Anemia

Definition: The bone marrow is not able to make enough red blood cells, which carry oxygen to all parts of your body. Tissues need oxygen to do their work.

Symptoms:

Pale skin, pale or bluish fingernail beds, muscle weakness, fatigue, chills, shortness of breath, dizziness, headache, sore tongue, sleepiness, fast heart rate, or slight fever.

If the amount of oxygen reaching the brain is poor, dizziness, depression, irritability, and headaches can result; if the oxygen reaching the tissue surrounding the heart is insufficient, angina-like chest pain may result.

Causes:

Decreased iron, vitamin K, vitamin B12 and/or folic acid intake, absorption, and/or use.

Chemotherapy.

Radiation to the pelvis, sternum, and long bones

Primary disease of bone marrow, e.g., leukemia.

of bone marrow by tumor.

diseases.

Renal/Kidney disease.

Primary tumors of the liver.

Metastatic disease of liver.

Treatment-related liver/hepatic toxicity.

Aging.

Exposure to toxic substances, e.g., benzene, antibiotics.

Blood loss.

Do:

Dont:

1. Do not be afraid to get help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving.

2. Do not do any exhausting activities.

Call MD:

Headache, dizziness (), ringing in the ears (), fast heartbeat (), hypersensitivity to cold, shortness of breath () on exertion, and difficulty sleeping ().

Blood loss in stool, urine, vomit, monthly period, or .

Active bleeding from operative site, nose, or venipuncture site.

Your doctor will check your blood cell count often during your treatment. If your red count falls too low, you may need a blood transfusion to increase the number of red blood cells in your body.

Bleeding

Definition: (Thrombocytopenia) A decrease in the number of circulating platelets in the blood.

Symptoms:

A steady flow of red blood, increased bruising, or nose bleeds.

Causes:

Disease of bone marrow.

Attack of marrow from tumors.

Bacterial or viral infection.

Platelet deficiency diseases.

Chemotherapy.

Radiation therapy to the pelvis, sternum, and long bones.

Massive blood transfusions.

Medications: Aspirin, Thiazides, Estrogens.

Alcohol.

Do:

Use acetaminophen in place of aspirin. In case of a nosebleed, apply firm pressure to the below the and tilt the head forward. (Tilting the head backward is sometimes suggested, but make sure that the bleeding is not in the back of the nostril.) If bleeding does not stop in a few minutes, place ice bags on the bridge of the nose and at the back of the neck. If external bleeding does happen, apply pressure to the site for five to ten minutes. If an arm or leg is involved, raise it above the level of the heart and then apply pressure for a few minutes. If bleeding continues for more than five minutes, notify the physician.

Dont:

1. Do not strain to move bowels.

2. Do not scrub anal area.

3. Do not try to "push anything back in" if it sticks out of the anal opening (i.e., hemorrhoids).

4. Do not use enemas, douches, rectal suppositories, and laxatives.

5. Do not use rectal thermometers.

6. Do not wait longer than two hours before trying to urinate.

Call MD:

Bleeding from anywhere (e.g., mouth, nose).

Bruises on skin, little dots on skin, especially on feet or legs.

If you have unstoppable bleeding.

If you became .

If you have fever with shaking chills.

Blood in the urine, red or pink urine, cloudy or smelly urine, pain upon urination, urgency to urinate.

Pain in the lower back, or on lower sides of the back.

If symptoms do not get better after treatment.

Blood in the stool, dark red or black bowel movements. (Remember that eating beets can cause red feces/stools and iron tablets can cause black feces/stools. This is normal).

Blood on toilet tissue, on underwear, sheets, underparts.

A.S.A. enseals

A.S.A. suppositories

A.S.A. pulvules

A.S.A. tablets

ABC Compound

Acucron tablets

Advil ibuprofen tablets

Advil ibuprofen caplets

Alka-Phenylbutazone

Alka-Seltzer

Alka-Seltzer Plus cold tablets

Alkabutazolidin

Alkabutazone

Alpha-Phed capsules

Alpha-Phed

Amersol

Anacin capsules

Anacin maximum-strength capsules

Analate

Ancasal Anodynos tablets

Apa-San tablets

APAP fortified tablets

Apo-Asen

Apo-Phenylbutazone

Arthra-G tablets

Dinol tablets

Disalcid capsules

Disalcid tablets

Doans pillsindocin

Dolene compound-65 capsules

Dolobid tablets

Dolprin #3 tablets

Drinophen capsules

Duoprin-S Syrup

Duradyne tablets

Durasal

Dynosal tablets

Easprin tablets

Ecotrin tablets

Ecotrin maximum-strength tablets Efficin

Emagrin tablets

Empirin with codeine tablets

Empirin tablets

Encaprin capsules

Entrophen

Equagesic tablets

Equazine-M tablets

Excedrin tablets

Excedrin extra-strength caplets, tablets

Osteolate

Oxycodone with aspirin tablets P-A-C new revised formula

P-A-C tablets

Pabalate tablets

Pabalate-SF

Pamprin-IB

Pepto-Bismol liquid

Pepto-Bismol tablets

Percodan tablets

Percodan-demi tablets

Persistin tablets

Phenetron Compound tablets

Presalin tablets Propoxyphene compound capsules

Protension tablets Cenaid tablets

Rhinex D-Lay tablets

Rhinocaps capsules

Rhinogesic tablets

Rid-a-pain compound capsules Riphen-10

Arthralgen tablets

Arthrin tablets

Arthritis pain formula (Anacin)

Arthritis-strength Bayer aspirin

Arthropan liquid

Ascriptin A/D tablets

Ascriptin tablets

Ascriptin with codeine tablets Ascriptin extra-strength tablets

Aspergum Aspergum junior

Aspirin and codeine phosphate tablets

Aspirin suppositories Aspirin tablets Axotal tablets Azolid

B-A-C tablets

B-A-C #3 with codeine

Bayer childrens cold tablets

Bayer aspirin tablets

Bayer childrens chewable aspirin

Bayer timed-release aspirin tablets

BC tablets

BC powder

Extra Strength Bufferin arthritis-strength tablets

Fendol tablets

Fiogesic tablets

Fiorgen PF tablets

Fiorinal capsules

Fiorinal with codeine capsules

Fiorinal tablets

Fiorinal-C

Gaysal-S tablets

Gemnisyn tablets

Haltran ibuprofen tablets

Hista-Compound #5 tablets

Histadyl and A.S.A. pulvules

(capsules)

