1. Nausea and vomiting: Nausea and vomiting are two of the most common and most frightening side effects of chemotherapy. The frequency and severity of occurrence varies from drug to drug and person to person.
Nausea and vomiting usually occur a few hours after chemotherapy and do not last long. Severe nausea and vomiting that lasts for several days is uncommon. Patients with abnormal nausea, vomiting for more than a day, or when they are so nauseous that they cannot even swallow liquids, must inform their doctors or nurses. Ma Xuezhen, Department of Oncology, Qingdao Central Hospital Liu Aihui, Department of Mammary Gland, Beijing Maternity Hospital
Changing the diet and taking antiemetic drugs can reduce both symptoms. Different antiemetics work for different people, so it is inevitable to try several drugs before your symptoms are reduced. Don’t give up easily, and you should continue to work with your doctor to find out what works best for you.
About half of all chemotherapy patients feel emotionally unstable before chemotherapy, which is called pre-treatment nausea. The best way to deal with pre-treatment nausea is with the help of relaxation techniques. (We’ll discuss this later).
You can also try the following.
1)・Don’t eat too much so your stomach doesn’t feel too full. Eat more meals and less throughout the day.
2)・Don’t drink with your meal, it must be an hour before or after your meal.
3)・Eat and drink slowly.
4)・Don’t eat sweet, fried or fatty foods.
5)・Eat food that is cold or at room temperature so you don’t smell unpleasant.
6)・Chew food slowly to help digestion.
7)・If you feel nauseous in the morning, eat dry foods such as cereal, toast or crackers before you get up. (If you have a sore mouth and throat or dry mouth, do not eat these things.)
8)・Drink cold, clean beverages such as apple juice, tea or deflated ginger ale.
9)・Suck on ice cubes, mints or sour candies. (If you have a sore mouth and throat, do not eat these things.)
10)・Avoid contact with odors that make you sick, such as oil smoke, cigarettes and perfume.
11)・Sit in a chair after a meal, but do not lie down until at least two hours after the meal.
12)・Wear loose fitting clothes.
13)・When you feel nauseous, you can breathe slowly and deeply.
14)・You can distract yourself by talking with friends or family, listening to music, watching movies or TV.
15)・Use ways to relax.
・If you often feel nauseous during chemotherapy, then do not eat at least a few hours before chemotherapy.
2. Hair loss: Hair loss (alopecia areata) can ruin a person’s mood. Not all chemotherapy drugs cause hair loss, and some people’s hair becomes just a little thinner. Your doctor will tell you if your hair loss is caused by chemotherapy. Most hair loss caused by chemotherapy will grow back after the chemotherapy is over. However, the color or texture of the hair may be different. Hair loss occurs in all parts of the body, not just on the head. Facial hair, hair on the arms and thighs, armpit hair and pubic hair can all be affected, but they usually do not fall out immediately. Generally, the hair begins to fall out after a period of chemotherapy. At that time, the hair falls out gradually or in clumps, and the remaining hair becomes dry and lusterless.
Your hair and scalp need special care during chemotherapy, try the following suggestions.
. Use a mild shampoo.
. Use a soft comb.
. If you must use a blow dryer, use a low and steady setting.
. Don’t use curls for your hair.
. Do not dye or style your hair.
… Cut your hair short. Short hair makes your hair look thicker and easier to handle even if you lose hair.
. Use sunscreen, wear a hat, scarf or wig to protect your hair from the sun.
. Use a satin pillowcase.
If you are going to wear a wig, here are some tips: .
. Shop for wigs before you lose a lot of hair, so you can choose according to the color, texture and style of your original hair.
. You can go to a wig store that specializes in wigs for cancer patients.
3. Fatigue: Fatigue is one of the most common side effects of chemotherapy, ranging from mental exhaustion to exhaustion. Fatigue is most severe at the beginning and end of chemotherapy. Like most other side effects, fatigue will be eliminated once chemotherapy is over.
During chemotherapy, the following suggestions can help you cope with fatigue.
* Get plenty of rest.
*Work out an exercise program with your doctor.
*Eat a balanced diet and drink plenty of fluids.
*Limit your activity level: do only those things that are important to you.
*Don’t be shy about asking for help when you need it. You can ask family, friends and neighbors to help with things such as child care, shopping, housework or driving.
*When your neighbors are shopping in a department store, ask them to stop by and pick up a few things.
*After sitting or lying down for a long time, get up slowly to avoid dizziness.
4. Anemia, infection and bleeding: The bone marrow produces three important blood components: red blood cells that deliver oxygen to the body’s cells; white blood cells that fight infection; and platelets that help blood clot and stop bleeding. Chemotherapy destroys bone marrow cells, which reduces the number of blood cells produced. The decrease in the number of each type of blood cell can cause specific side effects. Doctors will check the patient’s blood cell count during chemotherapy and give the patient growth factors to help the bone marrow produce new blood cells.
