Sunday, May 13, 2012

"Darling, Haven't You Ever Heard of a Delightful Little Thing Called Boarding School? " (Neutropenia Part II)

"Darling, haven't you ever heard of a delightful little thing called boarding school? "


In my post about low white blood cell counts,  I blathered on about neutropenia, fevers, and when you should come to the hospital if you are a cancer patient.  Many cancer patients will become neutropenic, but won't develop a fever and won't have to be admitted to the hospital.   Most likely you will get neutropenic, you'll observe precautions to keep you safe, and your bone marrow /white blood cell counts will come back on their  own in their own good time.  Or, if you are on Neulasta or Neupogen (growth factors that increase the production of white blood cells) they will come back a little more quickly due to the boost from those drugs.

As nurses, we get asked all the time, "Isn't there something I can eat or do to help my white blood cell counts (or red  blood cells, platelets) to come back more quickly? "  Not really.  Our best advice to you is to maintain a well balanced diet, drink plenty of fluids and follow the basic neutropenic guidelines for cancer patients undergoing chemotherapy listed below.

Try to stay away from people who are sick.  Sounds silly and obvious, right?  If you can possibly get out of going to that town meeting or concert in the middle of cold and flu season, do it.  If your aunt has a cold, postpone that lunch you had planned until your counts are higher and your aunt has recovered.  If everyone is hacking and coughing in the waiting room at  your doctor's office?   Put on a mask (ask  your nurse for a small stack of these for  your purse).   

Avoid air travel if you possibly can (or wear a mask if you have to fly) when your counts are low.  Do you have friends who are sick who want to come and visit you?  Tell them that you would rather visit by phone until they have recovered.  If you need to, designate a family "sentry" who will speak to them, drive that message home, and hold them off at the door.

Have kids?  Clearly this is easier said than done.  If you are a parent (especially with young children) you can't just schlepp the kids off to boarding school as my idol  Baroness Schraeder from The Sound of Music would suggest!  (Although you may want to!!)

If you have kids in your life, they will come home with germs and every cold and flu symptom under the sun.  When your neutrophils are low, you will be susceptible to get every single new infectious process that your kids (or grandkids) bring home to you.

What can you do?  Well, you may not be able to banish your own kids from your home, but you can keep their sick friends away when your counts are low.   Keeping the cancer patient safe and as germ free as possible should be a family goal.  It might take a lot of teaching and a lot of reinforcement until this becomes a reality.  I suggest starting your handwashing family campaign on the very first day of chemotherapy.   

Tell your family that the very best thing that they can do to help you is to wash their hands. Good handwashing (by everyone, no matter what age they are) is the number one way to fight the spread of germs.   If your kids don't listen to you, have your doctor or nurse drive this point home to them. Good handwashing is still the best prevention. When I say good, I don't mean the 2 second "splash and wave" under the faucet. I'm talking soap, hot water, lots of friction and hand movement for several minutes.

How many bathrooms does the house have? If the home has 2 bathrooms, "banish" the kids to the other bathroom so that the cancer patient doesn't have to share with them.

Hand sanitizer should be used when you are unable to wash your hands with water. It should be considered "in addition to" good handwashing, but shouldn't replace it.  Keep small bottles of hand sanitizer in your purse, car, or anywhere handy. Get a stash of them going. Everyone in the family should do the same.

However, don't use hand sanitizer a thousand times a day. The reason why teenagers are drinking hand sanitizer now?  Most brands are loaded with alcohol. Products with alcohol tend to dry you out. If you use hand sanitizers with alcohol too much, they can dry out your hands and cause cracks in your skin. This is a portal for possible germ entry.

Same thing goes for mouthwash. Most mouthwashes have a high percentage of alcohol in them. They can dry out your mouth and potentially cause cracks or sores on your lips or in the lining of your mouth. Use Biotene or another alcohol free mouthwash. Use baking soda and saline mouth rinses four times daily. Keep your lips slathered with Aquaphor or Chapstick (or whatever your brand of choice happens to be).

Whether it is a crack in your skin, a mouth sore, a cut, a wound. Any break or crack in the skin's surface or your mucosal lining is a potential entry point for bacteria. So, just be mindful of this.

Are you someone who loves to garden?  Always wear gloves and wash  your hands afterwards.

If you are constipated, take a stool softener. Straining to have a bowel movement can cause tiny rectal tears which could be an entry point for bacteria. No rectal temperatures.

Use lubrication if you are having sex, as women can get tears in the vaginal lining which can also become an entry site for bacteria.

Use paper towels or those new "disposable towels" for handwashing. Absolutely no sharing of towels. Those little hand towels that everyone uses in the guest bathrooms? NO. Towels should be just for the cancer patient and should be on a separate rack from everyone else's. Also wash them frequently in good hot water.

Toothpaste and toothbrush need to be put in a medicine cabinet or as far away from the toilet as possible. If they have one of those Sonic Care electric toothbrushes, a nice gift would be a new one with that "autoclave" feature....UV sanitizer, that's it. 

FAMILY TOOTHBRUSHES SHOULD NOT BE KEPT NEXT TO EACH OTHER in one of those old cup holder/toothbrush dispensers. If you use a manual toothbrush (aka the "old school" kind) get one of those little plastic caps to keep the bristles covered.  

While we are on the subject of teeth, if you are getting chemo, don't go to a dentist unless you tell your oncologist. Cleanings should be "gentle cleanings" and dentists need to be aware that you are receiving chemo.  Dentist appointments should not be scheduled during your nadir (the time of your chemo cycle when your counts are the lowest).  

Have your kids help cleaning the bathrooms and the kitchens.  They should be spit shining them!!!  Let them feel like they are helping you.   NO MOLD. NO MOLD. NO MOLD. They need some serious cleaning going on and they need to maintain it .

Other suggestions for family members? Remind them that the very best way that they can help is to clean up after themselves, good handwashing, pots and pan cycle settings on dishwasher. Sometimes patients designate particular glasses as "their own".

A really nice thing to do for your friend with cancer,  would be to grab some friends and chip in for a professional maid/cleaning service to come in once a month for a few months. Even just a one time heavy duty cleaning would help. The cancer patient should be out of the house the day they come in, if possible, as they will be stirring dust up. 

Pets: If the cancer patient has a cat, someone else needs to take over litter box duty. Someone else should do "pooper scooper" duty if they have a dog. Same thing if they have a bird. You can get toxoplasmosis ( a type of infection) from cat boxes and bird cages. They should also use hand sanitizer or wash their hands after they pet the cat or dog.

Diet: there will be more about the neutropenic diet in a later post. Cook meats thoroughly. Single servings. If you have to eat out, make sure that you know that the kitchen is clean in a trusted restaurant. Avoid the salad bar at your local restaurant like the plague. Food that sits out, that multiple people are touching or coughing on is bad news.

No one wants the cancer patient living inside a bubble. As long as patients and families are using good handwashing techniques, common sense, and some of the advice above, you should be fine.

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