• Glossary of Terms
• Patient Post Care
• Insurance Disclaimer
• Chemotherapy
• Resources

Glossary of Terms

Your doctors and nurses may use many new and unfamiliar terms throughout your diagnosis, treatment, and recovery. When someone from your health care team uses a term that you don't understand, ask for a definition. View our Glossary of Terms.

Patient Post Care

1. Do not use Aspirin or Aspirin compounds without the doctor’s approval. If you need something for
   discomfort, use Tylenol or a similar acetaminophen product.
   

2. If you should experience nausea, vomiting, diarrhea, or an increased discomfort after chemotherapy, that lasts longer than 24 hours or becomes severe in nature, call the office at (319) 233-2701 to report it an receive instructions about a solution.
   

3. After chemotherapy, liquids are very important. You should try to have at least 10 glasses of a nourishing type liquid each day for at least two days after your treatment. (Jell-O, pudding, ice cream, sherbet, popsicles, and custards are considered liquids).
   

4. Eat small, frequent and nourishing meals. This keeps nausea at a minimum and increases the amount of nourishment during a body’s stress period.
   

5. Be as active as you tolerate, but don’t overdo it. Make some time to rest when your body tells you to. Becoming overly tired is an added stress to your body.
   

6. It is important for your blood count to be checked on a routine basis. The chemotherapy can decrease your body’s ability to produce certain blood cells temporarily.
   

7. If you experience active bleeding, abnormal bruising, blood stools, nose bleeds that aren’t controlled with
   direct pressure, or bloody urine – Call the office as soon as you are able to report the problem. (The phone is answered 24 hours a day).
   

8. If the side effects of your medicines aren’t controlled by the methods instructed by the doctor and his nurses,
   call the office for further instructions.
   

9. Avoid alcoholic beverages while on chemotherapy.
   

10. Report a fever greater than 100.5 DAY OR NIGHT, WEEKENDS OR HOLIDAYS.
    

11. If white blood count is <2.0, Do not eat fresh fruits or vegetables.

REMEMBER, we can’t solve a problem unless you tell us about it

Insurance Disclaimer

Know your insurance policy!
This office is not responsible for investigating the details of your insurance policy for referral or testing. We do not have provider listings and ask you to be aware of requirements of your insurance plan when being referred outside this clinic. This is to ensure that you, the patient, not be subjected to any excessive bills due to unauthorized services.

We are happy to contribute any information necessary to support an authorization to another provider. Thank you.

Chemotherapy

How is Chemotherapy given?

How chemotherapy is given depends on the drug itself and the various factors concerning the patient.

• By Mouth
• In the vein (IV)
• Into the tissue just under the skin (subcutaneous)
• Into the cerebrospinal fluid (this is the fluid that surrounds our spinal cord and brain)

*When many needle sticks into a vein are expected, some patients will have a “port” surgically placed just under the skin in the upper chest. This port gives health care workers easy access to a vein to give medicines or to have blood specimens draw.

Chemo is usually given in “cycles”. A cycle of chemotherapy will differ from one regimen to the next. It is repeating the way a drug or a group of drugs is given in a specific number of days. The cycle is repeated a number of times. The doctor chooses the drugs and the cycle of chemotherapy from completed and successful research studies, which spell out the dose of drugs to be given and how often they should be given.
Sometimes the timing or dose of a chemo drug will have to be changed because of the way your body is responding to the drugs.

Chemotherapy means treatment with chemicals or medicine. Most people use the term chemotherapy or ‘chemo’, to mean treatment of cancer with medicines. Chemotherapy is one of the types of treatments for cancer. Surgery, for example, removes the cancerous tumor. Radiation therapy kills cancer cells that are in the radiation’s beam.
Immunotherapy helps rid the body of cancer by improving the body’s immune system.
Chemotherapy interferes with the growth and division of cancer cells. Sometimes it takes all four cancer treatments to cure of control certain cancers.

Chemotherapy Medication

To find the chemotherapy drug that you are taking, find the chemo drug at Chemocare.com and click on the drug name.

When to notify your physician

The symptoms you should report to your doctor:

• Temperatures taken in the mouth over 100.5 degrees
• Chills
• Persistent cough
• Easy bruising or bleeding
• Severe headache or stiff neck
• Burning or pain with urination
• Mouth or lip sores
• Severe shortness of breath
• Weight loss of over 5 pounds
• Cannot eat or drink for 12 hours
• Vomiting three times an hour for more than 3 hours
• Cannot take your medication because you are sick to your stomach
• Six or more loose, watery bowel movements in 24 hours.
• Blood on the toilet tissue or in the toilet bowl water.