Indocin

Intrabutazone

Isollyl Improved capsules

Isollyl Improved tablets

Kolephrin capsules

Korigesic tablets

Lanorinal tablets

Lanorinal capsules

Lortab ASA tablets

Magan capsules

Magan tablets

Magsal tablets

Robaxisol tablets

S-A-C tablets

Sal-adult tablets

Sal-infant tablets

Salatin tablets

Saleto tablets

Saleto-D capsules

Salimeph Forte tablets

Salocol tablets

Salphenyl capsules

Sine-Off

Sino-Comp tablets

Sinulin tablets

SK-oxycodone with aspirin tablets

Sodium salicylate tablets

Soma compound tablets

Soma compound with codeine

St. Joseph Aspirin for children St. Joseph cold tablets for children

Buf-tabs

Buff-a-Comp tablets

Buffaprin tablets

Bufferin tablets

Bufferin extra-strength analgesic tablets

Buffex tablets

Buffinol tablets

Butabarbital compound tablets

Butal compound capsules

Butal compound tablets

Butazolidin

CAMA arthritis-strength tablets

Codolan

COPE tablets

Corilyn infant liquid drops

Coryphen

Cosprin 650

CP-2 tablets

Damason-P

Darvon with aspirin

Darvon-N with aspirin

Dasikon capsules

Dasin capsules

Dia-Gesic tablets

Diflunisal

Major-cin tablets

Marnal tablets

Marnal capsules

Maximum-strength Bayer aspirin

Maximum-strength Midol

Medipren with ibuprofen tablets

Mejoral with aspirin tablets

Meprogesic Q tablets

Methocarbamol with aspirin

Micranin tablets

Midol 200 tablets

Midol caplets

Midol

Mobigesic tablets

Momentum caplets

Neo-Zoline

Norgesic tablets

Norgesic Forte tablets

Norwich extra-strength aspirin Norwich aspirin

Novasen

Novobutazone

Nuprin ibuprofen analgesic tablets Os-Cal-Gesic tablets

Synalgos-DC capsules

Suspac tablets

Synalgos

Talwin compound tablets

Tenol-Plus tablets

Tenstan tablets

Tisma tablets

Tranquigesic tablets

Trendar tablets

Triaphen-10

Trigesic tablets

Trilisalicylate

Trilisate liquid

Trilisate tablets

Tussirex syrup

Tussirex liquid

Uracel 5 tablets

Uromide tablets

Ursinus Inlay tablets

Vanquish capsules

Wesprin buffered aspirin

Central Nervous System (CNS)

Definition: The in the body including the brain and spinal cord along with their nerves. This system controls voluntary movements and thoughts.

Symptoms:

Peripheral neuropathy is a that may make you feel a tingling, burning, pain, weakness, or numbness in the hands and/or feet. Other nerve related symptoms include loss of balance, clumsiness, difficulty picking up objects and buttoning clothing, lowered to heat and cold, walking problems, jaw pain, hearing loss, stomach pain, and constipation.

Causes:

Chemotherapy (vincristine, vinblastine).

Radiation.

Injury.

Tuberculosis, malaria, herpes zoster, diphtheria, virus infections, and Lyme disease.

Diabetes, hypothyroidism.

Tumor pressure.

Medications as barbital, sulfonamides, phenytoin, and emetine.

Carbon monoxide.

Vitamin B .

Do:

Dont:

1. Do not wear slippery shoes.

2. Do not rely on your hands to see if things are hot or cold. Test temperature on an inner forearm.

Call MD:

If symptoms last more than two days.

Constipation

Definition: Passage of hard, infrequent feces/stools, which is often associated with abdominal and rectal pain.

Symptoms:

Bowel movements are hard, no bowel movement within one-two days, stomach or rectal pain, headache.

Causes:

Chemotherapy.

Low activity.

Poor nutrition.

Bowel obstruction.

Fluid and electrolyte .

Dehydration.

High calcium.

Low potassium.

Handling of intestines during surgery.

Drugs: narcotics, anticholinergics, antacids, iron, anticonvulsants, antidepressants, tranquilizers, and muscle relaxants.

Do:

Dont:

1. Do not use too much force or straining in trying to move bowels.

2. Do not use laxatives and enemas if your white blood cell count is low unless prescribed by your doctor.

3. Do not use foods that can cause constipation, such as chocolates, cheese, and eggs.

Call MD:

If you have not had a bowel movement for more than a day or two.

Severe pain or bleeding with bowel movement.

If you cannot move bowels within one or two days after taking laxative.

If you have lasting cramps or vomiting.

Dehydration

Definition: Loss or deprivation of fluid from body tissues.

Symptoms:

Dry mouth, thirst, dizziness, weakness, unable to swallow dry food, difficulty talking, dry skin, skin that "tents" when pinched, swollen, cracked, or dried tongue, fever, weight loss, little or no urine, dark yellow/orange urine, fatigue, headache, confusion, and sunken eyeballs.

Causes:

Primary tumors of the pituitary or adrenal gland, kidney, or stomach/intestines.

Metastatic disease resulting in a fluid shifts, e.g., edema, ascites, effusions.

Hemorrhage related to tumor invasion.

Surgical procedures resulting in trauma.

Wound drainage.

Nausea or vomiting.

Stomach/Intestinal suctioning.

Diarrhea.

Sweating with fever.

Excessive enemas.

Decreased water intake.

Decreased motivation to drink.

.

Inability to swallow liquids.

NPO (nothing by mouth ) ordered by the physician.

Decreased thirst sensation.

Decreased level of consciousness and/or neuromuscular control.

