Just having cancer can cause fatigue. Other causes include:
If you haven’t fallen asleep in 15 minutes, go to another room. Avoid mental stimulation and return to bed when you feel sleepy. If you still can’t fall asleep, get up again and repeat these steps as necessary.
Always tell your doctor about any changes in your thinking.
These symptoms generally will fade after chemotherapy ends, but each patient is different. Some may take a year or more after treatment to feel normal again; others may never regain full cognitive function.
Although you may not feel like eating, it is important to remember that good nutrition and maintaining a healthy weight are important parts of overall cancer care and recovery. Eating well can also help a person better cope physically and emotionally with the effects of cancer and cancer treatment. The following tips may be helpful in maintaining proper nutrition when your appetite is poor.
*Of course, eating a diet rich in fresh fruits, vegetables, fiber-containing cereals, and getting daily exercise often will result in regular bowel function.
- Avoid milk, dairy products, and citrus juices (citrus irritates stomach linings). In addition, fatty foods (hot dogs, pizza, bacon, fried foods, and gravies), foods that contain lots of fiber (whole wheat bread, bran, nuts, popcorn, seeds) or foods containing caffeine (coffee, tea, colas, Mountain Dew, chocolate) can also make diarrhea worse.
- Do drink plenty of clear liquids, especially water, Gatorade (which can be diluted to half-strength), and apple juice. It is often helpful to limit your diet to clear liquids for 12-24 hours, or until diarrhea stops, then gradually add clear soups, bread, and crackers. Once these stay down you can gradually resume your normal diet.
Imodium AD – This over-the-counter pill is useful to slow down diarrhea. Follow these instructions instead of the instructions on the box.
Lomotil – This prescription medication is a little more potent than Imodium.
Step 1: Start taking Imodium when frequent stooling begins. Take up to 8 Imodium (2 milligram) tablets. If you continue to have frequent stooling after taking 8 Imodium per day, go to Step 2.
Step 2: Alternate 1 Lomotil tablet and 2 Imodium tablets every three hours. If this schedule does not control frequent stooling go to Step 3, which is the maximum dose.
Step 3: 2 Lomotil and 2 Imodium every three hours
- Stop taking Imodium when BM’s are down to one or two daily, or when they begin to firm up. You can make yourself constipated if you take Imodium past this point.
- If Imodium is ineffective, call the nurse at your primary office for a prescription. The directions are exactly the same as for Imodium.
- If the above are ineffective you need medical evaluation and more potent medications. Those who become dehydrated from rapid fluid loss may need hospitalization.
Mucositis is a medical term that refers to the mouth sores and inflammation caused by some chemotherapy drugs. Some drugs, especially 5-FU and methotrexate, frequently cause this. Others, such as Taxol, Taxotere, Adriamycin, and Doxil, may cause mucositis in some patients. The severity of mucositis varies considerably. Some patients with mild sores simply have discomfort when eating. More severe mucositis can prevent any oral intake and lead to dehydration. Since the same chemo drugs that cause mucositis may cause diarrhea, patients with both of these problems may become dehydrated quickly. The following treatments may help to ease the discomfort of mucositis. However, once mucositis has started it simply takes time (a few days) to resolve.
Step 1. Keeping ice in your mouth during an infusion of 5-FU can reduce the severity of mucositis.
Step 2. Rinse your mouth frequently with a solution of two teaspoons baking soda in a cup of water. This should be repeated every 2-4 hours. Be sure to spit it out; do not swallow it.
Step 3. Avoid citrus juices, over-the-counter mouthwashes, hot or very cold foods, and spicy or salty foods.
Step 4. “Magic mouth wash” – this prescription anesthetic mouthwash can ease pain and allow you to eat or drink after using it. Ask your doctor or call the nurse for a prescription.
Step 5. If you see white patches in your mouth you may need a special antibiotic for yeast (thrush) infection. Call your doctor or nurse.
