Do What You Can to Ease Symptoms of Leukemia and Side Effects of Treatment

 

You will likely have physical concerns since your leukemia may cause symptoms and you may have side effects from your treatment. In this section, you’ll learn more about how to respond to some of the most common ones. You will not likely have all of these side effects or symptoms. They are listed alphabetically to help you find information when you need it.

Anemia (Low Red-Blood-Cell Levels)

Red blood cells carry oxygen throughout the body. If your body does not have enough oxygen, you may feel tired.   Decreased red-blood-cell counts can be caused by chemotherapy and radiation, by small amounts of blood loss, or by the leukemia itself.

Take these actions to feel better.

• Take short rests when you’re tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of fluids. Dehydration can make you feel tired.

• Talk with your health care provider about medications or treatments that may help manage your anemia.

Anxiety and Depression

Many people feel blue, anxious, or distressed after being told they have leukemia. These feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress.

• Talk with your family or friends.

• Consider joining a leukemia support group or finding a leukemia “buddy” who can help you cope.

• Ask your doctor about medications for depression and anxiety.

Appetite Loss

People with leukemia who eat well during treatment maintain their strength better and are more active. It is important to remember that your body needs energy to heal itself. Maintaining your weight is a good way to know if you’re giving your body the energy it needs. When you’re being treated for leukemia, a diet high in calories and protein is best.

The problem is that treatment, especially chemotherapy, can damage intestinal cells or affect areas of the brain controlling appetite. Radiation, if it involves your head or neck area, can change the way food tastes to you, make it hard for you to swallow, or reduce your appetite. Ask your doctor for a referral to a registered dietitian if you are having trouble maintaining your appetite. Also, try these tips to stimulate your desire to eat.

• If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and leukemia treatments cause you to use more protein than usual.

• Ask your doctor or dietitian about high-protein drinks, which can help supplement your diet.

• If you can, eat high-calorie foods to help you maintain your weight, such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, fruit bars, and ice cream.

• If you feel full quickly, eat small meals throughout the day instead of 3 large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your biggest meal in the morning. Many people getting treatment for leukemia find that this is when they have their appetite is greatest.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• On days you don’t feel like eating at all, don’t worry about it. Try again the next day. If you find that your appetite doesn’t improve in several days, talk with your doctor or nurse.

Bleeding Problems

Without enough platelets, your blood may have difficulty clotting and lead to a problem called thrombocytopenia.   Chemotherapy or targeted therapy may cause this. In some people with leukemia with very low platelet counts, small red pinpoint spots, called petechiae, may occur in the skin. Report these to your doctor or nurse right away. If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to uncontrolled bleeding. If bleeding becomes a serious problem, you may need platelet transfusions.

• Protect your skin from cuts, scrapes, and sharp objects.

• Shave with an electric razor. Take care when using fingernail or toenail cutters.

• Use a soft toothbrush to prevent bleeding gums. Be gentle if using dental floss or toothpicks. Check with your doctor before you have any dental work done.

• Take steps to prevent constipation, which can lead to rectal bleeding and hemorrhoids.

• Avoid contact sports or situations where you might be injured.

• Call your doctor if you develop a rash or unusual bleeding or bruising. This includes black, tarry stools; blood in urine or stools; or red pinpoint spots on your skin.

• Avoid aspirin or related medications, including nonsteroidal anti-inflammatory drugs, such as those that contain ibuprofen.

Bloating and Swelling

Some chemotherapy and targeted therapy drugs cause your body to retain water. This water retention will go away when your treatment ends.    

Here’s what you can do for relief.

• If your bloating is severe, your doctor may prescribe a diuretic (“water” pills).

• Reduce the amount of salt in your diet. Start by not adding extra salt when cooking and be sure to read food labels for sodium content.

Breathing Problems 

Feeling short of breath, called dyspnea, may make you feel anxious, which can make breathing problems worse. This side effect may be caused by radiation damage to your lungs and may not show up for several years. Talk with your doctor or nurse about what can help. Also, try these tips.

• Sit upright because it will give your lungs room to expand.

• Sleep with the head of your bed raised or sleep in a recliner.

• Use pursed-lip and abdominal breathing. Ask your doctor for instructions on how to do this.

• Avoid climbing stairs because it can tax your breathing.

• Avoid bending over because it compresses your lungs and makes it harder to get the air you need. Wearing slip-on shoes can help.

• Ask family or friends for help with activities that make you short of breath.

• Be aware of and avoid things that make your breathing worse, such as high humidity, cold air, pollen, and tobacco smoke.

• Ask your doctor or nurse to show you how to use relaxation exercises.

Constipation

Constipation, which is difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it’s wise to take these preventive actions. These same steps will give you relief if you are already constipated.

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative as prescribed.

Diarrhea

Diarrhea, which is loose or frequent bowel movements, may lead to dehydration if you don’t take these precautions. Radiation and many medications can cause bowel changes. Try these actions to control diarrhea.

• Avoid milk and milk products.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

• Eat low-residue, low-fiber foods such as those found in the BRAT diet (bananas, rice, applesauce, and toast).

• Increase your intake of fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Fatigue

Fatigue is a very common symptom and side effect of many types of treatment. In particular, low red-blood-cell counts, called anemia, can lead to fatigue. You may feel only slightly tired, or you may suffer from extreme fatigue. Fatigue can last 4 to 6 weeks after treatment ends. Taking these actions may help increase your energy level.

• Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, like walking, to your daily routine. It may help you sleep better.

• Save your energy for important tasks.

• Drink plenty of fluids. Dehydration can cause fatigue.