Drugs, e.g., diuretics, laxatives, antibiotics, tranquilizers, anti epileptics.

Do:

Dont:

1. Do not drink fluids with caffeine such as coffee, tea, chocolate and soda. Caffeine acts as a which causes fluid loss. For each cup of a caffeinated beverage you drink, you lose a cup and a half of fluid. If you do have anything with caffeine in it, it does not count toward fluid intake.

2. Do not get up suddenly. Blood pressure drops causing dizziness.

Call MD:

If vomiting, diarrhea, or fever continues for more than twenty-four hours, if urine is either very dark in color and of a small amount, or if there is no urine for twelve hours or more, if you become dizzy or if you feel faint as you stand up, or if you become disoriented or confused.

Depression

Definition: A state of being sad, discouraged, and in low spirits.

Symptoms:

Fatigue, decreased energy.

Loss of appetite.

Sleep problems.

Decreased physical activity.

Slowing of responses to stimulants.

Decreased libido.

Hopelessness.

Irritability.

Emotional lability.

Lack of trust of others.

Apathy.

Guilt.

Feelings of worthlessness.

Withdrawal.

Decreased social interaction.

Inability to concentrate. Slowed cognitive processes. Indecisiveness.

Regression and/or dependency.

Decreased or increased nutritional intake.

Decreased or increased physical activity.

Decreased social interaction and/or support.

Poor use of personal, social, professional, and economic resources.

Causes:

Diagnosis.

Prognosis.

Expecting side effects of treatment.

Surgery causing a loss of body part and/or function.

Cost of illness and treatment.

Loss of personal control.

Social isolation of hospitalization and illness.

Many crises and past losses.

Age.

Inadequate social support and financial resources.

Mood swings prior to diagnosis and treatment.

Changes in mood in times of stress and/or crisis.

Reactions of significant others to changes in mood.

Effect of mood swings, especially depression, and responses of significant others on client.

Do:

See Pain-Relaxation Techniques and Chapter 3 Feelings and Relationships.

Dont:

1. Do not try to handle depression on your own.

Call MD:

If you feel depressed or suicidal.

Definition: Passage of loose, watery feces/stools or greater than three bowel movements a day.

Symptoms:

Watery bowel movement, weakness or dizziness, cramping, or dehydration.

Causes:

Disease related, e.g., obstruction, presence of impaction (severe constipation with an overflow of intestinal liquids around feces/stool that is lodged in the intestine).

Radiation therapy to the bowel.

Chemotherapy.

Surgery to bowel.

Graft-versus-host disease in bone marrow transplantation.

Medications, e.g., antibiotics, antacids.

Diet changes, e.g., tube feedings, additional nutrition.

Inflammation or infection of the bowel.

Increased stress with poor coping strategies. Anxiety.

Use of nutritional supplements with a high osmolarity (large amounts of vitamins, minerals, sugar, and electrolytes).

(the inability to digest milk and milk products.)

Bacterial and viral infections.

Do:

bouillon, fruit-ade, apple juice, grape juice, Gatorade, weak warm tea, and gelatin.

Level I: 3/4 water and 1/4 supplement.

Level II: ½ water and ½ supplement.

Level III: 1/4 water and 3/4 supplement.

Level IV: full-strength supplement; this level is usually tolerated in five to seven days.

Apply a topical anesthetic (corticosteroid sprayer DecaSpray or creams may be prescribed to reduce inflammation), in ointment or spray form to promote comfort. Take frequent warm baths or sit in a tub of warm water to promote comfort. A mixture of 1000 physiologic bicarbonate, 100 ml of diphenhydramine HCL (Benadryl ) elixir, and one bottle of viscous lidocaine HCL (Xylocaine) may be used in a warm bath to relieve both pain and itching every four hours as needed. If happens, aluminum acetate solution (Domeboro), one package to a quart of water can be added to the warm bath to promote healing.

Dont:

1. Do not use alcoholic beverages, including liquor, beer, and wine.

2. Do not eat high-fiber foods which can lead to diarrhea and cramping.

3. Do not have beans, caffeinated foods, caffeine-containing soft drinks, candy, chocolate, coconut, coffee, creamed soups, flatus-forming foods such as broccoli, onions, and cabbage, foods and beverages containing caffeine, such as chocolate, coffee, tea, fresh and dried fruits, fried or greasy food, fruit juices (bananas, avocados, apples, and grape juice are permitted), jellies, milk and milk products if they make your diarrhea worse, milk shakes, nuts, olives, pickles, popcorn, potato chips, pretzels, puddings, raw vegetables, raw fruits, relishes, dried fruit, rich pastries, seeds, soft drinks, strong spices and herbs such as chili powder, licorice, pepper, curry, garlic, horseradish, sweets, tea, tobacco products, and whole-grain bread and cereal such as bran and granola.

4. Do not eat very hot or very cold foods.

5. Do not have only for more than two days in a row.

Call MD:

If diarrhea does not get better.

If you have 6 to 8 or more loose bowel movements per day for more than two days in a row.

If you notice blood in or around anal area or in the stool.

If you lose five or more pounds after the diarrhea starts.

If you have new stomach cramps or pain for two days or more.

If you do not urinate for twelve hours or more.

If you do not drink any liquids for more than two days.

If you have a fever greater than 100.5 degrees Fahrenheit.

If your abdomen suddenly becomes puffy or blown-up.

If you have been constipated for several days and begin to have a small amount of diarrhea or oozing of . This could suggest an (severe constipation).

Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. As you feel better, you gradually can add the low-fiber foods listed above. A clear liquid diet doesnt provide all the nutrition you need, so dont follow one for more than three to five days.

If your diarrhea is very severe, you may need to get intravenous fluids to replace the water and you have lost.

Edema

Definition: Swelling caused by excess fluid.

: Swelling due to clogging of the vein, damage of lymphatic , or lymph node dissection as in a mastectomy with lymph node .

Symptoms:

Pain and swelling in the arms.

Causes:

Vein obstruction, e.g., pressure from tumor, infection, .

