Lymphostasis after chemotherapy. Condition after chemotherapy. Internal organs condition

Distinguish between primary and secondary lymphostasis. Primary lymphostasis is caused by a congenital anomaly of the lymphatic system, mainly by the absence of lymphatic capillaries or lymphatic insufficiency.

Secondary lymphostasis is often caused by inflammatory diseases or tumors affecting the lymphatic vessels. The most common cause of lymphostasis is surgery and / or radiation therapy, which damage (traumatize) the lymphatic system.

Improving the transport function of the lymphatic bed leads to a violation of the outflow of lymph and, first of all, to the accumulation of fluid (edema) and proteins - products of cellular metabolism in surface tissues. The accumulation of protein substances stimulates the increasing densification of the tissue, which leads to a further deterioration in the outflow of lymph. If lymphostasis is not treated, then against its background, the rapid development of infectious complications, chronic inflammatory processes, scarring and proliferation of connective tissue is possible.

WHERE CAN LYMPHOSTASIS DEVELOP?

Most often, secondary lymphostasis affects the upper and lower extremities, for example, after removal of a tumor of the breast, prostate or ovaries, as a result of removal or irradiation of the lymph nodes. Lymphostasis of the trunk and genitals is also common. In the case of a tumor in the head region, lymphostasis of the head / neck may occur.

HOW TO TREAT LYMPHOSTASIS?

Lymphostasis not only significantly impairs the quality of life of patients, but is often accompanied by pain. If lymphostasis is not treated, the volume of the affected limb increases, the tissues become dense to the touch. With a neglected process and the absence of adequate treatment, infectious complications can join, and there is also a risk of malignant tumor transformation (lymphoangiosarcoma).

The main goal of treatment is to stop the progression of the disease, reduce the possibility of complications, and improve metabolic processes.

COMBINED REHABILITATION PHYSIOTHERAPY

Since the damaged lymphatic bed does not sufficiently cope with the transport function, the outflow of lymph must be supported from the outside. Therefore, regular manual lymphatic drainage, which a medical professional conducts and doses depending on the stage of lymphostasis, is an important prerequisite for creating conditions for a better outflow of lymph and softening of thickened areas.

Immediately after the procedure, it is necessary to create compression in the area of the lymphatic edema in order to avoid a new accumulation of lymph. For this, depending on the patient's condition, various bandages or compression garments are used. These therapeutic effects are collectively referred to as "combined physiotherapy rehabilitation".

SKIN CARE AND MOTOR ACTIVITY

Along with the therapeutic measures, the patient's own desire to help himself also plays an important role. First of all, it is necessary to carefully care for the skin and regularly engage in therapeutic exercises, since the dosed physical activity helps to maintain muscle tone and thereby maintains lymph circulation.

Until now, only the administration of selenium has proven itself as an additional drug therapy for lymphostasis. Medicinal preparations of inorganic selenium (for example, Selenase®) not only reduce edema, but, above all, prevent the development of erysipelas - a bacterial inflammation of the skin in the damaged area.

Selenium is an important trace element that supports the function of selenium-containing enzymes (glutathione peroxidase), as well as plasma selenoprotein. In both proteins, selenium is bound to a protein in the form of the amino acid selenocysteine. A selenium-containing enzyme is also 5-deiodase, which catalyzes the conversion of tetraiodothyronine (T4) to the active thyroid hormone triiodothyronine (T3).

Glutathione peroxidase is an integral part of the antioxidant defense system of cells. In the presence of a sufficient amount of substrate, i.e. reduced glutathione, glutathione peroxidase converts various hydroperoxides to the corresponding alcohols. In cellular or subcellular model systems, it has been shown that the integrity of cellular or subcellular membranes mainly depends on the intactness of the glutathione peroxidase system. It has shown a synergistic effect with vitamin E. Selenium, as a component of glutathione peroxidase, can reduce the degree of lipid peroxidation and membrane damage.

Selenium-containing glutathione peroxidase affects the metabolism of leukotriene, thromboxane and prostacyclin. Selenium deficiency suppresses immune responses, especially nonspecific, cellular and humoral immunity. Selenium deficiency affects the activity of certain liver enzymes, increases chemical or oxidative damage to the liver, as well as the toxicity of heavy metals such as mercury and cadmium.

The minimum dose of selenium required for a person depends on the chemical form of the element entering the body and the composition of the diet. The US National Research Council has recommended 70 mcg of selenium for men and 55 mcg of selenium for women. The German Nutrition Committee has recommended up to 100 mcg of selenium daily.

Selenium deficiency can occur in some cases in situations of increased consumption (pregnancy and lactation), with prolonged parenteral nutrition or a special diet (phenylketonuria), in patients on dialysis or with gastrointestinal diseases (chronic inflammatory bowel disease, gastrointestinal tumors). intestinal tract, cirrhosis, hepatitis), renal failure, in cases of an acute inflammatory response, the use of carbamazepine, phenytoin, valproic acid and in persons exposed to heavy metals or oxidants.

Selenium deficiency is associated with the development of endemic cardiomyopathy (Keshan's disease) and endemic osteoarthropathy with severe joint deformity, as well as skeletal muscle myopathy. Epidemiological studies indicate a correlation between blood selenium levels and the incidence of cardiovascular diseases (cardiomyopathy, arteriosclerosis, myocardial infarction), as well as cancer (especially of the digestive tract, chest and liver). The ability of selenium (200 μg / day) has been shown to reduce mortality from skin cancer, as well as lung, prostate and colorectal cancer.

