Research: Sheila Whitt, RN, BSN Clinical Research Angela Alonge, B.S., Clinical Research Coordinator Lab: Cheryl Pairel, M.A, M.L.T., P.B.T.
We are honored that you have chosen MidAtlantic Pelvic Surgery Associates as your oncology partner. We are committed to providing you with the highest standards of care. Our team of oncologists, special y trained nurses, medical assistants and office staff are dedicated to meeting this goal.
This resource manual wil help guide you as you receive chemotherapy. Please keep this manual and refer to it as needed. As always, please do not hesitate to cal with any questions or concerns. As your partner, we wil do whatever we can to make this journey a little easier.
MidAtlantic Pelvic Surgery AssociatesPhysicians, Nurses, and Staff Annandale Office3289 Woodburn Road Suite 320 (Gyn-Onc) Suite 130 (Uro-Gyn)Annandale, VA 22003 Main Office Number: 703.698.7100Chemo Room: 703.698.7100 ext. 403Fax: 703.876.4876 Calling MidAtlantic Pelvic Surgery Associates Calling MidAtlantic Pelvic Surgery Associates Oncology nurses are available to answer your cal s Monday - Friday between the hours of 8:00 am and 4:30 pm by dialing the chemo room number above. If you are have questions, need test results, or are having side effect problems, we are here for you. If we do not answer the phone, please leave a message and an oncology nurse wil return your cal . We check messages frequently throughout the day and we wil return your cal by the end of the business day. Phone cal s are sorted and the most urgent are cal ed back first. - Say your first and last name. Spel your last name. Say your birthdate. - Leave a detailed message. Use your Symptom Tracker if applicable.
- Leave a phone number(s) where you can be reached.
- If requesting a medication refil , include the name of drug, dose of drug, There is physician on cal 24 hours a day, 365 days a year for your urgent needs. Please cal the Main Number above. Press 1 to reach the on-cal physician.
Examples of an urgent nature: - Temperature of 100.5 of greater.
- Uncontrol able vomiting or diarrhea, more than 4 in a 24 hour period.
When cal ing the physician on cal , please have the fol owing information available: - your diagnosis.
- the chemo you are being treated with and the date of your last chemo.
- the phone number of a 24 hour pharmacy in case prescriptions are Approximate total infusion/treatment time: Medications to take at home before treatment: Your Calendar- Chemotherapy is typical y given in cycles, with rest periods between the cycles. A cycle can last 1 or more days. A cycle is typical y given every 1, 2, 3, or 4 weeks. A typical course may consist of multiple cycles.
- You wil have weekly blood draws on your rest periods.
- You wil see your oncologist or the nurse practitioner before each new Our infusion room is an open room consisting of eight recliners. The staff is upbeat and positive and we pride ourselves in making your treatment time a comfortable time for you. There are a few things we would like you to know so we can provide you quality care in a safe environment each time you come for a treatment.
- Eat normal y and drink plenty of liquids before your treatment.
- We have coffee and tea available.
- You are welcome to bring food and drink to your treatment. Please avoid foods with strong odors as a courtesy to other patients.
- There is a deli in the building next to ours that your guest may get food for - You may want to bring a pil ow and a blanket. You may get cool and/or - We ask that only one guest accompany you in the treatment room at a - No children under the age of 12 are al owed in the treatment room.
- Please limit cel phone use as a courtesy to those around you.
- You may want to bring laptops (no internet availability), dvd players with headphones, books, cards, MP-3 players, pil ows, blankets, anything to make your time more comfortable for you.
- Please bring your Symptom Tracker to each treatment and to your Chemotherapy is a common treatment for many cancers. It has been proven to be both safe and effective. However, there are possible side effects of chemotherapy. The body is made up of very smal cel s. Normal cel s in the body grow and divide in a control ed way. Cancer occurs when cel s keep dividing and growing without the normal control. Cancer cel s may also spread to different parts of the body through blood vessels and lymph channels.
Cancer treatments are used to control and destroy these abnormal y growing cel s.
