By Craig Moore, Cancer Survivor
If you are starting chemotherapy, knowing what to expect and having some information on how to handle side effects, can make things easier. While your oncologist provides essential medical information and prescribes drugs to help control your reactions to chemotherapy, it is likely that they have never personally experienced it. As a result, they may have limited information about its side effects and non-medical ways to deal with them.
The following is based on my own experience during my first 16 weeks of treatment. While I encountered most of the general challenges chemotherapy patients face, everyone is different with regard to their general health, the particular drugs administered, frequency of their infusions, the dosage they receive, and their own bio-genetic chemistry. This means that you may not experience all of these things and may face other challenges. Based on talking with other cancer survivors, my experience seems pretty typical.
So, let me start with some very important general things to be mindful of that may help you avoid problems and deal with side effects during treatment.
The single most important thing you have to do is drink at least 64 ounces of fluids each day. Don’t drink cold liquids. Rather, drink them at room temperature or warm. Avoid alcohol and only drink one cup of coffee in the morning if you have to. The best fluids to drink are: water, green tea, Silk soy protein (flavored milk substitute), almond milk, whey protein mixed with milk, warm chicken or beef broth, and, if dehydrated and need a quick boost, G2 (but it, like all Gatorade, has a significant amount of sugar which should be reduced in your diet).
One common side effect of chemotherapy is being cold and even having chills. Keep the thermostat on 74 or 75 all day and night to avoid getting chills. Wear soft sweatshirts and sweatpants to keep comfortable. Dress in layers when you go outside. If you do get chills and shivering becomes uncontrollable, call your oncologist as you may have a fever associated with infection. Wear gloves when handling frozen foods. Use cup holders on cold drinks (they have knitted ones online). Don’t go barefoot. Message your feet and fingers to improve the circulation (this also helps neuropathy if you experience it).
Chemotherapy weakens your immune system. Avoid being in crowds or around people who are sick; especially children. Wash your hands carefully every time you go to the bathroom (or empty your ostomy bag if you have one) and before you eat. Take your temperature if you suspect you may be coming down with any type of infection and if you have a fever of 100 or greater, call your oncologist right away. If you have to fly, wear a surgical mask and clean your seat area and tray with anti-bacterial wipes. Wear latex gloves if you prepare raw meat. Wash all vegetables. Cook food thoroughly. Use antibacterial wipes to all common surfaces including facets, refrigerator handles, doorknobs, toilet handles, and cabinet handles, especially after visitors are in your home or if there is someone ill in your home.
During and between some chemotherapy treatments you may experience skin problems, especially on your hands and feet. Your skin may even crack and bleed and may become red and sore. Your skin may peel off and even small cuts may take days to heal. This condition is really helped by using Coconut Oil. Buy a tub of it at the super market and keep it handy. I use it on my hands and feet at least twice a day and if my hands are dry after washing them I use it more often. You can also use it on your face or anywhere else on your body… great stuff. Moisturizers like Bag Balm are also useful.
Dental Care and Mouth Sores
You may experience mouth sores for several days during or between chemo treatments. Foods will not taste normal when this happens and it will be harder to find food you want to eat. The tissue in your mouth and throat may shed and swallowing may be difficult (you may feel like your airway is closing up, but it isn’t). If you can’t swallow liquids, call your oncologist. There is a mouthwash your doctor can prescribe called “Miracle Mouth Wash” that really helps this condition… ask for it. Also, do not use any over the counter mouthwash with alcohol in it (Listerine sells non-alcoholic mouthwash) because it will sting. Do not brush your teeth vigorously or use an electric toothbrush; use a gentle soft toothbrush. This is to avoid irritating your gums that may be inflamed or shedding tissue due to the chemotherapy. Avoid having any dental work done while on chemotherapy unless it is essential.
As your chemotherapy progresses, many foods may no longer taste good. I felt better eating several small meals and snacks each day and avoided large filling meals. (This was especially important because I had a temporary ostomy and had to avoid blockages.) I started eating cold cuts and sliced cheese, cottage cheese, hot dogs, tuna fish, etc. I avoided a lot of bread, cookies, muffins, cake, pasta, pizza, and other carbohydrates. You need a lot of protein to help build up muscles and tissues. For me, after a few weeks, most foods didn’t taste very good. There was a bitter citric taste in my mouth. To counter this, I ate sweet things… Dots, Twix, and Klondike Bars… to kill the taste. It works, but, sugar is not good for you… cancer loves sugar... so moderation or sugar free products are better. If you love wine (which I do), forget it… it tastes awful. (I didn’t drink at all during my treatment and this also helped reduce sugar.)
I ate a lot of baked fresh fish, hamburger, steak, pork loin, and baked chicken. I avoided most fried foods. I ate a lot of soft poached eggs with ham, sausage, or bacon for breakfast. Buckwheat pancakes are gluten free and high in protein. I bought a juicing machine that makes vegetable and fruit drinks. I ate some snacks with almond butter to get nut oil in my diet. I started each day off with a banana to get needed potassium, drank a cup of green tea, had a small glass of kefir for probiotics and then ate a regular breakfast about 2 hours later. I drank a whey protein shake each day.
