Thursday, March 29, 2012

"Hope is a good thing, maybe the best of things"...

That's the beginning of a quote from The Shawshank Redemption. It was a much safer title for a post than the original title that I had selected which was:   "FUCK STATISTICS".

This is a shout out to all of you websites, and authors of articles out there, who feel absolutely compelled to assault your cancer survivor readership with statistics....all of the time.   When you start every article with " ______, the deadliest form of cancer".  Or "one in 25 people with ____cancer will die.” ENOUGH.

WHAT IS UP WITH THIS????? SERIOUSLY. How would you feel if every single article you read about "your" type of cancer began with this?   Way to go instilling hope in someone who is newly diagnosed….NOT.

There may be some valuable information in an article. But do I want to send it to a patient when the opener starts like that?????

Here is what I know. There are patients that I know that "should have" been dead long ago based on statistics.   Yet, they are still here, thriving, and ALIVE.   

One of my favorite patients was told by some horrific doctor "by this time next year, you will most likely be dead". So every year on the anniversary of his appointment with that doctor, my patient wrote that doctor the nastiest of letters. My patient’s rationale? "Every year when he gets my letter, he's going to WISH that I was dead". I thought this was a scream.  No, I am not urging you all to write nasty letters to your doctors.  But that insensitive doctor deserved one. 

To patients, I say: use statistics to help you when you need to make a decision between treatments based on their historical effectiveness rate in clinical trials.   Then take the rest of those “1 in 265 patients with _____” statistics you read about and put them away.

I am also not telling you to live in denial.   "Okay, I get it.  My cancer is serious.  Now what is the plan?"

You are you. You are strong. You are fabulous.  You are a fighter.   You have friends and family who love you.   Many of you have faith in a higher power.   Many of you have faith in science.  Many of you have faith in both.  No mortal can say for sure what your course will be, even a doctor.
Doctors may have statistics that can sometimes guide you, and that is the right way to use statistics.  But doctors are not God, and statistics are numbers.  Every doctor or nurse out there can tell you stories about "miracles" or things that are "unexplained".  We also don't know everything there is to know about cancer yet.  We have a lot more to learn.  As long as there is research there is hope.

My patient who wrote the nasty letter to his doctor? At one point he got extremely depressed because every article that he read, assaulted him with the statistics of his disease. He just couldn’t shake the horrible statistics that leapt out at him on every page.

Finally one day I said to him (in a most unprofessional way), "Fuck Statistics”!!!!! Well, he howled with laughter. It became a frequently repeated catch phrase between us. I would repeat it sometimes when he was low, just to get him to laugh.

One day when he was due for CT scans and was horribly nervous, he sent me an email.   He said, "Every 3 months it gets harder. You wonder, is this the last set? What's the last tune? I get frightened. But then a little voice whispers softly to me, a voice that's not usually soft, but when needed can be.   And I remember 2 words:   "Fuck Statistics".

So, to all of you writers of “cancer” articles out there, I implore you!!!   You can get your message across without always clubbing someone over the head with the stats. To all of you cancer survivors out there?  Use statistics to choose the path, but choose HOPE to take you down the path.  Hope is a powerful thing.

On "HOPE"...

"Hope is a good thing- maybe the best of things... and no good thing ever dies." - Andy Dufresne (The Shawshank Redemption)

“So make your best choice. Be aggressive. Expect good results. If the results are bad, move in a different direction. Until the very worst happens, if it does, there is always cause for hope.” Bob Simpson.

“Hope is the thing with feathers, that perches in the soul, and sings the tune without the words, and never stops at all.” EMILY DICKINSON

“We all hope. It's what keeps us alive.” DAVID MAMET

“Hope is tenacious. It goes on living and working when science has dealt it what should be its deathblow”.   PAUL LAURENCE DUNBAR”

Sunday, March 25, 2012

More Young Survivor Resources

I went to the Annual Young Adult Cancer Conference this weekend.  Apparently it is every spring at DFCI.  It was really informative.  The young survivors there were quite incredible!!!  It was just an energetic and powerful day in every way.  In a later post I will describe some of the sentiments and comments of some of the young survivors, but here is a listing of some great resources discussed that day.

