Combating Chemotherapy Side Effects

Commonly prescribed anti nausea medicines include:

• Prochlorperazine (Compazine).

The below are often prescribed with standard chemotherapy's:

• Aprepitant (Emend)
• Granisetron (Kytril)
• Metoclopramide (Reglan)
• Ondansetron (Zofran)
• Dolasetron (Anzemet)
• Dexamethasone (Decadron)
• methylprednisolone (Medrol and many other names)
• haloperidol (Haldol)
• dronabinol (Marinol) (like medical marijuana!)
• ativan (lorazepam) and xanax (both of these are anti anxiety, not strictly anti nausea)

Prevention strategies:

Eating and drinking

• Eat and drink slowly.
• Drink liquids frequently and in small amounts.
• Eat many small meals throughout the day instead of three full meals.
• Avoid strong smells by eating food that is cold or at room temperature.
• Drink clear, unsweetened fruit juice or light-colored, non-caffeinated soda.
• If you are nauseated in the morning, keep dry foods such as cereal or crackers at your bedside and eat them before you get up (but not if you have throat or mouth sores or a lack of saliva).
• Do not eat sweet, fatty, or fried foods.
• Savor mints or tart candies (but nothing tart if you have mouth sores).
• Chew your food well to help with digestion.
• Drink an hour before or after, instead of with, each meal.
• Rest but do not lie down for at least several hours after eating.

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By David Drum
WebMD Medical Reference from "Making the Chemotherapy Decision"

This article deals with the physical side effects of chemotherapy, which can be quite powerful although they are almost always transitory. More than a dozen of the most common physical side effects experienced from chemotherapy drugs are included here, with suggestions on how to relieve them. Keep in mind that no one experiences all these side effects.

Methods and techniques to manage side effects include medications available to you through your doctor, practical or behavioral changes, and dietary and nutritional modifications that are helpful with some side effects, such as diarrhea. Nutritional methods of relieving some side effects are included in this article. Not included here are psychological or social side effects such as emotional stress.

Remember, no one experiences all the possible physical side effects of chemotherapy. More and more people undergoing chemotherapy experience no side effects at all, or side effects that are mild and easily controlled. Certainly, any side effects that are unusual or that bother you should be reported to your physician. Your medical oncologist is the final authority on controlling the physical side effects of chemotherapy.

Why Side Effects Occur

Your entire bloodstream may be flooded with powerful toxins for a short time during chemotherapy treatments, and many anticancer drugs pack quite a wallop. Chemotherapy's short, powerful toxic rush affects all of your body, especially those groups of cells whose rapid growth rates are similar to the growth rates of cancer cells, which the anticancer agents seek to destroy.

Cells grow and divide quickly in the hair follicles, which is the reason why you need to periodically cut your hair. Some of your fastest growing cells keep your skin smooth and your fingernails hard, forcing you to get a manicure now and then. Cells are continually produced and sluffed off all along the gastrointestinal system, which begins at your mouth and ends at your rectum, and includes the esophagus, stomach, and intestines. The cell growth and destruction that occurs inside your gastrointestinal system is a part of the complex natural process that routinely breaks down and digests an overwhelming variety of plant or animal foods. Within your bone marrow, a fresh new supply of nascent red and white blood cells called "stem cells" is constantly and quickly being generated. Within your body, approximately ten million cells are replaced every second.

Physical side effects spring from chemotherapy's inadvertent poisoning of these fast-growing cell groups, and the temporary knockdown of these cell populations that a dose of toxic chemicals imposes on your body. Most physical side effects are quite temporary, although in a few cases heart, lung, or reproductive organ damage can remain after treatment, and other side effects may occur years after treatment. Most side effects will eventually pass due to your body's extraordinary ability to heal and mend itself over time. Side effects are evidence that the chemotherapy drugs are affecting your body, and an unpleasant reminder that the drugs are working.

Physical side effects include immediate side effects that can come and go soon after the chemotherapy treatment is completed, such as nausea or vomiting. Chronic side effects such as low blood counts may linger through the course of treatment and sometimes beyond.

Achieving Control

Utilizing a multi-disciplinary approach to the side effects of chemotherapy allows you to attack the physical symptoms you experience from several angles, some of which you control. You may find that combination of medical and nonmedical techniques that is most effective for you in mitigating the side effects you experience. For example, one side effect, which has obvious psychological and physical elements, is pain. Pain may be relieved by medical means, of course, but for many people some pain relief can be achieved, or the effects of medicine enhanced, by the employment of self-help, stress-relieving exercises and techniques.

