Tips For Coping With CHOP-R, CVP-R, or Bendamustine-R
- From Patient Experience
TOPICS
Infusion Day | Nausea | Dealing With Constipation And Gas
Hydration / Electrolyte Balance | Prednisone | Mouth Sores | Muscle Cramping
Sleep | Fatigue | Hair Loss | Infection | Diarrhea | Other
First Rituxan Day - Checklist | When to Call your Doctor | Treatment Support
Also see Understanding Drug Therapy and Managing Side Effects pdf
 Communications: It will be important to inform our oncologist about unanticipated or severe difficulties we may be experiencing. For example, problems with nausea can be addressed by changing the medication and making sure it's started prior to giving the next cycle. Problems with infection and fever can be helped by giving growth factors to help part of the immune system to rebound more quickly... Other toxicities can be addressed by modifying the dose or the type of chemo. Communication is key so our oncologist is informed and can adjust accordingly.
See also: When to Call your Doctor
Expectations: Getting through Rituxan-based chemo 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:
Thanks to the WebMagic support board on an excellent thread.
We thank all for sharing their experiences and tips.
1) For the Infusion
a) Having a friend along for support and to drive you home if you are too tired from the Benadryl (given with Rituxan) 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
See also: First Rituxan Day - Checklist
Return to top
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.
Note: ginger capsules and other herbal supplments should be avoided. These are not regulated by FDA and may contain impurities such as heavy metals.
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 the odors that may offend you.
h) Breath through your mouth when feeling nauseous.
i) Food Tips for Managing Nausea and Maintaining Oral Health
When to Call your Doctor
Return to top
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.
Return to top
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)
Return to top
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.
Return to top
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
Return to top
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.
Return to top
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
Return to top
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
Return to top
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!!
Return to top
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
Return to top
13) Diarrhea
Uncontrolled diarrhea can lead to fluid depletion, electrolyte imbalance, skin damage, and even death if it persists too long.
Adapted from Diarrhea in Cancer ACS
Eat small meals often. Don’t eat very hot or spicy foods.
Keep track of the amount and frequency of bowel movements.
Try
clear liquid diet (one that includes water, weak tea, apple juice, peach or apricot nectar, clear broth, Popsicles, and gelatin with no solids added) as soon as diarrhea starts or when you feel that it’s going to start.
eating small amounts of foods that are easy to digest such as rice, bananas, applesauce, yogurt, mashed potatoes, low-fat cottage cheese, and dry toast.
Include
foods that are high in potassium (such as bananas, potatoes, apricots, and sports drinks like Gatorade® or Powerade®). Potassium is an important mineral that you may lose if you have diarrhea.
Avoid
acidic drinks, such as tomato juice, citrus juices, and fizzy soft drinks.
milk or milk products if they seem to make diarrhea worse.
greasy foods, bran, raw fruits and vegetables, and caffeine.
pastries, candies, rich desserts, jellies, preserves, and nuts.
alcohol or use tobacco.
Clean your anal area with a mild soap after each bowel movement, rinse well with warm water, and pat dry. Or use baby wipes to clean yourself.
Apply a water-repellent ointment, such as A&D Ointment® or petroleum jelly, to the anal area.
Sitting in a tub of warm water or a sitz bath may help reduce anal discomfort.
Take medicine for diarrhea as prescribed.
Resources
.gif) |
Cancer and diarrhea MedlinePlus
|
|
Diarrhea in Cancer ACS
|
|
A randomized trial of yogurt for prevention of antibiotic-associated diarrhea.
Dig Dis Sci. 2003 Oct;48(10):2077-82. PMID: 14627358 | Related articles
|
Return to top
14) Diet, Exercise, Vitamins - life style changes?
Exercise is highly recommended as a way to combat fatigue and improve quality of life.
During chemotherapy, choose foods wisely ... that provide nutrition and that are unlikely to have bacteria while your counts are low.
Soups can be an excellent choice.
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
|