Chemotherapy uses powerful drugs to stop the growth of cancer cel s. Cancer cel s are more sensitive to chemotherapy than healthy cel s because they divide more frequently. Healthy cel s can also be affected by chemotherapy, especial y the rapidly dividing cel s such as the bone marrow, hair, and skin. These can cause side effects of chemotherapy. The fol owing pages discuss the most common side effects of chemotherapy. The highlighted side effects are specific to your chemotherapy treatment. Altered Blood CountsWhite blood cel s, red blood cel s, and platelets are made in the middle of your bones cal ed the bone marrow . We wil be monitoring these cel s during your treatment with a blood test cal ed a Complete Blood Count or CBC. The time period when your blood cel counts are lowest usual y occurs 7 to 14 days after treatment. This is cal ed the “nadir ” period. This decrease is usual y temporary. Low blood counts may impact how you feel. The chemotherapy schedule or dose may be changed if the count is very low.
- White blood cel s, especial y neutrophils, fight infection.
- When your white blood cel count drops, you have an increased risk of - Signs and symptoms of infection include: - Temperature at or above 100.5 degrees, chil s or sweats.
- Cough or shortness of breath.
- Coughing up secretions that are yel ow or green in color.
- Soreness in your mouth, sores or white patches in your mouth or on - Burning or pain during urination.
- Redness, pain or swel ing of any area of your skin.
- Pus or drainage from any open cut or sore.
Monitor your temperature twice daily, in the morning and before 4 pm. Call immediately if your temperature is 100.5 degrees or more.
Advice to help decrease the chance of infection: - Stay away from people with colds or other infections.
- Avoid contact with anyone who has recently been vaccinated, including - Do not receive immunizations or injections without consulting your - Do not have dental work done without consulting your oncologist. - Avoid crowds as much as possible.
- Shower or bathe daily.
- Wash your hands frequently, especial y before eating, after using the bathroom.
- If you cough or sneeze, turn your head to your shoulder. If you sneeze or cough into your hands, wash your hands.
- Brush your teeth and/or provide oral care for your mouth after meals and - Avoid enemas, suppositories, tampons or douches.
- Use an electric shaver to prevent cuts in the skin.
- Wear shoes or slippers to prevent injury to the feet.
- If you cut or scrape your skin, clean and cover the injury.
- Wash fresh fruits and vegetables.
- Wear gloves while gardening. - Wear gloves while cleaning animal cages or fish tanks or cat litter boxes.
- Avoid jacuzzis and hot tubs- Sexual activity may continue, however, excessive friction during intercourse should be avoided by use of water - based lubricants. Avoid rectal intercourse. Use a recommended birth control method (consult your oncologist).
If your white blood cel count drops to a very low level, you wil be considered neutropenic. We wil be monitoring your white blood cel counts and will advise you to take special precautions. These are cal ed Neutropenic Precautions.
NEUTROPENIC PRECAUTIONS(In addition to The Advice to Help Decrease Infection) - Take your temperature 4 times each day. Cal immediately if your temperature is 100.5 degrees or higher.
- If your Neutrophil count is 0.50 or below, stay home.
- Avoid fresh fruits and vegetables.
- Avoid uncooked meals such as sushi. Al meats should be cooked - Avoid enemas, rectal suppositories and rectal temperatures.
- If you have pets, someone else needs to clean up after them.
Your oncologist may prescribe injections to increase your bone marrow’s production of white blood cel s.
- Red blood cel s carry oxygen to the cel s of your body. When your red - fatigue and/or weakness- shortness of breath- dizziness- lightheadedness- rapid heart rate Things you can do to help with symptoms of anemia include: - get up slowly from a lying or sitting position to avoid dizziness- rest more often and alternate activities and rest periods during the Blood transfusions may be necessary to replace red blood cel s.
- Platelets are blood cel s that help blood to clot. When your platelet count is low you are at risk for bleeding.
Signs and symptoms of a low platelet count that should be reported to your oncologist include: - bruising easily.
- smal , pinpoint-sized, red spots on the skin.
- blood in the urine causing it to be pink or red in color.
- blood in the stool causing it to be black or red in color.
- bleeding from the gums or nose.
- heavy or prolonged bleeding during menstruation.
- vaginal bleeding not caused by menstruation.
Things you can do to prevent injury when platelets are low include: - brush your teeth with a soft bristled tooth brush.
- blow your nose gently.
- use an electric razor.
- avoid contact sports.
- avoid using dental floss or toothpicks.
- avoid using tampons, enemas, rectal suppositories or rectal - keep stools soft by using a stool softener such as Senokot - S or its If an injury with bleeding occurs, apply pressure to the area. Cal your oncologist if the bleeding does not stop.
For nosebleeds, apply pressure to the nostrils while remaining in an upright position. Apply ice to the nose. Cal your oncologist if bleeding continues.