The following list of physical side effects may be intimidating if you have not yet begun chemotherapy treatment. Please remember nobody ever experiences all the possible medical side effects of chemotherapy. Your doctor will give you an idea of what side effects you might reasonably expect from chemotherapy. However, as you've probably discovered by now, it does no harm to be prepared.

Common Side Effects

Here is a list of the most common physical side effects of chemotherapy:

Nausea
Hair loss
Loss of appetite
Fatigue or anemia
Infections
Blood clotting problems
Mouth, gum, and throat problems
Diarrhea
Constipation
Nerve and muscle effects
Skin and nail changes
Kidney and bladder effects
Fluid retention
Tooth decay
Sexual/reproductive changes

Nausea

Chemotherapy drugs can affect either the stomach itself, or the part of the brain that controls the impulse to vomit. People who experience the side effects of nausea or vomiting can feel a bit nauseous most of the time, or very nauseous only part of the time. Nausea frequently begins a few hours after chemotherapy treatment, and some people may feel nauseated for a day or two. In addition, some people experience anticipatory nausea, in which they begin to vomit before their actual treatment begins. One medical oncologist tells the story of a patient he ran into in the supermarket many years after chemotherapy the patient recognized the doctor, paused to say hello, and then vomited.

Chemotherapy drugs that frequently cause nausea include cisplatin, cyclophosphamide, dacarbazine, dactinomycin, mechlorethamine, and streptozocin. Chemotherapy drugs with a low potential for creating nausea include bleomycin, fluorouracil, etoposide, methotrexate, chlorambucil, vincristine, vinblastine, mercaptopurine, and melphalan. Many people fear they will experience uncontrolled vomiting after receiving chemotherapy, but this side effect can almost always be controlled.

Tips for controlling nausea. Your doctor may recommend a number of medications that can control or lessen experiences of nausea. These antiemetic drugs are usually administered before chemotherapy actually begins so that the medication has time to take effect. Particular drugs and doses are sometimes changed until a proper fit is found to control your symptoms. Kytril and Zofran are among the newest and most effective anti-nausea medications.

Several classes of antiemetic or anti-nausea drugs help control nausea and vomiting. Anti-emetics are often administered orally or intravenously, with their use continued through the period when nausea is expected to subside. Phenothiazines include Compazine, Trilafon, and Torecan. These are "old drugs" with moderate effectiveness against problems like nausea and vomiting. Butyrophenones include Haldol, Inapsine, and Innovar and are sometimes prescribed for nausea if phenothiazines don't work. Corticosteroids such as Decadron and methylprednisolone have antiemetic properties and are sometimes used with good results. Sedatives or hypnotics like Valium, Dalmane, and sometimes marijuana (THC) may be prescribed to reduce nausea.

Dietary tips for nausea. Prevention is a good strategy if the anticancer drug you are taking is likely to have a side effect of nausea. Don't force yourself to eat if you really don't feel like eating, or don't let family members try to force you to eat out of a mistaken sense of "trying to help." Avoid eating overly large meals during the times when you are likely to experience nausea. Rather than large meals, try sipping small amounts of soup, juice, or carbonated drinks that are neither too hot or too cold. Taking these liquids with a straw may help you avoid unsettling movement. Note that going on a fast before receiving chemotherapy will not prevent vomiting; fasting is not recommended because it interferes with good nutrition. Prevent dehydration during bouts of nausea by drinking small amounts of clear and cool beverages every fifteen minutes or so, and then gradually work your way back up to normal eating by taking small sips of water every several minutes. Increase the intake until you can tolerate a small meal.

Practical tips for nausea. You might try wearing loose-fitting clothes during and immediately after chemotherapy treatments. Try to avoid odors that bother you such as smoke or perfume, because for some people, odors trigger nausea. Loud noises and certain sights or images can trigger vomiting in some people, and in those cases it's recommended that you avoid what makes you sick. After eating, try sitting up in a chair rather than lying down. It may help you to avoid sudden changes in position that can cause something akin to motion sickness. Be prepared with buckets, towels, and washable linens in case of unexpected vomiting, which might occur someplace like in the car on the way home from a treatment, especially with a child. Keeping something like an airsickness bag on hand may increase your comfort level if you are afraid you will vomit at the wrong time. Get plenty of rest. To control anticipatory nausea, you may benefit from relaxation techniques, such as deep breathing exercises. A bit of distraction, fresh air, and exercise can help many people stave off nausea.

