig.  Your insurance may cover the cost.
3. Avoid damaging hair, shampoo gently (use baby shampoo).
4. Avoid using a hot hair dryer, and permanent wave chemicals
or hair coloring.
5. Don’t use hair clips, barrettes, bobbie pins, rubber bathing caps,
braids or corn rows. These can all pull out fragile hair.
6. Use a soft hair brush.  Gently use a wide tooth comb.
Avoid rollers and hair sprays.
7. Protect your scalp from sunburn. If you don’t wear a wig,
consider wearing a scarf, turban, hat, and use sunscreen.
8. Avoid plaiting your hair or wearing it too tight.