Step 6. If you cannot eat or drink, call the nurse at your primary office for instruction or to be seen by a doctor. You may need to get IV fluids or more potent pain medications
What is anticipatory nausea and vomiting? Is it real or just in my mind?
Anticipatory Nausea and Vomiting, (ANV) is a conditioned, or learned response. For example, the nausea and vomiting that occur with a certain therapy may become linked with something else, such as the appearance of the hospital or a certain odor. That reminder or stimulus is then able to trigger ANV on its own. About one-third of the cancer patients who experience nausea develop ANV. It occurs more frequently among people who are young, highly anxious, prone to motion sickness, or taking treatment known to cause nausea. Medications can prevent this from occurring. Be sure to tell your doctor, or nurse if this occurs.
What should I eat on the day of chemotherapy treatment?
To decide what to eat on treatment days, you must find out what works best for you and eat what agrees with you and eat light. Appetite and interest in food can change from day to day. Since the body’s first need is fluid, choose from the following:
What medications are available to help control nausea and vomiting?
Fruit juice, Jell-o, Popsicles, Lemonade, Kool-aid, Water, Soup, Fruit punch, Sports drinks
If your treatment commonly causes nausea and vomiting your doctor may prescribe an antiemetic. Antiemetics are drugs that help control nausea and vomiting.
There are a number of effective antiemetics available to prevent or control chemotherapy-related nausea and vomiting. The best protection against chemotherapy-related nausea and vomiting is to prevent it by starting antiemetics before the chemotherapy is given and taking them for as long as the chemotherapy agent is likely to cause vomiting. Your doctor may prescribe an antiemetic to be taken 30 minutes to 1 hour before your chemotherapy starts. The antiemetic may be given by mouth or in the vein.
Organizing your medications can make your life simpler and help you get the most benefit possible from your treatment.
Keep a Record of Your Medications
Maintain a master list of all of your medications. This record should include basic information such as your name, home and work phone numbers, blood type, medical conditions, emergency contact information, your doctor’s name and phone number and a list of any food or drug allergies. Keep the drug list with you and bring it to every doctor’s appointment.
Include the following information about specific drugs:
- Name and strength of the medication
- Dosage instructions
- The color of the pill
- What you are taking it for
- When you began taking it
- Any food or drug interactions
- Any over-the-counter medications, vitamins and herbal supplements you’re taking. Some of these can interact with your prescription medication and possibly interfere with their effectiveness.
Pill organizers: These containers, available in different shapes and sizes at drug stores, have compartments for the pills to be taken each day, or at different times of the day. Some have child safety locks, reminder alarms and automatic pill dispensers. There are also an assortment of alarms and watches that signal you when it’s time to take medication.
Create your own organizer: Place each day’s pills in a small cup (or two cups if you take medications at two different times of day). If you must take pills several times throughout the day, an empty egg carton can be an effective organizer. Number the 12 sections of the carton for 12 hours of the day. Place the medication you need to take at that time in the proper container.
Charts and calendars: Write your drug schedule on a calendar, and cross items off when you have taken those pills. You can also use different-colored stickers on the lids of each medicine bottle. Every time you take the medicine, place a sticker of the same color on the calendar as a visual reminder of which pills you’ve taken.
Whether or not hair loss occurs depends on the type and dosage of the cancer drug. Ask your doctor if your chemotherapy treatment will result in hair loss so you can be prepared.
Hair loss usually begins 7-21 days after treatment begins, and starts to grow back after treatment ends, although some people start getting hair back during treatment. The time it takes to re-grow hair can vary from 3-12 months. Occasionally, the new hair will have a different texture or color.
Chemotherapy-induced hair loss cannot be prevented, but there are ways to cope:
- Consider cutting your hair short or shaving your head once hair loss begins
- Use mild shampoos and soft hair brushes
- Avoid blow dryers, curling irons, and other hot appliances
- Keep your scalp clean and moisturized to prevent skin problems
- Protect your scalp from the sun with hats, wigs or sunscreen
- Be creative: use colorful scarves, turbans or hats. Make sure headwear is not too tight or irritates the scalp.