Hair Loss

Alopecia or sudden hair loss happens to many people undergoing chemotherapy. Hair loss affects both men and women. It is the most visible side effect of chemotherapy, and although it is not physically painful at all, hair loss can be emotionally traumatic if it occurs. With some anticancer drugs, hair loss is almost a certainty, with others it's unpredictable. The actual extent of hair loss depends on the person and on the anticancer drug or drugs being taken. Facial hair, underarm, and pubic hair may be lost. Hair loss typically begins within three or four chemotherapy treatments; hair may fall out very gradually, in clumps, or even all at once. Stress and malnutrition can also cause hair loss. Fortunately, hair almost always grows back after the treatments are completed, and sometimes begins growing back even before then. Hair occasionally grows back thicker or thinner than before. Gray hair sometimes grows back in its original color. Ask your physician if hair loss is likely to occur with the treatment you are receiving, because it's a side effect you can plan for in advance.

Practical tips for dealing with hair loss. Having your hair cut short makes it appear thicker, and will help you minimize any problems you might have if you do lose hair. To minimize or slow hair loss, pamper your hair. Washing or shampooing hair will not cause hair loss in itself, but be sure to use a soft hair brush and a wide-toothed comb. Also use mild shampoo (preferably one indicated for use on damaged hair) and conditioner for fine or limp hair. Pat hair dry with a towel, or use the lowest settings on electric hair dryers when drying your hair, holding the dryer at least four inches from your head.

Do not have your hair dyed, and don't get a permanent during chemotherapy treatment. Do not use bobby pins, curlers, and don't put your hair in a ponytail even if you're a man. Wigs are available for both men and women. You may want to shop for a wig or hairpiece as a preventative measure, before you lose a lot of hair, because it's easier to match your natural color when you have hair to match. It may also be possible to borrow a wig local offices of the American Cancer Society sometimes have "loan closet" programs that loan wigs to cancer patients who cannot afford to buy them. You may even need two wigs, if your treatment is expected to last a year or more. Real hair wigs can also be made from your natural hair, if you cut it off before it falls out, but these wigs are expensive. Other types of custom-made wigs cost as much as $3,000, and are made from fine natural hair, with a foundation of lace which is custom fitted to your scalp. Less expensive ready-to-wear wigs can be purchased for as little as $75. Ready-to-wear wigs use nylon foundations and usually a more coarse grade of hair, sometimes synthetic hair, but they come in a wide range of styles and colors right off the shelf. Take a snippet of your hair and a snapshot of yourself before hair loss occurs. You may want to be fitted for a wig, or select scarves, hats, or turbans to wear in case you lose your hair. During re-growth, continue to pamper your hair. Minimize brushing and hair styling. Use as little as possible of mousse, styling gel, spritz, and hair sprays. Avoid permanents or hair dyes until the hair is at least three inches long and scalp is no longer sensitive.

Other methods of dealing with hair loss. Two medical methods are sometimes employed in an effort to minimize hair loss, but neither works all the time. Both methods involve wrapping the head in an attempt to minimize the amount of chemotherapy drugs which can reach the hair follicles of your head. One method uses an ice pack to cover the scalp. The other method uses a sort of scalp tourniquet or blood pressure cuff, which is inflated at the scalp to a level that exceeds the patient's normal blood pressure. Both are applied before chemotherapy treatments are begun, and continued for several minutes after each cycle of chemotherapy is completed. These methods may be comfortably used for short-duration chemotherapy, but not for chemotherapy that lasts a long time. Sometimes these techniques don't work to reduce hair loss. Some oncologists avoid both methods, because they fear the sanctuary that is created near the scalp may provide a site for a metastasis of cancer.

Loss of Appetite

Anorexia or loss of appetite is fairly common for people fighting cancer, due to physical as well as emotional stresses. Beware of protein or carbohydrate malnutrition. Taste alterations in many foods can also occur due to chemotherapy's effects; the taste alterations that occur are different in every individual but can affect appetite. Some anticancer agents dry the lining of your mouth, which can make it difficult to eat or swallow. Anti-nausea drugs can also cause the problem of dry mouth, which usually disappears when you stop taking the medication.

Practical tips on loss of appetite. It is important to keep your body as fit and well nourished as possible through chemotherapy, and then afterward, to help prevent a recurrence of cancer. A good moderate exercise such as walking may help you work up an appetite. Take heart in knowing that if your chemotherapy treatment is successful, and you achieve a complete or partial remission, your appetite will return as will your enjoyment of certain foods. Remember that cycles of rest are built into chemotherapy treatment, specifically to allow you to increase your intake of such essential nutrients as calories, vitamins, and minerals.

