Explanation of the Side Effects of Chemotherapy and Methods of Managing Them: Anemia

SIDE EFFECTS OF CHEMOTHERAPY
AND METHODS OF MANAGING THEM

ANEMIA - INFECTION

Music to accompany this page:
Strong Enough, by Cher

	Anemia			Constipation
	Appetite (Bloating)			Diarrhea
	Appetite (Decreased)			Fever
	Bleeding			Flulike Syndrome
	Blood in Urine			Hair (Increased)
	Blood Pressure (Decreased)			Hair (Thinning or Loss)
	Blood Pressure (Elevated)			Headache
	Bone Weakening			Heart Damage
	Central Nervous System Damage			Infection

ANEMIA
(Fewer Red Blood Cells)
DESCRIPTION
Anemia is the decreased production of red blood cells. Chemotherapy destroys the cancerous cells and the normal cells of your body, including the normal red cells. The red blood cells in your bone marrow divide at a rapid rate and are destroyed, which may lead to your developing anemia. If you are anemic, you may become tired more quickly than before. You may be dizzy when standing, feel light-headed, become upset easily, feel chilly, or be short of breath.
DURATION
Anemia caused by chemotherapy is temporary. Your body will replenish your red blood cells in time. However, since the life span of red blood cells is 120 days, and you'll receive a number of cycles of chemotherapy in this time period, you may need a blood transfusion. Waiting for your body to replace the red blood cells would take too long. Your chemotherapy will not be given again until your red blood cell count is within a healthy range for you.
SUGGESTIONS

Be sure to take your iron pills if they have been prescribed.

Change position slowly if you experience dizziness. When you first wake up, sit on the side of the bed for a minute before standing to help decrease the dizziness.

Eat green leafy vegetables, liver, and cooked red meats.

Prioritize your activities so you will have enough energy for important activities.

Rest as much as necessary to save your energy.

CONSULT A PHYSICIAN OR NURSE IF:

You are experiencing dizziness.

You become noticeably more tired.

APPETITE
Bloating
DESCRIPTION
Bloating is an overfull feeling that occurs after eating, often after having just a few bites of food. Bloating is due to the inability of the stomach and intestines to properly digest the food you eat. It may be related to the type of food you eat. Fatty, fried, and greasy foods tend to remain in the stomach longer and may cause you to feel full. Carbonated beverages, gas-producing foods, and milk may also cause bloating.
SUGGESTIONS

Avoid fatty, fried, and greasy foods, gas-forming vegetables (such as beans, broccoli, brussels sprouts, cabbage, cauliflower, corn, cucumbers, green peppers, onions, rutabagas, sauerkraut and turnips), carbonated beverages, chewing gum, and milk.

Eat frequent small meals instead of three large meals a day, and increase sweet or starchy foods and low-fat protein foods.

Eat slowly.

Sit up or walk after meals.

APPETITE
Decreased(Anorexia)
DESCRIPTION
The cancerous cells and some normal cells of your body that multiply quickly will be destroyed by chemotherapy. The normal cells that line your mouth, stomach, and intestines may be altered or destroyed by chemotherapy. Therefore, food and liquids may taste different to you. You may lose all desire to eat, but it is important that you continue to eat.
DURATION
Your decreased appetite is usually temporary and is relieved when you are no longer receiving a high amount or high frequency of your chemotherapy drug. However, it may take 2 to 6 weeks after the discontinuation or decrease of your therapy drug for your appetite to return to normal.
SUGGESTIONS

Add nutritive value to your beverages by using light cream for all or part of milk. Add 1 to 2 small dips of ice cream to milk beverages. Add 1 to 3 tablespoons of nonfat powder milk to each glass of milk.

Add raisins, nuts, or dates to muffins, rolls, and cereal. Add grated cheese to biscuits.

Chop and serve with gravy or broth any meat or dry food that might be difficult to swallow. Try salad dressings or mayonnaise on vegetables or meat to increase the ease of swallowing.

