Dealing with Cancer Treatment

Dealing with Cancer Treatment

Dealing with Cancer Treatment with VMOC

FatigueChemobrainNutritionConstipationDiarrheaMucositisNauseaManaging MedicationsOrganizing MedicationsHair LossLymphedemaBone HealthPeripheral Neuropathy
Fatigue is the most common symptom experienced by cancer patients. Fatigue is treatable; however, most patients do not report symptoms to their doctor in the belief that it may not be “important.” Cancer-related fatigue can have a serious impact on quality of life, as well as physical symptoms.

Just having cancer can cause fatigue. Other causes include:

Other causes include:
  • Aggressive surgery, chemotherapy or radiation treatments
  • Chemotherapy-induced anemia
  • Sleep disorders
  • Emotional distress
  • Pre-existing medical conditions: uncontrolled diabetes, thyroid problems, heart disease or rheumatoid arthritis
How to Cope with Fatigue
  • Exercise regularly. A 20-minute walk can help you relax, but don’t exercise in the evening.
  • Limit naps if possible. If you must nap, keep it under 30 minutes, and do something active right after waking.
  • Avoid alcohol, caffeine, chocolate, and nicotine in the evening.
  • Turn off the TV one hour before bedtime. Listen to quiet music or take a warm bath instead.
  • Keep a regular sleep schedule, even on weekends.
  • Do not read, watch TV or work in the bedroom.

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.

Chemobrain, formally known as cognitive dysfunction, is a symptom reported by many cancer patients. Chemobrain, or difficulty in efficiently processing information, is a legitimate, diagnosable condition that may be caused by chemotherapy treatment, the cancer itself, or secondary medical conditions such as anemia.

Always tell your doctor about any changes in your thinking.

Symptoms of Chemobrain
  • Difficulty concentrating on a single task
  • Problems with short-term memory; forgetting details of recent events
  • Feeling mentally “slower” than usual
  • Confusing dates and appointments
  • Misplacing objects
  • Fumbling for the right word or phrase

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.

Treatment of Chemobrain
People can use the following coping strategies to minimize the effects of chemobrain:

  • Exercise: Even five minutes of mild to moderate activity may improve mental function.
  • Memory Aids: Using a notebook, planner or list to keep track of things as they come to mind. A small recorder can also come in handy.
  • Treat fatigue and sleep problems: these conditions can worsen chemobrain symptoms.
  • Manage depression and anxiety: easing stress and elevating mood can ease chemobrain symptoms.
  • Minimize distractions: Employers are required by the Americans with Disabilities Act to make reasonable accommodations for health-related impairments such as chemobrain. A more soundproof environment, like an office or a cubicle in a different location can decrease distractions and improve concentration in the workplace.
Appetite changes are common with cancer and cancer treatment. Individuals with poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel full after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of muscle mass and strength.

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.

Good ways to deal with loss of appetite:
  • Eat five to six small meals a day and snack whenever you are hungry.
  • Determine what times of day you are hungry, make sure to eat at those times, and do not limit how much you eat.
  • Eat nutritious snacks that are high in calories and protein (for example, dried fruits, nuts, yogurt, cheeses, eggs, milkshakes, ice cream, cereal, pudding, and granola bars).
  • Keep favorite foods on hand for snacking.
  • Take a multivitamin daily.
  • Add calories and protein to foods by adding sauces, gravy, butter, cheese, peanut butter, cream, and nuts.
  • Drink fluids between meals rather than with meals. Drinking during a meal can make you feel full too quickly.
  • Choose nutritious drinks, such as milk, milkshakes, and juices.
  • Ask family members or friends to prepare foods when you are too tired to cook. Ask them to shop for groceries or buy precooked meals.
  • Try to eat in pleasant surroundings and eat meals with family or friends.
  • Eat food that is cold or at room temperature to decrease its odor and reduce its taste.
  • Ask your doctor about ways to relieve other gastrointestinal symptoms, such as nausea, vomiting, and constipation.
  • If your sense of taste is diminished, try adding spices and condiments to foods to make them more appealing.
  • Try light exercise, such as a 20-minute walk, about an hour before meals to stimulate your appetite. (Consult your doctor before starting an exercise program.) Exercise also helps maintain muscle mass.
Constipation is a very common problem during chemotherapy. Pain medications, chemotherapy drugs, erratic diets, pain, and emotional state may all contribute. Management of this problem is simple but usually requires continuous rather than intermittent treatment. Below is a standard prescription that works well for most people to result in a regular bowel movement (BM).

Other causes include:
  1. Stool Softener (Senokot, Colace, Docusate Sodium,) – Start by taking two pills daily, every day, then adjust your dose gradually up or down until you have a good BM every 1-2 days. If bowels get loose, stop taking pills until bowels firm up, then start again at a lower dose.
  2. Milk of Magnesia (MOM) or Haley’s MO – Take two tablespoons twice daily if you didn’t have a good BM the day before. Some people will need this frequently, others rarely or never.
  3. Dulcolax tablets or suppository – This may be tried once or twice if there are no results from Step 1 and Step 2. These should be used sparingly.
  4. Lactulose, , Magnesium Citrate, Fleet’s Enema – these should only be taken on Doctor’s Orders.