When an insufficient (below optimal) amount of selenium enters the body, the activity of glutathione peroxidase decreases, but no clear clinical symptoms are observed.

Selenium deficiency can be detected by low blood or plasma selenium levels and decreased glutathione peroxidase activity in whole blood, plasma, or platelets.

The required dose of Selenase® in the treatment of lymphostasis is determined by the level of selenium in the blood that can be achieved as a result of therapy (the level of selenium in the blood can be monitored in the laboratory; reference values: 0.1 - 0.2 μg / g).

Since most patients are diagnosed with very low blood selenium levels prior to taking Selenase®, higher doses are recommended initially. In the case of acute lymphostasis, it is recommended to take 1000 μg per day (2 vials of 10 ml) for 3 consecutive days, then from the 4th day until the onset of clinical improvement, 500 μg / day (1 vial of 10 ml). In chronic lymphostasis, therapy is recommended for 6 weeks at a dose of 300 mcg per day. After improvement of the condition, the dose is reduced. In this case, with a body weight of 75 kg, as a rule, 100 mcg of selenium a day is sufficient, which should be taken in the morning on an empty stomach.

Overdose (intoxication) with the drug

Symptoms of an acute overdose are a garlic smell of exhaled air, fatigue, nausea, diarrhea, and abdominal pain. In chronic overdose, changes in the growth of nails and hair are observed, as well as peripheral polyneuropathy.

Overdose treatment: gastric lavage, induction of diuresis, or high doses of vitamin C. In case of severe overdose (by a factor of 0), it is recommended to eliminate selenase by dialysis.

Studies involving patients operated on for a tumor in the head region show that a sufficient supply of selenium has a preventive effect on the size, clinical course and dynamics of lymphostasis. Therefore, it is necessary to normalize selenium levels prior to surgery or radiation therapy.

Selenase should not be mixed with reducing agents, for example, vitamin C, since in this case, precipitation of elemental selenium is not excluded. Elemental selenium is insoluble in water and is not bioavailable. These data also apply to drugs that were used shortly before the administration of selenase. Selenase should not be mixed with juice. Selenase and vitamin C should be taken at least 1 hour apart.

TIPS FOR PATIENTS WITH LYMPHOSTASIS

(with existing lymphatic edema or with the threat of its development)

The skin in the area of lymphatic edema is more prone to dryness than healthy skin. Due to wearing compression bandages and products, the skin loses additional moisture and fat, which must be replenished.

Use bath oils (for example, Balneum Plus, Hermal, Germany), as well as creams and lotions that do not contain fragrances and preservatives, which effectively cleanse and soften the skin, restore its barrier-protective function
For even minor skin lesions and insect bites, immediately treat the skin with an antiseptic (such as betadine, iodovidone, octasept, or octenisept). As a last resort, you can use a drink with a high alcohol content (such as vodka).
Avoid sunburn
In case of heavy sweating of the feet, use a special powder to reduce perspiration.
Cut your fingernails and toenails evenly.
In case of reddening of the skin in the area of lymphatic edema, which is not caused by any damage, consult a doctor immediately (danger of developing erysipelas!).
Carry antibiotics with you when traveling on vacation
Do not visit the sauna and bathhouse.
Do not rest in an area that is dangerous for insect bites
Eliminate strength sports (the effect of sports activity is enhanced by compression)
Prefer Wellness Physical Education!
Avoid kneading massage in the area of lymphostasis

Do not wear high heels or lace-up shoes
Do not walk barefoot outside the walls of your home
Don't wear tight underwear
Do not sit cross-legged for extended periods

In the area of lymphostasis, the skin is prone to dryness. At first, this manifests itself in peeling, then noticeable wrinkles form on the skin, later it can crack. Increased peeling can also be a sign of a fungal disease.

More careful skin care should be taken

Small red spots

May appear due to a local reaction of intolerance, in particular, after the use of ointments and creams. If the cause is an insect bite, disinfect immediately.

Large, well-defined red spots

The cause of their appearance may be an inflammatory infectious process, mainly erysipelas (erysipelas). It starts suddenly and can be accompanied by severe pain, fever, and pain.

An urgent doctor's consultation is required

Red spots with blurred borders

They are often observed in chronic chronic lymphostasis and indicate progressive changes in tissues.

Rough, punctuated areas of the skin

They indicate a long-term abnormal tissue change called induration or fibrosis.

Lymphostasis should be treated more intensively

Attention! They can be a sign of the progression of the underlying disease or the involvement of new areas and tissues in the pathological process.

Suspected thrombosis or embolism. It occurs most often on the legs, rarely on the arms

Doctor's advice is required

Red nodules, bubbles

may be a sign of a herpes virus infection
may appear due to increased interstitial pressure (ulceration and ulceration, possibly with fluid leakage).

An urgent consultation with a doctor is required!

They occur most often with lymphostasis on the legs due to fluid pressure due to gravity. They are usually harmless, but they are a sign of the progression of lymphedema.

Pronounced vascular network

A branched vascular pattern occurs after radiation therapy, but may also be due to mechanical causes of lymph congestion. Also occurs in the case of spontaneous hemorrhage.

A doctor's consultation is required!

Shallow and deep furrows

They are often found in progressive lymphostasis due to the alternation of tissue sections of different degrees of compaction, and can also appear due to wearing too tight clothing or improperly selected compression hosiery.

