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. 

Nausea and vomiting

(Generally mild)

What to look for?

• Nausea is feeling like you need to throw up. You may also feel light-headed.
• You 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.
• 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 team for the Nausea & Vomiting pamphlet for more information.
• Talk to your health care team if:
  • nausea lasts more than 48 hours
  • vomiting lasts more than 24 hours or if it is severe

Liver problems

Your health care team may check your liver function with a blood test. The liver changes do not usually cause any symptoms.

What to look for?

• Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe.

What to do?

If you have any symptoms of liver problems, get emergency medical help right away.

Mild joint, muscle pain or cramps;
Headache

What to look for?

• New pain in your muscles or joints, muscle cramps, or feeling achy
• Mild headache
   

What to do?

• Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
• Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
• Rest often and try light exercise (such as walking) as it may help.

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

Low neutrophils (white blood cells) in the blood (neutropenia)

(May be severe)

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.
 

What to look for?

• If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
• Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
• Do not eat or drink anything hot or cold right before taking your temperature.

You have a fever if your temperature taken in your mouth (oral temperature) is:

• 38.3°C (100.9°F) or higher at any time

  OR

• 38.0°C (100.4°F) or higher for at least one hour.

What to do?

If your health care team has told you that you have low neutrophils:

• Wash your hands often to prevent infection.
• Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
• Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

Low platelets in the blood

(May be severe)

When your 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 (poo)
  • coughing up red or brown coloured mucus
  • dizziness, constant headache or changes in your vision
  • heavy vaginal bleeding
  • red or pink coloured urine (pee)

What to do?

If your health care team has told you that 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.
• Take care of your mouth and use a soft toothbrush.
• Try to prevent cuts and bruises.
• Ask your health care team what activities are safe for you.
• Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a 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 does not stop or is severe (very heavy), you must get emergency medical help right away.

Neuropathy (Tingling, numb toes or fingers)

(May be severe)

What to look for?

• Numbness or tingling of your fingers and toes may happen after starting your treatment. 
• Sometimes it can be painful and feel like burning sensation, which may be severe.

What to do?

• Talk to your health care team if you have symptoms of neuropathy.
• Numbness and tingling may slowly get better after your treatment ends.

In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice.

Constipation

What to look for?

• Having bowel movements (going poo) less often than normal.
• Small hard stools (poo) that look like pellets.
• The need to push hard and strain to have any stool (poo) come out.
• Stomach ache or cramps.
• A bloated belly, feeling of fullness, or discomfort.
• Leaking of watery stools (poo).
• Lots of gas or burping.
• Nausea or vomiting.
   

What to do?

To help prevent constipation:

• Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains.
• Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less.
• Be Active. Exercise can help to keep you regular.
• If you take opioid pain medication, ask your health care team if eating more fibre is right for you.
   

To help treat constipation:

• If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do.

Ask your health care team for the Constipation Pamphlet for more information.

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.

Cough and feeling short of breath

What to look for?

• You may have a cough and feel short of breath.
• Symptoms that commonly occur with a cough are:
  • Wheezing or a whistling breathing
  • Runny nose
  • Sore throat
  • Heartburn
  • Weight loss
  • Fever and chills
• Rarely this may be severe with chest pain, trouble breathing or coughing up blood.

What to do?

• Check your temperature to see if you have a fever. Read the above section "What should I do if I feel unwell, have pain, a headache or a fever?".
• If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
• If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.

Dry mouth

What to look for?

• You may have a dry or sticky feeling in your mouth or throat,
• Your saliva may be thick and stringy.
• You may have cracks in your lips or at the corners of your mouth
• You may have difficulty chewing, tasting, swallowing or talking

What to do?

• Use sugar-free gum or lozenges (e.g. those that contain xylitol) to help keep your mouth moist.
• Suck on ice chips or sugarless popsicles to help relieve dry mouth.
• Rinse your mouth often (every 1 to 2 hours) with a homemade mouthwash.
• To make a homemade mouthwash, mix 1 teaspoon of baking soda and 1 teaspoon of salt in 4 cups (1L) of water
• Do not use store-bought mouthwashes, especially those with alcohol because they may irritate dry your mouth
• Spray your mouth with water or artificial saliva products (e.g., Moi-Stir Spray®, Biotene® products) as needed to keep it moist.
• Apply mouth lubricant (like Biotene Oral balance gel®) after you brush your teeth, at bedtime, and as needed.
• Use a steam vaporizer at night to relieve nighttime dry mouth
• Speak to your health care team about the right product for you.

See our Mouth Care pamphlet for more information.

Talk to your health care team if your dry mouth does not improve or if it is severe. 

Trouble Sleeping

Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends.
 

What to look for?

• You may find it hard to fall asleep or stay asleep.
• How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep.
• You may wake up too early or not feel well-rested after a night's sleep.
• You may feel tired or sleepy during the day.
   

What to do?

Talk to your health care team if it does not improve or if it is severe

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.

Dizziness

What to look for?

• You may feel light-headed and like you might faint (pass out).

What to do?

• Lay down right away so you do not fall.
• Slowly get up and start moving once you feel better.
• Do not drive a motor vehicle or use machinery if you feel dizzy.

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 trastuzumab emtansine is being injected into your vein.
• Talk to your health care team if injection site reactions do not improve or are severe.