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Do What You Can to Ease Symptoms and Side Effects of Treatment for Non-Hodgkin Lymphoma

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It’s likely that you will have physical concerns about your lymphoma. You may have symptoms from the disease, 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. Your reaction depends on the treatment you get. We’ve listed symptoms and side effects alphabetically so that you can easily find tips to ease the problems you are having.

Anemia (low red blood cell levels)

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your red blood cell count. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. During treatment, your doctor will take small amounts of your blood to check your cell levels. Decreased red blood cell counts can be caused by chemotherapy and radiation, by small amounts of blood loss, or by the lymphoma itself.

If your doctor tells you that you have anemia, 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.

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

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

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

  • Talk with your doctor 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 lymphoma. These feelings may continue or come back throughout treatment.

Taking these actions may ease your distress:

  • Talk with your family, friends, or a member of the clergy.

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

  • Ask your doctor about medications for depression and anxiety.

  • Ask your doctor for a referral to a social worker, psychologist, or psychiatrist. 

Appetite loss

People who eat well during treatment maintain their strength better. It’s 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 lymphoma, 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 to the head and neck 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 cancer treatments cause you to use more protein than usual.

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

  • If you can, eat high-calorie foods to help you maintain your weight, such as oil, margarine, 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 these foods to increase your intake of fluids: 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 lymphoma find this is when their appetite is largest.

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

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

Bleeding and bruising (from thrombocytopenia)

During treatment, your doctor will take small amounts of your blood to check your cell levels. One thing they check for is your level of platelets, which are involved in normal blood clotting. Chemotherapy can lower platelet counts in your blood. The result can be a condition called thrombocytopenia. Without enough platelets, your blood may not clot well, which may cause easy bruising or bleeding. If your doctor or nurse tells you that your platelet count is low, take these actions to avoid injuries that could lead to bleeding or bruising. You may need platelet transfusions.

If your platelet count is low, you should take these actions:

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

  • If you shave, use 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 hemorrhoids and rectal bleeding.

  • Avoid contact sports or situations where you may 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 pinpoint red spots on your skin.

  • Talk to your doctor before taking aspirin, ibuprofen, or other pain relievers; vitamin E; or any other drugs or dietary supplements. Some of these may increase your risk for bleeding. 

Bloating and swelling

Some chemotherapy and biological 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, commonly called a water pill.

  • 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.

  • Walking as often as you can may help reduce the bloating. 

  • Elevating your legs may help reduce swelling. 

  • Take off tight-fitting rings.

  • Wear loose clothing.

Breathing problems (shortness of breath called dyspnea) and coughing

Shortness 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 a while. 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, if possible, since that can tax your breathing.

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

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

  • 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. It is a very common side effect of chemotherapy. Taking pain medications can also lead to constipation. It’s wise to take the following preventive actions. These same steps may 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.

  • Don’t take over-the-counter enemas without first checking with your doctor.

Diarrhea

Diarrhea, which is loose or frequent bowel movements, may lead to dehydration. Radiation and many chemotherapy drugs can cause bowel changes:

  • Avoid milk and milk products if they make it worse.

  • 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 such as over-the-counter Imodium (loperamide) that may help.

Hair loss

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

Try these coping tips:

  • Consider cutting your hair short before your 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.

Increased infections (from neutropenia)

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your white blood cell count. Several different types of treatment for lymphoma, including chemotherapy and monoclonal antibodies, can lead to a decrease in the number of white blood cells called neutrophils. The condition is called neutropenia. Without enough of these white blood cells, your body may not be able to fight infection. You may experience symptoms of infection, such as fever, chills, or redness or swelling at the site of an injury. If your doctor or nurse 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.

  • Be extra careful to avoid cuts and open sores that could become infected. 

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

  • Avoid fresh, unwashed, uncooked fruits and vegetables and other foods, which may carry germs.

  • 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°F (38.1°C) or higher, 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 a number of things such as pain, anxiety, depression, or your lymphoma 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 alcohol, caffeine and tobacco, especially close to bedtime.

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

  • Avoid long naps during the day.

  • Ask your doctor if over-the-counter diphenhydramine may be helpful, or if prescription medications can help.

Mouth changes

Sores on your mouth and lips, called mucositis, may hurt and make eating an unpleasant experience. Radiation and some chemotherapy drugs 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 these problems:

  • Keep your mouth and lips clean and moist. Brush your teeth with a soft-bristled toothbrush after meals and before bedtime. If you normally floss, keep doing so at least once a day. If you don't usually floss, talk with your doctor before you start. 

  • Sip water frequently.

  • Eat soft and pureed foods, which 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 that have alcohol in them 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 pain medication, if needed.

  • Call your doctor or nurse if your temperature reaches 100.5°F (38.1°C) or higher.

Nausea or vomiting

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

  • Acute-onset nausea and vomiting occur 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.

  • Refractory vomiting occurs when you’re no longer responding to antinausea treatments.

To prevent nausea, take these actions:

  • Ask your doctor or nurse 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 the pills, 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:

  • Take drugs with food, as directed.

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

  • Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

  • Eat foods that are at room temperature or cold. The smells from hot foods may make 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 nausea.

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

Numbness, tingling, or muscle weakness in your hands or feet (from peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage. This is 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. Consider using a shower chair or railing to decrease your risk of falling while bathing.

  • Take care of your feet, and look at them often for signs of injuries or sores. Wear shoes when walking, even when at home. 

  • To prevent burns, use warm, not hot, water for bathing and washing since you may not be able to sense temperature as well in damaged areas. Use a thermometer to check the temperature of the water. It may help to turn down the temperature of your hot water heater to help lower the risk of scalding. 

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

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

Pain

Pain can be the result of treatments. Try these tips to ease pain:

  • Take 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 (such as yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexuality and reproduction changes

Feelings of depression from having lymphoma 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 health care 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 treatment is male or female infertility. This means you may not be able to have children. Be sure to talk with your doctor about the options you have to protect your ability to have children in the future. Your doctor may refer you to a specialist called a reproductive endocrinologist.

Skin changes

Radiation treatment can cause dry or red skin in the area being treated. Certain areas are more sensitive than others. Monoclonal antibodies can cause rashes, and lymphoma itself can cause severe itchiness. Here’s what you can do for relief:

  • Ask your doctor or nurse about using topical ointments and steroid creams for itchy skin rashes.

  • Protect your skin from sun exposure, especially between 10 a.m. and 3 p.m., by covering up or wearing sunscreen of at least 15 SPF.

  • Ask your doctor or nurse 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, which is less irritating to skin. Don’t use lotion before shaving. And don’t use hair-removal products. Both may irritate your skin.

Tiredness

Tiredness is a very common symptom and side effect of many types of treatment. In particular, low red blood cell counts can lead to fatigue. You may feel only slightly tired, or you may suffer from extreme fatigue. Fatigue can last several 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, such as walking, to your daily routine. It may help you sleep better.

  • Save your energy for important tasks.

  • Drink plenty of fluids to avoid dehydration, which can increase 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.

Trouble thinking and remembering

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

  • Be sure to get enough rest and sleep. 

  • Make lists and write down important information

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