Feel free to call us at 319-233-2701.

How to manage your side effects

Diarrhea

What Is It?

• Diarrhea (loose stools) is a side effect that may be caused by chemotherapy or radiation to the abdomen.
• Diarrhea can be mild or severe. If not treated, diarrhea can get worse and can even be life threatening.

What Can You Do?

• Eat small amounts more often. Six small meals a day may be better than three large meals. Serve liquids at room temperature and drink them slowly. Avoid very hot or cold drinks.
• Let carbonated beverages like pop fizz before you drink them.
• Drink 8-10 cups of fluids a day. A variety of fluids are best. Try clear liquids such as: clear soup or broth, ginger ale, weak tea, 7-Up, or Gatorade.

Foods to Try:

• Bananas, apple sauce, peeled cooked apples, apple juice and white grape juice
• Toast made with white bread
• Macaroni, noodles or white rice with no sauce
• Baked, broiled or mashed potatoes with no skins
• Cooked vegetables that are mild, such as: asparagus tips, green beans, carrots, spinach and squash
• Remember no skins
• Fish, poultry and meats that are cooked, broiled and roasted.
• Scrambled eggs, smooth peanut butter, yogurt, or buttermilk are all good sources of protein

Foods to Avoid:

• Milk and ice cream
• Whole grain bread and cereal
• Nuts, seeds and coconuts
• Fried, greasy or fatty foods
• Fresh and dried fruit
• Prune juice
• Raw vegetables
• Rich pastries
• Popcorn, potato chips and pretzels
• Coffee, tea and soft drinks with caffeine
• Alcoholic beverages
• Cooked fruits and vegetables with seeds or skins, such as: berries, corn and tomatoes
• Chocolate

Should You Develop Diarrhea, Take the Following Steps:

1. At first sign of diarrhea (loose, watery, or frequent stools), take 2 Imodium AD tablets and then take 2 tablets every four hours.
2. If you are free of diarrhea for 12 hours, stop taking Imodium AD.
3. Drink clear fluids, broth, Gatorade, or Pedialyte – DO NOT drink fruit juice – until diarrhea stops.
4. Record the number of stools you have each day.

When to Call Us:

• 3 or more watery stools over 24 hours
• Diarrhea that lasts for more than a 24 hour period
• If you have any questions about diarrhea and what to do about it
• Feel lightheaded, dizzy, or have lost more than 3 pounds in 2 days

Constipation

What Causes It?

• Some chemotherapy drugs, such as Vincristine, or Velban.
• Pain medicines, such as Codeine, Morphine, Tylenol #3, Tylox, Percocet, MS Contin, Roxanol, Duragesic patched, Darvocet, Dilaudid, or Levodromoran.
• Changes in your dietary habits or an increase in fluid intake.
• Decrease in activity or spending more time in bed.

What Can You Do?

• Look for changes in your normal bowel pattern. Are you moving your bowels less often? Has the color changed? Are the stools harder?

To Prevent or Lessen Constipation

• Try to increase fluid intake to 8 full cups per day. Try water, fruit juices, coffee, tea, ice cream, sherbet, soup, popsicles, Jell-O and broth. Warm and hot liquids often work well.
• Eat high-fiber foods every day. High-fiber foods include bran, whole wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit and popcorn.

To Relieve Constipation, Try the Following Non-Prescription Medicines:

• Peri-Colace and Senekot S are stool softeners and laxatives. Either or these drugs can be used. Start with 1 tablet a day.
• Milk of magnesia works best if taken with 1 full glass of water. Milk of magnesia works well if taken at bedtime, 1 hour before meals or 2 hours after meals. It can take up to 8 hours to work.
• Fiber laxatives such as Metamucil or Citrucel can be taken as directed on the container. They are good mixed in fruit juices. Fiber laxatives should only be used when you are able to drink 8 cups of fluid a day.

When to Call Us:

• Constipation for more than 48 hours
• Change in your bowel habits
• Abdominal pain

Nausea and Vomiting

What Causes It?

• Some chemotherapy drugs
• Radiation therapy over the stomach or esophagus area
• Some strong pain medicines, as well as other medicines
• Remember, continued vomiting can lead to serious problems such as dehydration!

What Can You Do?