Also as an update, I have added some resources that I found out about at the OMG summit in Las Vegas.

Imerman Angels (connecting new survivors with survivor mentors)

The keynote speaker blew me away.  Jonny Imerman spoke about "Finding Meaning and Purpose in Your Experience".   This amazing young man took his cancer journey and went on to help thousands of other young cancer survivors.  I had heard of his group before, but hearing him speak in person and watching him talk to other young survivors was truly impressive.  His energy, humor and compassion just electrified the audience.

His story:  he went to his own cancer center when he had finished his treatment for testicular cancer and spoke to other young survivors.   Several years later he founded his own non-profit group that matches up the cancer survivor with a mentor that has the same type of cancer.  The mentor is available to help answer questions and give hope to the newer cancer "fighter" or survivor.

This group has members all around the world.  Truly awesome!!!  This site is great for "newbies" or for those survivors who want to volunteer as mentors.  Also, he brought up THE most important time for a mentor.  The period of time when you finish treatment and you kind of feel "out there" without your safety net (md,nurse, structure of clinic).  He mentioned that you feel very alone at this time (one of the most common things I hear) and that it is the perfect time to get a mentor at his website.

If you are a veteran, please think about signing up as a mentor!!


The Sam Fund

I've mentioned this organization in 2 previous blog postings.  I had spoken with and emailed with Sam Watson before, but to meet her and to hear her speak!!  Honestly, I was just amazed that someone so young has made such a difference in the world.  She is awesome and her organization is awesome!!!

I mentioned in previous posts about the financial assistance for young survivors.  Several folks at the conference mentioned how beneficial the webinars on her website are in helping young survivors to save money on health insurance, how to look for jobs and how to explain gaps in your resume etc.  Just by watching the webinar, one woman learned how to save about $600 a month on health insurance.  So please....check it out!!

The very amazing Samantha Eisenstein Watson!!


Cancer and Careers  (for survivors of all ages)

Jonny, Sam and several young survivors attending the conference spoke of how fabulous "Cancer and Careers" group was.  100% free legal and job assistance, counseling, information, helpful tips.

Cancer Legal Resource Center  (for survivors of all ages)

"CLRC, a program of the Disability Rights Legal Center and Loyola Law School Los Angeles, specializes in providing practical information on the legal, financial and employment rights of people with cancer.

First Descents

Many of the young survivors present (as well as Jonny and Sam) raved about this organization.  Sounds AWESOME!!!

"First Descents offers young adult cancer fighters and survivors (ages 18 to 39) a free outdoor adventure experience designed to empower them to climb, paddle and surf beyond their diagnosis, defy their cancer, reclaim their lives and connect with others doing the same".

This group sounds similar, providing adventure retreats for young survivors:

The "Always Keep Pedaling Foundation"  (The AKP Foundation)

Cancer Transitions Program

One young survivor spoke about a great program through Livestrong.  A great series to help those transitioning back into their new normal after cancer.  The program the person who spoke attended it at MGH, but it sounds like one site only has the program running for two time periods.   It sounds like the new grant period is underway, so keep checking back here for current locations:

Sy's Fund

Funding for young survivors for things like:  laptops, electronics, art supplies, cameras and integrative therapies. 

"We are here to support your hobbies, personal pursuits, and passions, those things that have nothing to do with cancer and everything to do with making life a little easier while undergoing treatment or medical care".

Just with all good funds, sometimes they "temporarily dry up" until they receive more donations.  The woman I spoke to from this group said they were temporarily not taking any more applications, but keep checking back here.