Clean your mouth after each meal.

Dilute condensed cream soups with 1 cup of milk, instead of water, and add extra nonfat dry milk or undiluted evaporated milk.

Drink acidic beverages such as lemonade; they may increase your appetite.

Eat a high-calorie diet (such as cream, butter, margarine, sugar, syrup or jelly) if you are not overweight. You may find the same ingredients perk up you appetite, but you need more of them. For example, if you normally use one teaspoon of sugar on breakfast cereal, now try three or four teaspoons. Increase your use of spices and seasonings.

Eat high protein foods, for example, milk, eggs, cheese, peanut butter, and nuts. Meat products may taste bitter. Plastic rather than metal utensils may reduce the bitter taste. If you need more salt to make meat more tasty, and you are not on a salt-restricted diet, you may be able to enjoy cured meats such as ham, bacon, sausage, and corned beef, or you may want to try marinating meats in soy sauce. Meats can even be marinated in sweet fruit juices or sweet wines and cooked with fruit over them to improve their taste.

Eat small, frequent snacks (six per day) that include foods you best tolerate, even if you are not hungry.

Eat when you are hungry even if it is not your regular mealtime.

Half an hour before your meals, exercise for 10 to 15 minutes.

Have someone else prepare your meals if odors bother you.

Keep easy-to-prepare snacks on hand, such as peanut butter, cheese and crackers.

Limit your fluids with food. Leave room for the solid food.

Look for recipes that seem appealing.

Perform progressive muscles relaxation or another stress reduction technique before meals. These techniques may assist in reducing tension before eating.

Plan your daily menu in advance so that you will have many portions of food ready to serve when you do not feel like cooking.

Put nonfat dry milk and pasteurized liquid eggs or egg substitutes in your cooking and baking. These ingredients are an excellent source of nutrition.

Seeing food can decrease your appetite. Whenever possible, keep food out of sight except when eating. For example, use non-see-through containers, keep food in cupboards, not on the counter.

Serve foods attractively. Socializing increases your appetite, so eat with someone whenever possible.

Take advantage of the many convenience food available, such as frozen dinners.

Take supplemental vitamins if they have been prescribed.

Try to eat one third of your daily protein and calorie requirement at breakfast if you can tolerate breakfast relatively well.

Use high-protein, high-calorie sandwich fillings. This may include eggs, chicken, turkey or tuna salad with mayonnaise; grated raw carrot with mayonnaise and nuts; peanut butter with bananas, bacon, or jelly; cream cheese with nuts, ham, olives or jelly; and cold cuts.

Vary odors and textures of foods from meal to meal to increase your appetite.

CONSULT A PHYSICIAN OR NURSE IF:

You are losing weight rapidly, for example, five pounds in a week.

You notice a major change in appetite.

BLEEDING
(Thrombocytopenia)
DESCRIPTION
Chemotherapy destroys the cancer cells and the normal cells of your body. It particularly destroys those cells that grow at a fast rate. The platelet cells in your bone marrow divide quickly and may be destroyed by chemotherapy. Platelet cells are necessary for normal clot formation (to help you stop bleeding). When your platelet count is low, you will have a tendency to bleed longer than you normally would. The physician or nurse will tell you if your platelet count is low, in which case you must be careful in your everyday activities so as not to injure yourself.
DURATION
Decreased platelet cell count is temporary. Your bone marrow will replenish your platelet cells usually within two weeks. Your chemotherapy will not be given again until your platelet count is within a healthy range for you.
SUGGESTIONS

Avoid blowing your nose too hard, coughing too harshly, or straining too much with a bowel movement.

Avoid drinking alcoholic beverages, including beer and wine.

Avoid raw and coarse raw vegetables.

Avoid strenuous activity, lifting heavy objects, and bending over from the waist.

Avoid tampon use during menses.

Be careful not to bump or cut yourself. If you bleed, apply pressure over the area for five to ten minutes with a bandage or clean piece of linen. Also apply ice wrapped in a plastic bag over teh area once the initial bleeding has stopped.

