Hair thinning or loss

(May be severe)

What to look for?

• Your hair may begin to become thin or fall out during or after treatment.
• In most cases, your hair will grow back after treatment, but the texture or colour may change.
• In very rare cases, hair loss may be permanent.

What to do?

• Use a gentle soft brush and avoid hair sprays, bleaches, dyes and perms.

Nausea and vomiting

What to look for?

• Nausea is feeling like you need to throw up, you may also feel light-headed.
• May feel nausea within hours to days after your treatment.

What to do?

To help prevent nausea:

• It is easier to prevent nausea than to treat it once it happens.
• Take your preventative anti-nausea medication(s) as prescribed, even if you do not feel like throwing up.
• Drink clear liquids and have small meals. Get fresh air and rest.
• Do not eat spicy, fried foods or foods with a strong smell.
• Limit caffeine (like coffee, tea) and avoid alcohol.

If you have nausea or vomiting:

• Take your rescue (as-needed) anti-nausea medication(s) as prescribed.
• Ask your health care tam for the Nausea & Vomiting pamphlet for more information.
• Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe.

Low platelets in the blood

(May be severe)

• When platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.

What to look for?

• Watch for signs of bleeding:
  • bleeding from your gums
  • unusual or heavy nosebleeds
  • bruising easily or more than normal
  • black coloured stools (poo) or blood in your stools
  • red or brown coloured mucus when you cough
  • dizziness, constant headache or changes in your vision
  • heavy vaginal bleeding
  • red or pink coloured urine (pee), except for the 2 days after your EPIrubicin treatment
     

What to do?

If you have low platelets

• Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
• Check with your healthcare team before you go to the dentist.
• Try to prevent cuts and bruises.
• Ask your health care team what activities are safe for you.
• Low platelets may delay your treatment. Your health care team may recommend blood transfusion.

If you have signs of bleeding

• If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.
• If you have bleeding that doesn’t stop or is severe, you must get emergency medical help right away.

Hot flashes, feeling or wave of warmth

You may sweat more or have trouble sleeping because of this.

To help prevent hot flashes :

• Avoid triggers such as spicy food, alcohol and caffeine (tea, coffee, and soft drinks),
• Exercise regularly. Ask your health care team what exercises are appropriate for you before you start any new exercise.
• Quitting smoking may also help.

If you have hot flashes :

• Keep cool; dress lightly or in layers that you can easily remove and drink plenty of liquids unless you have been told otherwise.

Hot flashes may improve over time. Talk to your health care team if this is bothersome for you.

Other symptoms of having low testosterone levels

• Decreased sexual function or desire to have sex
• Breast swelling or tenderness
• Low energy
• Mood changes, depression
• Thinning of the bones and higher risk of fracture
• High cholesterol and effects on your heart

Other symptoms of having low estrogen levels

• Vaginal dryness (possibly with discharge or bleeding)
• Memory loss
• Mood changes, depression
• Thinning of the bones and increased risk of fracture

Contact your health care team if these feelings bother you.

Mouth sores

What to look for?

• Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks.
• In more severe cases they may make it hard to swallow, eat or brush your teeth.
• They may last for 3 days or longer.

What to do?

To help prevent mouth sores: 

• Take care of your mouth by gently brushing and flossing regularly.
• Rinse your mouth often with a homemade mouthwash.
• To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.
• Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth.

If you have mouth sores:

• Avoid hot, spicy, acidic, hard or crunchy foods.
• Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection.
• Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow.

Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information.

Fatigue 

What to look for?

• Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.
   

What to do?

• Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
• Check with your health care team before starting any new exercise.
• Pace yourself, do not rush. Put off less important activities. Rest when you need to.
• Ask family or friends to help you with things like housework, shopping, and child or pet care.
• Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less).
• Avoid driving or using machinery if you are feeling tired.

Ask your health care team for the Fatigue pamphlet for more information. 

Diarrhea

What to look for?

• Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment.
   

What to do?

If you have diarrhea:

• Take anti-diarrhea medication if your health care team prescribed it or told you to take it.
• Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol.
• Eat many small meals and snacks instead of 2 or 3 large meals.
• Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less.
• Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy.
• Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day.

Ask your health care team for the Diarrhea pamphlet for more information.

Reactions at the injection site 

What to look for?

• Your skin may become red, itchy, bruised, and/or swollen where the injection was given.
• Site reactions are usually mild and go away within one to three days.

What to do?

• Tell your nurse right away if there is any burning, stinging or other pain while epirubicin is being injected into your vein.
• You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction in your treatment.
• Talk to your health care team to find out which treatment is right for you.