Chemotherapy : Central Nervous System Problems

by National Cancer Institute

(Page 5 of 10)

Chemotherapy can interfere with certain functions in your central nervous system (brain) causing tiredness, confusion, and depression. These feelings will go away once the chemotherapy dose is lowered or you finish chemotherapy. Call your doctor if these symptoms occur.

Infection

Chemotherapy can make you more likely to get infections. This happens because most anticancer drugs affect the bone marrow, making it harder to make white blood cells (WBCs), the cells that fight many types of infections. Your doctor will check your blood cell count often while you are getting chemotherapy. There are medicines that help speed the recovery of white blood cells, shortening the time when the white blood count is very low. These medicines are called colony stimulating factors (CSF). Raising the white blood cell count greatly lowers the risk of serious infection.

Most infections come from bacteria normally found on your skin and in your mouth, intestines and genital tract. Sometimes, the cause of an infection may not be known. Even if you take extra care, you still may get an infection. But there are some things you can do.

How can I help prevent infections?

• Wash your hands often during the day. Be sure to wash them before you eat, after you use the bathroom, and after touching animals.

• Clean your rectal area gently but thoroughly after each bowel movement. Ask your doctor or nurse for advice if the area becomes irritated or if you have hemorrhoids. Also, check with your doctor before using enemas or suppositories. (See the section "Constipation.")

• Stay away from people who have illnesses you can catch, such as a cold, the flu, measles, or chicken pox.

• Try to avoid crowds. For example, go shopping or to the movies when the stores or theaters are least likely to be busy.

• Stay away from children who recently have received "live virus" vaccines such as chicken pox and oral polio, since they may be contagious to people with a low blood cell count. Call your doctor or local health department if you have any questions.

• Do not cut or tear the cuticles of your nails.

• Be careful not to cut or nick yourself when using scissors, needles, or knives.

• Maintain good mouth care. (See the section "Mouth, Gum and Throat Problems.")

• Do not squeeze or scratch pimples.

• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry using a light touch. Do not rub too hard.

• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.

• Clean cuts and scrapes right away and daily until healed with warm water, soap, and an antiseptic.

• Avoid contact with animal litter boxes and waste, bird cages, and fish tanks.

• Avoid standing water, for example, bird baths, flower vases, or humidifiers.

• Wear protective gloves when gardening or cleaning up after others, especially small children.

• Do not get any immunizations, such as flu or pneumonia shots, without checking with your doctor first.

• Do not eat raw fish, seafood, meat, or eggs.

• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.

Symptoms of Infection

Call your doctor right away if you have any of these symptoms:

• Fever over 100° F or 38° C.
• Chills, especially shaking chills.
• Sweating.
• Loose bowel movements.
• Frequent urgency to urinate or a burning feeling when you urinate.
• A severe cough or sore throat.
• Unusual vaginal discharge or itching.
• Redness, swelling, or tenderness, especially around a wound, sore, ostomy, pimple, rectal area or catheter site.
• Sinus pain or pressure.
• Earaches, headaches, or stiff neck.
• Blisters on the lips or skin.
• Mouth sores.

Report any signs of infection to your doctor right away, even if it is in the middle of the night. This is especially important when your white blood cell count is low. If you have a fever, do not take aspirin, acetaminophen, or any other medicine to bring your temperature down without checking with your doctor first.

Blood Clotting Problems

Anticancer drugs can affect the bone marrow's ability to make platelets, the blood cells that help stop bleeding by making your blood clot. If your blood does not have enough platelets, you may bleed or bruise more easily than usual, even without an injury.

Call your doctor if you have any of these symptoms:

• unexpected bruising.
• small, red spots under the skin.
• reddish or pinkish urine.
• black or bloody bowel movements.
• bleeding from your gums or nose.
• vaginal bleeding that is new or lasts longer than a regular period.
• headaches or changes in vision.
• warm to hot feeling of an arm or leg.

Your doctor will check your platelet count often while you are having chemotherapy. If your platelet count falls too low, the doctor may give you a platelet transfusion to build up the count. There are also medicines called colony stimulating factors that help increase your platelets.

How to Help Prevent Problems If Your Platelet Count Is Low

• Check with your doctor or nurse before taking any vitamins, herbal remedies, including all over-the-counter medicines. Many of these products contain aspirin, which can affect platelets.
• Before drinking any alcoholic beverages, check with your doctor.
• Use a very soft toothbrush to clean your teeth.
• When cleaning your nose blow gently into a soft tissue.
• Take extra care not to cut or nick yourself when using scissors, needles, knives, or tools.
• Be careful not to burn yourself when ironing or cooking.
• Avoid contact sports and other activities that might result in injury.
• Ask your doctor if you should avoid sexual activity.
• Use an electric shaver instead of a razor.

Mouth, Gum, and Throat Problems

Good oral care is important during cancer treatment. Some anticancer drugs can cause sores in the mouth and throat, a condition called stomatitis or mucositis. Anticancer drugs also can make these tissues dry and irritated or cause them to bleed. Patients who have not been eating well since beginning chemotherapy are more likely to get mouth sores.

In addition to being painful, mouth sores can become infected by the many germs that live in the mouth. Every step should be taken to prevent infections, because they can be hard to fight during chemotherapy and can lead to serious problems.

How can I keep my mouth, gums, and throat healthy?

• Talk to your doctor about seeing your dentist at least several weeks before you start chemotherapy. You may need to have your teeth cleaned and to take care of any problems such as cavities, gum abscesses, gum disease, or poorly fitting dentures. Ask your dentist to show you the best ways to brush and floss your teeth during chemotherapy. Chemotherapy can make you more likely to get cavities, so your dentist may suggest using a fluoride rinse or gel each day to help prevent decay.

• Brush your teeth and gums after every meal. Use a soft toothbrush and a gentle touch. Brushing too hard can damage soft mouth tissues. Ask your doctor, nurse, or dentist to suggest a special toothbrush and/or toothpaste if your gums are very sensitive. Rinse with warm salt water after meals and before bedtime.

• Rinse your toothbrush well after each use and store it in a dry place.

• Avoid mouthwashes that contain any amount of alcohol. Ask your doctor or nurse to suggest a mild or medicated mouthwash that you might use. For example, mouthwash with sodium bicarbonate (baking soda) is non-irritating.

If you develop sores in your mouth, tell your doctor or nurse. You may need medicine to treat the sores. If the sores are painful or keep you from eating, you can try these ideas:

How can I cope with mouth sores?

• Ask your doctor if there is anything you can apply directly to the sores or to prescribe a medicine you can use to ease the pain.

• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth and throat.

• Eat soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or scrambled eggs, yogurt, cottage cheese, macaroni and cheese, custards, puddings, and gelatin. You also can puree cooked foods in the blender to make them smoother and easier to eat.

• Avoid irritating, acidic foods and juices, such as tomato and citrus (orange, grapefruit, and lemon); spicy or salty foods; and rough or coarse foods such as raw vegetables, granola, popcorn, and toast.

How can I cope with mouth dryness?

• Ask your doctor if you should use an artificial saliva product to moisten your mouth.
• Drink plenty of liquids.
• Ask your doctor if you can suck on ice chips, popsicles, or sugarless hard candy. You can also chew sugarless gum. (Sorbitol, a sugar substitute that is in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)
• Moisten dry foods with butter, margarine, gravy, sauces, or broth.
• Dunk crisp, dry foods in mild liquids.
• Eat soft and pureed foods.
• Use lip balm or petroleum jelly if your lips become dry.
• Carry a water bottle with you to sip from often.

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