Brush your teeth gently with a soft brush. If bleeding occurs when you floss your teeth, stop flossing for a few days, then try gently flossing again. If bleeding occurs, again stop flossing and wait another few days before trying again. Check with your physician before having dental work done.

Do not take any type of injection unless absolutely necessary. Be sure the physician or nurse giving you an injection knows that your platelet count is low.

Do not use aspirin or products that contain aspirin. Check the labels of all drugs you are taking for salicylic acid. If you are not sure about a drug, ask your physician, nurse, or druggist whether you should use the drug while your platelet count is low. Use acetaminophen in place of aspirin.

Drink eight to ten 8-ounce glasses of fluid a day to keep the intestinal lining in good condition and to avoid constipation.

Eat protein-rich foods and beverages.

If you must have blood drawn or be given an intravenous injection, put pressure on the needle site for at least five minutes to control bleeding after the needle is removed.

Take prescribed steroid medications with milk, food, or an antacid such as Maalox.

Tell the person drawing your blood not to use a tourniquet.

Use adequate lubrication and avoid vigorous thrusting during intercourse.

Watch for unexplained bruises (especially on your legs and feet). If an arm or leg is involved, elevate it above the level of the heart.

CONSULT A PHYSICIAN OR NURSE IF:

Bleeding continues after having applied pressure for 10 to 15 minutes.

If you have a major injury or are hemorrhaging spontaneously, go immediately to the nearest hospital emergency room. Be sure to explain your chemotherapy and low platelet count.

You are coughing, vomiting, or you tend to be constipated. Your physician will prescribed drugs for these conditions. A cough syrup is usually prescribed for coughing.

You notice any changes in your vision.

You notice blood in your vomit, stools (which may be red or black and tarry), urine, or sputum.

BLOOD IN URINE
(Hematuria)
DESCRIPTION
Chemotherapy can be very irritating to the bladder. After the drug has been broken down (metabolized) in your body, it is eliminated through the kidneys to the bladder. Higher concentrations of your medicine then collect in the bladder, which is a reservoir for urine until you urinate (void). The drug may irritate the walls of the bladder, causing them to bleed. If this happens, you will pass bloody (pink with clots) urine when you urinate. Other signs and symptoms of irritation include difficulty urinating, higher frequency of urination, and low back pain.
DURATION
Chemotherapy can cause slight to sever bleeding from the bladder. This toxic (damaging) effect - in its severest form - is very rare and usually occurs only after the drug has been given for many years (four to ten years). If bladder bleeding occurs, chemotherapy is discontinued and another drug is prescribed to treat your disease. Once the original drug that caused the bladder to bleed is discontinued, the bleeding usually subsides after several days.
SUGGESTIONS

Drink at least two quarts of fluid a day to flush your bladder.

Empty your bladder as soon as you feel the urge to urinate and also before going to bed at night.

CONSULT A PHYSICIAN OR NURSE IF:

You experience any of the signs or symptoms of bladder irritations: bloody urine, difficulty or burning when urinating, high frequency of urinating, or low back pain.

BLOOD PRESSURE
Decreased (Hypotension)
DESCRIPTION
Chemotherapy may cause your blood pressure to fall (decrease). The symptoms of low blood pressure are dizziness and lightheadedness when changing position or standing.
DURATION
Your lowered blood pressure may be a problem as long as you are receiving chemotherapy. If the amount or frequency of the drug is reduced, your blood pressure will increase. When the chemotherapy regimen is completed, your blood pressure should return to the range normal for you before you took the drug.
SUGGESTIONS

If dizziness or lightheadedness occurs, sit or lie down. These sensations will pass.

Take your time when changing your position, for example, from lying to sitting, or from sitting to standing.

CONSULT A PHYSICIAN OR NURSE IF:

You experience dizziness or lightheadedness.