• Take action to treat a poor appetite because eating improperly can make you tired. And as long as diarrhea isn’t a problem for you, it may help to eat plenty of fruits, vegetables, and complex carbohydrates, such as whole wheat bread.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

Hair Loss

Losing your hair (called alopecia) can be upsetting because baldness is a visible reminder that you are being treated for leukemia. Chemotherapy and radiation can cause hair loss. Keep in mind that your hair will probably grow back after treatment.          

Try these coping tips:

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair and you’ll be ready with head coverings, if you choose to use them.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Infection 

Without enough white blood cells, your body may not be able to fight infection. Many types of treatment can cause low white-blood-cell counts, called neutropenia. You may experience symptoms of infection, such as fever, chills, or inflammation at the site of an injury.

If your doctor tells you that your white-blood-cell count is low, take these actions to stay healthy.

• Avoid crowds or people with colds or infections. Wear a surgical mask in these situations.

• Wash your hands often throughout the day to kill germs. Have those around you do the same. Bathe daily to keep the number of bacteria down.

• Don’t touch your eyes or nose unless you’ve just washed your hands.

• Avoid fresh, unwashed, uncooked fruits and vegetables, which may carry germs. Also, don’t eat sushi or other raw meats.

• Avoid fresh flowers and plants, which may carry mold.

• Ask your doctor whether you need antibiotics to help prevent infections.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5^◦ or higher, severe chills, a cough or hoarseness, lower back or side pain, painful or difficult urination, or any sores or redness.

Insomnia

Trouble sleeping, called insomnia, can be caused by anxiety, depression, or your leukemia treatment. Use these tips to improve your rest.

• Keep a regular bedtime schedule.

• Use your bed only for sleeping, not for watching TV.

• If you don’t fall asleep in 15 minutes, get up, do something else, and try again later.

• Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

• Don’t eat, drink fluids, or exercise close to your bedtime.

• Avoid long naps during the day.

Mouth Changes

Sores on your mouth and lips (mucositis) may hurt and make eating an unpleasant experience. Radiation and several types of chemotherapy cause mouth sores. In addition, you may experience a strange taste in your mouth following a stem cell transplant. This is due to the preservative used to freeze the stem cells. Taking these actions can either help prevent or ease some of these problems.

• Keep your mouth and lips clean and moist. Brush your teeth after meals and before bedtime; floss every day.

• Sip water frequently.

• Eat soft and pureed foods that are easier to swallow if you have a dry mouth.

• Suck on sugar-free candies or fruit bars or chew sugar-free gum to increase moisture in your mouth and to help with changes in taste.

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate or make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

• Call your doctor or nurse if your temperature reaches 100^◦ or higher.

Nausea or Vomiting

Nausea or vomiting may result from almost all types of treatment for leukemia. It may range from barely noticeable to severe. Understanding the different types of nausea may help.

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting means vomiting occurs despite treatment to prevent it. It requires other types of treatment.

To prevent nausea, take these actions.

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take your medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed.

To help ease nausea or vomiting if you have it, try these tips.

• If directed to do so, take medicines with food.

• Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or were nauseated from stress. These may be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Avoid fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help decrease your nausea.

Numbness, Tingling, or Muscle Weakness in Your Hands or Feet (Peripheral Neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy can cause this. Other signs of this problem are ringing in your ears or feeling too hot or too cold. If you have symptoms such as these, take precautions to protect yourself.

• Take extra care walking and moving so that you don’t fall.

• To prevent burns, use warm, not hot, water for bathing. Consider using a shower chair or railing.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. He or she can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Pain

Try these tips to ease pain. In particular, bone pain can be the result of biologic therapy, or bone damage, a long-term side effect from stem cell transplants. After transplants, bone tissue can die if it doesn’t get enough blood. You may need to have part of a bone or joint replaced if the damage, called aseptic necrosis, is severe enough. 

• Take aspirin or ibuprofen to help relieve muscle cramps.

• Take other pain medications regularly as directed by your doctor; don’t wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

• Change your activity level. See if you feel better if you rest more or move around more--either may help.

• Distract yourself with music, funny videos, or computer games.

• Use heat, cold, relaxation techniques (like yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexuality and Reproduction

Feelings of depression from having leukemia or fatigue from many types of treatment can have a negative impact on your sexual desires. Taking these actions may help you cope with these changes.

• Talk with your partner about changes in your desire or ability to have sex.

• Explore new ways to share affection and intimacy.

• Discuss sexual concerns with your doctor or with other members of your healthcare team. They may be able to refer you to a counselor who specializes in sexual problems or to a sexual rehabilitation program.

A potential long-term side effect of a stem cell transplant is ovary damage. This means you may stop having periods and may become infertile. Be sure to discuss with your doctor how long you need to keep using birth control. 

Skin Changes

Radiation treatment can cause dry or red skin in the area being treated. Certain areas are more sensitive than others. Certain therapies can cause itchy skin rashes. Here is what you can do for relief.

• Use topical ointments and steroid creams for itchy skin rashes.

• Protect your skin from sun exposure, especially between 10AM and 3PM, by wearing sunscreen with an SPF of at least 15.

• Ask your doctor or nurse about what kind of lotion you can use to moisturize and soothe your skin. Don’t use any lotion, soap, deodorant, sunblock, perfume, cosmetics, or powder on your skin within 2 hours after treatment.

• Wear loose, soft clothing over the treated area.

• Don’t scratch, rub, or scrub treated skin.

• Don’t bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don’t apply heat or cold to the treated area. Bathe only with lukewarm water.

• If you must shave the treated area, use only an electric shaver. Don’t use lotion before shaving. And don’t use hair-removal products.

Trouble Thinking and Remembering 

You may have mild problems with concentration and memory during and after chemotherapy or biologic therapy. Fatigue can aggravate the problem. Taking these actions may help.

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

• Ask your doctor about nutritional supplements that may help with memory.