(1) Anemia: When there are too few red blood cells, the body’s tissues do not get enough oxygen to work properly. This phenomenon is called anemia, and the symptoms are fatigue, dizziness, pallor, chills, and even shortness of breath. Use the methods described in the previous section “How to deal with fatigue” to address the symptoms of anemia. It is also important to tell your doctor about your symptoms. Doctors will always check the patient’s red blood cell count during treatment. If your red blood cell count drops very low, you will need a blood transfusion or growth hormone to promote the growth of red blood cells.
(2) Infections: A very low white blood cell count is called leukopenia, which reduces your ability to fight infections. A type of neutrophilic white blood cell is especially important for fighting infections. A deficiency of neutrophilic white blood cells is called neutropenia. Infections can occur anywhere in the body, but usually in the mouth, skin, lungs, urinary tract, rectum, and reproductive organs. If your white blood cell count drops a lot, your doctor may delay treatment, lower the dose of chemotherapy drugs or use growth factors to increase the number of white blood cells produced by your bone marrow.
Take the following steps to prevent infection.
*・Wash your hands regularly, especially before meals and before and after using the restroom.
*・Remain away from people with infectious diseases such as colds, flu, measles or chicken pox.
*Avoid going to crowded places.
*Remain away from children who have just been immunized against polio, measles, mumps, and rubella.
*Clean the rectal area completely after each bowel movement. If you get a fire or have hemorrhoids, see your doctor before using enemas or suppositories.
*Do not tear the skin of the nail.
*When using scissors, needles or knives, be careful not to cut yourself.
*Use an electric razor, not a razor, so as not to cut your skin.
*Use a soft toothbrush to avoid damaging your gums.
*Do not squeeze or scratch the bumps.
*Take a warm bath once a day (not too hot). Dry the skin gently, not very hard.
*If the skin is dry and cracked, use lotion or oil.
*Clean wounds with warm water, soap and antiseptic.
*When bathing animals or children, wear gloves.
*Do not give immunizations until your doctor confirms it.
When your white blood cell count is low, your body is not immune to infection, even if you are very careful. Be very aware of the signs and symptoms of a possible infection and check your body regularly, paying special attention to your eyes, nose, mouth, genital and rectal areas. Symptoms of infection include.
*Fever of 38°C or higher
*Chills
*Sweating
*Loose bowel
*Burning sensation when urinating
*Severe cough or sore throat
*Unusual vaginal discharge or itching of the vagina
*Redness, swelling, or sensitivity around wounds, sore spots, bumps, venous catheters, or arterial access junctions
*Abdominal pain
Tell your doctor immediately about all signs of infection. Do not use aspirin, antipyretics or other medicines to reduce your fever, even if you have a fever, without your doctor’s permission.
(3) Bleeding or clotting problems: Chemotherapy drugs can affect the bone marrow’s ability to produce platelets (platelets help stop bleeding by filling up damaged blood vessels and helping blood to clot). If you don’t have enough platelets in your blood, you will bleed or bruise more easily than usual, even with a small injury. You should tell your doctor if you notice small red spots of bruising on your skin, light red urine, or dark, bloody stools. You should also tell your doctor about bleeding from your gums and nose, severe headaches, dizziness, increased weakness, or joint and muscle pain. Your doctor will check your platelet count often during your treatment, and if it is too low, you will need to have platelets put in.
To avoid problems if your platelet count is very low, follow these suggestions.
* Do not take any medications without your doctor’s permission. This includes aspirin and other over-the-counter anti-inflammatory painkillers. This is because some of these drugs can destroy platelets and worsen bleeding problems.
*Do not drink any alcoholic beverages without your doctor’s permission.
*Use an extra soft toothbrush to clean your teeth.
*Use soft cotton paper to gently clean your nostrils.
*Be careful not to cut yourself when using scissors, needles, knives, or other tools.
*Be careful not to burn yourself when ironing clothes or cooking. Wear insulated gloves when reaching into the oven.
*Don’t engage in sports and other activities that make you vulnerable to injury.
*Use an electric razor instead of a razor.
5. Oral cavity: Good oral care is important during cancer treatment. Chemotherapy drugs can cause pain in the mouth and throat, dryness and fire or bleeding. Oral pain is not only very painful, but can be caused by bacteria in the mouth. Infections can be difficult to deal with during chemotherapy and can cause serious problems. Therefore, it becomes important to take all measures to prevent them. Here are some suggestions for keeping your mouth, gums and throat healthy.
*Visit your dentist before chemotherapy to get your teeth cleaned and to address cavities, hazel swelling, gum problems and poorly fitting dentures.
* Ask your doctor for guidance on the best way to brush your teeth during chemotherapy.
*Find a daily fluoride toothpaste to prevent tooth decay, as chemotherapy can easily make cavities in your teeth.
*Gently brush your teeth and gums with an extra soft toothbrush after each meal. A toothbrush that is too hard can damage the soft oral tissues.
*If your gums are very sensitive, ask your doctor to recommend a special toothbrush (fleece or ribbon) and toothpaste.