BLOOD PRESSURE
Elevated (Hypertension)
DESCRIPTION
Chemotherapy may cause your blood pressure to rise (be elevated). The symptoms of high blood pressure are headaches, nosebleeds, or vision problems.
DURATION
Your elevated blood pressure may be a problem as long as you are receiving chemotherapy. If the amount or frequency of the drug is reduced, your blood pressure may decrease. When the chemotherapy regimen is completed, your blood pressure should return to the range normal for you before you took the drug.
SUGGESTIONS

Take regularly the medicine prescribed to control your blood pressure. Even though you may feel good, you still need to take your blood pressure pill.

Use measures you have found in the past that help you to relax. They may be useful in lowering your blood pressure. For example, take naps and do mild exercise, deep rhythmic breathing, yoga, or meditation.

CONSULT A PHYSICIAN OR NURSE IF:

You experience headaches, nosebleeds, or vision problems.

BONE WEAKENING
(Osteoporosis)
DESCRIPTION
After you have taken your chemotherapy drug for a time (up to a year), your bones may become brittle and fragile. he medicine has reduced the amount of calcium in your bones that is needed for bone strength.
DURATION
If you show signs of weakening of the bones, your chemotherapy may be decreased in amount or discontinued. It will take several months to years to reestablish the strength of the bones.
SUGGESTIONS

Avoid heavy lifting.

Avoid sudden movement (twisting, jerking).

Do not abruptly stop taking your medicine.

Prevent falls by making your environment safe, such as removing scatter rugs, installing handrails, and providing adequate lighting.

Take a shower rather than a tub bath. Install a handrail beside the toilet bowl.

Take calcium carbonate ( 1,500 mg to 2,000 mg) every morning.

Walk with support if necessary.

CONSULT A PHYSICIAN OR NURSE IF:

You had a fall.

You have pain in a bone without having fallen or otherwise injured yourself.

CENTRAL NERVOUS SYSTEM DAMAGE
(CNS Toxicity)
DESCRIPTION
Chemotherapy interferes with certain functions of your central nervous system (brain). The symptoms that may occur include tiredness, somnolence (urge to sleep), mental confusion, and depression.
DURATION
The symptoms of CNS toxicity are reversible once your chemotherapy drug is lowered in dosage or discontinued. Another drug may be prescribed as a replacement.
SUGGESTIONS

Tell a family member or neighbor if you are experiencing confusion and have him phone the physician's office and report this symptom. (With CNS toxicity a nap will not decrease the tiredness or somnolence nor will past self-care measures relieve the depression.)

CONSULT A PHYSICIAN OR NURSE IF:

You develop any of the symptoms, especially mental confusion and depression.

CONSTIPATION
DESCRIPTION
Chemotherapy may diminish the nerve impulses to your intestines. These impulses are needed to move the food you eat through your intestines. Once the food you have eaten has been broken down by digestion, the waste material (stool) may not move through the intestines as well as it did before your chemotherapy.
DURATION
Constipation caused by chemotherapy is temporary and is relieved when you have completed the therapy. Within a week after the drug has been discontinued, your normal bowel habits should return.
SUGGESTIONS

Avoid cheese products and refined grain products.

Drink plenty of fluids, eight to ten glasses a day.

Eat high-fiber foods that include whole-grain cereal, bran, raw fruits, dates, prunes, vegetables, nuts, dried fruits, and raisins. Add bran to your diet, starting with two teaspoons per day. Increase this amount gradually to four to six teaspoons; too rapid an increase can cause diarrhea. If you have trouble chewing raw fruits and vegetables, try grating them.

Eat fruits like oranges, peaches, pears, and prunes.

Exercise if you are able to and walk as much as you can. If you are confined to bed, do bed exercise by contracting and relaxing different muscles.

Respond immediately to the urge to defecate.

Take enemas and suppositories if stool softeners and laxatives are not effective.

Take stool softeners and laxatives, if approved by your physician. If you require pain medication - especially narcotics - take bulk-forming laxatives, such as Metamucil. Some laxatives when used continually can irritate the bowel, often making it difficult to regain normal bowel habits once chemotherapy or pain medicines are discontinued. Colace is an example of a stool softener.