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Lymphostasis

Salvation from cancer requires great sacrifices, it only says "cut out the tumor", in fact, even a tiny tumor is removed "in one block" with adjacent tissues and lymph nodes of several levels. Cancer of the mammary gland up to 5 cm with axillary lymph nodes suspected of having metastases is removed together with the gland and axillary, subclavian and even subscapularis subcutaneous fat. A huge lymphatic collector is removed, which carries the lymph from half of the organs of the chest and arm, but nothing remains in return. And where should the fluid move if the lymph nodes are gone, and only a postoperative scar remains on the way to the thoracic lymphatic duct?

Today, it is possible to remove small breast tumors with a part of the organ, but a partially preserving operation still requires removal of the lymph nodes affected by metastases and mandatory postoperative radiation. Seriously damaged soft tissues become much denser with the formation of scars, and again the lymphatic fluid stagnates in the vessels, because there is nowhere for it to move - there are no lymph nodes. And this happens not only during breast surgery, but during irradiation of the uterus or removal of the lymph nodes of the inguinal and retroperitoneal regions with testicular tumors, sarcomas and melanomas of the lower extremities.

How does lymphostasis occur?

Surgical or radiation exposure to the lymph nodes that drain the lymph fluid from the extremities leads to the predicted stagnation of lymph for such a situation. This condition has long been called "elephantiasis" among the people, and in the medical literature stagnation of lymph is called "lymphostasis", and the edema resulting from this is called "lymphedema".

After surgery on the axillary, inguinal, femoral, retroperitoneal lymph nodes, edema is inevitable, but its severity depends not only on the volume of the operation, but also on the individual characteristics of the tissues. Typically, delicate and sensitive tissues respond to trauma with large scars. Postoperative scarring affects large blood vessels, slowing blood flow in them, which complements the severity of edema. It is especially difficult to deal with the pathological condition with the initial varicose veins of the lower extremities.

After radiation treatment for cancer of the cervix or uterine body, scar tissue grows at the site of the destroyed tumor, and every year it becomes denser, involving an ever larger area, up to the pelvic bones, in the process. On the one hand, the scar is benign, but the resulting abnormalities are too significant. The development of connective tissue in the area of surgery and radiation involves nerve trunks, which causes pain and movement disorders in large joints.

Chemotherapy also makes its contribution, since drugs are mainly administered intravenously, the inner lining of the vessel is damaged, the vessel is partially or completely obliterated - its lumen is narrowed by cicatricial changes in the endothelial membrane. Venous blood flow is impaired, which responds with edema of the underlying anatomical areas. Antineoplastic hormonal drugs, taken for years, cause blood clots to form. The cancer itself initiates an increase in blood viscosity. There is a reason for the development of lymphostasis, and far from the only one, each of these reasons complements and aggravates lymphatic edema.

How lymphostasis grows

Lymphatic edema begins almost immediately after surgery, with radiation therapy, it builds up gradually over several weeks or even months. First, the hand or foot swells, they look like a water cushion, as a rule, the fingers are less affected than the back of the hand or foot. The fingers move, and the liquid flows out slightly, the branched vascular network also helps. Then the swelling spreads to the forearm to the elbow or lower leg. The spread of edema to the shoulder or thigh is already the III degree of lymphostasis.

The spread of edema is painful due to tissue stretching and compression of small nerve endings with excess fluid. There is a feeling that with awkward movement, the skin can burst, so patients try not to move the limb, which does not help at all, and can even increase the edema. Lowering the limb promotes blood flow, but if the arm can be carried high, then the leg cannot rest indefinitely on the pillow. The first time after resting in an elevated position, the swelling decreases, but over time it works less and less.

The inflamed skin and subcutaneous tissue gradually grows with connective tissue, replacing them with a cicatricial structure. A minor injury to the skin constantly oozes with clear lymph, which causes wounds to heal for weeks. Local immunity is reduced, therefore, staphylococcal infection often develops - erysipelas, which significantly aggravates the existing lymphostasis. Staphylococcus aureus settles for years, and each relapse of erysipelas supplements the defects of the soft tissues of the limb.

And it is no longer a tumor that becomes the reason for the appointment of a disability group, but lymphedema and a hand hanging because of it with a whip or a barely moving "elephant" leg.

Why does lymphostasis interfere with life

Lymphostasis is not only a cosmetic defect, it is vascular and nerve damage, leading to limited functionality. At first, when lymphatic edema of the limb only appears, it is protected so as not to increase the blood flow to the tissues and, due to this, the increase in pain. Gradually, anatomical disorders and a protective regime with limited movement leads to a progressive decrease in muscle strength, up to atony and subsequent muscle atrophy. And if the leg is forced to somehow walk, then the hand is taken care of, so atrophy of the upper limb appears faster and more pronounced.

Despite the urgent recommendations of the oncologist, immediately after the operation to begin to develop the limb, this is not done. Why? Firstly, it’s scary that something will suddenly be damaged, the operation was recent. Secondly, it is necessary to consult and train a specialist in physiotherapy exercises, which is not on the staff of the state oncological institution. In this early period of lymphostasis formation, when the edema still decreases after rest, there is no access to the necessary preventive care and early rehabilitation.

Thirdly, the patient is psychologically not at all ready for independent active actions, the emotional state does not correspond, due to stress it is impossible to remember the order of the exercises. We need the help of a specialist in exercise therapy - physiotherapy exercises, who every day will help to do exercises, overcoming pain and fear. This is the only way to form a stereotypical behavior that helps to minimize the manifestations of lymphatic edema.

