Treatments

Managing Side Effects

The side effects of chemotherapy you may experience are generally dependent on the type of chemotherapy given. Below are some of the most common general side effects of chemotherapy and information on how to manage them. For more information on how to manage the specific side effects of chemotherapy you are experiencing, we encourage you to visit www.chemocare.com, where side effects are listed alphabetically with explanations and management tips.

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Constipation

Defined as less frequent and/or harder than usual bowel movements, constipation can be a result of pre-existing conditions, cancer and any pain or other medications you may be taking. Remedies you have used in the past for mild constipation may not be effective. You will likely need some form or combination of a stool softener (like docusate sodium or Colace) and a stimulant laxative (like senna, milk of magnesia, or dulcolax) as well as other laxatives (like miralax or lactulose). A handout with the information below about constipation is provided in your new patient packet . Please review it for helpful information. Remember, if you are already without a bowel movement for more than one day, you will need to start at level 2 or higher right away.

You may use Milk of Magnesium 1-3 times daily or Miralax 1-2 times daily at any level.

  • Level 0: Docusate Sodium 100 mg by mouth twice a day; Senna 2 tablets by mouth at bedtime

          If no bowel movement in 24 hours, then go to level 1

 

  • Level 1: Docusate Sodium 100 mg by mouth twice a day; Senna 2 tablets by mouth twice a day

          If no bowel movement in 24 hours, then go to level 2

 

  • Level 2: Docusate Sodium 100 mg by mouth three times a day; Senna 3 tablets by mouth three times a day

          If no bowel in 24 hours, then go to level 3

 

  • Level 3: Docusate Sodium 250mg by mouth twice a day; Senna 4 tablets by mouth three times a day; Dulcolax 3 tablets by mouth three times a day

If you experience diarrhea using these medications, stop taking the medications above for 24 hours and then restart the medications at one level lower than you were on when the diarrhea occurred. 

If you are on dialysis or have kidney failure, avoid any foods or laxatives containing magnesium or potassium (i.e., Milk of Magnesium or prunes).

Avoid suppository and enema use unless previously discussed with your doctor

Always consult a nurse or doctor if you have any questions or concerns.

Always call your doctors office if symptoms worsen.

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Nausea and Vomiting

Nausea is an unpleasant feeling of the need to vomit. Vomiting is the actual expulsion of stomach contents through the mouth. While many types of chemotherapy can produce these effects, there are many medications that can be used alone or in combination to help minimize them. In addition, anti-nausea medications can be given in many forms in case you are so nauseated you can’t keep pills down long enough for them to take effect. Some can dissolve on or under the tongue, others can be given as rectal suppositories. Using these medications, often in combination, before the nausea or vomiting gets severe (e.g. “at the first hint”) can help prevent or minimize your discomfort. Waiting until you actually vomit may be too late. Please let the nurses or doctors know if you are using your anti-nausea medications to their full strength/dose/combination and still experiencing nausea and/or vomiting. If needed, we administer intravenous anti-nausea medications in the office. Remember that the nurses in the office will give you different anti-nausea medications than you are taking at home, so you can begin to take your medication immediately, even though you had anti-nausea medications in the office.
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Fatigue

This is more than just feeling tired. It is a daily lack of energy that is overwhelming and like nothing you have experienced before. It is not totally relieved by rest or sleep like a typical episode of feeling tired. Fatigue may linger for weeks or months after chemotherapy has ended. Science has not yet determined all the factors that play a part in fatigue. Therefore, a treatment for this side effect is not easily forthcoming. Fatigue may be both physical and mental. Some mild exercise alternating with rest periods can help the physical part. Computer games or crossword/word puzzle games can help with the mental part. Try to maintain a diet with moderate to high protein and calories and 48 to 64 ounces of fluids daily. Take naps as needed, and pick and choose your activities carefully to conserve energy. Staying active, within reason, helps to lessen the fatigue even though it sounds counterproductive.
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Diarrhea

Defined as more frequent and looser bowel movements than usual, diarrhea can be caused by some chemotherapy medications, as well as other cancer treatments, or even the cancer itself. It can also be caused by other infections as a result of cancer treatment that may lower your immune system defenses. In severe cases it can lead to dehydration, so please let our office know if diarrhea is a problem for you and you have not been able to keep it under control with home measures. Imodium over the counter can be used. Take one tablet after each loose stool, up to 8 tablets every 24 hours. Other medications to use in addition to the Imodium can be prescribed to slow diarrhea down. You may be asked to leave a stool sample for testing to determine if an infection is the cause. Please keep up your clear liquid (you can see through it) intake and limit your solid food intake during episodes of diarrhea. You may also try the BRAT diet (bananas, rice, applesauce and toast) to decrease the diarrhea.
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Dehydration

With excessive loss of body fluids (through vomiting, diarrhea, or a high fever) or a lack of fluid intake (nausea, low appetite, trouble swallowing) over an extended period of time, your body can become dehydrated. The best way to treat dehydration is to prevent it. Be aggressive in treating your symptoms of nausea or diarrhea. Let our office know if you have a fever of 100.5 degrees Fahrenheit or above, or if you are having difficulty swallowing fluids so we can help you manage these problems. If you have been over 24 hours with little fluid intake or severe vomiting or diarrhea, please let our office know. We may need to give you fluids intravenously. Try to contact us before noon so we can arrange this for you.
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Mucositis/Mouth Sores

Some kinds of chemotherapy (or radiation to the mouth or throat) can cause inflammation to the mucous lining of the mouth and throat. This is sort of like a bad, weepy sunburn inside your mouth and/or throat. It can be very painful and interfere with your ability to eat, drink, or sometimes even talk. It usually goes away as you recover from your last treatment cycle of chemotherapy (or radiation). Keep your mouth as clean as possible by rinsing with warm mild salt water, or even plain water frequently. Use a gentle toothbrush; avoid harsh alcohol containing mouthwashes and even dental floss if your gums are bleeding. Keep your lips moisturized with lip balm. Take your pain medications and use a numbing ointment like Orabase, Oragel, or other baby teething product. Let our office know if this is a problem for you, as other medications may need to be prescribed for pain or infections. Your chemotherapy dose may also need to be adjusted to reduce/prevent this from occurring again.
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Sexual Intercourse

Science has not given us the final answer to the safety of sexual intercourse during the weeks/months or for the weeks/months immediately following chemotherapy. Any bodily fluid/secretion has the potential to transmit chemotherapy from one person to another. Therefore we suggest the use of condoms to keep the transmission of bodily fluids (semen and other secretions) from one partner to another to a minimum for at least 2 weeks after receiving chemotherapy. However, the risk of possible chemotherapy spread through bodily fluids is highest during the first 72 hours after receiving chemotherapy.
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Pregnancy

It may take up to 6 months or so for the sperm to be free of the altered genetic effects of the chemotherapy to make it safe for patients to consider pregnancy. In that case it is recommended that adequate birth control methods be used during the time of chemotherapy and for at least 6 months following chemotherapy.
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