Aspirin, naproxen and ibuprofen increase the risk of bleeding and shouldn’t be used unless approved by our oncologist. Tylenol is safe to use.
Platelet transfusions may be necessary to replace platelets. Nausea and VomitingChemotherapy may cause nausea and vomiting.
You may be given IV and/or oral anti-nausea medication with our treatment.
Take your anti-nausea medication at the first sign of nausea or queasiness. Do not wait until vomiting occurs.
If you vomit more than 4 times in a 24 hour period, call your

Some things you can do to help ease nausea and vomiting include: - eat smal , frequent meals and snacks throughout the day instead of - do not lay down right after you eat.
- avoid food and drinks with strong odors.
- avoid spicy and greasy foods.
- drink ginger ale or cola.
- suck on ice chips or popsicles- eat foods at room temperature or slightly cooler to decrease odors. DiarrheaDiarrhea can be defined as having 4 or more loose watery stools in a day.
Some things you can do to control diarrhea: - start taking Imodium. Take 2 tablets with the first loose bowel movement and 1 tablet with each additional loose bowel movement. Maximum dose is 4 tablets a day.
- drink 8 - 10 cups of clear liquids a day; water, ginger ale, gatorade,tea, broth, or jel o. It is important to replace the fluids that are lost with diarrhea. Dehydration can be a serious complication from diarrhea.
- fol ow the BRATT diet: eat frequent, smal meals of bananas, rice, applesauce, toast and tea. Plain pasta is also good. - use alcohol free baby wipes instead of toilet paper to minimize skin - Topical applications or medication may be needed to enhance rectal comfort and promote healing. Tucks, Desitin or A&D ointment are available over the counter.
An occasional bout of loose stool may be expected after chemotherapy. Some foods that may make diarrhea worse include:- milk of milk products.
- spicy, greasy foods.
- caffeine, chocolate- high fiber foods such as vegetables, nuts, fruits and whole grains. - If diarrhea is not relieved after taking Imodium for 24 hours. - stomach cramping and abdominal pain continues without relief.
- if you are unable to drink at least 8 oz. of liquid an hour ConstipationConstipation may be related to a number of causes including the effects of chemotherapy, anti-nausea medication and narcotics for pain control. Constipation is a decrease in the number of bowel movements or passing hard, dry stools.
Some things you can do if you are experiencing constipation: - increase fiber in the diet by adding vegetables, fruits, nuts, raisins
and bran.
- add prunes and prune juice to your diet.
- drink at least 8 glasses of fluids a day
- drink hot liquids to stimulate the bowel.
- try Smooth Move Tea. It is available at grocery stores.
- engage in daily exercise such as walking.
If diet and exercise do not relieve constipation, begin using Senokot –
S (1 or 2 tabs) daily or Miralax daily. Generic Senokot – S is fine to

Medication management of constipation:
Take a laxative/stool softener. Senokot-S (generic is fine) 2 tablets in Take Dulcolax: Take 10-15 mg before breakfast or in the evening. Try Milk of Magnesia: 2 - 4 tablespoons at bedtime or upon rising, fol owed by 8 oz. of fluid. Repeat in 4 hours if no result.
Consider a Dulcolax suppository to stimulate lower bowel.
If no result in 3 days, call your oncologist.
DehydrationDehydration can be a complication from vomiting, diarrhea, fever or decreased intake of fluids. A sign of dehydration is dry mouth.
- low blood pressure- rapid heart rate- dizziness or feeling lightheaded when standing- rapid weight loss- confusion- dark colored urine or urinating less Call your oncologist if you experience any of the symptoms of dehydration .
FatigueFatigue is a common side effect of chemotherapy and can increase throughout your treatment.
Some things you can do to help with fatigue include: - space your activities with rest periods throughout the day.
- maintain good nutrition.
- drink plenty of fluids.
- engage in moderate daily exercise.
- rest when you need to.
Sore Mouth and Throat (Stomatitis and Mucositis)Chemotherapy can cause irritation to the lining of your mouth and throat.
- dry mouth.
- thick oral secretions.
- sores in the mouth.
- white patches on the tongue or tissues of the mouth.
- red, irritated gums.
- pain.
- difficulty in swal owing.
Some things you can do to help with the symptoms include: - use a soft bristled toothbrush. If this is too painful, clean your teeth and - avoid flossing.
- avoid spicy or acidic foods.
- avoid mouthwash that contains alcohol.