After the operation, women are given very correct "Memo on the prevention of lymphostasis", which describes what can and cannot be done. But against the background of severe stress associated with the detection of an oncological disease, as well as in the postoperative period, intellectual capabilities temporarily decrease, the woman is confused, she does not control herself enough to force herself to perform exercises and follow “what can and cannot”.

What to do with lymphostasis?

It is necessary to begin with a consultation on the selection of compression underwear that creates external pressure and prevents the increase in swelling of the limb. Elastic bandaging is the last century, it is impossible to bandage your leg optimally on your own, and there is nothing to say about the hand. The pressure of the bandage is uneven, while there must be a certain gradient: more pressure in the lower part and less in the upper part, so that the liquid can flow out and not stagnate. Today, special gloves and stockings, T-shirts and tights are available that create optimal pressure.

It is necessary to immediately start physiotherapy exercises with a specialist. Only a stranger - a methodologist or an exercise therapy doctor - will help not to feel sorry for yourself. After some time, after daily exercises under the supervision of a specialist, you can switch to independent exercises, but while life is in pain, you do not need to build illusions, alone, without control and even "authoritative pressure", nothing will work. This is how a person is arranged, he regrets himself, especially with such a serious reason.

Rehabilitation should begin in the surgical ward and continue for the entire period of preventive chemotherapy as long as there is a negative effect on the vessels. A rehabilitation specialist will in time attach hardware methods for eliminating lymphatic edema. Lymphostasis is considered incurable because most patients are treated for stage IV lymphedema, when cicatricial changes are formed, and trophic changes in soft tissues have occurred, when the muscles are already atrophied and the joint is "locked" by contracture.

You should not understand the treatment of lymphostasis only as exercise and a handful of pills that improve the circulation of fluids. There are various hardware techniques, each has its own therapeutic niche and its own optimal time: pneumomassage, LED therapy, hydrokinesis therapy, manual lymphatic drainage and much more. The puffiness of the limb is affected by the treatment, social and physical activity, psychological state, profession, concomitant vascular diseases, endocrine disorders, and even the season.

Lymphostasis is a disability, and in the long term - the impossibility of self-service or movement. The limb is there, it is in place, but it does not work - this is a functional amputation of the limb. To prevent this from happening, it is necessary immediately after the operation to begin active prevention of the preservation of the arm or leg. Call us to find out about the capabilities of the Yusupov hospital in the fight against lymphostasis and the maximum preservation of limb function.

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Lymphostasis in cancer patients

The branch of medical science that studies the causes, symptoms, methods of diagnosis and treatment of malignant neoplasms is called oncology. Lymphostasis, its treatment and prevention are one of its directions. Signs of the disease can appear both before and after surgery.

Lymphostasis in cancer

Lymphostasis develops when there is a mismatch between the production of lymphatic fluid and its outflow. There are such forms of lymphostasis: primary and secondary. The cause of primary lymphostasis is congenital malformations of the lymphatic vessels. Lymphostasis in cancer patients is a secondary form of the disease.

The cause of lymphostasis in cancer is the defeat of the lymph nodes by metastatic atypical cells or the interruption of the lymph outflow pathways during surgery. By no means in all cases, limb edema develops after the operation. If patients in the postoperative period take anticancer drugs, follow the doctor's recommendations, then lymphostasis may not develop, or it will go away within 2-3 months.

Quite often, lymphostasis of the chest and upper limb develops after radical mastectomy (removal of the breast). In advanced stages of ovarian, uterine or prostate cancer, lymphostasis of the lower extremities occurs. With oncology, lymph stagnation can also occur in the case of the appointment of radiation therapy to patients. Sometimes scars form at the site of exposure to X-rays, which compress the lymphatic vessels. Lymphostasis can be caused by cancer of the lymphoid tissue.

Methods for the diagnosis and treatment of lymphostasis in cancer patients

The diagnosis of "lymphostasis" in oncology usually does not cause doubts in the doctor after questioning and examining the patient. However, in order to determine the tactics of treating patients, the following diagnostic tests are prescribed:

Doppler ultrasonography (ultrasound);

Diagnostic methods such as isotope lymphography (lymphangioscintigraphy) and contrast-enhanced lymphoangiography are considered inappropriate to use in cancer patients. It is necessary to find out the source of the appearance of metastases. For this, depending on the presence of signs of damage to internal organs, appropriate diagnostic studies are performed.

Treatment of lymphostasis in cancer patients is carried out after establishing the cause of the edema. To do this, after the operation, an active drain is placed, through which the lymph flows into a special receiver. Patients are prescribed medication. Lymphostasis decreases after chemotherapy. A good lymphatic drainage effect is observed after gymnastic exercises, Nordic walking and swimming. You should be careful about carrying out any type of massage and physiotherapy procedures for cancer patients.

Lymphostasis can be a sign of cancer, a complication of surgery or radiation treatment. For its prevention, after the operation, an active drainage is placed, and exercise therapy is prescribed to patients. If the patient observes the doctor's recommendations, lymphostasis in cancer patients may not develop. To do this, you need to contact a specialist when the first signs of the disease appear.

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Lymphostasis after radiation therapy

Lymphostasis appeared shortly after radiation therapy, moderate, did self-massage, was practically not treated - did not grow.