• Eat small amounts and snacks more often. Six small meals a day may be better than three large meals.
• Eat and drink slowly. Chew food well.
• Avoid fried, high-fat or spicy foods.
• Try to avoid odors that bother you, such as cooking smells, smoke or perfume.
• Try cool foods without strong odors, such as ginger ale, popsicles, Jell-O, dry cereals, crackers, toast, pudding, canned fruits and cold meat sandwiches.
• Eat salting crackers or other bland foods, such as toast or cereal when you first get up in the morning.
• Try ice chips or hard candy to relieve nausea.
• Try to drink 9 full cups of fluid to prevent dehydration.
• Rest in a chair after eating. Do not lie flat for at least 2 hours.
• After your treatment, eat a light lunch or supper.
• Red meat is often difficult to tolerate. White meats such as turkey, chicken and fish “go down” better.
• Medicines called ‘antiemetics’ can be taken to control nausea and vomiting. The medicines are prescribed by your doctor. Take them as directed.

When to Call Us:

• Nausea or vomiting that lasts for more than 48 hours.
• Nausea and vomiting which is not relieved by taking your medicines as directed. 

Hair Loss

What Causes It?

• Hair loss is usually a result of chemotherapy or radiation therapy to parts of the body covered by hair.
• Radiation to the scalp will cause loss of hair in the treated area, but no where else.
• The hair loss will occur about two weeks after treatment has started. Hair will usually begin to grow again two to three months after treatment is over. Some patients may find that the new hair growth is thinner or sparser than before and that the texture or color may have changed.
• Hair loss related to chemotherapy can affect any or all hairy parts of the body (scalp, eyebrows, eyelashes, armpits, pubic area and legs).
• It may be sudden or gradual.
• While it may be emotionally difficult to lose your hair, it may help to remember that hair loss is usually temporary. It may even grow back during treatment.

What Can You Do?

• You may find it helpful to get a wig or toupee. Wigs and toupees may be a tax deductible medical expense. Some insurance companies may cover the cost. The America Cancer Society has limited coverage also.
• Wigs and turbans are available at the American Cancer Center. Ask your nurse or one of the volunteers to help you.
• We suggest that you get your hair-piece before you begin, or at the start of the chemotherapy. This will let you match your own hair style and color. You will be prepared in case you lose your hair very quickly.
• You can wear scarves, turbans or caps.
• In cold weather wear a hat, scarf, wig or other head covering. A large amount of body heat is lost through the scalp. The scalp is also very sensitive to wind. The scalp is sensitive to the sun. Protect against sunburn by keeping your head covered and by using sunscreen of at least SPF 15.
• You may find it helpful to have your hair cut short.
• Scalp care is important. Treat it gently. Washing your hair does not make it come out faster. Shampoo every 2 to 4 days to keep the scalp clean using mild shampoo. Pat dry with soft towels. Washing your scalp every day may be too harsh. Avoid use of curling irons, curlers, permanents, dyes, hair bands, clips and hair sprays.
• If the scalp becomes dry, use Aloe Vera gel 97-100 percent pure or Eutra cream. You can get these at your drugstore 

Mouth Care

What Do You Need To Do?

It is important to do mouth care after meals and at bedtime. The mouth care you need to do is:

• Brush your teeth/dentures with a soft toothbrush at least twice a day or after each meal.
• Rinse with salt and soda water, which you can make by adding 1 teaspoon of salt and 1 teaspoon of baking soda to 1 quart of water. This does not need to be refrigerated and can be kept for 24 hours. Do this rinse after each meal and at bedtime.
• If you want to use a mouthwash, stay away from ones that have alcohol.
• Keep lips moist to prevent cracking. You can use Chapstick, Vaseline, Blistex, or Orabase.

Avoid alcohol and cigarettes. They dry the lining of the mouth.
Good nutrition can help keep the mouth healthy and heal mouth sores. Our dietician can also give you more information.

What Are Some Of The Problems and What Can You Do About Them?

Sore Mouth

• Mouth sores may be red, shiny, swollen areas or white spots or patches. The mouth may be tender. Bleeding can occur.
• A soft bland diet may be more soothing to your mouth. Avoid hot, spicy and acidic foods.
• Choose soft, soothing foods such as ice cream, milkshakes, baby food and soft fruits such as: bananas, applesauce, mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, cottage cheese, macaroni and cheese, custards, puddings and gelatin. You can also puree cooked foods in the blender to make them smoother and easier to eat.
• Your doctor can prescribe medicine to help relieve discomfort from mouth sores.