Another survivor matching or "one to one" program:

Need to raise funds for a friend who is a cancer survivor?  This site helps you start a fundraising page.

A great website/link clearinghouse for all things "young survivor related":

6 Day Camps in Hawaii for Young Survivors:

Sharsheret:  Your Jewish Community Facing Breast Cancer:

That's it for now.  Two amazing young survivors who are making a difference for other young survivors, and some great resources mentioned!!!  Rock on Jonny and Sam!!!  Rock on young survivors!!!!!!!!!!!  Rock on OMG Summit!!!

The Notebook - Reposting this by Request

I emailed someone last weekend with this tip, which reminded me that it would be a good thing to post here.  It is a simple thing, but so important. 

We always tell those who are newly diagnosed to:

1)  Bring someone else with you who will take notes of what the doctor is saying.  Someone to be your "eyes and ears".   It is WAY too much information for one person to try to process and write down all at once. 

2) Get a 3 ringed looseleaf notebook to store all of your cancer related information in.  It will make your life easier.

Also, please add this to "best gifts for cancer patients".  Make one up for a friend, if you want to give them a useful gift.

Sections of the notebook should include:
  • Plastic sleeve with slots to put all business cards in (stick this in the front of the notebook).  Put all of your doctor (surgeon, medical oncologist, radiation oncologist) nurse and clinic phone numbers in here, and keep it right up front.
  • Calendar of your treatment, or a timeline of events and procedures since your cancer diagnosis.
  • Pathology Reports and Operation/Surgery reports
  • Lab reports
  • Scan/Xray reports
  • List of all medications that you are on and what you take them for.
  • A section to put all of the print out information on chemotherapy drugs that your nurses will give you.
  • If you are on a clinical trial, keep a copy of your research consent form here.
  • Financial:  Keep all your receipts.  Gas, parking, receipts for payments for prescriptions,  co-pay receipts etc.  You will be able to deduct a lot of these at tax time.  Also, some assistance funds require copies of receipts (Lyphoma and Leukemia Society used to do this), so save all of your receipts!!
Livestrong used to give away free ones.  These are kind of bulky.  You can make your own pretty cheaply.

Ask for copies of your pathology report and your operative note (if it is ready) right when you are in the office when you see your surgical oncologist.  This will save you a trip to medical records later. Every doctor that you will see along the way will want to see these reports.

Every time you go for chemo, ask for a copy of your labs.  Every time your MD sits down and explains your scan results, ask for a copy of the report for your files and put it in your notebook.

Yes, they may have electronic medical records at your hospital, but if you go to another hospital anywhere along the way, if you have all of this information in one handy place, your life will be easier. You'll be needing to refer back to your notebook quite a bit.

I would make about 5 extra stacks of your pathology report, operation report, most recent scans and recent md note to have on hand in case you go for a second opinion, go for a clinical trial eval.  If you have a copy of your oncologist's note, it has your cancer history on it and your current medications.  This will save you from being tortured by young residents and fellows all asking the same question! Make sure to tell your MD if the medication list is not up to date, so they can reconcile this.

Don't forget a section for the financial part of things. You want to save all of your medical bills in one spot (don't forget all the "little" expenses that you incur that you may be able to write off on your taxes next year. Parking, co-payments for medicatios etc can all add up. Save all these receipts. Also, make sure to really look at the bills you get from the hospital and the insurance company. Hospitals are notorious for weird billing and goof ups on bills, especially when insurance companies are involved. You don't want to be paying for something your insurance company already paid for.

Finally for your notebook, I would suggest a journal (or if you have a blog....print out your posts from it).   Even if you are not a journal person now.  I can't tell you how many of my patients have been happy that they kept a journal.  It helps them to see what they have accomplished and what they were thinking along the way.  It is also a reminder of their timeline of events.  You could be the next Pulitzer Prize winner!!!