Cancer Fighting Nutrients
It is well known that a healthy diet can play a role in cancer prevention. Likewise, nutrient supplements can add to your arsenal of weapons to prevent certain cancers and slow their growth. Some oncologists do not encourage their patients to take supplements during chemotherapy because they are unsure of the interaction. But most agree that taking some supplements may help prevent the recurrence of cancer following treatment. Even if a particular supplement is not effective for you or your cancer, they are usually not harmful and they promote good general health. The following is a list of some of the most studied nutrients that have become popular with cancer survivors. Please remember to discuss these and any other supplements (and dosages) you may want to take with your oncologist to make sure there are no possible interactions with your cancer treatment.
- Curcumin with BioPerine – 400 mg. capsules – I take one in the morning and one in the evening. This supplement is a powerful anti-inflammatory that comes from the spice turmeric and has been shown in clinical research to actually kill cancer cells and slow their progression. It can be taken during chemotherapy and has been shown to make some chemotherapy more effective. Curcumin may also help prevent cancer recurrence after your treatments are over. You can order it online.
- Vitamin D3 – Your body absorbs vitamin D3 from the sun. You probably will not get enough vitamin D3 in the winter when there is much less sunlight. Even in the summer it is hard to absorb enough from the sun and many people want to avoid sun exposure. It has been shown to reduce chronic inflammation that can promote some types of cancer. It is available over the counter at your pharmacy or at the supermarket.
- Vitamin E – Research has shown that vitamin E, especially in the form of gamma-tocotrienol, has been shown to reduce colorectal cancer cell growth and can even induce tumor cell death (autophagy).
- N-acetyl cysteine (NAC) – Studies have shown that people at risk for colorectal cancer who took 600 mg. per day had a 40% reduction in the reoccurrence of colonic polyps.
- Cimetidine (commonly known as Tagamet, a well-known over the counter medication used to alleviate heartburn) – has been shown in a study published in the British Journal of Cancer that colon cancer patients taking 800 mg. per day with their chemotherapy had adjusted 3-year survival rates of 93% compared with 59% for those who did not. It is not taken to prevent cancer, but as a supplement during treatment and to reduce metastatic risk following treatment. Discuss this with your oncologist to see if this is appropriate for you to take as it may interact with other medications you are taking.
- Potassium – this is an essential electrolyte we all need and is part of staying hydrated. During my treatment I ate one banana each morning when I got up to make sure I had enough in my diet. Potatoes are another good source. I avoid orange juice as a source of potassium because the sugar content is so high and it is very acidic. It is sold in capsules in the pharmacy or supermarket.
- Magnesium – this is another essential electrolyte you need each day. It is used in over 200 different biological processes your body carries out. You can take it in a pill or capsule once a day and it is available at the pharmacy or super market.
- Vitamin B-12 helps restore your red blood cells. Keeping up your red blood count is critical during chemotherapy as the drugs they give you destroy these cells. I take a 5000 microgram capsule each day, but your physician may suggest a different dose. B-vitamins are also being used to treat peripheral neuropathy at some clinics. Available over the counter at the pharmacy or the super market.
- Biotin – this is a supplement that helps restore your skin and fingernails. It will really help you with mouth sores, skin problems, and can slow down any hair loss you may experience during chemotherapy. I take 1000 mg per day. It is also available over the counter at the pharmacy or the supermarket.
- Aspirin – Aspirin has long been thought to help prevent some cancers and taking it daily should be considered if your oncologist agrees. If it upsets your stomach, you can take coated aspirin (Ecotrin). Because it thins your blood, you should check with your primary care physician before starting daily doses.
Exercise and Rest
It is very easy to try and do too much. When you are given a chemotherapy infusion, you may also get steroids. Steroids control nausea, but may also cause cycles of high energy where you can’t relax and need to do something and other times may cause you to crash and feel exhausted. They can affect your sleep. Be aware of this potential and try not to do too much while they make you feel full of energy. It might lead you to feel very tired later on that day. Take naps when you feel tired.
Light exercise, however, is good for you. A study done at the Dana Farber Institute in Boston showed that cancer patients that engaged in moderate exercise had significantly higher survival rates at 5 years than patients that did no exercise. The trick is to not overdue it. Short walks outside when it is not too cold or even some light exercises will actually make your chemotherapy go better… but, do not try to do too much!
Dizziness and Forgetfulness
When you have been sitting or lying down for a while and try to get up, you can get dizzy. This is because you may be dehydrated or anemic from your cancer treatments. This may also be caused by inadequate eating and drinking, vomiting, or diarrhea. You have to get up slowly and make sure you are stable before taking any steps. Have someone help you up and put your arm around them. You can pass out and fall if you are not careful. I had this happen several times and learned to be more careful. Do not go up or down stairs without using a railing. Your ability to drive may be impaired. You should discuss this with your oncologist.
Your short-term memory may get worse. The usual problems of remembering to do things or forgetting names many of us experience as we get older may become worse. It varies with each individual and the treatment they have. This is not unusual and often resolves within 6-12 months after treatments are completed. Make lists, organize things, and work around it. Be aware you may also transpose numbers and letters when working.
Stay in Touch
I hope this information is helpful. I invite you to send in any questions or comments that can be shared with other cancer survivors. In the coming months I hope to focus on some of these general issues in more depth and your experiences can be part of that effort.