*Rinse your toothbrush carefully after each brushing and place it in a dry place.
*Avoid commercially available mouthwashes, as many of them contain large amounts of salt and alcohol. It is best to ask your doctor to recommend a mild mouthwash or a mouthwash with antibiotics added for preventing oral infections.
If the pain in your mouth worsens (stomatitis), you may need to see your doctor for treatment. If the pain is preventing you from eating, you can try the following.
* Ask your doctor for a solution to the pain and ask them to prescribe medicine to relieve the pain.
*Eat cold foods. Hot foods can irritate your mouth and throat.
*Use soft, refreshing foods such as ice cream, baby food, soft fruits (bananas and applesauce), mashed potatoes, cereal, hard-boiled or scrambled eggs that are five-cooked, cheese, macaroni and cheese, cream cakes, puddings and jellies. You can also add cooked foods to soups and blend them in a blender to make them smooth and easy to eat.
* Avoid harsh, acidic foods such as tomatoes, citrus fruits and fruit juices (tangerines, grapefruit and lemons); spicy or too salty foods; and rough or dry foods such as raw vegetables and toasted bread.
If dry mouth makes it difficult for you to eat, try the following.
* Ask your doctor if you can use artificial saliva products to moisten your mouth.
*Drink more water.
*Suck on ice cubes, popsicles or sugar-free candy.
*Bite sugar-free gum.
*Moisten dry foods with butter, margarine, gravy, condiments, or broth.
*Soak crisp, dry foods in water.
*Eat soft soup-cooked foods.
*Lips are too dry, use lip balm.
6. Diarrhea: When chemotherapy affects the superficial cells in the intestine, it may lead to diarrhea. If diarrhea lasts more than 24 hours or is accompanied by pain and cramps, it is time to see your doctor. In severe cases, your doctor will prescribe anti-diarrheal medication. However, do not take over-the-counter medications without your doctor’s permission.
You can also try the following to control diarrhea.
* Eating fewer and more frequent meals.
* Not eating foods with lots of fiber that tend to cause diarrhea and abdominal pain. Fiber-rich foods include pumpernickel bread and cereal, vegetables, beans, dried fruits, squash, popcorn, and fresh and dried fruits. Conversely, eat foods that contain less fiber, such as refined bread, refined rice, pasta, creamed cereal, peeled canned fruit, yogurt, eggs, peeled mashed or sliced potatoes, vegetable soups, and skinless chicken and fish.
*Avoid coffee, tea, alcohol and sweets.
*Avoid fried, greasy and spicy foods.
*Do not consume milk and milk products if they make your diarrhea worse.
*Eat more potassium-rich foods, such as bananas, oranges, potatoes, peaches and almonds, unless your doctor objects.
* Drink plenty of drinks to replace the water lost from diarrhea. It is best to drink milk, apple juice, water, light tea, broth and ginger beer. Chill them to room temperature and drink them slowly. When drinking soda, deflate it first.
If diarrhea is severe (seven or eight times in a day), see your doctor immediately. Ask your doctor for advice on whether to eat liquid food to give your stomach and intestines a rest. When you feel better, gradually eat foods with low fiber as listed above. Do not eat liquid foods for more than three or four days, as they are not nutritious enough to meet your needs. If the diarrhea does not improve, you will need fluids to replace the lost water and nutrients.
7. Constipation: Some people become constipated because of chemotherapy; others become constipated because they are less active or less nutritious than usual, or they are taking some kind of pain medication. If you haven’t relieved your large hands for more than two days, inform your doctor. You may need to use laxatives or enemas. Do not use these options without talking to your doctor, especially if your white blood cell count or platelet count is very low.
You can try the following for constipation.
* Drink more water to loosen the bowel. Warm and hot water is especially effective.
*Eat more foods that contain a lot of fiber. These foods are brown rice, cereal, vegetables, fresh or dried fruit, dried fruit, and popcorn.
*Do exercise. Going for walks and doing exercises can help with constipation. Remember to talk to your doctor before increasing your activity level.
8. Nerves and muscles: Some chemotherapy drugs can produce peripheral neuropathy, a condition that causes tingling and burning sensations and numbness and weakness in the hands and feet. Other nerve-related symptoms include loss of balance, clumsiness, difficulty holding and buttoning clothes, difficulty walking, jaw pain, hearing loss, stomach pain and constipation. In addition to affecting the nerves, certain chemotherapy drugs can also affect the muscles, causing weakness and pain. Nerve and muscle function can be hindered, but in most cases it is not serious. They are usually short-lived and get better with time. It is necessary for the patient to stop chemotherapy temporarily and tell the doctor about the nerve and muscle symptoms right away, making sure to tell the doctor about the pain caused by peripheral neuralgia. Caution and common sense can help you with nerve and muscle problems. For example, if you have numbness in your fingers, be very careful when using sharp, hot or otherwise dangerous objects. If your balance is impaired, walk carefully and use handrails on stairs and mats in the bathroom.