Dietary tips if food tastes different. Eliminate the foods that bother you from your diet, and look for substitutes. Try substituting chicken or fish for red meat, if the taste of meat annoys you. Try roasted peanuts rather than salted peanuts, if salted peanuts taste unpleasant. Try a different method of preparation microwaving rather than frying, for instance. Experiment. It is possible that you can find foods you might actually enjoy more than usual during chemotherapy. Experiment with different flavors and tastes. A zinc deficiency can accompany some cancer treatments, but may be remedied with a supplement containing zinc. Nutritional supplements such as Ensure pack a lot of calories into an easy-to-digest liquid form. A number of brands and flavors of these supplements are available, some milk-based and some non-milk-based, and you may want to experiment with these first to see if you like them, and then to determine if they help you retain your weight. Baby food is also quite easy to digest.

Dietary tips if you have dry mouth. Try drinking a bit more fluid than usual between and during meals, a total of eight or more glasses a day. Try a lip salve to keep your lips moistened. You might try lemonade or hot tea with lemon, which can stimulate your mouth to produce a bit more saliva. You may want to try eating softer foods, such as soups and puddings. Cold foods may be easier to swallow than hot foods. Simply sucking on lemon drops or sugar-free candy helps some people.

Fatigue

What physicians term bone marrow suppression is a common side effect of some chemotherapy drugs. Bone marrow suppression affects your body's ability to manufacture new red blood cells, and it can make you feel tired and fatigued almost all the time. A shortage of red blood cells means your body gets a bit less oxygen than normal, as one function of red blood cells is to carry oxygen from the lungs to all the parts of your body. This anemia can make you feel quite weak or fatigued. Other symptoms may include feeling dizzy, short of breath, or chilled. Pale skin and muscle weakness can be aspects of anemia. Dehydration, lack of sleep, and poor quality sleep are among the other factors that may contribute to fatigue.

Tips for combatting fatigue. Your doctor will do blood count tests frequently and may order a blood transfusion if red blood cell levels get too low. A prescription from your doctor could help you relax or sleep.

Practical tips for combatting fatigue. Get plenty of rest. If you can anticipate your periods of fatigue, plan ahead for them. Try to limit your activities to those you feel are essential. Ask someone to help you with the housework, or to drive you to the supermarket when you feel strong enough to shop. When getting up, get up slowly to minimize dizziness. Sometimes fatigue is a result of several factors, and some experimenting around may help you. Stress, worry, and anxiety are among the psychosocial factors that can be a significant cause of fatigue, and you might want to try some stress-relieving techniques.

Dietary tips for handling fatigue. Eat more foods rich in iron, such as liver, red meat, or green, leafy vegetables. For several hours before you go to bed, avoid foods containing caffeine such as coffee, chocolate, or colas. Meals may be organized in advance, with portions of dishes or casseroles frozen in smaller portions, so that the physical act of preparing and serving a meal doesn't exhaust your energies. Drink more water and other liquids to prevent dehydration.

Infections

Bone marrow suppression also affects the production of white blood cells, which are an important component of your body's immune system. White blood cells fight off most of the germs you normally encounter in the course of your life. Chills, fever, sweating, diarrhea, or redness or swelling around a sore or pimple may be signs of infection. Another sign is if you bruise easily.

Tips for treating infections. Your doctor can prescribe antibiotics to combat infections, so be sure to notify your doctor promptly if you see symptoms of infection appear. Don't take aspirin or any other medication to alleviate symptoms until you speak with your physician or nurse.

Practical tips to avoid infections. Fourteen days after treatment, the white blood cell levels usually fall to their lowest point, so this is when the possibility for infection is highest. Be unusually careful and clean during the time you are most vulnerable to infections. It is just common sense to steer clear of people who have infectious diseases such as measles or the flu. Minimize your exposure to crowds. Wash your hands frequently, before and after you eat or use the bathroom. Wear protective clothing or gloves when gardening or picking up after dogs or cats. Clean any cuts or nicks in the skin immediately, using soap and warm water followed by an antiseptic. Use an electric razor rather than a blade to shave your face or legs, and a soft toothbrush dipped in warm water to brush your teeth. Gently pat your skin dry after a warm bath or shower, and carefully clean yourself after each bowel movement. If you have access to a bidet, its use can make the act of going to the bathroom a bit more sanitary and help you keep yourself clean. Portable bidets which fit inside a regular toilet are available, too.

Dietary tips to avoid infection. Be careful to avoid uncooked fruits or vegetables, raw eggs, raw milk, and food items that may have been handled by others, as well as stagnant water.

