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Patients Against Lymphoma


SupportTips for Coping with CHOP+R therapy

Last update: 04/13/2011

Also see

First Rituxan Day - Checklist | When to Call your Doctor | Treatment Support

Tips For Coping With CHOP-R, CVP-R, or Bendamustine-R
 - From Patient Experience

Thanks to the WebMagic support board on an excellent thread.
We thank all for sharing their experiences.

Infusion Day | Nausea | Dealing With Constipation And Gas   
Hydration / Electrolyte Balance
| Prednisone | Mouth Sores | Muscle Cramping   
| Fatigue | Hair Loss | Infection | Diarrhea | Other 

Also see Understanding Drug Therapy and Managing Side Effects  leukemia-lymphoma.org  pdf 

Getting through CHOP-R is not a picnic, but generally not as bad as we are led to believe from the movies. For most patients, the anti-nausea drugs control symptoms well and some patients are able to work. For some, but not all, symptoms worsen as treatment progresses. The following are tips that different patients have suggested:

1)  For the Infusion

a) Having a friend along for support and to drive you home if you are too tired from the Benydryl can be helpful.

b) Bring things to keep you occupied: Ipod, puzzles, laptop, books etc.
Be sure to clean the keyboard, which can be a source of bacteria.

c) Wear comfortable, loose clothing.  Bring a blanket, pillow and/or slippers if you like.

d) Bring snacks. 

e) Sucking on a popsicle or ice chips during the Cytoxan infusion can be helpful.

f) If you have one, bring along your mediport information card.

g) Lidocaine and sticky pads can help to numb skin over a port.

i) See for about PICC lines

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2) Things To Prevent Or Help Nausea

a) Ask your doctor to provide a prescription several days prior to the first chemo treatment. 
Prior approval may be required by your insurance company. Delays -and unnecessary suffering - can be avoided with sufficient advance notice.

b) Good anti-nausea meds;  Take what is prescribed consistently and proactively for at least 3 days. (eg. Kytril, Zofran, Ansamet Compazine etc). If what is initially prescribed isn't working for you, discuss alternatives with your doc.

c) Ginger can be helpful: 1) slice or crush about a half inch of fresh ginger in a mug and steep this in hot water like tea.  2) Might try ginger root capsules.

d) Eating small snacks throughout the day can be helpful. Some found a handful of Cheerios helped.

e) One person found that the smell of a freshly cut tart apple helped quell her nausea.

f) Avoiding fried and fatty foods may be helpful.

g) Avoid odors that offend you.

h) Breath through your mouth when feeling nauseous. 

Food Tips for Managing Nausea and Maintaining Oral Health

When to Call your Doctor

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3) Dealing With Constipation And Gas

a) Senakot-S (a gentle laxative with a stool softener) and/or Colace (stool softener).  
Take these regularly for roughly ten days if your oncology team is OK with this.

b) Eat foods high in fiber. Prunes or prune juice can be helpful.

c) Drink lots of fluids.

d) Some have found charcoal capsules for helping with flatulence.

e) Do not let constipation get out of hand. If what you are doing isn't working speak with your doctor or nurse. Constipation can easily get out of control if not dealt with early.

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4) Stay Hydrated And Maintain Proper Electrolyte Balance

a) Drink adequate fluids.

b) A mixture of half Gatorade and half water can be helpful.

c) Drink plenty of fluids before needle sticks. It plumps up the veins and makes a successful stick easier. 

5) Heart-burn

a) Over the counter or prescribed medicines can help with this. (eg. Prevacid, Pepsid-ac, Zantac)

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6) Prednisone (CHOP or CVP)

a) To avoid its bad taste: 1) ask the druggist for gel caps to put the prednisone in. 2) Take it with milk or chocolate milk or take it with food; can wrap it in bread or take it with pudding.

b) If you have an emotional crash when you stop, your oncologist might be willing to taper the dose more slowly if you ask.

c) Many people need a prescription sleep aide to achieve a good nights sleep when taking Prednisone.