Damage to lymphatic vessels, e.g., tumor infiltration, obstruction, inflammation, and due to radiation,

surgery to lymph nodes.

Increased tiny blood vessel pressure and .

Blood clots that prevent return of blood flow to the heart.

Emotional response caused by the nervous system, e.g., laryngeal edema resulting in hoarseness.

Decreased plasma proteins.

Abnormal protein losses in renal dysfunction.

Inadequate dietary intake of proteins.

Liver disease.

Allergic reactions.

Bacterial infections.

Fluid becomes trapped in fluid spaces, e.g., peritoneal, pericardial, and/or pleural spaces.

Medications, e.g., estrogens, ACTH.

Do:

Diuretics.

Lymphedema sleeve.

Mechanical pumps.

Consults with occupational and physical therapy departments.

Provide referrals to support groups, e.g., Reach to Recovery.

Dont:

1. Do not try to apply elastic stockings to decrease swelling unless ordered by the doctor.

Call MD: Check with your doctor or nurse if you notice swelling or puffiness in your face, hands, feet, or abdomen.

Fatigue

Definition: A feeling of weariness, tiredness, or temporary loss of physical or emotional. is a temporary state relieved by rest. may not be relieved by rest, lasts over time, and often prevents you from doing daily activities. Approximately ninety percent of people with cancer may have both acute and chronic fatigue because of the illness, a side effect of treatment, and a result of the emotional stress caused by the diagnosis.

Symptoms:

Decreased concentration and memory, increased hours of sleep without feeling rested and revitalized, impaired problem solving ability feeling tired or exhausted, difficulty concentrating, and sleeping more.

Causes:

Alcohol.

Amputation.

Anemia.

Anorexia.

Anxiety.

Biotherapy.

Bone marrow depression.

Chemotherapy.

Depression.

Diabetes.

Illness progression.

Fever.

Liver/Kidney damage.

Low potassium.

Poor nutrition.

Destruction of cells.

Metastasis.

Nausea and vomiting.

Pain.

Radiation therapy.

Side effects of medications.

Sleep changes.

Surgery.

A buildup of waste products in the body.

Do:

Include nutritional supplements if unable to maintain a balanced diet (e.g., Sustacal, Ensure, Carnation Instant Breakfast).

Dont:

1. Do not drink stimulants, such as coffee, tea, or cola, late in the day.

Call MD:

Your doctor may order blood transfusions if the cause is due to low blood levels, sedatives, antidepressants, or professional counseling.

Fever/Chills

Definition: Body temperature above 100 degrees Fahrenheit or 39 degrees Celsius.

Symptoms:

Flushed face, hot and dry skin, aching, increased pulse and breathing.

Causes:

Decreased absolute granulocyte count (SEGS + BANDS) WBC

Transfusions.

Drugs, e.g., amphotericin.

Heat.

Exercise.

Dehydration.

Caffeine.

Infection.

Inflammation.

Do:

Dont:

1. Do not take over-the-counter or prescription products (especially with aspirin) without asking your doctor.

Call MD:

Your doctor may order blood work to find the cause or prescriptions to treat it.

Hair Loss (Alopecia)

Definition: Loss of hair.

Symptoms:

Hair loss can happen anywhere on the body (scalp, facial, axillary, pubic)

Causes:

Radiation to the scalp greater than 4500 rads can cause permanent or temporary loss.

Chemotherapy:

Chronic stress.

Protein loss.

Medications.

Aging.

Endocrine diseases.

.

Heredity.

Do:

Dont:

Try hair transplant techniques or products that claim to grow hair.

Call MD:

If you have concerns regarding hair loss.

Definition: Bacteria, viruses, fungi and parasites enter the body, multiply, and injure the tissues.

Symptoms:

Redness, swelling, tenderness, pain, pus, fever more than 100 degrees Fahrenheit or 38 degrees Centigrade, shaking chills, sweating,, fatigue, , cough, unusual vaginal discharge or itching, abnormal breath sounds, back pain, diarrhea, burning and/or pain on urination, frequent urination, rectal discomfort with bowel movements, sore throat, earache, or runny nose.

Causes:

Decrease in the ability of the body to resist infection.

Tumor infiltration of bone marrow.

Nutritional deficiencies.

Exposure to toxic substances.

Genetically acquired immune deficiency syndromes (AIDS).

Immunosuppressive therapy, e.g., anti rejection agents, chemotherapy, and radiation therapy.

Age.

Steroid therapy.

Primary cancer of blood-forming tissues, e.g., leukemia and lymphoma.

Autoimmune illnesses.

Decreased secretions in eyes, ears, nose, mouth, and throat.

Loss or impaired function of hair or cilia, e.g., absence of eyelashes, absence of cilia movement in bronchial trees after smoking.

Poor skin condition, e.g., IV , surgery, cutaneous lesions, mucosal lesions.

Immunosuppression.

Effects of tumor growth, e.g., invasion, obstruction, necrosis.

Viral, bacterial, or fungal infection.

Drug reactions.

Do:

Dont:

1. Do not take temperature rectally.

2. Do not take enemas.

3. Do not take any medications in suppository form.

4. Do not take any medications that have aspirin or acetaminophen unless the doctor orders it.

5. Do not try to "bring the fever down" with ice baths or alcohol baths.

Call MD:

Report signs and symptoms of infection: redness, swelling, tenderness, pain, pus, fever more than 100 degrees Fahrenheit or 38 degrees Centigrade, shaking chills, sweating, low body temperature, fatigue, generalized discomfort, cough, unusual vaginal discharge or itching, abnormal breath sounds, back pain, diarrhea, burning and/or pain on urination, frequent urination, rectal discomfort with bowel movements, sore throat, earache, or runny nose.

Your doctor may postpone your next treatment or give you a lower dose of drugs for a while.

Loss of Appetite (Anorexia)

Definition: A feeling that you dont want to eat or cant.

Symptoms:

Food tastes different, feeling full, metal taste in the mouth, unable to eat without gaging, feeling like a lump is in your throat, nausea, and the smell of food is not pleasing.

