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January 24, 2000

Dealing With ILL Effects of Chemotherapy
Sue Nowlin, RN

Dealing With ILL Effects of Chemotherapy
Nausea and Vomiting
Sore Mouth

What to Report to Doctor or Nurse
The Problem of Fatigue

Meal Preparation
General Exercise Tips and Suggestions for Energy Conservation
General Tips

When I was young I would run to the shore in search of the perfect shell. Now I walk my beaches in gratitude for each precious fragment. I have learned to value survivors.
Dr. Vali Mitchell

Dealing With ILL Effects of Chemotherapy
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Chemotherapy drugs can have a variety of ill effects to the body. Some of these effects (such as vomiting) are short term, while others (such as hair loss) are long term. Some effects (such as nerve damage) can be permanent. Being aware of ill effects can help prevent serious problems.

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Because immunity is affected by chemotherapy, infections can occur and be serious.
Avoid crowds' especially large ones with young people
Avoid contact with people with contagious diseases such as flu or chicken pox
Wash your hands frequently, before eating and after using the bathroom
Prevent breaks in skin, do not squeeze or scratch pimples
Do not use dental floss; use a soft toothbrush and brush after every meal and at bedtime and use mouthwash of 1 tsp. of baking soda in a cup of water, or 1 tsp. of salt dissolved in 1 quart of water
Do not tear or cut your cuticles
If your skin becomes dry, use lotion or oil to soften it
Shower, instead of bathe, at least once per day
If you cut or scrape your skin, wash at once with soap and water After each bowel movement, wash the rectal area gently and thoroughly, glycerin wipes (babywipes) are good
If you become constipated, ask the doctor or nurse for advice

Nausea and Vomiting
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Eat small meals frequently (6 to 8 times per day)
Avoid sweets and fatty, fried foods
Eat foods at room temperature
Eat dry foods like toast, crackers or dry cereal
Avoid heavy meals before therapy
Avoid odors
Rest after eating
Breathe through your mouth if you are nauseated

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Drink plenty of fluids, particularly fruit juices, water, Gatorade or All Sport, or electrolyte replacement fluids such as Pedialyte
Avoid dairy products
Avoid beans, coffee, nuts, cabbage, broccoli, cauliflower, and spicy foods until diarrhea subsides
When diarrhea slows, add foods low in fiber such as rice; bananas, mashed potatoes, toast, and crackers
Avoid carbonated drinks
Take Imodium as directed by your physician (See Immodium instructions)

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Drink plenty of fluids, enough to urinate every 2 hours
Eat high fiber foods (fruits, bran, vegetables, whole grain cereals, etc.)
Keep active
You may use a laxative or stool softener

Sore Mouth
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Drink a lot of fluids
Suck on ice chips
Use sugarless gum or hard candy
Moisten dry foods before chewing
Eat moist foods such as ice cream
Avoid acid foods (tomatoes, oranges, grapefruits). Eat apricots, pears, beans, squash or peas
Avoid salt and spicy foods
Use mouthwash that does not contain alcohol, such as Rembrandt, every 2 hours
Use lip balm

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Eat 3 to 5 servings of vegetables (fresh and raw is best, but frozen or canned is ok). Any vegetable is acceptable
Eat 2 to 3 servings of fruit (fresh fruit is best)
Avoid fried, fatty food
Use dairy products freely if you do not have diarrhea
Eat cereals and breads
Eat beans, peas and nuts
Eat eggs, fish and poultry

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Eat well
Keep a journal of your activities, body functions, and symptoms and bring it with you to your doctor's appointment. Write down your questions
Keep your treatment goal in mind
Ask questions and become knowledgeable about your disease and its treatment
Set goals for yourself
Talk to others, particularly other patients
Exercise, but discuss limitations with your doctor

What to Report to Doctor or Nurse
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Fever over 100° F
New onset of pain or any unrelieved pain
Nausea, vomiting, or diarrhea for more than 2 days duration
Sores in your mouth
Increasing weakness

Suggestions for Energy Conservation and General Exercise Tips
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Trust him when dark doubts assail thee.
Trust him when thy hope is small.
Trust him when to merely trust him
Seems the hardest thing of all.

The Problem of Fatigue
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The symptoms of cancer fatigue include extreme weariness, weakness, exhaustion and tiredness. The following are suggestions for energy conservation to deal

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Wash hair in shower, not while leaning over sink.
Sit to dry off.
Use a terry robe instead of drying off with a towel.
Use a shower bench or lawn chair to sit while showering.
Use safety strips on the floor of the tub.
Install a grab rail
Use a hand-held shower while sitting.
Use moderate temperature instead of hot water.
Use a long-handled sponge or brush to reach feet and back.

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Don't lean forward unsupported
Rest elbows on counter or dressing table.
Use long-handled combs or brushes to avoid holding arms overhead.
Use an elevated commode seat.