A note about bladder infections. Bladder infections and other urinary tract problems can occur with chemotherapy, particularly if you experience nausea and vomiting or some other symptom that prevents urination, which is your body's way to clear the bladder and kidneys of chemical waste products. To prevent bladder infections, drink adequate amounts of fluids. Urinary tract infections have symptoms including frequent or urgent urination, burning sensation, off-colored or bloody urine, fever, chills and fatigue, or low back or flank pain. Your doctor may prescribe antibiotics or offer other suggestions to relieve these symptoms.

Blood Clotting Problems

Bone marrow suppression also affects the body's ability to manufacture the platelets that help blood clot. You may bleed or bruise more easily than normal while undergoing chemotherapy. You may see small red spots under the skin or have unusual looking urine or stools. Your gums or nose may bleed. Once this type of bleeding has begun, patients must frequently go to the hospital for blood transfusions to replace red blood cells and platelets lost from bleeding.

Tips for blood clotting problems. Report any unusual symptoms of this nature to your physician. Ask exactly what symptoms you might expect and what precautions he or she suggests. Always talk to your doctor before using medication, even aspirin or AlkaSeltzer, because some of these over-the-counter medications thin the blood and slow down its ability to clot.

Practical tips to avoid blood clotting problems. Avoid potential injuries. Be very careful not to injure yourself by not playing contact sports such as football or soccer. Avoid cutting yourself with sharp knives or kitchen tools. If you cook, wear a padded glove while handling hot dishes, and be careful not to burn yourself by avoiding very hot household objects such as heater vents and lit light bulbs. Wear protective clothing while gardening, and gloves while handling thorny plants such as rose bushes or cacti. Use an extra soft toothbrush dipped in warm water to brush your teeth. Blow your nose very gently, without applying pressure to your nostrils to minimize nosebleed.

Mouth and Throat Sores/Infections

Mouth and throat problems. Sores in the mouth or stomatitis may open you up to the possibility of infection from germs that live in the mouth. The tissues of the mouth and throat may become irritated, bleed, or become unusually dry. You may have trouble swallowing. You may have problems with cold sores, medically known as herpes simplex. Some people also get a yeast infection called thrush, which looks like little white patches on your gums or inside your cheeks. Inflammation or mouth pain can greatly inhibit normal eating or drinking.

Tips for mouth and throat problems. Mouth sores usually last only three to eight days, although they may affect your appetite for longer than that. Prevention takes time and attention, but it's much easier than medical treatment. Your doctor can prescribe an antifungal medication to control thrush. Many yeast infections respond to lozenges or throat drops that contain clotrimazole, or mouth rinses containing Mycostatin. Acyclovir, an antibiotic, can be prescribed to prevent the recurrence of herpes simplex. Kaopectate, milk of magnesia, or other liquid drugs are sometimes recommended to mitigate pain because they coat the sores and keep away the saliva. A combination of drugs may be necessary to achieve control in the most severe cases. If time permits, you should see a dentist or a periodontist before beginning chemotherapy. Always tell your dentist you are beginning or undergoing chemotherapy, and ask if he or she has any additional suggestions for keeping your mouth and gums clean.

Practical tips for mouth and throat problems. Generally speaking, keeping your mouth as clean as possible helps. Mouth rinses such as those using baking soda or those recommended by your doctor can help neutralize the acidic residue in your mouth. Commercial mouthwashes that contain salt or alcohol will irritate the soft lining of your mouth. Carefully use dental floss. It may help keep your mouth clean to carefully brush your teeth or dentures after every meal with a very soft toothbrush, using baking soda and water, or a nonabrasive toothpaste. Clean and then store your toothbrush in a dry place after use.

Dietary tips for mouth and throat problems. If your mouth or throat is sore, you may wish to eat cool, smooth foods like milkshakes, cottage cheese, or puréed vegetables and meats. Avoid spicy or hot foods that make your mouth sting. Liquid nutritional supplements such as Ensure and Sustacal are available at pharmacies and can be a good source of calories and proteins for some people at this time because they are not irritating to the mouth. Milk-free supplements are available if lactose intolerance is a problem. A diet containing adequate vitamins, minerals, and protein can speed the healing of mucous membranes.