Causes:

Poor nutrition and low levels of zinc.

Surgery or radiation to head, neck, mouth, sinus, ear and throat.

Chemotherapy and other drugs.

Biological response modifiers.

Nausea and vomiting often cause a continuing aversion to specific foods and beverages.

Poor oral hygiene. Dentures that cover the taste buds. Infection of the mouth.

Aging.

Do:

Dont:

1. Do not take appetite stimulants without consulting your doctor.

Call MD: If you have poor appetite, weight loss, unable to drink fluids, or if you have concerns.

Loss of Breast or Testacle

Definition: Removal or part or all of the breast or testicle.

Symptoms: none

Causes:

Surgery.

Radiation.

Do:

: A surgical procedure to recreate the natural contour of your breast by using a prosthesis or your own tissue. It can be done at the time of your mastectomy, weeks later, or years later. A breast implant is a rubber sac filled with either saline or silicone. Usually a tissue expander is placed in the breast under anesthesia first to stretch the skin to fit the size of the implant. This can be done outpatient. Over time, the expander is filled with saline by inserting a small needle into the sac periodically. A few months later, the skin is stretched enough to fit the implant.

involves moving fat and muscle from one area of the body to the breast. This involves a hospital stay of several days. This is beneficial since a nipple can be created. In either case, consult a plastic surgeon to find out more details about the benefits and risks, and to see if you are a candidate for reconstructive surgery.

Dont:

1. Do not try new methods without consulting your doctor.

Call MD:

If you are experiencing pain, bleeding, discomfort, or concerns.

Mouth Sores (Stomatitis)

Definition:

: Inflammation of the esophagus.

: Inflammation of the oral cavity.

: Dryness of the mouth.

: Difficulty swallowing.

: Inflammation of the mucous membranes.

Symptoms:

Redness, swelling, bleeding, sores, white patches, dry cracked areas, or pain in the mouth and throat.

Causes:

Chemotherapy.

Antibiotics.

Radiation therapy that includes head and neck, salivary glands, chest, abdomen, and pelvis in treatment fields.

Graft-versus-host disease.

Poor mouth care.

Dehydration.

Immunosuppression.

Surgical removal of the salivary glands.

Drugs, e.g., antihistamines, atropine, phenothiazines for nausea.

Alcohol or nicotine.

Do:

Dont:

1. Do not use extreme temperatures in foods.

2. Do not eat foods that need much chewing, such as tough meats, chewy candy, or raw whole vegetables.

3. Do not use lemon or glycerine swabs.

4. Do not use citrus fruits such as oranges, lemons, limes, tomatoes, or juices of these fruits. Instead, use apricot, pear, or peach juice and avoid carbonated beverages.

5. Do not eat hot, spicy foods such as pepper, curry powder, horseradish.

6. Do not use petroleum jelly if using oxygen therapy.

Call MD:

If inside the mouth and gums look red, shiny, or swollen, blood in mouth, small ulcers or sores in the mouth, on gums, or on tongue, a white or yellow film in the mouth decreased appetite pain in the mouth, feelings of dryness, mild burning, or increased sensitivity to hot and cold foods, soft whitish patches or pus in the mouth.

Nausea and Vomiting

Definition: Unpleasant sensation similar to sea sickness or motion sickness. Can lead to emptying stomach contents.

Symptoms:

Throwing up, dizziness, dislike smells, pain in abdomen, or queasiness.

Causes:

Cancer of the central nervous system.

Food toxins, infection, or motion sickness.

Chemotherapy.

Radiation therapy to the stomach, intestines, esophagus, and/or brain.

Waste products from cell destruction.

Irritation or obstruction of .

Drugs, e.g., digitalis, morphine, antibiotics, vitamins, iron.

Pain.

Concentrated supplemental feedings.

Electrolyte imbalances, e.g., .

Kidney problems.

Nausea caused by thinking of treatment.

Tension, anxiety.

Seeing or smelling things that trigger nausea.

Do:

Dont:

1. Do not take only clear liquids for more than two days in a row.

Call MD:

If you vomit more than three times an hour for three or more hours, have dizziness, weight loss greater than five lbs./wk, if any blood or material that looks like coffee grounds appears in the vomit, or if you cannot take in more than four cups of liquid or ice chips in a day.

Definition: A sensation of discomfort or agony.

Symptoms: A person says they are in pain, restlessness, slow mobility, inability to do routine tasks.

Causes:

Pressure on nerves from tumor.

Metastasis.

and edema.

Diagnostic and surgical procedures.

Long-term effects of radiation therapy, e.g., scarring of tissues and .

Long-term effects of surgery, e.g., .

Side effects of cancer therapy, e.g., stomatitis, infection, inflammation of tissues in radiation field, and phantom limb pain.

Prior illnesses or conditions, e.g., arthritis, dysmenorrhea, musculoskeletal disease.

Over activity.

Immobility and/or poor body positioning.

Anxiety caused by effect of diagnosis of cancer on activities of daily living, role performance, relationships, communication patterns, and economic factors.

Do:

What does the pain feel like? (Dull, ache, itching, nagging, sharp, stabbing, stinging, burning, pricking, squeezing, crushing, cutting, pinching, tingling, pulsing, shooting, gnawing, pressing, boring, flickering, or cramping).

How much pain do you have during a day?

How often do you have pain?

What time of day is the pain the worst?

Where does it hurt?

Does the pain go anywhere else?

On a scale of zero to ten with zero being no pain and ten being the worst pain you can imagine, that youd kill yourself rather than endure it for fifteen seconds, how much does it hurt right now?

What makes your pain better?

What starts your pain?

Does it come and go or is it constant?

Does it interfere with your activities?

What makes your pain worse?

What medication(s) have you taken in the past and what medications are you taking currently for the pain?

Is the medication working now?

Have you tried any other ways to help reduce the pain?

If yes, what were these and did they work?

Relaxation or meditation relieves pain or keeps it from getting worse by easing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and make other pain relief methods work better. It will slow your breathing and heart rate, lower blood pressure, lower oxygen need, increase memory, reduce anxiety, improve performance, relieve sleeplessness, and provide a feeling of well-being.

