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October 2, 2000

Doxil Side Effects Relief - Do's and Don'ts
Information Sheet for the Prophylaxis and/or treatment of ppe and stomatitis

Christina Carr and Susan Temple, RN, MSN
In Memorium - Christina Carr, November 9, 2003

Cooling Procedures (Stomatitis and PPE)
B. Pyridoxine (Vitamin B6) for PPE
C. Topical DMSO for PPE
D. Other Topical Measures

A. Cooling Procedures (Stomatitis and PPE)
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In general, utilize cooling procedures during days 1-3 (minimum) of each cycle, continuing for up to 6 days.
Apply ice packs to hands and feet (malleable gel ice packs or bags of frozen peas are recommended.) Alternate on and off for 15-20 minutes at a time.

Sucking ice chips and/or Popsicles

Refrain from eating or drinking any very warm/hot/spicy foods or liquids which includes hot tea, coffee, hot soups, etc.

Stay in cool places (in shaded areas, air-conditioned rooms, etc.)

Soak hands and/or feet in basins of cold water when possible (e.g. while watching television, reading or listening to the radio) for short periods of time.

Take cool baths or stay in the pool during the summer. Avoid hot showers, hot tubs, hot baths for at least four days following your treatment.

Keep hands and feet uncovered (no gloves, socks, etc.)

Avoid all tape, tight fitting clothing and shoes (eg tight belt, jeans, etc.) Absolutely NO nylons!!! Wear very loose fitting (couple of sizes larger than you normally wear) sports bras. No elastic!!!

Protect skin from the sunlight. Wear 15-30 sun screen or a long sleeve blouse. Stay in the shade.

Avoid increased pressure on the soles of the feet or hands, for at least 5 days after treatment. NO - aerobics, power walking or jumping. Example: Do not have treatment and then go to Six Flags for the day!!!!

Avoid vigorous activity (no digging, pruning or vigorous gardening).

No chopping hard food by hand or using a garlic press. Do not use any sort of force or pressing motion (increased pressure on the palms of the hands).

Do not lean on elbows or sit in a position that wodld create pressure.

No activity that wodld cause friction such as sexual intercourse.

B. Pyridoxine (Vitamin B6) for PPE
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B6 is available over-the-counter in any health store or pharmacy. Take 50-150 mg/day beginning at the first signs of redness or tingling. Can also be taken prophylactically.

C. Topical DMSO for PPE
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Topical DMSO (99%) may be applied to affected areas at the first signs of redness or tingling and can be combined with the use of ice packs as listed in the cooling procedures.

D. Other Topical Measures
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Topical moisturizers or creams can be used. These shodld be applied carefdlly without unnecessary rubbing and can be used with the cooling procedures. Avoid lotions and creams with perfumes, alcohol or glycerin.
1) Use creams only such as Euercin.

2) Bathe in Aveeno (over-the-counter) bath treatments (tepid water temperature).

3) Bag Balm (found in pet section of Walmart) has sdlfur which helps when fingers and toes are cracking at the joints.

4) For mouth sores, have physician prepare the mouthwash that heals the sores. Miracle Mouthwash

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