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BY JON GARINN | JANUARY 2, 2012
While preparing a supplement on side effects, I learned about something that many patients and caregivers are aware of but few people know how to manage: co-toxicities. The supportive care medications that are used to manage side effects of cancer treatment, such as insomnia and nausea or vomiting, also have side effects.
Nausea and Vomiting
Drugs given to prevent nausea and vomiting frequently have side effects, ranging from sleepiness and headache to appetite stimulation and diarrhea. Yet uncontrolled nausea and vomiting can interfere with a patient's ability to receive cancer treatment by causing chemical changes in the body, loss of appetite, dehydration, physical and mental difficulties, a torn esophagus, broken bones and the reopening of surgical wounds. If patients do find they can't stomach anti-emetics, what alternative therapies are there? We'll discuss this and more in our special supplement, but we're always interested in hearing from you, as well.
Mouth Sores
Because fast-growing mucosa cells are particularly sensitive to chemotherapy, patients often develop mouth problems, ranging from dryness to ulcers. Yet preventive mouthwashes can adversely affect taste and stain teeth, and some analgesic and anesthetic treatments can lead to throat irritation, headache and fever. We'll discuss how choosing certain foods and practicing good oral hygiene can make eating easier, but we'd also welcome your advice.
Diarrhea
Damage to the digestive tract resulting from chemotherapy can lead to diarrhea, making antidiarrheal therapy necessary. Mild to moderate fluid intake can aid in rehydration. But when diarrhea needs to be controlled with medications such as Lomotil or Imodium, patients can sometimes experience nervousness or drowsiness. We'll discuss nonmedical management and prevention of diarrhea, such as diet and hydration products, but we'd also like to know how you manage this side-effect.
Constipation
Patients receiving certain painkillers or chemotherapy drugs may experience constipation. Although consuming adequate fluids and fruits can stimulate bowel function, many patients must take a stimulant laxative to prevent and treat constipation, with side effects ranging from stomach upset and nausea to bloating and cramping. We'll suggest ways, such as diet and exercise, to maintain normal bowel functioning that will minimize these effects, but we'd also like to learn how you handle this common problem.
Neutropenia, Thrombocytopenia and Anemia Patients being treated for cancer can experience low white blood counts (neutropenia), low platelet counts (thrombocytopenia) or low red blood counts (anemia), requiring drug interventions with side effects ranging from nausea, fever and bone pain to flushing, hypotension and hypertension. We'll discuss possible preventive measures, such as taking acetaminophen or a non-steroidal analgesic for bone pain; avoiding drugs that can affect the functioning of platelets, such as aspirin, ibuprofen and naprosyn; and early initiation of therapies at the first signs of anemia.
Fatigue
The most prevalent side effect of cancer treatment is fatigue. Medication to treat pain, depression, vomiting, seizures and other problems related to cancer can cause fatigue, as well as radiation therapy. But because fatigue is a complex condition with possible biological, psychological or behavioral causes, most of the available treatments are for treating symptoms rather than underlying causes. We'll discuss nonmedical management strategies, including diet and exercise, sleep and activity patterns, stress reduction and complementary therapies. Still, we'd like to hear from you.
Neuropathy
This is a side effect of several chemotherapy drugs that is challenging to treat, with some drugs like gabapentin able to provide relief in some situations. We'll explore this side effect in detail, but we would welcome your management strategies, as well.
So, share your side-effects strategies with us and we'll share them with our fans, followers and friends. And look for our Managing Side Effects supplement, coming soon!
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Would like to see discussion on long-term effects of pelvic radiation. I am experiencing these issues 5 years after treatment. Could not completely empty my bladder, so had to have a catheter inserted.... possible reconstruction surgery in the future.
- Posted by Lisa Erter 1/4/12 10:25 AM
After 7 years of treatment with surgery, chemo and radiation, this is what I have found works best for me. For mild N&V: ginger tea or chewing crystallized ginger.
For diarrhea: immodium for acute attacks, raw fermented foods (sauerkraut, carrots, beets, or pickles) for prevention.
For constipation: walking, exercise, plenty of fluids, plenty of fruits and veggies. Add glycolax if needed.
For neuropathy: acupuncture.
Sometimes a drug holiday helps immensely. That would be a vacation from drugs, not more drugs. I decline dexmethazone at chemo because it makes me "buzz" and break out in acne. This won't work for everyone, since some chemo is so sickening, but mine is fairly low on the nausea inducing scale. And I voluntarily took several months off chemo when my blood counts were getting worse. The docs talked about adding Neulasta. I declined that too. I have chronic cancer now, no cure to be had. It is a balance of quality and length of life for me. Even though I know cancer is growing in me, I feel really good with cancer and no chemo. Sometimes less treatment is better.
- Posted by Linda Simon 1/4/12 11:51 AM
A couple more thoughts-
For neuropathy, Crocs are helpful. The squishy soles cause less pain and tingling. There are some styles that don't look like clunky Crocs. And cooling the feet helps. I use a sunburn gel with lidocaine and aloe. I have also given my feet a cucumber "mask", grated fresh cucumber slathered on my feet. It's so cool.
A real holiday is great too. Travel to new places, bob in warm water. Compression stockings or sleeves reduce lymphedema when flying (the air pressure in planes is less than on the ground and swelling is much worse without the compression).
And warm water aerobics with the geriatric set is a sweet general pick me up.
I too would like an article on long-term effects of pelvic radiation.
- Posted by Linda Simon 1/4/12 2:01 PM