Diarrhea

Chemotherapy can produce loose bowels or diarrhea because the cells in the intestinal tract are vulnerable to the effects of anticancer drugs and the body's natural response is to try to quickly rid itself of damaged cells. Diarrhea dehydrates the body and may block elimination of waste products through the urine if it continues for long periods of time, because of the body's natural tendency to conserve limited water. Diarrhea is sometimes accompanied by vomiting. Emotional stress, lactose intolerance, chemotherapy, or radiation treatment directed to the abdominal region, fecal impactions, and other factors including the use of antibiotics and sensitivities to certain foods can cause diarrhea. Along with losing water, you can also lose important minerals your body needs, such as potassium. Diarrhea may occur a week or so after a chemotherapy treatment.

Tips for combatting diarrhea. Always contact your doctor if diarrhea continues for more than 24 hours. If you have pain or cramping simultaneously, your doctor should be notified immediately. Some medications your doctor may prescribe include Kaopectate, Lomotil, Imodium, Omodiu, paregoric, cholestyramine, Donnatal, or Robinul. You doctor may wish to prescribe medication to relieve the diarrhea; although if you have an infection, he or she may want to prescribe antibiotics first. Consult your doctor if diarrhea continues after you have taken medication to stop it. Your physician may suggest that you go on a clear liquid diet for a day or two to rest your bowels, knowing that you can make up the calories you miss later.

Dietary tips for combatting diarrhea. Your fluid intake is quite important, so don't stop drinking. Try small amounts of water, fruit juice, soup, or even drinks such as Gatorade, a product formulated for athletes to replace lost electrolytes. The so-called BRAT diet of bananas, rice, applesauce, and weak herb tea can be easily digested and is used by many hospitals to control diarrhea. Avoid foods that may aggravate your bowels milk products, raw fruits and vegetables, spicy, greasy foods, or even coffee and tea. Foods that are high in potassium and don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes.

Constipation

Some anticancer drugs and some painkilling drugs can cause constipation, as can inactivity or poor diet. For example, some drugs used in chemotherapy such as vincristine and vinblastine, and other symptom management drugs such as narcotics and tranquilizers, can slow down the normal movement of the bowels. Emotional stress can be a factor, as can a lack of normal eating or drinking because of nausea or fatigue.

Tips for handling constipation. Your doctor can prescribe laxatives and stool softeners, some of which are as natural as olive oil or mineral oil. Only take laxatives under your doctor's supervision. You should not self-medicate for constipation by taking laxatives or suppositories before checking with your doctor. Enemas or suppositories have a risk of causing infection at the times when your blood count is low. Your doctor may prescribe a medication to stimulate the bowels. If your white blood cell count is lower than 1,800, you should avoid raw fruits and vegetables, including lettuce, which would normally be recommended as dietary remedies for constipation.

Practical tips for constipation. Regular and moderate exercise helps many people relieve this problem.

Dietary tips for constipation. Unless your blood counts are low or your doctor forbids it, try a high-fiber diet, including whole grains, fruits, vegetables, dried fruits, and fruit juices such as prune juice. Ideally, you should start the high-fiber diet before beginning chemotherapy treatments that might cause constipation. If you increase the amount of high-fiber foods you eat, you should also probably increase the amount of fluid you drink because the fluid helps the fiber work. Drink eight to ten glasses of fluid a day to avoid dehydration, and try more nutritional fluids such as juice, milkshakes, and eggnog rather than water if you feel the increased amounts of fluids are decreasing your normal appetite. Avoid refined foods such as white bread and candy. Also avoid chocolates, cheeses, and eggs, which can cause constipation.

Nerve and Muscle Effects

Some chemotherapy drugs, in some people, produce side effects that affect the nervous system or the muscles. The hands or feet tingle, feel numb, weak, or even burn. This neuropathic pain, or neuropathy, can affect the nerves after treatment with some chemotherapy agents, such as the platinum-based drugs or paclitaxel. Sometimes even a very light touch can trigger nerve pain. You may experience a loss of balance and have trouble with motor coordination. Sometimes the muscles can feel tired or weak or sore. Pain in the jaw or stomach and hearing loss can also be symptoms.

Tips on nerve and muscle effects. Use common sense when getting around. If you don't feel right, be careful. If your balance is a bit off, use handrails and supports wherever possible, or have them installed in the home. Some forms of exercise can help neuropathy, perhaps because this increases the flow of blood to the site. Simply squeezing little rubber balls or stimulating the skin on the feet by rolling them over an abacus-like device might be helpful. Ask for help if you need it. Report these types of problems to your physician.

