Chemotherapy

Your oncologist has determined whether you will need chemotherapy, radiation or a combination of both. Your doctor and nurse navigator will be involved in your treatment management. You will have to learn to understand your white cell count which will determine your treatment scheduling.

Chemotherapy

You have been told that you will need chemotherapy. The first questions are:

• What kind of chemotherapy and what are the names of the drugs that I will be taking?
• What is the treatment cycle and how often will I take these drugs?
• Should I use a Port?
• What side effects can I anticipate?

The Importance of a Port

When your chemotherapy regime is outlined and a starting point is suggested, your medical team could suggest a Port to be inserted into your chest wall to be the receptacle to deliver the drugs themselves. The insertion of the port ensures your comfort and freedom of being picked with endless needles, trying to find a suitable vein to receive the drugs. This line will serve as the vehicle to receive the chemotherapy and to distribute it systemically throughout your body. Your nursing team will review the directions on how to take care of the port, the procedures they will follow to insert the needle for chemotherapy delivery and the procedure she will use to flush the line and keep it from plugging up. The port option was not a well known option while I was going through my treatment. If your doctor is suggesting a port ... go for it. The discomfort will be lessened and you will feel more comfortable.

Every doctor who inserts a port hs a different procedure and a different site for placement. Inserting the port is done typically as an outpatient and is done with quick-acting general anesthesia. Afterwords, the port site can be painful but the discomfort lasts only a short time. Sometimes the placement of the port will interfere with your bra strap. Please see your mastectomy specialist in your area and she will guide you to the appropriate bras and post-operative bras to help you. There is always a solution for comfort with many different bras availale to you today. You just have to try them on until you find one that suits your situation.

Ask Questions

• Will it hurt when you insert the needle for treatment?
• Will this interfere with my bra strap?
• Will it be uncomfortable when I sleep?
• Can I take a bath and soak with a port?
• How do I keep that area clean?

On the first day of chemotherapy your nurse will guide you through the process. She will explain everything she is doing and why she is doing it. Once the chemotherapy has been instilled or if there are several drugs that she is working with, you may have some down time between infusions. Create your own "Chemo Kit" so you have everything you need:

• Large comfy bag
• Bottle of water
• Your favorite non-perishable such as crackers with peanut butter, breakfast bar, salted peanuts, pack of cookies. Something dry to munch on.
• Good book - something inspirational or short chapters. Easy to read and digest from nerves on chemo day
• Good magazine, crossword puzzle or note games
• Your current medications, in case someone wants to talk about what you are taking and you just can't remember
• Cozy cap - you may want to take your wig off and wear a cozy cap. If you doze off you won't have to worry about your wig being straight
• Bible, prayers and prayer cards if appropriate
• Tape player, iPod or other electronic device to listen to your music or book to tune the world out
• Pillow for your eyes in case you want to take a snooze
• Blanket to keep you cozy
• Extra set of underwear - just in case
• Tissues or handkerchief
• Pack a sense of humor and good hope

Most chemotherapy treatment centers treat multiple people in one big room at one time. Typically there are recliner chairs which are comfy and accessible. In most hospital systems there are a few private rooms, so if you wish to be private talk to your nurse and request some tme alone in one of those rooms. Although, I felt OK at treatment there were a couple of times when I definitely wanted to be by myself and wanted to cry by myself, not in front of everyone.

There are many questions needed to be asked:

• Will I get sick and what happens if the nausea continues while I am at home?
• What other side effects can I anticipate?
• White cell count. What does it mean and how will it affect my treatment scheduling

Years ago, anti-nausea drugs were not as affective as they are today. Patients became so violently ill that they could not stomach the consequences of chemo and stayed in bed with the shades turned down for the entire month. With the advent of new synthetic anti-nausea drugs recommended by your doctor you will find that the nausea is more under control than ever before. Some patients may still have a great deal of trouble. Doctors and nurses are very sensitive to this issue and the combination and dosages of these drugs need to be manipulated and adjusted in order to gain control of nausea. Please keep in mind that most people going through chemotherapy work full time and do not have significant problems. Work with your nurse navigator to find the right balance for you.