In the axillary region of the p / o there was a "seroma" - a cavity in the place where the drainage stood, was repeatedly punctured, but it remains as a multi-chamber cyst with a serous content of 6.6x3.6 cm - the dimensions do not change.

There are no enlarged lymph nodes.

Ultrasound, mammography and PET in January, there are no signs of relapse.

2. Can cystic formation in the armpit disrupt the lymphatic drainage?

3. What can be associated with increased lymphostasis almost a year after treatment.

5. Is it advisable to purchase a pneumatic massager at home and how often should you massage?

If the clinical situation is favorable, a course of complex compression therapy (manual massage + pneumatic compression + arm banding + possible options)

Edema reduction - selection of a compression sleeve.

Self-supporting compression therapy.

Ilyukhin Evgeny Arkadievich

Where can I go with my illness?

Lymphostasis

Lymphostasis is a disease that develops due to a violation of the process of lymph formation and its normal outflow through the lymphatic main pathways. According to the latest WHO data, this pathology, also called lymphedema, or lymphatic edema, occurs in 10% of the world's population.

The disease is characterized by the following symptoms: progressive tissue edema, an increase in the affected limb in volume, coarsening and lesions of the skin with ulcers. Chronic lymphedema leads to the development of elephantiasis, which causes disability.

Causes of pathology

The causes of such a dangerous disease as lymphedema can be different, and the range of provoking factors is wide. The accumulation of lymphatic fluid in the tissues can be the result of heart failure, renal pathology, when the main ducts and highways of the body cannot cope with the outflow of lymph.

Also, the causes of lymphostasis can be hidden in chronic venous insufficiency, thrombophlebitis syndrome, arteriovenous fistulas. If the amount of fluid removed from the tissues is excessive, the expansion of the lymphatic vessels develops, their tone decreases, the functioning of the valves is disrupted - all this leads to lymphovenous insufficiency.

The main causes of lymphostasis:

pathology of the lymphatic system (in most cases - congenital lymphedema);
obstruction of the lymphatic system highways after injuries, burns or surgery, after removal of the breast;
compression of lymphatic capillaries by tumors or inflammatory foci.

Post-mastectomy lymphedema (removal of the mammary gland due to cancer) occurs in 10–40% of patients who have undergone this operation. If the intervention has caused the development of pathology, then lymphedema of the upper extremities usually occurs. During the operation, axillary lymph nodes are often removed, which may undergo invasion of metastases. After a mastectomy, the patient should be registered with a phlebologist and lymphologist.

Allocate the primary and secondary forms of pathology.

Primary lymphostasis, that is, congenital lymphedema, develops for the following reasons:

congenital anomalies of the structure of the lymphatic ducts and highways;
underdevelopment of capillaries;
valve failure;
hereditary predisposition.

Usually paired limbs are subject to defeat. If lymphatic edema of the hand occurs, the second may also show signs of lymphostasis. Congenital lymphedema can be diagnosed as early as adolescence.

Secondary lymphostasis occurs after injuries or pathologies of the lymphatic system, which was initially normally formed. In women, the condition may worsen after a mastectomy. Secondary lymphedema develops mainly on one limb. In most cases, the disease affects the area starting from the lower leg to the knee and has an inflammatory-infectious or post-traumatic etiology (nature).

Symptoms of lymphostasis

Depending on the stage in which lymphedema is, the manifestations and symptoms of the disease can be as follows:

Mild stage - mild edema that appears in the evening and disappears overnight. The swelling of tissues increases with excessive physical exertion, with sedentary or standing work. If the lymphatic edema of the legs is at an initial stage, it should be treated with conservative methods.
The middle stage is swelling that does not go away. The fluid accumulates in the tissues constantly, chronic lymphedema develops, the symptoms of which are as follows: on the edematous surface, the skin is stretched, inflammation leads to the proliferation of connective tissue. These symptoms may be accompanied by pulling pains in the legs, the appearance of cramps. As a result of loads, lymphostasis is aggravated, the affected limb does not tolerate long motor activity, gets tired.
Severe stage - elephantiasis, the formation of cysts and fibrous nodes. Severe lymphostasis develops, its symptoms consist in a significant change in the contours of the affected limb. The development of contractures leads to a limitation of the functionality of the arm or leg, tissue nutrition is disturbed, ulcers, inflammatory infiltrates, eczema appear on the skin.

This is how lymphedema proceeds, the stages of which can move from one to another, in the absence of timely diagnosis and therapy. In this case, the signs of lymphostasis increase starting from the fingers of the limb, then capturing all large sections of the connective tissue. So, lymphostasis of the lower leg cannot occur separately from the lymphatic edema of the foot.

In general, the symptoms of lymphedema are as follows:

changes in the shape and volume of the affected limb;
the formation of folds on the skin that do not move when palpated;
feeling of tension and fullness in the affected areas of the body;
It's a dull pain;
changes in the skin;
lymphorrhea (lymph leakage);
inability to form a skin fold on a sore limb.

Secondary lymphostasis develops quickly, in contrast to the congenital form, which can be asymptomatic for years. The patient may notice the first signs of the disease after an injury or an operation. Secondary lymphedema can be corrected only in conjunction with treatment of the underlying disease that caused it.

Lymphostasis of the lower extremities

Lymphostasis of the legs is the most common type of this pathology. The factors provoking the disease can be hidden in advanced varicose veins, pathologies of the renal and cardiovascular systems. Lymphatic edema of the legs occurs more often due to a strong load on the lower limbs, if they are already susceptible to changes as a result of concomitant diseases.