- to keep your mouth moist and help prevent sores use salt and baking - Mix 1 teaspoon of salt and 1 teaspoon of baking soda in 1 quart of water. Swish in mouth and spit out. Store in a closed container.
- if you have dentures, be sure to remove them and perform denture and Your oncologist can prescribe a medication or rinse that can help with sore mouth and throat.
Hair Loss (Alopecia)Some chemotherapy treatments cause hair loss. - hair wil start to fal out approximately 14 days after your first treatment.
- the degree of hair loss depends on the type of chemotherapy you - your eyelashes and eyebrows may be affected and fal out.
- your nasal hair can be affected and can cause a “runny nose”.
- you may experience scalp tenderness while hair is coming out.
- it is important to protect your head from the cold and sun. - it is a good idea to shop for a wig BEFORE you start treatment or before your hair begins to fal out so you can buy a wig that can be styled and colored to look like your current hairstyle.
- most insurance companies wil pay for a wig. We wil provide you with a prescription for a wig. Check with your insurance company to find out the wig al owance.
- the American Cancer Society is a resource for free wigs- consider participating in the “Look Good Feel Better” program. This is a great program during which a licensed cosmetologist and other chemotherapy patients can share hair and makeup tips. - hair loss is temporary. When the hair grows back, it may have a different Numbness and Tingling (Neuropathy)Neuropathy is the result of chemotherapy irritating nerve endings. - neuropathy can cause uncomfortable and sometimes painful sensations that can be described as burning, numbness, stabbing, prickling or tingling.
- these symptoms are usual y noticed in the fingers and/or toes first.
- neuropathy wil usual y resolve after treatment is completed, but in some cases may worsen and become permanent.
- notify your oncologist or nurse if you are experiencing any of the Medication to begin before your treatment starts to prevent neuropathy: Vitamin B1, 100 mg once a day.
Vitamin B6, 100 mg twice a day.
If your symptoms become painful, your oncologist can give you a prescription medication.
Some things you can do if you experience neuropathy to prevent injury include: - wear shoes with rubber soles and good support.
- check water temperatures careful y to avoid burns.
- walk slowly and use handrails when using stairs.
- be careful when handling sharp objects.
- inspect skin for cuts and abrasions daily.
- massage your hands and feet. This promotes circulation, stimulates nerve endings, and can help with pain.
Sexual ChangesChemotherapy can remain in your body fluids for 48-72 hours. Care should be taken to protect your partner from your body fluids during this time. - it is very important that women do not become pregnant while on chemotherapy and for some time after completing therapy.
- you may experience irregular menstrual cycles and menopausal symptoms including hot flashes and vaginal dryness.
- women may experience painful intercourse as a result of vaginal dryness - you may have a decreased interest in sex or be too fatigued to engage in Skin and Nail ChangesChemotherapy can affect the skin and nails.
- please call your oncologist if there is redness, swelling or pain along - certain chemotherapy drugs can cause an acne-like rash. Rashes may also indicate an allergic reaction. Please call your oncologist. - skin may become dry and itchy.
- you may experience changes in skin pigmentation and color. - You may be sensitive to sun exposure. The use of sunscreen is highly - you may experience facial flushing and/or night sweats from Decadron, a medication given before chemotherapy.
- nails may become brittle, cracked, or discolored. In rare cases, the nails Some things you can do to decrease the side effects on your skin and nails include: - wear sunscreen with a SPF 15 or greater .
- avoid using lotions that contain perfumes and alcohol. Instead, use a lanolin-based lotion such as Udder Cream, Eucerin, Aveno, or Aquaphor.
- wash with a mild, moisturizing soap.
- avoid pushing back cuticles or biting fingernails.
- avoid wearing tight shoes as this can increase toenail and circulation - avoid use of artificial nails.
- avoid manicures and pedicures. Keep nails trimmed. Use oil-based nail polish remover to avoid further drying of the nails and adding to the brittleness Shingles is a virus infection that causes a painful rash. It can appear anywhere on your body most often appears as a band of blisters. Please notify your oncologist if you have these symptoms.
Memory Problems
Some chemotherapy may affect your memory.
- you may be unable to remember things, and have difficulty concentrating
and fol owing directions. You may feel “disoriented” at times.
- you may have trouble learning new things, or you may forget how to do
things that you have done over and over again.
- you may forget what happened in a day.
Some things you can do to help with memory problems:- keep one note pad or diary in your possession at al times. Write down everything that is important to you. Keep lists of things you need to do in the same place.
- keep a detailed calendar of events at al times.