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Loose-fitting clothing allows easier breathing.
Organize early to avoid rushing to dress.
Lay out clothes before starting to avoid extra steps.
Sit while bringing foot to knee when applying shoes and socks to avoid leaning over.
Wear slip-on shoes
Use a long-handled shoehorn and a sock aid.
Fasten bra in front, then turn it to the back.
Wear front-button shirts instead of pullovers.
Use a reacher and/or dressing stick.

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Wear low-heeled shoes with a shock-absorbent sole or insole
Use a wheelchair for long trips.
Maintain good posture while driving.
Use cruise control if possible.
Install handrails.
Install ramps.
Place chairs strategically to allow rest stops .

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Spread tasks over the week.
Do a little bit each day.
Delegate heavy work.
Hire help.
Use a wheeled cart or carpenter's apron to carry supplies.
Do whatever you can do sitting.
Use long-handled dusters, mops, etc.

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Make a list first.
Organize list by store aisle.
Combine errands to reduce the number of trips.
Use the grocery cart for support.
Use a power scooter if the store has one.
Shop at less busy times - it will take less time.
Shop with a friend.
Delegate shopping

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Use a laundry cart with wheels.
Use an automatic washer and dryer.
Sit to transfer clothes to the dryer if possible.
Use commercial pre-wash instead of scrubbing
Sit to iron and adjust board height.
Use a lightweight iron with a spray attachment.
Slide iron onto a heat-resistant pad between uses to minimize lifting.
Hang clothes on doorknob instead of top of door.
Wear clothes that do not need ironing.

Meal Preparation
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Assemble all ingredients before you start.
Use mixes or pre-packaged food.
Use cookware you can serve from.
Use smaller appliances
Use electric knife and can opener.
Use ergonomically designed utensils.
Transport items on a rolling cart.
Store frequently used items at chest level to avoid bending and stretching.
Line ovens and burner drip pans with foil.
Sit while preparing foods.
Rest elbows on the table or counter.
Let dishes soak instead of scrubbing.
Use a dishwasher.
Let dishes air dry
Use a jar opener.
Don't lift heavy pans off the stove; ladle food out at stove.
Use placemats instead of tablecloths; they are easier to place on the table and easier to clean.
Use lightweight utensils.
Prepare double portions and freeze half for later.
Drag garbage bags instead of lifting (or use a wheeled can.)

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Plan activities around the table or in the room to allow sitting.
Instead of going to the park' go somewhere you can sit or lie down.
Delegate some childcare responsibilities if possible.
Teach small children to climb onto your lap rather than picking them up.
Teach children to make a game of some household chores.

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Plan workload around your best times of day.
Arrange workspace ergonomically.
Take periodic rest breaks

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Wear comfortable clothing
Use adaptive equipment.
Select less, strenuous activities.
Co with a friend.
Use a wheelchair or golf cart.

General Exercise Tips and Suggestions for Energy Conservation
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Maintaining an exercise program throughout cancer treatment is not only safe, but also an effective way of managing fatigue, depression' and treatment side effects.

Be sure to discuss your exercise plan with your physician before starting an exercise program and throughout your cancer treatment.

Exercise is not recommended If you are experiencing the following symptoms:
Irregular or resting pulse higher than 100 beats per minute
Recurring leg pain or cramps.
Chest pain.
Acute onset of nausea during exercise.
Dizziness/blurred vision/faintness.
Bone/back or neck pain of recent onset.
Illness with fever.
Sudden onset of shortness of breath, muscular weakness or unusual fatigue.

General Tips
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1. Pace yourself
Schedule rest periods throughout the day - at feast one hour of rest for every four hours of work.
Rest before you become tired.
Do only one task at a time
Follow heavy activities with light activities.

2. Organize yourself
Plan ahead to give yourself enough time to complete tasks without rushing.
Duplicate frequently used items and store them in several convenient locations.
Eliminate unnecessary trips - before beginning a task collect all items to be used and take them to your workspace
Clean up as you work to eliminate a large clean up at the end.

3. Prioritize
Determine whether someone else can do the activity.
Determine whether the activity can be altered
Determine whether the activity can be eliminated.

4. Use good body mechanics.
Use your legs to lift or to bend low to the ground.
Push heavy objects rather than pulling or lifting them.
If working at a table, check the height so that you do not have to bend over to work - ideally about six inches below your waist when standing by the table.
Use both your arms and your legs symmetrically.
Stand or squat with a broad base of support - legs should be shoulder width apart with one foot in front of the other.
Keep loads close to your body when lifting or carrying
Avoid twisting motions.

I have learned and accepted that I have control of my Life and no one or anything will stand in my path to keep me from having the life I deserve. I want quality in my life and I know that I have to be the one to find it and keep it. However, this is a daily effort and it is worth fighting for each day.
Becki Bitler

Sometimes it sucks And sometimes it doesn't.
Joan Johansen

Pamphlet courtesy of
Department of Medical Oncology of North Bend Medical Center, Coos Bay, Oregon
Sue Nowlin, RN

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