Skin and Nails

Chemotherapy may result in minor skin problems such as rashes, redness, acne, itching, peeling, even a "dry look" or dry-feeling skin. Pruritus is an intense itching of the skin, which can be caused by dehydration or by some drugs used in chemotherapy. Some chemotherapy drugs or radiation therapy treatments may actually cause the skin to change in appearance, and occasionally to darken in color. Most chemotherapy makes the skin unusually sensitive to the effects of the sun. Since fingernails are just hardened skin cells, a related effect is that fingernails may become more brittle than usual, or change in color or appearance.

Medical tips for skin and nail changes. Let your doctor know if you develop a sudden or severe bout of itching, if you break out in a rash, or if you begin wheezing or have trouble breathing these can be symptoms of an allergic reaction. Ask about ointments or medications that relieve rashes and similar symptoms.

Practical tips on protecting skin and nails. Protect and pamper your skin and nails to prevent skin problems. Wear loose-fitting clothes. Wear protective gloves or clothing while performing chores. Take showers or sponge baths rather than long baths. Use creams or lotions when your skin is moist after a bath. Use water-based moisturizers. Keeping your face clean with medicated creams or soaps can help acne. Over-the-counter fingernail hardeners can help brittle nails, but discontinue their use if irritation results. Always protect your skin from wind and temperature extremes and from bright sunlight. Studiously drinking eight to ten glasses of fluid a day may help, too. It may help you to avoid unusually strenuous exercise. Cornstarch, baking soda, oatmeal, or soybean powder added to bath water can, in some cases, provide relief. Cool wet packs may help relieve itching. Train yourself not to scratch where your skin itches, because that irritates the skin and makes it itch even more.

Kidney and Bladder Problems

Some drugs used in chemotherapy can cause temporary or permanent damage to the kidneys or irritate the bladder. A few anticancer drugs cause the urine to turn orange, red, or yellow or to smell medicinal. Men may also experience a change in the appearance or color of semen.

Tips for kidney and bladder problems. Check with your doctor to see if the types of drugs you are taking can affect these organs, and ask what symptoms might be normal to expect. Always report unusual symptoms to your doctor. Some signs you should be sure to report include painful or frequent urination, discolored urine, and chills and fever.

Dietary tips for kidney and bladder problems. Drinking plenty of water and other mild fluids helps assure a good flow of urine through the kidneys and speeds the irritants out of your system as quickly as possible.

Puffiness (Fluid Retention)

Some drugs used in chemotherapy, particularly the hormones such as prednisone, may cause your body to retain fluid. Fluid retention will increase your weight even if you don't eat extra food. You may appear puffy in your face or other parts of your body. This side effect should be distinguished from a medical condition called lymphedema, caused by the backing up of lymph fluid in certain areas of the body after radiation therapy or surgical removal of lymph nodes.

Tips for fluid retention. Your doctor may be able to prescribe medicine to help your body shake off some of the excess water. Lymphedema occurs rarely, in either the chronic or acute form to prevent it, work with your physician and a physical therapist to develop an effective exercise program and a good nutritional program high in protein.

Dietary tips for fluid retention. Avoid the excessive use of table salt, or foods with high levels of sodium such as TV dinners.

Tooth Decay

Some chemotherapy drugs will cause you to be unusually vulnerable to tooth decay and gum or periodontal infections.

Tips for preventing tooth decay. As previously mentioned, it's a good idea to see your dentist or periodontist before you begin chemotherapy. Have your teeth cleaned. Have cavities filled, dentures well fitted, abscesses, and gum disease treated if possible. Ask your dentist the best ways to brush and floss your teeth while you are receiving chemotherapy treatments. Your dentist may suggest a fluoride rinse or a gel to use each day that will help prevent unnecessary tooth decay. You may want to carefully brush your teeth after eating, using a very soft toothbrush dipped in warm water to soften the bristles before each brushing.

Sexual and Reproductive Problems

A person's sexual urges and desires, and even the sexual organs themselves, may be affected by chemotherapy. Your age, general health, and the type and length of chemotherapy are factors that affect the severity of side effects in this area. Men may experience infertility, lowered sperm counts, and other reactions. Women may find their ability to produce some hormones reduced, or sustain damage to the ovaries, resulting in irregular or halted menstrual periods. Women can experience a "false menopause," with symptoms such as hot flashes, itching, and discomfort or dryness of the vagina that can make intercourse painful and leave them vulnerable to vaginal infections. Men or women may experience a change of attitude about sexual intercourse as a result of either physical or psychological factors. Painkilling narcotics can inhibit sexual desire. In addition, experiencing some of the other physical side effects of chemotherapy will affect normal sexual function and desire, which may be either diminished or different in form during chemotherapy. For instance, pain makes it difficult to relax, but painkilling medications may lessen interest in sexual activities even as they relieve the pain. Emotional stress and powerful emotions such as anger, anxiety, and depression also greatly affect sexual desire in most people and powerful emotions may be felt not only by the person receiving chemotherapy, but by the spouse or lover as well.