Friday, March 16, 2012

Weed and Chemo

"I Did Not Inhale".....Bill Clinton
"Puh-leeze".....Sandy Allten

I live in a state where pot is not legal.  However "medical marijuana" is now legal in Maine, which is an hour away.  This posting is not to address the many arguments on whether or not pot should be legalized in the U.S.   This post is to merely address the use of marijuana by legitimate cancer patients.

One of the questions we invariably get from new patients is "Can I smoke pot?"  The second is that they have heard of a "pill form of marijuana" and can they get a prescription for that?   That "pill" is the FDA approved drug Marinol (you will also hear about Dronabinol which is the active ingredient in Marinol).  It is a synthetic version of THC which is the active ingredient of marijuana.  There is one other FDA approved Cannabinoid and that drug is called:  Cesamet.

Both of these drugs are FDA approved for the indication of cancer related nausea and vomiting that has not responded to other antiemetic (anti-nausea) drug regimens.  Bottom line:  most insurance companies will ask what other anti-nausea medications you have already tried before they will approve this.   Marinol is also approved for anorexia which is basically lack of appetite caused by disease or chemotherapy.

If you are a doctor or nurse, your job is to empathize with your patient and to not pass judgment on them.  If they are using any type of drug (other than the ones you are prescribing for them) you would rather they tell you about it than not tell you.  That is because the drug they are using may affect the action of the chemotherapy drugs.  Most drugs are metabolized in the liver and your doctor needs to know what herbs, supplements, drugs or alcohol you are using at the same time you are receiving chemo because it could alter the effectiveness of the chemo drugs they have prescribed.  I'll be posting something about herbs and supplements at a later date.

As health professionals,  if something is illegal, we are never going to come out and say to do it.  We are going to say something like, "while I am not endorsing it, if you are using it, we advise you to do this....".  I recently heard a doctor say it in a great way.  He said something to the effect of "if you are using marijuana, we would rather you not smoke it, as smoking it can cause a fungal infection in the lungs of an immunocompromised patient".   He repeated it twice.  What that patient heard was that he was going to have to make brownies instead of smoking it if he was going to continue to use it (and he was going to continue to use it).

I've had many patients who have used marijuana while we have treated them with chemo.  Many of them have either not had to take nausea and vomiting medications prescribed by us because the marijuana works well enough by itself.  Or, they have used it to supplement the drugs we give them for nausea.  Many of them say that it helps their anxiety, pain, appetite, nausea, vomiting, mood too.  This only makes sense.  If you ever "knew of anyone" in college who used pot, think back to those descriptions of the "hungry horrors" or ravenous food cravings that the pot users experienced.

My motto is basically "whatever gets you through the night, it's alright, alright" (thank you John Lennon).  If pot can help you get through some of the side effects of chemo when nothing else works, then that works for me. What most health professionals don't like about pot is the smoking aspect of it. Any cancer doctor or nurse is not going to like the smoking or inhalation aspect of it more than the "illegal" aspect of it.  This is because we have seen the effects of smoking.  We hate cigarettes more than anything.

Some patients have tried Anzemet, Zofran, Kytril, Compazine, Emend (several of our "high test" drugs that we give chemo patients to prevent nausea).  We love these drugs and they have revolutionized the way we give chemo now (compared to back in the 1970's) by enabling us to give highly "emetogenic" chemo regimens (some chemo drugs are more "barf inducing" than others).   While we love these drugs, we also recognize that some of them cost $50 per pill.  We also recognize that some of them can cause you to become very constipated which forces you to take yet another pill to combat this side effect.

This article discusses chemo regimens and their likelihood of making you feel nausea and vomiting:  
Also make sure you check out Dr. Hesketh's algorithm in that article.  In it, he discusses that if you add another chemo to the mix from a certain group, that it increases the likelihood that the drug regimen will cause you to vomit.  As cancer doctors and nurses....we hate to hear that you have thrown up.  We will mix up your meds and try different regimens, all with the goal of  NO VOMITING!!!

