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Do What You Can to Ease Side Effects of Treatment for Multiple Myeloma

It's likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. In this section, you'll learn more about how to respond to some of the most common side effects and symptoms from treating multiple myeloma.

Here are some common side effects from treatment for multiple myeloma and how to ease them. You may not have all of these. We've listed them in alphabetical order so that you can find help when you need it.

Anemia (low red blood cell levels) and fatigue

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 there are fewer red blood cells, then less oxygen is carried throughout your body and you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss; by chemotherapy, radiation, or stem cell transplants; or by the cancer 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.

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

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

  • Drink plenty of water. Dehydration adds to fatigue.

  • Talk with your doctor about medications or treatments that may help manage your anemia.

  • Take action to treat a poor appetite because eating improperly can make you tired. 

  • 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. 

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. 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 cancer support group or finding a cancer "buddy" who can help you cope.

  • Ask your doctor about medications for depression and anxiety.

Bleeding and bruising

Certain kinds of chemotherapy may reduce your blood platelet count. Without enough platelets (thrombocytopenia), your blood may have trouble clotting. Even a minor injury may cause you to bleed or bruise.

If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to uncontrolled bleeding:

  • Call your doctor if you develop a rash, bleeding, or bruising.

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

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

  • Use a soft toothbrush to prevent bleeding gums.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation may include difficult or infrequent bowel movements. It 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 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 only as prescribed by your doctor.

Diarrhea

This may be a side effect of chemotherapy. Many drugs used in cancer treatments can also cause bowel changes. Diarrhea includes loose or frequent bowel movements, or both. To avoid dehydration, take these precautions:

  • Avoid milk and milk products if you already have diarrhea or if you are lactose-intolerant. 

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

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

  • Drink more fluids, such as water and broth, to prevent dehydration.

  • Ask your doctor about medications that may help.

Drowsiness

Severe drowsiness may be a side effect of immunotherapy. It may get better after several weeks of treatment. If you are noticing this, talk with your doctor about these options for relief:

  • Adjusting the dose you take

  • Changing the time you take the drug. Some people find that it's helpful to take their medicine before bedtime or to take it twice a day. Don't change your schedule without your doctor's instructions.

Dry or irritated skin

This may be a side effect of radiation therapy used by itself or as preparation for a bone marrow transplant:

  • Check with your doctor or nurse about protecting your skin from sun exposure by wearing sunscreen of at least 15 SPF (sun protection factor). Don't apply sunscreen or other lotions to your skin without first checking.

  • 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, cologne, cosmetics, or powder on your skin within two hours after treatment because they may cause irritation.

  • Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

  • Don't scratch, rub, or scrub treated skin. After washing, gently blot dry.

  • 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 because it causes less irritation to the skin. Don't use lotion before shaving. And don't use hair-removal products. Both can cause irritation to the skin.

  • Keep your nails well-trimmed and clean to avoid scratching your skin.

Hair loss

Losing your hair (called alopecia) can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy and radiation to the head can cause scalp hair loss. Keep in mind that your hair should 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.

Menopausal symptoms

Some types of chemotherapy can damage a woman's ovaries. Or it may cause menopausal symptoms in women who've not yet reached menopause. These symptoms include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant. For some women, the loss of a menstrual period is permanent:

  • If needed, talk with your doctor about birth control before treatment begins.

  • Talk with your doctor about ways to manage menopausal symptoms, such as using lubricants for vaginal dryness, doing mild exercise, and talking with a therapist about mood swings or signs of depression.

  • Report any unusual bleeding to your doctor.

  • Continue to get regular pelvic exams.

Mouth sores (mucositis)

Some types of chemotherapy may cause mouth sores. These may hurt and make eating an unpleasant experience.

Take these actions to prevent sores in your mouth:

  • Brush your teeth after meals and before bedtime. Check with your doctor about flossing.

  • Keep your mouth and lips clean and moist.

  • Use sugar-free candies or gums to increase moisture in your mouth.

Taking these actions can ease the pain if you get sores in your mouth:

  • 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 the sores. Smoking can also make you more susceptible to sores.

  • Ask your doctor about topical mouth medications.

  • Ask your doctor or nurse about taking over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

  • Call your doctor or nurse if your temperature reaches 100.5° F (38° C) or higher.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea:

  • Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six 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 occurs despite treatment to prevent it. It requires additional treatment.

  • Refractory vomiting occurs after one or more chemotherapy treatments--essentially, you're no longer responding to antinausea treatments.

Most nausea can be prevented. 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 the 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:

  • 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.

  • Do not eat 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.

Neutropenia (low white 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 white blood cell count. Many types of chemotherapy can cause low white blood cell counts, as can the cancer itself. Lowered white blood cell counts are called neutropenia. Without enough white blood cells, your body may not be able to fight infection.

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.

  • Wash your hands often or use hand sanitizer throughout the day to kill germs.

  • Call your doctor right away if you have any of these signs of infection: a temperature of 100.5° F (38° C) or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

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. This can be a side effect of chemotherapy or immunotherapy or from the cancer itself. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, your doctor may adjust your dose. Or your doctor may prescribe medicine or some vitamins. You should also take these precautions to protect yourself:

  • Take extra care walking and moving so that you don't fall. Wear only well-fitting shoes.

  • Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing to improve your stability.

  • 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.

Thinking and remembering problems

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

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.

Vision problems

You may experience blurry vision or have trouble focusing on small or light print. This may be a result of treatment with steroids, such as dexamethasone and prednisone. Taking these actions may help you cope:

  • Wear corrective lenses (such as glasses or contacts) when you're out and about.

  • Rest your eyes if they become tired.

  • Use a magnifying glass for reading or buy large-print books to prevent eyestrain.

  • Use the appropriate amount of light when you are at home.

  • Remove throw rugs and other low-lying objects in your home to prevent falls.

Weight gain

Weight gain may be a sign of damage to your thyroid, which can be a side effect of immunotherapy or from the high-dose chemotherapy or radiation you get before a stem cell or bone marrow transplant. Take these actions to help manage your weight:

  • Increase the amount of your daily exercise. Strive to be active every day.

  • Eat a balanced, low-calorie diet.

  • Increase the amount of fruits and vegetables you eat. And drink more water. These can help fill you up and are good for you without adding a lot of calories.