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7) Preventing And Dealing With Mouth Sores

a) Rinse mouth frequently

1) 8 oz warm water and a half teaspoon of salt; or

2) Rinse with a mixture of a teaspoon of baking soda and  8 oz water; or

3) Get a prescription for magic mouthwash.

4) Diphenhydramine & Kaopectate (dentist RX for mouth sores)

b) Ice pops or frozen Jello can be soothing.

c) Watch the temperature of your food. Your mouth may burn more easily.

d) Brush your teeth after every meal and snack. If brushing is too painful because of mouth sores a baby toothbrush may help or just a fingertip with a bit of toothpaste.

When to Call your Doctor

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8) Muscle Cramping

a) The following foods/drinks might help: tonic water with quinine, Gatorade, and/or bananas. Red potatoes also are high in potassium.

b) If your doctor puts you on a potassium supplement and you have a hard time swallowing the pills, it also comes in a tasteless powder form you can mix with food or drink.

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9) Sleep Disturbance

a) Prescribed medicines can help.  Talk with your doctor and see if he/she thinks there is one that might help you. Examples of prescribed meds that people here have found helpful: 
Ambien, Lunesta, Ativan, Xanax and others.

b) Low dose Trazedone helps some with sleep and since its in a different class then the medications listed above it is less addicting.

c) Sleep disturbance, especially early morning awakening, can be a symptom of depression. If you are depressed, go over your symptoms with a doctor to see if he/she feels an antidepressant might help you.

d) Google "sleep hygiene" for tips on behavioral strategies for coping with insomnia

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10) Dealing With Fatigue

a) Maintaining a gentle exercise program such as walking can help reduce fatigue and make it easier for you to sleep at night.

b) Take a nap if you need it.

c) Ask others for help when you need it.

d) If you are depressed, discuss this with your doctor. Medications can treat depression.

e) Identify what's most important to do, and use your energy for these tasks.

f) Try to include shorter versions of activities you enjoy.

g) If you are able, take short walks or light physical activities to help combat fatigue.

h) Try activities such as prayer, meditation, yoga, guided imagery, visualization, etc.

i) Try eating smaller portions of food and avoid foods that may make you sluggish.

j) Limit your use of caffeine, alcohol and foods that are high in sugar or difficult to digest.

k) Maintain a diary of how you feel each day.

l) Moderate exercise!  Within your limits.  Studies seem to support keeping active.

Also see Fatigue

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11) Hair Loss (not Bendamustine)

a) It will generally fall out around the time of the second cycle.  Shave it ahead of time as its
messy and disconcerting watching huge clumps of hair fall out. It is empowering to some people when they shave their head and "take control" over that one thing. 

b) If you plan to wear a wig, get it ahead of time so they can match your natural color if that's want you want.

c) Be a blonde one day, red head the next. Go wild with scarves and find your inner gypsy!!

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12) Reduce Risk Of Infection

a) Wash your hands often, especially after being in public places, around others with colds etc. Keep nails short. It's harder to keep nails clean that are long.

b) Avoid crowds when your counts are low.

c) Follow guidelines given by your treatment center.

d) Clean equipment and tools you will use frequently, such as keyboards, cutting boards ... air dry.  

e) When you can't wash your hands, have a hand sanitizer with you. 

Also see Avoiding Infection

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13) Diarrhea

Uncontrolled diarrhea can lead to fluid depletion, electrolyte imbalance, skin damage, and even death if it persists too long. 

a) Diet can help: One person found that oatmeal, cantaloupe, tomatoes and some raw foods helped her. Others have found that binding foods, like rice and bread help

b) If it's extreme prescription Tylenol 3 helped one patient as it is constipating, the OTC Imodium A.D. liquid also helped the same person.

c) One person recommended prescription Questeran

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14) Other

a) Discuss your risk of Deep Vein Thrombosis (DVT) (a clotting condition) with your doctor. An aspirin a day may reduce this risk. One or two of us have had problems with this that might have been avoided.

b) If you experience any unusual symptoms or fever, call your doctor or oncology nurse.  Do not feel you have to wait until office hours if you are really uncomfortable or anxious about something.

Food Tips for Managing Nausea and Maintaining Oral Health

Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright 2004,  All Rights Reserved.