Lie down in a quiet room. Stare at an object or close your eyes and concentrate on your breathing or on a peaceful scene. Breathe in (inhale) deeply and slowly. At the same time, tense your muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, stiffen your arms and legs, or draw up your arms and legs as tightly as you can. Hold your breath and keep your muscles tense for a second or two. Breathe out (exhale) and let your body go limp and feel the tension draining. Think of words such as limp, heavy, light, warm, or floating. Repeat the process with another muscle or muscle group. You also can try a variation of this method, called "."

Focus your attention to the sensations at the top of your head. Let your scalp relax. Feel your forehead relax and let go. Feel your eyebrows sagging down and your eyelids become very heavy. Allow your cheeks and face muscles relax. With each breath in, fresh air fills your lungs and brings in energy. With each breath out, the tension is forced out of your body. Let your jaw relax. Your lips and chin are limp.

Now let the muscles of your neck relax. Let that warm comforting feeling spread down your throat and neck.

Feel the relaxation travel to your shoulders. They feel very heavy. The wave of tingling relaxation moves down your back inch by inch. The muscles release tension with each breath. Allow your arms to rest heavily as the feeling goes through to your hands, then each finger. Allow the tension to escape through your fingertips. You feel very calm, safe, and relaxed completely.

Notice how regular your breathing has become. Allow the clean crisp air flow over your chest to your abdomen. You feel deeply relaxed. Now enjoy the sensation of release as your thighs and buttocks relax. Warmth and heaviness move down past you knees to your calves, ankles, feet, then toes. Feel the tension drain out your toes. Every part of your body feels heavy, warm, comfortable. Each breath in feeds all areas of your body with healthy nutrients. Each breath out eliminates all waste, pain, and stress.

Now remain relaxed and begin breathing slowly and comfortably, concentrating on your breathing, taking about nine to twelve breaths a minute. To maintain a slow, even rhythm as you breathe out, you can say silently to yourself, "In, one, two; out, one, two." To end your slow rhythmic breathing, count silently and slowly from one to three. Open your eyes. Say silently to yourself. "I feel alert and relaxed." Feel alert, refreshed, and energetic. Wiggle your fingers and toes. Lift your arms above your head and stretch. Begin moving about slowly.

With the help of special machines, people can learn to control certain body functions such as heart rate, blood pressure, and muscle tension. The machine will sense when your body shows signs of tension and will let you know in some way such as making a sound or flashing a light. The machine will also give you when you relax your body. This may help you to reduce anxiety and help cope with pain. Biofeedback usually is used with other pain-relief methods. Eventually, you can control your relaxation responses without having to depend on feedback from the machine. Your doctor or nurse can refer you to someone trained in teaching biofeedback.

Many people find and comfort through spiritual or faith healing, although it may make patients more to guilt and depression if they think that feelings caused their cancer.

A positive mental attitude can improve your to standard therapies. Imagery is using your imagination to create mental pictures or situations. Imagery is a way of daydreaming that uses all of your senses-sight, touch, hearing, smell, and taste. Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or cant go out of the house, you may find that imagery helps reduce the closed-in feeling; you can imagine and revisit favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep.

Get comfortable. Close your eyes. Breathe slowly and feel yourself relax. Concentrate on your breathing. Breathe slowly and comfortably from your abdomen. As you breathe in, say silently and slowly to yourself "In, one, two." As you breathe out, say "Out, one, two." Breathe in this slow rhythm for a few minutes. When you are ready, imagine that the air you breathe in blows this healing ball of energy to the area of your pain. Once there, the ball heals and relaxes you from pain, tension, or discomfort such as nausea. When you breathe out, imagine the air blows the ball away from your body. As it goes, the ball takes your pain with it. Repeat the last two steps each time you breathe in and out and imagine that the ball gets bigger and bigger as it takes more and more discomfort away from your body.

You can also imagine that the medicine/chemotherapy/radiation is killing the cancer or pain like an army of soldiers, you are cutting wires that carry pain signals from each part of your body to your brain, or the cancer/pain is shrinking or being eaten by PAC-MAN.

To end the imagery, count slowly to three, breathe in deeply, open your eyes, and think "I feel alert and relaxed." Begin moving about slowly.

Visualization is similar to imagery. With visualization, you create an inner picture that your fight against cancer. Some people getting chemotherapy use images of rockets blasting away their cancer cells or of knights in armor battling their cancer cells. Others create an image of their white blood cells or their drugs attacking the cancer cells.

Distraction means taking your mind off pain, worries, or discomforts by turning your attention to something else. Try watching TV, listening to the radio, reading, going to the movies, working with your hands by doing needlework or puzzles, losing yourself in a good book, building models, or painting. Distraction works better than medicine if pain is sudden and intense or if it is brief, lasting only five to forty-five minutes. Distraction is useful when you are waiting for pain medicine to start working. If pain is mild, you can probably distract yourself for hours.

Some people think that a person who can be distracted from pain does not have severe pain. This is not true. Distraction can be a powerful way of temporarily relieving even the most severe pain.

This is a technique in which mild are used on selected areas of the skin by a small power pack connected to two . The sensation is described as a buzzing, tingling, or tapping feeling. The small electric can be adjusted so that the sensation is pleasant and relieves the pain. Your doctor or a physical therapist can tell you where to get a TENS unit.

Skin stimulation is the use of pressure, , temperature change, or chemical methods. Scientists believe that nerve pathways give the sensations of pain, heat, cold, and pressure to the brain. It also changes the flow of blood to that area. When the skin is stimulated, your pain sensation is lessened or blocked for hours after it is finished. This technique does not use much energy, so it may be useful when you are tired.

Massage is a form of skin stimulation. It uses pressure, , heat, cold, and .