- take a family member or friend with you to al your doctor’s appointments. - keep your mind busy with crossword puzzles, word games, or reading. Exercise your mind! These are drugs that you wil take at home or wil be given in your IV before you receive your chemotherapy.
Decadron. Generic name = DexamethasoneThis medication has multiple uses. For patients receiving Taxol, it may be prescribed to prevent an adverse reaction that may occur. Other uses include suppression of inflammatory responses (ie. rash) and it is also used as an ant-nausea medication.
You may be taking this drug at home or receiving it in your IV.
- Insomnia- Hypertension- Ulcers- Flushed face- Sweating Take 20 mg (5 pil s) 12 hours before your chemotherapy appointment.
Take 20 mg (5 pil s) 6 hours before your chemotherapy appointment.
12 hours before chemotherapy. Take Decadron - 5 pil s at: ____________ 6 hours before chemotherapy. Take Decadron - 5 pil s at: _____________ BenadrylThis medication is an antihistamine. It works to prevent an adverse reaction that may occur.
It wil be given to you in your IV.
- sedation- dizziness- low blood pressure- blurred vision PepcidThis medication decreases the amount of acid the stomach produces. Aloxi
This medication is used to prevent nausea and vomiting related to
chemotherapy. It blocks the signals from the nausea center in your brain.
It wil be given to you in your IV.
The anti nausea effects of Aloxi work for five days. If you have
nausea at home, use Compazine. Do not use Zofran during this time.

Compazine. Generic name = Prochlorperazine.
This medication is used to prevent nausea and vomiting related to chemotherapy. It blocks the signals from the nausea center in the stomach.
This medication may be used at any time that you are experiencing nausea or vomiting.
- dry mouth- low blood pressure- blurred vision- urine retention If you experience tightness in the jaw or jerking movements, stop the medication and notify your oncologist or nurse.
Zofran. Generic name = Ondansetron
This medication is used to prevent nausea and vomiting related to
chemotherapy. It blocks the signals from the nausea center in the brain
just as Aloxi does. Because Aloxi and Zofran work on the same center of
the brain, do not take Zofran for 4 days after your chemotherapy.
Phenergan Suppositories. Generic name = Promethazine. Use: This medication is used to prevent nausea and vomiting related to chemotherapy. This medication should be used if you are vomiting and are unable to take in oral medication.
- sedation- sleepiness- dizziness- dry mouth- urine retention- rash Pain Control
- pain can occur due to procedures, treatments, disease. Or other reasons.
If you are having pain that is not relieved with Tylenol, a pain medication
may be prescribed for you.
- be sure to take your pain medicines as prescribed.
- take “as needed” pain medicines at the first sign of pain.
- let your oncologist or nurse know if you have pain that is not relieved or if
you are having side effects from your pain medicine.
- constipation is a common side effect of pain medications. Take a stool
softener, such as Senekot – S, daily to prevent constipation.
- if the dose of your pain medication is increased, you may need to
Increase the dose of your stool softener.
- use the Pain Intensity Scale to rate your pain and communicate your
pain ratings with your oncologist, nurse practitioner, or nurse.
- relaxation and guided imagery exercises can be helpful in addition to pain medication.
- please cal your oncologist if you are having pain that is not relieved with your pain medication.
Port- A-CathA Port-a-Cath (medi-port or port) is a device which is used to deliver medications into the bloodstream. It can also be used for blood draws by a qualified professional. The port is placed under the skin. It is about the size of a quarter and half an inch thick. It consists of a smal disk which is attached to a smal tube, or catheter, that extends from under the skin into a large vein. Life With Cancer, a part of Northern Virginia’s Inova Health System, offers support and education for anyone affected by cancer to help people cope with their individual cancer and its treatments. Services provided include: - support and short term counseling- education- children and teen programs - informatioin and resources- referrals- community and workplace presentation- mind-body / wellness programs American Cancer Society - 703.938.5550- Offers 1 free wig to every patient receiving chemotherapy. - Offers Road to Recovery program that can assist patients with free transportation to and from their homes for doctor visits. Cal 1-888-227-6333 for Road to Recovery. Formerly the Gynecologic Cancer Foundation.
Created for patients and caregivers through the Oncology Nursing Society.
Created by patients for patients. Tips on self care.
Provides free makeup and hair tips provided by a licensed cosmetologist. Provides free, professional support services for anyone affected by cancer.
Provides free house cleaning for women undergoing chemotherapy.


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