The drugs used in your treatment affect normal as well as abnormal cells. Normal cells that may be affected include those of the bone marrow, the mouth, stomach, intestines, peripheral nerves, the reproductive system and hair follicles. These cells, however, will return to normal. The toxic effects of the drugs usually last a relatively short time.

Some patients have no side effects whatsoever. Others have only a few. Although everyone is very much an individual and may react to chemotherapy differently, certain side effects almost always occur with particular drugs and dosages while other side effects only rarely occur.

Bone Marrow Suppression

Your bone marrow is responsible for manufacturing the cells in your blood:

white cells: fight infection
red cells: carry oxygen
platelets: help to clot blood

If your white cell count is low, particularly your neutrophils (white blood cells which surround and destroy bacteria in your body), you will not be able to fight infection as easily. You can expect your neutrophil count to be at its lowest 7 to 10 days after chemotherapy. Although you should try to avoid people with colds, flu or other infections, the most common source of bacterial infection when your white count is low is bacteria normally carried in your bowels. Signs of infection include areas of redness or tenderness, elevated temperature (38 C or higher), chills, shakes (rigors), sore throat, mouth sores, cough, or itching or burning in the genital area. If your bladder is infected, you may have pain or burning, urinary frequency or urgency when you urinate. It is very important to notify your doctor or nurse if you have any of these symptoms.

To check your temperature you will need to buy a thermometer. If you do not know how to use a thermometer, tell your nurse. Sometimes infections are severe and life threatening. Treatment may require hospitalization in order to receive intravenous antibiotics.

If your red cell count is low you may feel more tired than usual and become short of breath with activity. You may look pale and feel cold, dizzy or irritable.

If your platelet count is low, you may notice bruises on your body or small purple spots called petechiae. You should watch for bleeding from your gums, nose, urine or stool. If you notice any of these symptoms, let your doctor know. If your platelet count is low, use a soft toothbrush, sponge stick or waterpick on low setting to brush your teeth. Remember to blow your nose gently.

Your nose and gums may bleed more easily. Applying pressure to your nostrils will usually stop the nose bleed. If any bleeding occurs, inform your doctor. Do not take A.S.A. (Aspirin®), products containing A.S.A. or other non-steroidal anti- inflammatory drugs (eg. naproxen, indomethacin) if you have low platelets.

All drug effects on bone marrow are temporary and, if necessary, transfusions are available to help replace temporary deficiencies in red cells and platelets, but not white cells. The vast majority of patients will go through their course of treatment without these toxic effects. It is important to report any of the symptoms of bone marrow suppression to your doctor or nurse immediately.

Blood samples will be taken as frequently as necessary to check your counts and make sure that they are high enough.

Fatigue

Tiredness is a common symptom associated with chemotherapy and cancer. Adequate rest may be helpful. Please ask your nurse about the booklet "Making the Most of Your Time & Energy".

Mouth Problems

Sore Mouth Some drugs affect the lining of your mouth and your mouth may become sore. This problem, if it occurs, will only last a few days. Don't use commercial mouthwashes. They often contain alcohol and can irritate your mouth even more.

Rinse your mouth every 2-4 hours with club soda or a mixture of soda bicarbonate (baking soda) and water. Mix three tablespoons (45ml) of soda bicarbonate with 4 cups (1 litre) of water and keep this mixture in the fridge. Unused mixture should be discarded after 48 hours. Use as often as you find necessary. Ulcers may be due directly to chemotherapy effect on the lining of the mouth or may be due to complicating infection especially by candida albicans (a fungus) or herpes simplex (a virus). There is specific treatment available for some of these infections. In addition, a topical anesthetic mouthwash can help relieve the discomfort while your mouth heals. Again, call the doctor or nurse if this happens.

If a toothbrush hurts your mouth, use your finger wrapped in a soft wash cloth or a sponge stick. Waterpicks are also very useful for maintaining good mouth hygiene. Try blended, smooth and creamy foods such as eggs, soup, casseroles, ice cream or pudding. During this time you should avoid hot, acidic, rough or spicy foods. Cold or room temperature foods are preferred because they are less irritating. For further suggestions about your diet, contact the dietitian.

Dry Mouth

You may find that your mouth is very dry. Sipping on juices and other fluids throughout the day will ease this discomfort. Sugar free candies, gum, or ice chips can be effective.

Dental Work

While on chemotherapy you need to discuss any possible dental work with your nurse or physician.

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