CONSULT A PHYSICIAN OR NURSE IF:

You have had no bowel movements for three or more days, for example, if your normal pattern is daily bowel movements and on the fourth day your bowels have not moved; or if your normal pattern is every two to three days an on the sixth day your bowels have not moved.

DIARRHEA
DESCRIPTION
Chemotherapy destroys the cancerous cells and the normal cells of your body, especially those normal cells that are produced at a rapid rate. The cells lining your mouth, stomach, and intestines divide at a rapid rate. As they are destroyed, you may develop diarrhea. The severity of diarrhea varies in individuals. The number of your bowel movements may increase and the stool consistency may range from very soft to liquid.
DURATION
Diarrhea caused by chemotherapy is temporary. The cell lining in your mouth, stomach, and intestines will regenerate. The diarrhea will usually stop if your drug dose is decreased or if the drug is withheld for several days.
SUGGESTIONS

Apply nonprescription ointment that contains lidocaine if your anus is sore. A layer of Desitin or A and D Ointment, for example, applied around the anal area, can soothe irritation. Clean the area with warm water very gently but thoroughly after each bowel movement, and then pat the area dry before applying the soothing lotions.

Avoid drinking beverages while eating food. Avoid things that can cause gas or cramps such as beans, beer, cabbage, chewing gum, highly spiced foods, too may sweets, skipping meals, and swallowing air while talking or chewing. Also avoid greasy foods. Allow carbonated beverages to lose their fizz before drinking them. Avoid caffeinated beverages, such as coffee, tea and sodas.

Avoid food that contains fat.

Avoid food that contains roughage and bulk. Do not eat beans, bran, dried fruits, legumes, nuts, skins and seeds, whole-grain cereals, and raw fruits (such as apples, cherries, dates, figs, and prunes) and vegetables (such as brussels sprouts, cabbage, celery and lettuce).

Avoid tobacco products.

Drink plenty of fluid (eight to ten glasses daily) that is at room temperature. Drinking more fluid will not cause more diarrhea, as some people may think. You need the extra fluid to replace what you have lost. Avoid hot or cold fluids since they will increase intestinal contractions.

Eat foods high in calories and protein, such as fish, poultry, and ground beef that is baked, broiled, or roasted until tender.

Eat foods high in potassium, such as asparagus, apricots without the skin, baked potatoes without the skin, bananas, broccoli, halibut, mushrooms, and saltwater fish. Drink peach nectar or nonfat milk.

Keep the anal area clean by washing with mild soap and water or take sitz baths. A and D Ointment may provide soothing relief and promote healing of the irritated area.

Keep track of the number of bowel movements you have in a day to assess possible dehydration. The signs and symptoms of dehydration are dryness of skin and mouth, decreased urine volume, and sunken eyes.

Take a liquid diet if the diarrhea becomes severe. Mild liquids such as fruit ades,ginger ale, and peach or apricot nectar are usually tolerated well.

Take nonprescription medicine, such as Kaopectate or Pepto-Bismol, to control the diarrhea.

The severity of the diarrhea may be decreased if you drink boiled milk and eat applesauce, bananas, cottage cheese, low-fat cheese, rice, yogurt, or nutmeg in capsules on on applesauce. Nutmeg decreases the mobility of your gastrointestinal tract. However, strong spices and herbs stimulate the tract and are to be avoided. When the diarrhea diminishes, gradually add your regular diet to these foods. If you cannot tolerate milk, do not drink it.

CONSULT A PHYSICIAN OR NURSE IF:

Your diarrhea becomes severe (more than five liquid stools in a day) and the nonprescription drugs are not effective.