In pregnant women, lymphatic edema of the legs develops due to disturbances in lymph circulation, but pregnancy in this case is not the root cause of the disease. Most likely, primary lymphedema, which has been asymptomatic for many years, worsened and manifested itself precisely during this period.

Dysfunction of lymph outflow leads not only to tissue edema, but also to its slagging. The acidity level of the skin increases, which leads to its thickening, a decrease in protective functions. The limb becomes vulnerable to attack by bacteria, infectious processes, inflammation and ulcers develop on the affected leg.

Lymphostasis of the hand

Pathology such as upper limb lymphedema affects mainly the female population. In most cases, lymphostasis of the upper extremities in women develops after a mastectomy.

Pathology appears when the lymphatic vessels are injured or completely removed during the operation. This disrupts the outflow of lymph from the upper extremities, which leads to disturbances. If lymphostasis of the upper extremities has developed a long time after the operation, or the area of edematous tissue has become hard and poorly palpable, medical intervention is urgently needed - a relapse of the tumor process is possible. Treatment of hand lymphostasis should be comprehensive, the success of therapy depends on the stage of the disease and on the timely identified concomitant pathologies.

Which doctor deals with the treatment of lymphostasis

Lymphedema is treated by lymphologists and vascular surgeons. It is important that the therapy is carried out by a competent specialist, since lymphatic edema is fraught with complications.

Treatment of lymphedema is best done in a specialized clinic, adapted for high-quality diagnostics and equipped with all the conditions for carrying out hardware and drug treatment of the disease.

Diagnostics

Treatment of lymphostasis involves a preliminary full diagnosis of the body. Examination methods recommended for suspected pathology:

Ultrasound of veins and capillaries of the lower extremities;
Ultrasound of the internal organs of the abdominal cavity;
Ultrasound of the internal organs of the genitourinary system and small pelvis;
blood tests - general and biochemistry;
general urine analysis;
lymphography - to determine the level of patency of the lymphatic lines;
magnetic resonance imaging or computed tomography - to identify and evaluate changes in tissues.

If lymphedema is diagnosed, treatment should be started immediately without waiting for complications.

Lymphedema treatment

Consider how to treat lymphostasis so that therapy is effective. The goal of treatment is to restore the normal outflow of lymphatic fluid from the affected limbs.

Lymphatic drainage massage performed manually or using a pneumocompression device.
Physiotherapy procedures - magnetotherapy, laser therapy.
Wearing a compression jersey that is sized to suit the desired degree of compression.
Compliance with a diet based on restricting salt intake.
Remedial gymnastics, swimming.
Drug therapy, including phlebotonic drugs that have a lymphotropic effect, enzymes, immunomodulatory agents. Dosages should be selected individually by the attending physician.
Local treatment of inflammatory and infectious processes of the skin.

If a diagnosis of lymphedema is made, treatment with folk remedies can only give a supportive effect, but cannot be considered as the main method of therapy.

Here are some ways to keep your body in remission and improve lymph drainage:

Tar treatment. You need to take one onion, bake in the oven and peel it. Add a fly in the ointment to the softened root vegetable. Apply the composition to the affected limb in the form of a compress and leave overnight. In the morning, it is recommended to eat a teaspoon of royal jelly with the addition of honey. The course of treatment is 2 months.
Herbal therapy. Means for oral administration are prepared as follows: sandy immortelle, Icelandic moss, birch and oak bark, horse chestnut are mixed in equal parts. Two tablespoons of the collection are poured into 0.5 liters of boiling water, the composition is boiled for several minutes. Drink the broth in 100 ml 4 times a day.
Garlic honey tincture. Pass three hundred grams of peeled garlic through a meat grinder, pour it with liquid honey. The composition should stand for 7 days. Consume 1 tbsp. l. three times a day for two months.

It is necessary to treat lymphostasis with folk remedies in combination with the main therapy.

Massage

The procedures should be carried out by a qualified specialist, choosing the technique individually, depending on the condition of the diseased limb.

With the help of manual massage or a pneumocompression device, it is possible to stimulate lymph drainage, facilitate blood circulation through the affected area of the body and remove tissue swelling at least partially.

The course of massage sessions is usually 10 days, it must be carried out regularly.

Prevention

Remember: it is better to prevent than to treat lymphatic edema, especially in the legs. The disease can be prevented by observing the following rules:

timely treat infectious foci and wounds;
provide therapy for chronic diseases of the renal and cardiovascular systems;
deal with the treatment and prevention of varicose veins;
in case of a neoplasm in the breast, choose the method of mastectomy with the removal of only sentinel lymph nodes, without applying total removal.

An important question is how to cure lymphostasis if the disease has already been diagnosed. Cases of complete recovery from lymphatic edema are rare, basically the pathology has to be treated throughout life, trying to keep the body in a stage of stable remission.

The prognosis for the treatment of lymphedema is serious, all patients with such a diagnosis should be registered with an angiosurgeon. Refusal of therapy leads to an even greater spread of edema, tissue infection and dysfunction of the limb. Therefore, it is important to recognize lymphedema in time. At the first signs of edema that does not go away, you must immediately contact a specialized clinic. The earlier therapy is started, the higher the chance to prevent dangerous complications.

Lymphostasis. How can I help myself?

What is lymphostasis?