*Of course, eating a diet rich in fresh fruits, vegetables, fiber-containing cereals, and getting daily exercise often will result in regular bowel function.

The following treatment plan is primarily for diarrhea caused by chemotherapy. Please talk with your doctor about treatment for other causes.

  • 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

Oral Care:
Good oral care is important during cancer treatment. Some chemotherapy drugs can cause sores in the mouth and throat, as well as dryness, irritation or bleeding. Mouth sores can become infected, so it’s important to practice good oral hygiene and to tell your care team about any symptoms.

To keep your mouth, gums and throat healthy during cancer treatment:

  • See your dentist before starting chemotherapy to have your teeth cleaned and to address problems such as cavities, abscesses, gum disease or poorly fitting dentures
  • Brush your teeth and gums after every meal with a soft toothbrush and a gentle touch
  • Rinse your toothbrush well after each use and store it in a dry place
  • Rinse your mouth with mouthwash after every meal, you should not use commercial mouth wash if you develop mouth sores
Keeping Nausea Under Control
How and why do nausea and vomiting occur?

Nausea and vomiting are reactions to stress or to foreign substances in the body. The part of the brain that controls this reaction is known as the chemoreceptor trigger zone (CTZ). Chemicals released during treatment can stimulate the CTZ and cause nausea and/or vomiting. Unfortunately, certain chemotherapy drugs can cause nausea and vomiting. Luckily, there are many drugs that your doctor can prescribe to prevent, lessen, or relieve the nausea and vomiting associated with chemotherapy.
These medications are called anti-nausea drugs or anti-emetics. These are a group of medications that can be used to control nausea and vomiting and can be given in different ways. For example, if you are unable to keep anything down, don’t worry because the drugs can be given through an I.V. catheter, a patch, rectally, under the tongue, or even in a shot if you cannot swallow. Also, there are several things that patients with these symptoms can do to help themselves feel better besides medications.
Things you can do to guard against chemotherapy nausea:
Fluids:

  • Drink fluids throughout the day like water and juices. Many persons on chemotherapy need to drink at least two quarts of fluids per day. Also, if you are vomiting it is important to replace the fluids lost to avoid getting dehydrated.
  • Avoid drinking liquids at meals.

Eating habits:

  • Eat small amounts of food throughout the day.
  • Eat before you get too hungry.
  • Eat dry foods such as dry cereal, toast , or crackers without liquids especially first thing in the morning.
  • Avoid heavy, high fat and greasy meals right before chemotherapy.
  • Do not eat your favorite foods during this time. They will no longer be favorite foods if you begin to associate them with nausea and vomiting episodes.

Surroundings:

  • Avoid strong odors.
  • Don’t lay flat for at least two hours after eating. Rest by sitting up or reclining with your head elevated.
  • Fresh air and loose clothing may be helpful after eating.
  • Exercising after eating may slow down digestion and increase discomfort.

Distraction:

  • Relax and try to keep your mind off the chemotherapy. Bring soothing music, relaxation tapes, or CD’s, with you to chemo. Perhaps you would like to bring a funny movie to watch during chemotherapy and/or a friend or family member to keep you company.

Other ways to minimize chemotherapy nausea:

  • If you are vomiting, stop eating. Once you stop vomiting, start back on food slowly. Start with small amounts of clear liquids, such as broth, juice soda, sports drinks, or water. Then, advance to light, mild foods like jello, bananas, rice, or toast. Soon, you will be back to solid foods.
  • Avoid caffeine and smoking.
  • Suck on hard candy, popsicles, or ice during chemotherapy.
  • Take the medications for nausea and vomiting as prescribed by your doctor. If you are running low, ask for a refill.
  • Notify your nurse or doctor if you feel nauseated during chemotherapy.

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.

Cancer treatment usually involves taking a lot of medications. In addition to drugs directly related to treatment, cancer patients may also be taking medications for pain, nausea, low blood counts and other treatment- or cancer-related symptoms. Some patients may have to take up to 20 pills a day, and keeping track of medications can be a challenge. With some organization, you can make sure you’re taking the right medication at the right time, and avoid dosing errors.

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.
There are a variety of ways to help you remember when to take your medications. Choose the system that works best for you.

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.

Most cancer patients who undergo chemotherapy will experience hair loss, which can significantly alter their appearance. Chemotherapy drugs target rapidly-growing cells in the body, but cannot distinguish between cancer cells and other fast-growing cells like hair follicles. Hair loss can occur all over the body: head, face, limbs, underarms and pubic area.

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.

Loss of bone mass is common as people age. Cells that help rebuild bone don’t get replaced at the same rate, resulting in bones that become thin and porous (full of tiny holes). This condition, called osteoporosis can result in fractures.

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.

Certain chemotherapy treatments can cause damage to the peripheral nervous system, which include all nerves outside the brain and spinal cord. The condition is called peripheral neuropathy, which commonly causes tingling, burning, weakness or numbness in the hands and/or feet.

Other symptoms of peripheral neuropathy include:
  • Loss of balance
  • Clumsiness
  • Difficulty picking up objects and buttoning clothing
  • Walking problems
  • Jaw pain
  • Hearing loss
  • Stomach pain
  • Constipation

If you have one or more of these symptoms, report them to your doctor immediately. Medications may be able to reverse peripheral neuropathy, and physical therapy can help you maintain normal function.