Personally, I've only cared for a few patients on Marinol (the synthetic pill version of THC) and I didn't think it helped them all that much.  A nurse I work with though, really likes it for some of her patients.   So perhaps it works better with some patients, and some drug regimens more than others.

I will say that one of the greatest marketing strategies of any company that I have ever seen was from the makers of Marinol.  Years ago, the drug representative from the company that made Marinol, actually gave out small pans of brownies with the drug information in it.  OMG....this made me howl.  Genius!!!

Now....I will come back to two negatives for using marijuana while on chemo.  #1:  it really can cause a life threatening fungal infection in the lungs to develop.  Stem cell transplant patients and high dose chemo patients are especially susceptible to this when their white blood counts are low and they are considered immunocompromised.  The most concerning fungal infection it can cause:  Aspergillus or Aspergillosis.  Fungal infections are typically hard to treat.  Aspergillosis is really hard to treat.  It also can be tough to diagnose, depending on where you are being treated.   It can take weeks to months to treat with IV and oral anti-fungal agents.  Sometimes it can be fatal.

Another negative but true story....I had a patient on an experimental chemo drug that has a known side effect of weakening of the heart muscle.  We knew that she smoked pot, as she admitted that during her treatment.  When she started the new chemo that was known to affect the heart, she went for a cardiac echo to evaluate her heart function before she started and then 2 cycles after she started.

Well, one day she came in to the clinic "a little stoned".   The resident requested that the patient submit to a drug test.  She did as she knew that we all knew about her marijuana use.   Her urine tested positively for cocaine.  A cardiac echo a short time after that showed a HUGE decrease in her cardiac function in just 2 months.  It was attributed to the chemo drug AND the cocaine use.   We had to take her off the experimental chemo drug.  The sad thing was this experimental chemo drug was working like gangbusters on her tumors. 

Most of you are probably thinking....well she shouldn't have used cocaine.  Here's the thing:  she swore up and down that she did not use cocaine, just pot.  Honestly, I believe her because she had always been so forthcoming with us about her marijuana use.  I found out later that the person who sold her the stash of pot had "laced" the pot with cocaine.  If she had purchased her pot at an "approved" place in one of the states that allows medical marijuana, she might have been able to continue on her experimental chemo and maybe her outcome would have been a lot brighter than it turned out to be. 

So the moral of the story?  Bake it, don't burn it, if you are going to use it.  If you are using it, hopefully you are getting it in a state where you can get it safely.  Make sure that your healthcare providers know that you are using it.  If you are using it, make sure your white blood counts are at a decent level.  And finally, if you are using it, we hope that it is helping you.

States that allow medical marijuana:

The author of this book once gave the keynote speech at the Oncology Nursing Society's National Congress Meeting.  He was very humorous.  I remember thinking the book was okay, not great, but it definitely dealt with the issue of medical marijuana.  He was college aged and living at home when he developed Hodgkin's Lymphoma.  His mother was anti-drug, but later ended up growing a marijuana plant in her garden to help her son get through some of the side effects of chemo.  A mother's love!!

Monday, March 12, 2012

Red Rover Dog Walking

Best Idea Ever!!!          

One day I was skulking around at a large hospital in Boston in their cancer center.   I love to do this.  I have no shame.  I will look anywhere I can to find resources for my patients.   In a perfect world, all cancer survivors would get the same information and would be offered the same resources.  It wouldn't matter if they were treated at a "wealthy" hospital or a safety net hospital.  It wouldn't matter if they lived in a rural area, or in an urban area.  In my mind, cancer survivors deserve any help that we can give them.  But I digress!!!

So while skulking, I saw a flyer for residents of Barnstable,  MA.  It offered free dog walking (to any cancer patient with a dog) who was undergoing cancer treatment.  OMG...what an awesome idea!!!!!  Being a dog lover AND a cancer patient lover,  I was totally ashamed that I had never thought of this excellent idea myself.

