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Handbook
"Putting It All Together"
Complications may be related to one or all of the types of treatment you receive. These include, but are not
limited to:
- Chemotherapy may be an important part of your treatment. Chemotherapy is the use of drugs to
kill cancer cells. The kind and number of medications you receive will depend on the type of disease you have. It
can be used alone or in combination with other types of treatment.
- Surgery may be a part of diagnosis, treatment or management of complications.
- Radiation is a local treatment and may be used alone or in combination with other types of treatments.
Your health care team will plan the best treatment for your situation and will work with you in its planning.
Complications and side effects may occur in relation to any of the above treatments. Some things to watch for
are described below.
Chemotherapy
Because cancer cells grow and divide rapidly, chemotherapy drugs are given to kill fast-growing cells. But
certain normal, healthy cells also are fast growing, and chemotherapy can affect these cells too. For example,
it can damage normal, fast growing cells such as those in your mouth, throat, bowels, skin, hair and bone marrow.
Hair loss (Alopecia)
Many chemotherapy drugs may cause hair loss ranging from thinning to complete hair loss. It usually begins about
the second or third week after administration of the drug. Body heat is lost through the head, therefore you may
feel colder after you lose your hair. You may choose to wear a cap, scarf, wig or turban. If you plan to get a
wig please ask your nurse for a prescription and additional information. The prescription may help you in obtaining
insurance coverage. Hair loss is usually temporary. Regrowth may take three to five months after the chemotherapy is
done.
Loose or watery stools (Diarrhea)
Loose or watery stools can occur with some chemotherapy drugs. It will be important for you to keep track of the
number of diarrhea stools. Notify your physician if this lasts for more than 24 hours, or if you are noticing any
symptoms of dehydration. Signs of dehydration may include dizziness or feeling lightheaded, especially upon moving
to an upright position, dark or concentrated urine, dry mouth or an increase in pulse.
Mouth Sores (Mucositis or Stomatitis)
Mouth sores can occur with chemotherapy. The sores can develop on the tongue, gums or in the throat. It is important
to have good oral hygiene. In addition, you may be instructed to use a salt and soda rinse.
Recipe: 1/2 teaspoon of salt and 1/2 teaspoon of baking soda in a cup of warm water. Rinse and spit four times a
day.
Call the doctor if your mouth sores stop you from eating, drinking or if you have difficulty swallowing.
Nausea and Vomiting
Nausea and sometimes vomiting may be experienced with some chemotherapy drugs. It can begin shortly after
chemotherapy is given and the duration varies from person to person. You will be given medications to minimize or
prevent this side effect. Please call the doctor if you are unable to keep down any fluids. Do not worry if you do
not feel like eating solid foods. It is often times helpful to eat small, frequent meals.
Low Blood Counts
Your blood is made up of several important cells that are made in the bone marrow. Some of these include platelets,
red cells and white cells. Many chemotherapy drugs affect the bone marrow's production of these cells because they
are fast-growing. This is common, but there are symptoms that may occur and should be recognized when your blood
counts are low. Your blood counts will be monitored during chemotherapy. If we, or you, need to do something
different related to your low blood counts, we will call you to inform you of what would be the best course of
action.
The following information is provided to help alert you to these signs and symptoms:
White Blood Cells
Purpose:
Your white blood cells (WBC's) help protect your body by fighting bacteria and other germs that cause infections.
Neutrophils, Granulocytes, Poly's, Bands and Stabs are all names for the portion of the total WBC that fight
infection.
Normal Values
Total WBC: (4.0 - 10.0K/mm3 or 4,000 - 10,000/mm3)
Neutrophils: (1.4-7.5K/mm3 or 1400-7500/mm3)
Symptoms of Infection:
- Fever of 100.5 degrees F. or greater, shaking /and or chills
- Cough, sore throat
- Sweating not related to exercise
- Urinary frequency, urgency, burning or odor
- Diarrhea
- Fatigue or flu-like symptoms
*Report any of the above symptoms to your doctor or nurse as soon as possible.
Precautions:
White blood cells are the cells most affected during chemotherapy-putting you at risk of getting an infection.
Please use good judgment to try to avoid infection, such as:
- Avoid physical contact with people who have a contagious infection such as the flu or a cold
- Practice good personal hygiene, especially frequent hand washing
- Go to a movie on Tuesday when the crowds are smaller versus on a Saturday
- Do not share drinking glasses
- Carry out mouth care as directed
Platelets
Purpose:
Platelets help your blood clot so that too much bleeding is prevented.
Normal Value:
(150-450k/mm3 or 150,000 - 450,000/mm3)
Symptoms of bleeding related to low platelets:
- Nose bleed that does not stop after 20 minutes
- Easy bruising
- Prolonged bleeding from a cut
- Black or bloody stools
- Pink, red or brown urine.
- Pin-point sized red or purple spots on your skin (called petechiae)
- Bleeding from the gums that does not stop
- Bleeding in the whites of the eyes
- Bloody sputum (spit)
- Severe headache that comes on quickly and does not go away
- Excessive or abnormal vaginal bleeding
*Report any of the above symptoms to your doctor or nurse as soon as possible.
Precautions:
- Avoid injury and limit strenuous activity
- Apply pressure and ice to sites of bleeding
- Do not use sharp objects such as needles, razor, etc when your platelet count is low
- Do not use aspirin or any aspirin-containing products such as PeptoBismol while on chemotherapy unless
instructed to do so by your doctor. (It is a good idea to look at the ingredients of over-the-counter
medications. Many contain aspirin or aspirin-like products).
- Avoid constipation as straining can cause injury
Red Blood Cells
Purpose:
Red blood cells carry oxygen to all of the organs in your body. Hematocrit and Hemoglobin are the blood tests
that measure the ability of your red blood cells to carry oxygen.
Normal values:
Hemoglobin (Hgb): 12.0-16.0g/dl
Hematocrit (Hct): 35.0-48.0g/dl
(Values for men generally run a little higher)
Symptoms of low values or Anemia:
Mild Anemia:
- Shortness of breath on exertion
- Weakness and/or fatigue
Severe Anemia:
- Shortness of breath that interferes with normal activities of living, such as walking short distances
- Palpitations of the heart
- Profound weakness and/or fatigue
- Pale color of the skin
- Dizziness
- Headache or ringing in the ears
*Report any of the above symptoms to your doctor or nurse as soon as possible.
Management of Anemia:
- Take frequent rest periods
- Eat high carbohydrate, high protein well-balanced diet
- Avoid strenuous activities
- You may be asked to have blood counts drawn in your hometown or to come to the clinic to be evaluated
- At times you may require a red blood cell transfusion
- Notify your doctor or nurse regarding these symptoms
Chemotherapy affects other organs of the body such as the kidneys, heart etc. Although severe side effects are
infrequent, it is impossible to predict in advance who will experience these side effects and who will not.
You will be given information relating to the chemotherapy drugs that you will be receiving and which side
effects might be expected. It is always important to communicate these side effects to your doctor or nurse.
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