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Nearly every cancer patient complains of fatigue, and this can be the most difficult side effect to manage. Sometimes it is due to anemia, which results because the chemotherapy drugs impair production of red cells. If severe enough, your physician may recommend blood transfusion or treatment with drugs that stimulate the production of red cells. Regular rest and restricting yourself from activity that is too demanding can help prevent fatigue. Because dizziness can also be associated with fatigue, be careful when changing positions, and avoid situations in which you might be injured as a result of dizziness: driving, operating machines (including kitchen appliances and sewing machines) and climbing ladders and steps.

Related to fatigue is a poorly defined but very common side effect often termed “chemo brain.” Many patients will complain of mental fuzziness, difficulty in concentrating and memory problems during treatment. For most patients, these complaints resolve when treatment is completed, but it is difficult to know exactly why they occur. These symptoms are best managed by simple, non-medical means: get plenty of rest; use memory assist such as a notebook to write down things you need to remember; avoid making decisions and tasks that require focus as long as you are having difficult; and enlist the help of family members to help you navigate the day. This is one place where patients report that a sense of humor is a great help. Laughing at the small problems that “chemo brain” can create, and remembering that it is temporary helps maintain balance.

Just as chemotherapy drugs prevent the production of red cells, they can prevent the production of the white cells that prevent infection and the platelets that prevent bleeding. As a result, cancer patients are more likely to suffer from infections, and are more likely to bruise or bleed, even from relatively small trauma. Your physician will keep track of your blood cell counts in an effort to prevent serious complications from white cell and platelet loss, and my prescribe medications to help stimulate production of these cells if your counts are low enough. It will be important for you to avoid situations which might result in bleeding, bruising and infection. Good hygiene, including proper and frequent hand-washing and avoiding crowds during cold-and-flu season will help avoid infection, and your physician may also request that you limit contact with your pets when you are most vulnerable to infection. Should you develop a fever or other signs of infection, or signs of bleeding (after tooth-brushing, unexplained bruises or blood in the urine or stool), notify your physician immediately.

In addition to nausea and vomiting, many patients experience oral or gastrointestinal side effects. Patient may develop sores in the mouth, constipation or diarrhea. Advise your physician if any of these develop, but for the most part common sense remedies will be sufficient. If constipated, increase the amount of fiber and fluid you are consuming, and use a gentle laxative if your physician approves. For diarrhea, avoid foods that are bulky and be certain to consume sufficient fluid and electrolyte replacement. Your physician may also recommend medication to help control bowel movements. If you develop mouth sores, advise your physician who can prescribe oral rinses to help manage the discomfort. Be aware that some patients also experience thrush, an unpleasant yeast infection of the mouth and throat that causes patchy white or red areas on the tongue, gums and surfaces of the mouth. This can usually be treated with a rinse. Thrush can also occur in the vagina, and is treated with creams that are directly applied. Occasionally the yeast that causes thrush (or other pathogens) can also cause infection of the bladder (cystitis); if you experience frequent urination, discomfort passing urine, or burning in the urethra, advise your physician immediately so that proper treatment can be started.

Nausea and vomiting as side effects of chemotherapy.

Mucositis as a side effect

Shingles in cancer patients

Managing your chemotherapy side effects

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