FEVER
DESCRIPTION
Fever, often accompanied by chills, can be caused by chemotherapy and is a reaction of your body to the drugs. Usually several hours after you have taken the chemotherapy drug, your temperature will begin to rise. On the days you are not receiving the chemotherapy, you should not have a fever. it is important that you are aware of this pattern, because you could have a fever from an infection on days when you are not receiving chemotherapy or while you are on chemotherapy.
DURATION
Fever caused by a chemotherapy drug will continue as long as you are taking the medicine. With time, the fever will be less high even if you are still on chemotherapy.
SUGGESTIONS

Check your temperature every 4 hours while you are awake.

Drink plenty of fluids, about 2 to 3 quarts a day of ice tea, fruit ades, fruit juices, water; eat ice cream, Jello and watermelon.

Take an aspirin substitute(such as Tylenol) to help you feel more comfortable. Check bottle for the ingredient acetaminophen. In chemotherapy, aspirin is generally not given to lower your temperature since it could cause bleeding if your blood count is low.

Take tepid (lukewarm) sponge baths to reduce fever and promote comfort.

CONSULT A PHYSICIAN OR NURSE IF:

Your oral temperature goes above 101.5 degrees and taking an aspirin substitute has not reduced the fever.

FLULIKE SYNDROME
DESCRIPTION
Flulike syndrome caused by chemotherapy is a reaction of your body to the drug(s). On the days you are not receiving chemotherapy, you will not experience the flulike syndrome. It is important that you are aware of this pattern, because the flu symptoms from a viral infection that you may have will be present on days you are not receiving chemotherapy. They symptoms of the flulike syndrome include muscle aches, fatigue, nausea, slight fever, and loss of appetite. You will be getting chemotherapy even if you have these symptoms as long as the side effects are not severe.
DURATION
Flulike syndrome caused by chemotherapy usually subsides within one to seven days after chemotherapy is completed.
SUGGESTIONS

Gargle with warm salt water to relieve soreness in your throat.

Rest in bed and drink plenty of fluids (two to three quarts of fluid a day).

Take the medicines you usually take to relieve the symptoms of the flu. Use an aspirin substitute, such as Tylenol. Aspirin is generally not recommended since it could cause bleeding if your blood count is low.

CONSULT A PHYSICIAN OR NURSE IF:

Your symptoms become severe.

Your temperature is above 101.5 degrees.

HAIR
Increased (Hirsutism)
DESCRIPTION
Body and facial hair may increase. It does not mean that anything is wrong.
DURATION
The intensity of this side effect of chemotherapy diminishes as the amount of the drug is decreased. Your hair distribution will return to normal after the medicine is discontinued.
SUGGESTIONS

Tweeze or shave excess hair with electric razor. Do not use electrolysis.

CONSULT A PHYSICIAN OR NURSE IF:

Your symptoms distress you.

HAIR
Thinning or Loss (Alopecia)
DESCRIPTION
Chemotherapy destroys the cancerous and the normal cells of your body, especially those normal cells that are produced at a rapid rate. The hair follicle cells divide at a rapid rate and are therefore destroyed, causing some or all of your hair (scalp, eyebrows, eyelashes, facial and public hair) to fall out.
DURATION
Your hair will start to grow again in three to four months even if you are still receiving chemotherapy. The nature and color of your new growth of hair may be different from your pretreatment hair. If you had curly hair, you may regrow straight hair. If you had thick hair, you may regrow fine hair.
SUGGESTIONS

Avoid bleaching, teasing, curlers, permanents, and hair spray; these make the hair brittle, causing it to fall out faster during chemotherapy.

Buy wigs, scarves, and false eyelashes if you wish; they are tax-deductible medical expenses and may be covered by your insurance.

Cut hair to shorter length if possible.

Keep your hair clean and wash it gently with a pH-balanced shampoo, such as Redken or Nexxus.

Talk to your physician or nurse about any feelings or questions you have about your altered appearance.

Use a soft-bristle brush to remove tangles.

CONSULT A PHYSICIAN OR NURSE IF:

Your symptoms distress you.