For pain relief, massage is most effective when using slow, steady, circular motions. You can massage over or near the area of pain with just your bare hand or with any substance that feels good such as talcum powder, warm oil, or hand lotion. Depending upon where your pain is, you may do it yourself or ask a family member or friend to give you a massage. Remember, having someone give you a foot rub, back rub, or hand rub can be very relaxing and may relieve pain. Some people find brushing or stroking lightly more comforting than deep massage. NOTE: If you are having radiation therapy, avoid massage in the treatment area.

Pressure can be applied with the whole hand, the heel of the hand, the fingertip or the knuckle, the ball of the thumb, or by using one or both hands to encircle your arm or leg. You can experiment by applying pressure for about ten seconds to various areas over or near your pain to see if it helps. You can also feel around your pain and outward to see if you can find "trigger points," small areas under the skin that are especially sensitive or that trigger pain. Pressure is usually most effective if it is applied as firmly as possible without causing pain. You can use pressure for up to one minute. This often will relieve pain for several minutes to several hours.

Vibration over or near the area of pain may bring short term relief. For example, the scalp attachment of a hand-held vibrator often relieves a headache. For low back pain, a long, thin battery operated vibrator placed at the lower back may help. You may use a vibrating device such as a small battery-operated vibrator, a hand-held electric vibrator, a large heat-massage electric pad, or a bed vibrator.

When certain chemicals are injected into or around a nerve, that nerve is no longer able to send pain. A local anesthetic, which may be combined with cortisone, provides temporary pain relief. For longer lasting pain relief, phenol or alcohol can be injected. A nerve block may cause muscle . Loss of all feeling in the affected area is a frequent side effect of a nerve block.

Acupuncture uses special needles which are inserted into the body at certain points, depths, and angles. Specific groups of acupuncture points are believed to control areas of pain sensation. The procedure has been used as an anesthetic in China and elsewhere to treat many types of pain. Most doctors believe that it is not harmful if the needles are sterile. Acupuncture should not be used for patients who are getting chemotherapy because of the danger of increased bleeding or infection where the needles are placed.

Hypnosis puts you in a trance-like state that can help reduce discomfort and anxiety. It is similar to sleep, but you are completely aware at all times. A trained person can hypnotize you, or you can learn how to hypnotize yourself.

Dont:

Do not try these techniques without consulting your doctor.

Call MD:

Medications may be ordered like analgesics, antidepressants, sedatives, hypnotics, and/or tranquilizers.

Potassium

Definition: A part of body fluid that is responsible forand muscle functioning.

Hyerkalemia: Serum potassium levels greater than 5.5 meq/L.

Hypokalemia: Serum potassium level less than 3.5 meq/L.

Symptoms:

Muscle weakness, dizziness, thirst, confusion, and changes in EKG.

Causes:

Poor or of potassium.

Kidney failure.

Liver metastasis.

Addisons disease.

Lymphoproliferative diseases, e.g., leukemia, lymphomas, Hodgkinss disease.

Release of potassium from platelets.

Release of potassium from white blood cells, e.g., chronic leukemia.

Decreased intake of potassium.

Anorexia.

(nothing by mouth).

Vomiting.

Diarrhea.

Draining wounds.

Stomach suctioning.

Villous adenoma of the rectum.

Carcinoid syndrome.

Medications.

Potassium depleting diuretics.

Antibiotics and/or antifungal agents, e.g., Ticarcillin, amphotericin.

Chemotherapy, e.g., AMSA.

Hyperaldosteronism.

Inappropriate ADH syndrome.

Do:

Dont:

1. Do not start taking your old prescription of potassium or someone elses.

2. Do not get up suddenly.

Call MD:

Oral potassium or intravenous potassium chloride may be prescribed.

Sexual and Reproduction Dysfunction

Definition: Inability to produce children, abnormal function of sex organs, difficulty in sexual performance.

Symptoms: Irregular , inability to obtain or maintain , painful intercourse, decreased sex drive, inability to enjoy making love.

Causes:

Tumors of reproductive organs.

Invasion of tumor resulting in hemorrhage, obstruction, or necrosis.

Prolonged hospitalizations.

Forced dependency.

Role reversals.

Surgery: men who have testicular cancer and undergo lymph node dissection often have little or no semen at ejaculation. Recovery of semen may take months or years, or may not happen at all.

Radiation therapy to the male reproductive organs area can cause temporary pain during ejaculation, decreased semen volume, and genital skin irritation. About 80 percent of men will have erectile problems after receiving genital-area radiation therapy.

Lack of privacy.

Structural removal of body parts, e.g., vaginectomy, pudendal nerve damage, vulvectomy.

Reproductive problems, e.g., anovulation, oligospermia, spontaneous abortions.

Functional problems, e.g., impotence, retrograde ejaculation, vaginal scarring, amenorrhea.

Genetic changes, e.g., mutations of ova and/or sperm, teratogenetic effects of chemotherapy or radiation therapy.

Impaired self concept, body image, feelings of attractiveness as a sexual being, e.g., masculinization or feminization or obesity resulting from hormone therapy, role reversal.

Inadequate control of symptoms resulting from cancer therapy.

Changes in libido.

Feelings like anxiety, fear, depression, mood swings, anticipatory grief, loss of control, and loss of intimacy.

Drugs: Antidepressants, Antihypertensives, Narcotics.

Fatigue and hormonal changes.

Do:

Vaginal while undergoing radiation therapy will help reduce the possibility of vaginal stenosis and contractures (tightening).

express desire for sexual interaction when you feel able; do not wait for your partner to express interest.

1. Empty before sexual activity.

2. Use pouch cover.

3. If leaks happen, shower together and continue sexual play.

4. Tuck pouch into supporting belt.

5. Turn appliance to side.

6. Try alternative positions if there is uncomfortable rubbing.

7. For women: crotchless, lacy underwear covers the appliance, but leaves the genital area open.

Dont:

1. Do not have intercourse if your white blood counts are dangerously low, because you are at risk for infection.

Call MD:

If you notice new or more pain, bleeding, or a change in erectile function or semen volume. Report any suspected vaginal infection, redness, swelling, foul-smelling discharge, or itching.