Lymphostasis is swelling of soft tissues as a result of the accumulation of protein-rich fluid in the lymphatic vessels. Most common in the arm and leg, but can also affect the head, neck, chest, abdomen, and genitals. Lymphostasis can be significantly reduced and is managed with manual lymphatic drainage massage and combined decongestant therapy. Therapy includes compression bandages, skin care, and exercise. Most patients see significant results within the first two weeks of therapy.

Lymphostasis problem

If you are experiencing any of the symptoms listed below, it may be lymphostasis. Remember, early detection is the key to preventing and minimizing the effects of a disease:

Lower limbs

Swelling of the feet
Shoes got tight
Swelling at the base of the fingers
Numbness and tingling
Feeling of warmth in the affected limb.

Upper limbs

Swelling or hardness of the breast after removal of the tumor
The bra is tight
Swelling, pressure, heaviness in the arm,
Rings or bracelets began to crush
Sensation of warmth in the hand.

What causes lymphostasis?

One of the causes of lymphostasis is surgery to remove lymph nodes, usually during cancer treatment. The lymph nodes filter the fluid flowing through them, capturing bacteria, viruses and other foreign matter, which are then destroyed by white blood cells. Without normal lymph drainage, fluid can build up in the injured arm or leg, leading to the development of lymphostasis.

Medication, radiation therapy, and lymph node injury can also cause illness. This type is called secondary lymphostasis.

Primary lymphostasis manifests itself at birth or develops during puberty. The reason for this is not known.

What can be done?

Treatment for lymphostasis depends on its cause and includes compression therapy, massage, proper nutrition and skin care. In addition, you also participate in the process and can help yourself, enhancing the effect of treatment, as well as for prevention.

Raising an arm or leg that is swelling can help facilitate drainage of lymphatic fluid. Whenever possible, raise the limb above the level of the heart. Do not put pressure on the armpits or groin area, and do not hold the limbs unsupported for very long, as this can increase swelling. Light exercise can help reduce swelling. Using the muscles during exercise helps the lymphatic fluid to circulate naturally. But exercise also increases blood flow to the muscles. If you have edema, it is important to properly bandage the affected limb during exercise.

After surgery or radiation therapy

If you have had surgery to remove certain lymph nodes, use the affected arm or leg as much as possible. Most people recover within a week after surgery and are able to return to their normal activities. Patients can start prophylaxis of lymphostasis immediately after surgery, chemotherapy, radiation therapy, or after completing cancer treatment.

When removing lymph nodes in the hand

Treatment of arm lymphostasis after removal of lymph nodes or radiation therapy, as part of cancer treatment, is primarily to control their condition, even several years after surgery. See your doctor immediately if symptoms of infection such as redness, pain, or swelling increase.

Do not do blood tests or measure blood pressure on the affected limb. Always tell your healthcare provider about it.

Wear gloves when gardening or doing other household chores.

When removing lymph nodes in the groin

Wash your feet daily in warm, but not hot, water. Use a mild soap, preferably one that has moisturizing properties. Use a moisturizer regularly.

Wear comfortable shoes.

Wear compression stockings.

Treat any cuts, scrapes, insect bites, or other injuries.

Use sunscreen and insect repellent to protect your skin from sunburn and insect bites.

Read about the effective complex treatment of lymphostasis on the website of the ICC lymphology clinic.

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Russian Academy of Medical Sciences
Professor Semiglazov V.F.

What is chemotherapy?

The term CT is formed from two words "chemical" and "treatment", denotes the use of drugs for therapeutic purposes that have the ability to inhibit the development of tumor cells or damage them. The term CT usually means all types of drug treatment of neoplasms, including the use of synthetic drugs and substances of plant origin. CT acts on the cause of the disease. The goal of chemotherapy is to stop the division of tumor cells, their spread throughout the body, and inhibition of tumor growth. Unfortunately, the existing drugs are not selective, i.e. purposefully damaging only the tumor. Possessing an antitumor effect, they have a side effect of non-normal tissues - bone marrow, the mucous membrane of the gastrointestinal tract, hair follicles, etc. In order to damage the largest number of tumor cells, anticancer drugs are used, as a rule, in maximum doses. This explains their toxicity.

How and where is HT performed?

As a rule, chemotherapy is carried out in a hospital setting. This can be a regular hospitalization during chemotherapy, or you can receive another course in a day hospital.
The routes of administration of chemotherapy drugs are different. The most commonly used drug is intravenous administration. Some drugs are given intramuscularly or orally (taken by mouth).

What to look out for when administering the drug intravenously:

The needle should be in the vein. If you experience pain, burning or bloating in the injection area, be sure to inform the nurse about it, because this may indicate that the drug is partially injected past the vein.
The duration of the infusion can be different, and depends on which drug is being administered to you.
As a rule, the administration of the drug is not accompanied by pain or discomfort. With the introduction of some drugs, a metallic taste, dry mouth, and sometimes dizziness may appear.
With the introduction of chemotherapy drugs, allergic reactions may occur: facial flushing, shortness of breath, dizziness.

You must inform your doctor about the occurrence of the above symptoms.
After completing the procedure, it is recommended to rest for 10-15 minutes.