Ideas to Keep You Up and Your Stomach Down

• Drink plenty of fluids, water preferably. However juice, Smart Water, tea, ginger ale, Gatorade, etc. All these products are appropriate and will keep you hydrated.
• The morning of your treatment eat a simple and easy breakfast - a bowl of cereal such as oatmeal with a banana, hard boiled egg and a slice of toast of breakfast bar
• Do not focus on eating 3 meals a day while going through treatment. Eat more often, a little at a time, and keep drinking fluids
• For me the night of treatment I ate pizza ... go figure. I guess I just needed something like that to sit on my tummy. Find your own special trick and keep using it
• Follow your doctor's orders for guidance with anti-nausea medications. Be aware of the side effects of those medications and discuss with your nurse and/or doctor what the doses of the medications to decrease related side effects. Talk with your treatment life coach for information as well.
• Your body needs encouragement with fluids, proteins, minerals and constant nourishment. Talk with a trained professional and discuss what you have found that works. Talk to your doctor about any health supplements you are taking or wish to take. During chemotherapy your body will metablolize differently and it will be important that you check things out with your oncologist to get his/her blessing
• Mints, chewing gum, lifesavers will help resolve the metallic taste in your mouth caused by chemotherapy. There is also a product called Quesy Drops that are all natural and formulated to quell the nausea, help keep your tummy from barking back and diminish the metallic taste
• Initially, after chemotherapy is infused, especially with Adriamycin (which is red in color) your urine may be red tinged. Please continue to drink fluids. If your urine continues to be discolored for several days after chemotherapy, contact your doctor or nurse and let them know

Other Side Effects

• Hair Loss: My first question was - will I lose all my hair? Talk to your doctor or nurse regarding your course of treatment and whether it will cause hair loss. Chemotherapy typically cause hairloss around the 14th day after your first treatment. Your hair will begin to come out in clumps. See your wig specialist to clip your hair and obtain your wig. We recommend selecting your wig prior to treatment so you and your stylist can select a wig that is right for you. You will be ready when your hair starts falling out

- If your treatment will cause hair loss, yes you will lose all of your hair - head, pubic, arm pits, legs, arms and eye brows. That took some getting used to. I bought a wig, designed some hats that would cover my bald head and focused on my treatment and getting better.

-You will need to wear a wig or head covering for 6 to 9 months until your own hair grows back. Your hair may grow back with a different texture and color.

- Use Alra Shampoo, formulated to hydrate your scalp, before, during and after hair loss to keep you comfortable

• Numbness or tingling: Some chemotherapy drugs can cause a neruopathy occurring in your hands and/or feet. Contact your doctor or nurse for their direction. Be aware of how you are picking up things and make sure that you are using appropriate oven mitts in the kitchen for the oven and stove. If the sensation/s continue to progress, your doctor may prescribe medications for you and/or decrease your dose of chemotherapy.
• Mouth sores: Good oral hygiene is always a good standard to use. If sores do occur, contact your doctor or nurse. They may offer some medication for relief or suggest an over-the-counter preparation that will be effective. It is best to drink cool liquids, refer to my Oncology Milk Shake (below) that can be served in small amounts and give you the proteins and vitamins needed to aid in healing.
• Diarrhea: Either of these things may occur with chemotherapy. I had intense abdominal gas due to the Cytoxan that I took orally. My doctor then changed the protocol and gave it to me intravenously which helped. If diarrhea occurs, contact your doctor or nurse for guidance. Avoid spicy foods, alcohol and a diet high in fiber and vegetables which may increase diarrhea.
• Constipation: Can occur with some chemotherapy drugs and also is associated with pain medications. Consult your doctor or nurse immediately for a recommendation for a laxative or stool softener. Avoid using enemas and/or using suppositories. Check with your medical team first before doing anything. Increase your fluid intake and increase the amount of fiber in your diet as necssary and with guidance from your medical team.

Susan's Oncology Milkshake

Years ago, when I was a homecare nurse, I developed a milkshake I call the "Susan's Oncology Milkshake." I created this shake when my patients complained of not being able to eat great amounts of food while undergoing chemotherapy. Today with nausea this shake still is effective and soothing for chemotherapy patients:

• 1 can Ensure (Your choice of flavor)
• 1 scoop ice cream or forzen yogurt (Your choice of flavor/no nuts)
• 4 - 5 ice cubes
• 1 raw egg
• 1/2 banana
• Flavoring of your choice such as chocolate syrup or vanilla flavoring
• Put all ingredients in the blender andblend until it becomes frothy
• Pour and serve into a 6 oz. juice glass. Put the container in the refrigerator and serve as the patient requests throughout the day
• Show this recipe to your doctor before you use to make sure all ingredients are approved by your doctor or nursehttp://www.susansspecialneeds.com/