Maria Silva is a professional dog walker/pet sitter in Cape Cod.  Her husband is a cancer survivor.  While he was receiving treatment for his Lymphoma in Boston in 2007, Maria's friends took turns walking her dog.   She was so grateful for this assistance.   When his treatment was over, she vowed to do this for others.

When I saw the flyer for her free dogwalking services, I called her to get the low down and to make sure that her offer was truly real.  It was.  

If you are a cancer patient receiving treatment and live in Barnstable MA, give Maria a call.  If you have a pet, and do not have cancer and live in the Barnstable area, I urge you to support Maria's business.  After all, don't you want someone who is filled with kindness taking care of your pet?

Rock on Maria!!!!  You have a huge heart and this is such a great thing to do!!

If you don't live anywhere near Barnstable, MA isn't this a great idea that you could try in your own home town?  Volunteer dogwalker or pet sitter for a cancer survivor undergoing treatment?  You could put your own flyers up at your local cancer center.  The minute I retire, this is exactly what you will find me doing.

Perhaps you are busy, work crazy hours and this is way too ambitious.  Perhaps you offer to walk the dog of one cancer patient who lives near you.  Or, to correlate with the "best gifts to give a cancer patient"...if you know someone who is going through treatment, offer to walk or pet sit their dog on a regular basis.  Or give them a coupon book good for 20 days of dogwalking to be used on days when they need it the most.

If a cancer patient is admitted to the hospital for a few days unexpectedly, you can bet that they will be worrying about their pet.  Offer to watch, feed or walk their pet.  On those days when they are really dragging and feeling their worst, can you imagine what a relief it would be for someone to offer to take their pet for a long walk?

This is definitely in my top ten favorite resources of all time for cancer patients.  Maria Silva, you are a genius!!!!!

Sunday, March 11, 2012

Fluids and Dehydration

The topic of Dehydration comes up frequently for those undergoing chemotherapy.

"Dehydration occurs when you lose more fluid (and electrolytes) than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If you don't replace lost fluids, you may get dehydrated.

Common causes of dehydration include intense diarrhea, vomiting, fever or excessive sweating. Not drinking enough water during hot weather or exercise also may cause dehydration. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk".

Being dehydrated can make you feel very tired (and sometimes weak and dizzy). When you are going through chemotherapy you already feel more tired than usual. Add dehydration to the mix and your “normal” treatment related fatigue can increase exponentially.  
Dehydration can be sneaky. You may feel that you are already drinking plenty of fluids. Long ago I learned that you don’t just ask a patient, “are you drinking enough fluids?” because the answer is always yes. I  learned that you always ask “about how many glasses of fluid are you drinking in a day?”  "What is the size of the glass?"   Invariably I find out that the person thinks they are drinking a lot more than they actually are.
Some patients really do drink a lot and yet still can become dehydrated. The general rule is if you think you are drinking enough, drink some more. 
I have yet to meet a patient who doesn’t feel better when they come in and get a bag (1 liter) of IV fluids for hydration. They are amazed with the level of energy that they have afterwards. 
Why don’t people drink as much as they should? We are all guilty of this.  If you are busy, you don’t think about it. With cancer patients, it may be one more thing to think about in a day when they barely have the energy to remember to get showered and dressed in the morning.
We know this.  We just ask you to do what you can.   It might help you to be more conscious of how much you are drinking, even if that means writing it down daily in a notebook using old fashioned tally marks.

Some patients fill up a pitcher at the beginning of every day.  When that is gone they know that they are done drinking for the day.

It is easy to say drink more, but if you feel queasy and can barely get solids down, drinking liquids can be difficult to do.  It may be helpful for you to know that there are “fluids” in places that you might not realize.