- Wigs are an option, although good-quality wigs can be expensive. Some insurance plans may help cover the cost of a wig.
- Embrace your baldness!
What is lymphedema?
Lymphedema is a collection of protein-rich lymphatic fluid, usually in the arm or leg. It is caused by interruption of normal lymphatic flow often due to surgery, radiation, infection or trauma. It is the protein in the fluid that makes it difficult to treat. The protein acts as a magnet for more swelling and serves as a food source for infections.
What causes it?
With normal lymphatic flow, the amount of fluid going into the arm or leg is equal to the fluid that is going out. In lymphedema, the amount of fluid going in is greater than the amount that can go out because of the damage to the “transport system”. It is sort of like the plumbing in an old house where the pipes are narrow. As long as the water is just a trickle, the plumbing can handle it. But when there is a lot of water, it goes out too slowly and backs up until it overflows.
When can it start?
Lymphedema occurs most commonly in women who have had breast surgery with removal of lymph nodes, followed by radiation therapy. It can appear weeks, months or even years after the initial surgery. It may also occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.
Will it go away by itself?
Although there are cases when lymphedema has spontaneously resolved and never recurred, for most patients it is a chronic problem requiring an ongoing effort to control.
How is lymphedema treated?
A treatment plan is based on evaluation by the therapist. It may include one or more of the following elements:
Skin care: Avoidance of injury and infection, good hygiene and proper moisturization is very important. We will teach you proper skin care.
Massage: Two basic types of massage are used to treat lymphedema. Manual lymph draining is a precise and gentle form of massage that helps mobilize the fluid and direct it to other pathways. Soft tissue mobilization (or myofascial release) is a type of massage used to release scar tissue and other tightness that might be contributing to the swelling. Sometimes massage is taught to patients or family members to carry out at home.
Exercise: You may be instructed in stretching exercises to loosen up the tissues in the region or specialized exercises to help move the fluid out. You will be given written instructions for these exercises.
Bandaging: This is a precise technique which uses cotton low-stretch bandages to apply constant pressure on the limb. Bandaging is usually done in combination with other methods.
Compression Garments: These are elastic fabric garments similar to a girdle or support stocking that apply pressure to the arm or leg to help move fluid out and keep new fluid from collecting.
Medicine: Sometimes antibiotics or other medications are prescribed as part of your treatment plan.
Bone loss can also occur in men or women with poor nutrition, inadequate intake of calcium and vitamin D, or who are confined to bed for long periods due to illness. Cancer treatments can also contribute to bone loss. Possible causes of cancer-related osteoporosis and bone fractures include:
- Some chemotherapy drugs can decrease calcium levels in the body
- Radiation therapy to the pelvic region, especially for women over the age of 65
- Spread (metastasis) of cancer to the bone from the original tumor site
- Hormone therapy to suppress testosterone in prostate cancer patients
- Steroid treatments
Tips for Bone Health –There are steps that can help reduce your risk of bone loss and promote strong, healthy bones during cancer treatment.
Early detection: A bone density scan can determine if bone loss is occurring. A scan can be performed before, during and after cancer treatment.
Calcium: This mineral maintains bone health and strength. Calcium decreases as we age, so it’s important to replace it with diet or a supplement. Calcium-rich foods include cheese, yogurt and broccoli, or choose from calcium-fortified foods such as orange juice, milk and pasta.
Vitamin D helps your body absorb and retain calcium. Vitamin D is manufactured in the skin using energy from sunlight and can also be found in vitamin D fortified food, such as milk.
Bisphosphonates: these prescription medications slow the rate of bone loss and may even help promote new bone growth.
Exercise: Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) stimulates production of bone-forming cells and also helps build muscles, providing more stability.
Maintain a healthy weight: a nutritionally-balanced diet is crucial to healthy bones. People who are underweight are more prone to bone loss and fractures.
Prevent falls: Take steps to make your environment free of dangers that could cause a fall. Don’t leave papers or magazines on the floor, and remove scatter rugs and other clutter that can trip you up.