HEADACHE
DESCRIPTION
Chemotherapy may cause you to have headaches. This nervous system symptom occurs because your chemotherapy is slightly irritating to nerve tissue.
DURATION
Your headaches may occur most frequently just after you have received your chemotherapy. When the treatment is completed and the drug is discontinued, this symptom will subside.
SUGGESTIONS

Avoid noise and bright lights if you have a headache.

Lying down for one to two hours after your chemotherapy may help.

Resort to the measure you have found helpful in the past to alleviate a headache.

Take analgesics (pain pills) as you have in the past when you had a headache. Do not take aspirin products if your platelet cell count is low.

CONSULT A PHYSICIAN OR NURSE IF:

Your own measures do not alleviate your headache.

HEART DAMAGE
(Cardiac Toxicity)
DESCRIPTION
Certain chemotherapy drugs can cause changes in normal heart functioning. The drugs are particularly toxic (harmful) to the heart muscle cells. Signs and symptoms of altered heart functioning are any puffiness or swelling in your body, especially your ankles; shortness of breath; dizziness; loss of appetite; and skipped heartbeat or palpitations (fluttering) of the heart.
DURATION
The specific drug will be discontinued if any heart changes occur as a result of the chemotherapy. Another drug will be used to treat your disease.

CONSULT A PHYSICIAN OR NURSE IF:

You develop any of the signs or symptoms of altered heart function.

INFECTION
(Leukopenia)
DESCRIPTION
The cancerous and the normal cells of your body that multiply rapidly will be destroyed more quickly by your chemotherapy. White blood cells in your bone marrow may be destroyed, thus making you more susceptible to infections. Even though your white cell count is low, you may not have an infection. The sighs and symptoms of an infection are sore throat, cough, and nasal congestion; a burning feeling when urinating; shaking chills; burning (pain) at the anus; pain, redness, swelling, and warmth at the site of injury to the skin; and fever. You may have an infection and the injury site may not become red if you are low in a particular kind of white blood cell (neutrophil). Eye or ear drainage may be a sign of infection.
DURATION
Low white blood cell production is a temporary side effect of chemotherapy. Your body will replenish white blood cells to a healthy count usually within four to ten days of treatment. You will not receive chemotherapy while your white blood count is low, but only when your white cell count is within a healthy range for you.
SUGGESTIONS

Always wear shoes to prevent cuts on your feet.

Avoid getting sunburned. Wear sunscreen and avoid the sun whenever possible.

Avoid rectal temperature taking and use of rectal suppositories.

Do not take vaccinations unless they have been approved by your physician. Avoid contact with people who have an infection or have recently been vaccinated against mumps, measles, polio, or small pox (such as infants and children).

If you do cut yourself, wash the cut promptly with soap and water and bandage it if necessary.

If you have an infection, drink two to three quarts of fluids a day. If you have heart of kidney condition, consult the physician or nurse.

Perform excellent hygiene daily. Wash your hands before eating and after using the bathroom. After each bowel movement, clean the rectal area gently but thoroughly.

Practice deep breathing two to three times an hour, when awake.

Protect your hands from cuts and burns. You can wear gloves when working in the garden, wear rubber gloves when doing dishes, and use a protective pot holder or glove when cooking.

Stay away from people with colds when your white cell count is low. Stay away from crowds. Avoid going to church, shopping, movies at busy times, and so on. Your physician will tell you if these precautions are necessary.

Take rest periods during the day if you become tired.

Take your temperature every four hours while awake if you have signs of an infection.

Use a cuticle cream remover rather than picking or cutting nail cuticles.

Use a deodorant rather than an antiperspirant, which blocks sweat glands and may promote infection.

Use an electric razor to avoid breaks in skin.

Use antiseptic mouthwashes (that contain no alcohol) daily, and have any dental problems taken care of before you begin chemotherapy to prevent possible infection.

Women should use sanitary napkins rather than tampons to reduce risk of infection.

CONSULT A PHYSICIAN OR NURSE IF:

You experience any of the signs or symptoms of an infection.

Your oral temperature goes above 101.5 degrees or you experience shaking chills.

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