Tips for handling sexual problems. Most people need love and loving relationships more than ever during chemotherapy. Unfortunately, they may have a hard time accepting affection because they don't feel "lovable" because of changes in their appearance or attitude. For instance, women who have experienced a mastectomy may not feel that they are lovable without a breast, and dealing with this loss of body image will take patience and reassurance on the part of her partner. Men treated for prostate cancer may experience impotence. Prostheses such as artificial breasts and penile implants are available and will help make you comfortable as you move back toward normalizing sexual relationships.

Many people may find sexual issues difficult to discuss, and some changes in perception and attitude may be necessary to maintain a healthy sexual relationship. Oftentimes, professional counseling can be quite helpful.

Most people can live without sex more easily than they can live without love. Some individuals may wish to be touched and held more frequently, rather than just having intercourse. A partner may wish to change the time of day or the position used for sex. A vaginal lubricant may help women prepare for sex. Even though it may be difficult to begin discussing these issues, talk about your situation as fully as you can with your partner, who should also be made to understand that emotional stress may come along with your treatment and temporarily affect your own desire. Tell your partner that you still feel love for him or her.

Delivering love and affection may require huge adjustments on the part of both partners. Problems that were latent in the relationship may get worse. Couples who have been sexually active before chemotherapy very frequently find ways to continue sexual activity. Touching, sensual massage, and kissing are all sensual romantic pleasures, and they can be real and creative expressions of love. Gestures such as giving the other person little cards or presents can be important, too.

Give everyone time to adjust. Expressions of affection don't have to be physical. Note that many sexual problems have their roots in emotional issues rather than physical issues. Unfortunately, one partner may withdraw, leaving the other partner feeling abandoned. Rebuilding a relationship isn't easy. It might help either partner, or both partners, or the family to participate in a support group, in counseling sessions, or even to seek the services of a reputable sex counselor if adjustments are difficult.

Tips on handling reproductive problems. Prior to chemotherapy, men might want to deposit some sperm in a sperm bank as a precaution. This is most important to young men who have not begun families. Sperm banks are not to be found in every town, but are located in most large cities. A cost is involved in sperm banking, and a sample of sperm should be analyzed in a laboratory before deposit to assure a level adequate for fertilization. Men undergoing chemotherapy should plan to use effective birth control methods during intercourse, because anticancer agents can cause damage to chromosomes in sperm, and children conceived during chemotherapy may suffer genetic damage.

Unlike sperm banking, storage of eggs for women is not yet perfected. Egg storage is not recommended yet, because it is only done in research facilities. Nonetheless, women should seek to avoid becoming pregnant during chemotherapy, due to the possibility of birth defects in children conceived while undergoing chemotherapy. Upon the advice of a gynecologist, women already pregnant may want to delay the start of chemotherapy for a period of time until the fetus is developed enough to withstand its effects. Women with vaginal dryness or itching may wish to change their style of dress to include loose, comfortable clothing. Using a water-based vaginal lubricant such as KY Jelly will protect against infection or injury to the mucous membranes during sexual intercourse. Any vaginal infection should be treated promptly. Women should watch for unusual discharges, and tell their doctor when their menstruation usually occurs.

Reporting Side Effects

Your doctor will probably advise you which side effects might be expected with your chemotherapy and which should be reported, including the side effects that should be reported immediately. In addition to the side effects already discussed, some of the side effects to watch out for include fever, shaking, chills, bleeding, bruising, increased pain, uncontrolled pain, and any new side effects never experienced before including rashes, headaches, shortness of breath, and swelling.

Some side effects occur very rarely, but might be a cause for concern if they appear. As a general rule, while undergoing chemotherapy, anything you don't expect or understand relating to your body should be reported as soon as possible to your doctor or your cancer nurse.

Even when your doctor or nurse has warned you that you might expect a particular side effect, notify your doctor if the experience is worse than predicted, lasts longer than predicted, or makes you extremely uncomfortable. When in doubt, tell your medical team and let your doctor decide whether or not the symptoms you're experiencing are important enough to be treated.

Managing any side effects you experience will keep you sailing through chemotherapy treatment, holding fast to your aim to recover your good health. But physical side effects are only a part of the total picture. Good nutrition is also of paramount importance to your recovery.

*** POSTED ON MARCH 29, 2005 ***