Dry Mouth

• A dry mouth can be uncomfortable or make it hard for you to eat.
• Drink 8-10 cups of liquids a day.
• Suck on ice chips, Popsicles or sugarless hard candy. Chew sugarless gum.
• Dunk or soak dry foods in liquid.
• Use extra butter, gravies, sauces, salad dressings, yogurt, or mayonnaise to moisten food.
  

Difficulty Swallowing

• The throat can get sore from chemotherapy or radiation. If you have pain where you chew and swallow, let your doctor or nurse know.

When to Call Us:

• Mouth sores or mouth soreness
• Pain with eating or swallowing
• Bleeding from mouth or gums

Low White Blood Count – Neutropenia

What Is It?

• White blood cells help you fight infections by destroying germs in your body. When your white blood cells are low from chemotherapy or radiation therapy, you may be more susceptible to an illness. This lowering of white blood cells is neutropenia.
• Your nurse will talk to you about predicted time your counts will be low. This low count time is called nadir.
• Your white cell count will be carefully checked during your treatments. If your white blood cell count is too low, your doctor may postpone your treatment or give you a lower dose of chemotherapy.

What Can You Do?

1. To decrease chance of infection:

• Wash Your Hands often, especially after using the bathroom or before eating.
• Avoid large crowds of people who have colds, flu or chicken pox during the time of your low white blood count.
• Brush your teeth and rinse your mouth after meals and at bedtime.
• Do not get any immunization shots without checking with your doctor first.
• Keep your bowels regular with diet and stool softeners as prescribed.
• Get plenty of rest.

2. Take your temperature if you should feel feverish or have any of the following:

• Severe cough or sore throat.
• Shaking chills.
• Sweating, especially at night.
• Diarrhea lasting more than 2 days.
• Painful or burning urination.
• Any area on your body which is red, painful or warm to touch.
• A wound or incision that has pus-like drainage.

When to Call Us:

If your temperature is 100.5 or higher, notify your doctor right away, anytime day or night! DO NOT wait until the following morning to see if you are feeling better or if your temperature goes down. Do not take Tylenol unless instructed by your doctor. Notify your doctor or nurse if you have any of the following:

• Severe cough or sore throat.
• Shaking chills.
• Sweating, especially at night.
• Diarrhea lasting more than 2 days.
• Painful or burning urination.
• Any area on your body which is red, painful or warm to touch.
• A wound or incision that has pus-like drainage.

Decrease in Platelets

What is it?

• Platelets aid in the clotting of blood. The number of platelets can decrease as a result of chemotherapy or radiation therapy. If your blood does not have enough platelets, you may bleed or bruise more easily, even from a minor injury.

What Can You Do?

• Use only an electric razor.
• Do not take aspirin or aspirin-containing medicines.
• Tylenol (acetaminophen) is OK.
• Prevent constipation. Use stool softeners as prescribed.
• Use a soft bristle toothbrush. You may flood, unless it causes excessive bleeding.
• Do not put yourself at risk of injury. For example, wear gloves when working in the garden. Wear shoes when outdoors. Avoid bumps, bruises and falls.

If active bleeding occurs:

1. Apply direct pressure and elevate the area when possible.
2. If bleeding does not stop after 10 minutes, call your doctor or nurse.

When to Call Us:

• Increased bruising, red or purple freckles under the skin. These often happen in the leg and ankle area.
• Nose bleeds that do not stop after 10 minutes.
• Mouth or gums that bleed easily.
• Pink or red urine.
• Bright red or black, tarry stools.
• If you are vomiting red blood or vomit that looks like dark coffee grounds.

Anemia

What is it?

• Chemotherapy or radiation therapy can reduce the body’s ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, your body does not get enough oxygen to do its work. This is called anemia.
• Anemia can make you feel very weak and tired. You may also feel dizzy; have chills, shortness of breath or increased heart rate.
• Your doctor will check your red blood cell count often during your treatments. If your red count falls too low, you may need a blood transfusion.

What can you do?

• Plan your activities to allow for rest periods. Do only the things that are important to you.
• When sitting or lying down, get up slowly. This may help prevent dizziness.
• Eat well. Include iron-enrich foods, such as green, leafy vegetables and red meat if you can tolerate it.

When to Call Us:

• Extreme weakness for more than 48 hours.
• Increased shortness in breath.
• Dizziness or lightheadedness.

Resources

• Types of Complementary and Alternative Medicine (CAM)
• National Center for Complementary and Alternative Medicine
• Patient Resource Center
• Medical Encyclopedia
• American Cancer Society