Shortness of Breath (Dyspnia)

Definition: Breathing difficulty happens when not enough oxygen is in the body. Either the lungs cannot breathe in enough air, or they cannot bring enough oxygen to the bloodstream.

Symptoms: Gasping for air, fast breathing, wheezing or coughing, holding the throat or chest, face turning blueish/grey, feeling like there is not enough air.

Causes:

Chronic lung disorders.

Airway obstruction.

Pneumonia.

Pain.

Immobility.

Malnutrition.

Obesity.

Stress or anxiety.

Surgery.

Anemia.

Chemotherapy.

Radiation.

Fluid in the lungs.

Do:

Dont:

1. Do not lie down.

2. Do not panic.

Call MD:

If you have chest pain, breathing becomes faster, pulse rate increases, skin looks pale or takes on a bluish color, skin feels cold and clammy, nostrils flare when inhaling, breathing is accompanied by wheezing, if there is thick, yellow, green, and/or bloody sputum, or if a fever happens.

If shortness of breath becomes a chronic problem, the patient may get a doctors prescription for oxygen therapy at home. Oxygen can be stored in a big tank, several smaller ones with extension tubing, and a portable tank which can be attached to a wheelchair. Safety precautions must be taken with oxygen use. The patient, visitors, and family should beware of flames of any type: cigarettes, pilot lights, and so on can cause an explosion. Care should be taken not to get kinks in the tubing that will block the flow. The flow rate should not be increased unless the physician orders it.

Skin Changes

Definition:

Itching (): Want to rub or scratch.

Brown spots/liver spots: Darkened areas or freckles.

Rash: A series of red or white spots clumped in a pattern.

Symptoms:

The usual symptoms of radiation recall are patches of redness and shedding or peeling of the skin, but there may also be blisters and wet, oozing areas of skin that peel. After the skin reaction heals, the skin will be permanently darkened. Darkening of the skin. This may happen in the nail beds (sometimes in bands), inside the mouth, on the gums or teeth, as lines along the trunk, or along the veins used for chemotherapy administration. Sensitivity to sun and light. Sensitivity to the sun is a common reaction that causes some people to suffer severe sunburn after just a short exposure to the sun.

Causes:

Surgery, e.g., wound healing.

Radiation therapy, e.g., local skin reaction in treatment field.

"" is a reaction that can happen when chemotherapy is given after radiation therapy. It may happen several weeks or months after radiation therapy has ended, and involves only the skin that has been exposed to radiation before.

Chemotherapy, e.g., allergies to cancer drugs, fluid and electrolyte conflicts related to side effects of drugs (dehydration, high calcium)

Immunotherapy, e.g., local skin reactions at present or previous injection areas, allergic response.

Graft-versus-host disease.

Aging.

Dry atmospheric conditions.

Allergic reactions to foods, clothing, drugs, and so forth. Liver and/or kidney dysfunction.

Anxiety.

Sun exposure.

Do:

Wash underclothes or any clothes that will come in contact with the treatment area with a mild detergent. Use

water-soluble skin moisturizers on damp skin.

Dont:

1. Do not drink alcoholic or caffeinated beverages.

2. Do not scratch.

3. Do not scrub skin.

4. Do not expose skin to strong, direct sunlight or heat.

5. Do not expose skin to the cold.

6. Do not use hot water for baths; instead, use warm water.

7. Do not use a lot of top bedding.

8. Do not use scented alcohol-based products or harsh detergents on skin.

9. Do not use deodorants, perfumes, adhesive bandages, powders, tape, and cosmetics on the skin in the treatment area.

Call MD:

If you have a yellowish tone to skin and/or whites of eyes, deep orange-colored urine, white or clay-colored feces/stools, bruises or areas of blue or purple skin, difficulty breathing, redness or rash on skin, swelling in an area that is discolored, or itching.

Sleeplessness (Insomnia)  (See pain-relaxation techniques)

Definition: Inability to go to sleep, stay asleep, or sleep long enough, uninterrupted, to feel rested and relaxed on awakening.

Symptoms:

Tossing and turning at bedtime, takes longer than thirty minutes to fall asleep, cant stay asleep for longer than a few hours, and need naps to feel rested.

Causes:

Tumor invasion, e.g., obstruction, pain, fever, shortness of breath, pruritus, fatigue.

Surgery, e.g., pain, frequent monitoring, narcotics.

Chemotherapy.

Drugs, e.g., narcotics, caffeine, sedatives, steroids.

Changes in sleep environment, e.g., hospitalization.

Increased physical and/or psychological stress.

Decrease in physical exercise.

Depression.

Do:

Dont:

1. Do not go to bed with worries.

2. Do not do exhausting activities or exercise before bedtime.

3. Do not eat a large meal or drink caffeinated beverages before bedtime.

4. Do not take naps during the day if possible.

5. Do not take diuretic medications or drink a large amount of fluid after dinner to avoid waking to use the bathroom.

6. Do not be afraid to take pain medication. It is not addicting in the patient with cancer.

Call MD:

If the pain is severe, unrelieved by medications, or you have swelling, redness, or fever with it.

Urinary Tract Problems/Kidney Dysfunction

Definition: Decreased ability of the kidney to do normal functions of filtration, secretion, and elimination of fluids, electrolytes, and waste products of cellular metabolism.

Symptoms: Frequent urination, decreased urine output, discoloration of urine, low back pain, or incontinence.

Causes:

Chemotherapy.

Radiation therapy.

Infection.

Tubular damage resulting from fever.

Rapid tumor cell lysis resulting from radiation therapy, chemotherapy, and/or immunotherapy.

Renal toxicities of drugs, e.g., antibiotics.

Do:

Dont:

1. Do not wait more than six to ten hours before urinating.

Call MD:

If you have frequency or urgency (feeling that you must urinate right away) of urination, burning or pain on urination, urine that is cloudy, dark, reddish or brownish in color, or contains blood, fever, chills, or weakness, or low back or flank pain. You also should be aware that some anti-cancer drugs cause the urine to change color (orange, red, or yellow) or to take on a strong or medicine-like odor.