Jello is technically a liquid. A popsicle is technically a liquid.  Anything that  becomes a liquid at room temperature will count as "fluid" and will help you to keep properly hydrated.  
Can’t get down a full cup of liquid?   Maybe you can get down a popsicle every 1-2 hours. 1 popsicle = 90 cc. Can’t imagine getting down another glass of water? Try a bowl of strawberry jello with a little whipped cream.  A bowl is about 160cc of fluid. Soup, milk shakes, popsicles, all are considered“fluids” at the end of the day, and may make it easier for you to stay hydrated.
Can’t stand the taste of water or just not a water drinker? Crystal Light, Mio, True Lemon products are some examples of flavorings you can add to water to help get them down.  Ask your oncology nutritionist or dietician, as many clinics get free samples of these to give to patients.


Maybe you have always loved your tap water but due to the metal taste from chemo you are having a hard time getting it down. Try bottled water and add some of the flavors above. Make sure it is cold. It is usually easier to get “cold stuff” down.
Not eating or drinking much else during the day? Make your own popsicles with "Pedialyte" or any liquid that you used to enjoy in drink format, but try freezing it. Same goes for fruit juice. Love cranberry juice? Buy a cheap popsicle form/maker for your freezer and make your own popsicles.  Pedialyte is a mild electrolyte replacement drink that they give to kids. 
Adults can also try sports drinks.  Gatorade is everyone's first impulse to buy when they think they need more fluids or electrolyte replacement (can also be used to make popsicles).  Just be mindful as Gatorade and a lot of sports drinks have a lot of sugar in them which can actually cause increased diarrhea in some patients. 
Frappes and milkshakes count as fluids, but may also give you some extra protein and calories that you may be needing too.  If you like Carnation Instant Breakfast or Ensure  and need the extra nutrients that those provide,  you can try freezing those liquids into popsicles too.
Did you eat cereal in the morning? How much milk did you pour over it?  That amount of milk counts for your daily total of fluid.  An individual sized milk carton is 240cc or 1 cup of fluid.
Did you eat a can of soup at lunch?   One bowl is 160 cc’s.   A warning, just be careful as soups and many canned items contain a lot of sodium, so if you have puffy feet from some types of chemo (Docetaxel), you may not want to eat a lot of sodium/soups. 

Try to alternate your fluids so you don’t get bored and so that you have a little variety.  Also if you just drink one kind or one flavor of a beverage, I promise you that when chemo is over just the thought of that beverage will make you queasy or disgusted.

How much fluid should you have per day?  We usually say 8 to 10 glasses of fluid per day.  That would be about 1500 to 2000cc per day (1.5 to 2 liters) but some folks may require more.  Ask your doctor, nurse or nutritionist.  If you are a chemo patient and also have cardiac or heart issues, you need to discuss how much fluid you should have daily with your medical team.
Try keeping track of your fluid intake for a week and see if you notice any difference in your fatigue levels.
So next time when your nosy nurse asks you (with the suspicious hairy eyeball expression) “Are you really drinking enough fluids?” you can confidently say “yes, miss nurse smarty pants, I had 2 liters per day x 5 days”. This will shut her up and impress her!!!
One more thing....we won’t deprive you of your daily cup of tea or coffee, but they don’t really count in your calculations of fluid ingested. That is because tea and coffee tend to dehydrate you. They make you urinate a lot. So try to limit these to 1 or 2 glasses a day at the most.

Hopefully by tanking up on your fluids, you will feel a little less fatigued!!!
Here are some basic “amounts” or conversions for popsicles, jello etc so that you can figure out how much fluid you had in a day.
Fluid measurements
1 ounce = 30 cc
8 ounces = 240 cc
1 cup = 8 ounces = 240 cc

Sample measurements
Coffee cup = 200 cc
Clear glass = 240 cc
Milk carton = 240 cc
Small milk carton = 120 cc
Juice, Jell-o or ice cream cup = 120 cc
Soup bowl = 160 cc
Popsicle half = 40 cc
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