Complications

"A serious illness requires desperate means"
Schiller

Side effects (PE) depend on the individual characteristics of the organism. More often occur in debilitated patients, elderly people, as well as with impaired liver and kidney function, with the introduction of large doses of drugs (high-dose chemotherapy) and the use of special modes of their use.
By the timing of the onset of complications are distinguished:

direct PE - observed in the first hours after drug administration, maximum 24 hours (vomiting, nausea, drug fever, fainting, dizziness, headache, less often diarrhea, skin rashes, general allergic reactions).
the nearest PE - appear in the course of chemotherapy, more often in the second half of the course or towards the end of it (myelodepression, dyspeptic syndrome, neurological and autoimmune disorders, toxic lesions of the urinary system, peripheral neuropathies).
delayed PE - occur 1-6 weeks after the end of the course of chemotherapy (liver and myocardial dysfunction).
distant PE - develop later than 6-8 weeks after the completion of chemotherapy (complete hair loss, decreased immunity, cardiac disorders).

According to the degree of manifestation, PE is divided into mild, moderate and severe.
Next, we will dwell in detail on the main toxic manifestations of chemotherapy.

NAUSEA- an unpleasant, painful sensation in the epigastric region and the oral cavity, accompanied by general weakness, sweating, increased salivation, a feeling of coldness in the extremities, pallor.

VOMIT- a complex reflex act leading to the eruption of the contents of the stomach (sometimes together with the contents of the small intestine) out through the mouth (less often through the nose).

Uncontrolled nausea and vomiting worsen not only the quality of life of patients, causing severe physiological and psychological discomfort, but also, leading to serious consequences (dehydration, electrolyte disturbances), dictate the need to reduce the intensity of chemotherapy and even stop it.

Nausea and Vomiting can be:

acute - within 24 hours after drug administration,
delayed - within a few (2-6) days after chemotherapy,
preliminary - before the introduction of chemotherapy, it develops in patients who previously received chemoradiation treatment, accompanied by severe nausea and vomiting.

Antiemetic drugs:

serotonin receptor antagonists
- ondasetron (zofran, emesset, latran)
- nauban
- kythril
dopamine antagonists
- metoclopramide (cerucal, metoclop, raglan)
corticosteroids - dexamethasone
benzodiazepines

lorazepam (ativan, loram, merlit)
diazepam (valium, seduxen)

In addition to medications, nausea can be reduced by doing the following:

In the morning, it is advisable to do light breathing exercises on the balcony or with an open window. Try to undress and get some fresh air, sometimes it helps a lot.
Before breakfast, suck on a piece of ice, a slice of frozen lemon, tkemali sour plum, cherry plum or a few cranberries.
Eat dry foods on an empty stomach: croutons, dryers, toast, chips, cookies, etc.
Eat small meals throughout the day so that your stomach does not overflow.
Avoid food that has a specific taste, do not eat foods with a strong smell.
Do not eat fried, especially fatty foods, dairy sauces, whole milk (these foods can be included in the diet when the nausea has passed).
It is not recommended to eat too sweet dishes.
Do not eat too salty and overly spicy hot food.
Avoid drinking liquids with meals to prevent your stomach from filling up with liquid. Try to drink more between meals. Drink the liquid at least one hour before or after a meal. Drink cold, clean, unsweetened drinks.
Eat slowly so that a large amount of food does not enter the stomach at the same time; chew food thoroughly.
Avoid eating food just before the administration of drugs.
Chilled food can bring relief: meat, cottage cheese, fruits. Sour foods (lemons, cranberries, pickles), pickles, and tomatoes can reduce nausea.
If you know in advance at what point you will have nausea or vomiting, do not eat foods that you like during this period, as a negative conditioned reflex may occur. Patients complain that they are "turned out" from some of their favorite foods, as they were taking them, while nausea and vomiting came, and now these foods cause unpleasant associations in them.
Use ready-made frozen food that can be reheated at low temperatures or food that does not need to be cooked.
Try not to cook your own food. Entrust this to relatives, friends, neighbors. Sit in another room or take a walk while the food is cooked. This is especially true for fatty and fried foods with a strong smell.
Avoid any odors (food, smoke, perfume). Avoid foods and drinks that smell like nausea, such as boiling coffee.
Eat light snacks throughout the day.
Remove dentures on the days you are receiving chemotherapy, as foreign bodies in your mouth can contribute to vomiting.
Try to breathe through your mouth when you feel nauseous.
Observe good oral hygiene, it is recommended to rinse your mouth with lemon water.
Popsicles can reduce nausea in many people, and you can also use chewing gum or hard candy.

MUCOSITE (STOMATITIS)- damage to the oral mucosa, leading to inflammation, and in severe forms to painful ulcers and infection. This is a severe toxic reaction that can involve the tongue and gums. Most often, stomatitis occurs if chemotherapy includes drugs such as methotrexate, fluorouracil, doxorubicin, bleomycin. It is important to identify stomatitis at the initial stage. To do this, during the course of chemotherapy, potentially causing stomatitis, it is necessary to eat a slice of orange every morning and, if it starts to "tingle" in the mouth, inform the attending physician.
Prevention measures for stomatitis:

complete sanitation of the oral cavity before chemotherapy
cryotherapy (cold therapy): resorption of ice pieces 10-15 minutes before and during chemotherapy (a total of 30-60 minutes)
objective systematic assessment of the state of the oral mucosa.

Signs of stomatitis:"Tingling", redness of the oral mucosa, profuse saliva, pain when chewing food. Bubbles, swelling of the tongue, burning sensation, discomfort may appear.
When stomatitis occurs, therapy is prescribed to reduce inflammation.

a diet with the inclusion of soft, warm, non-irritating, thermally processed food in the diet,
cleaning agents: 3% hydrogen peroxide solution, weak potassium permanganate solution, sodium bicarbonate solution, irrigation with 0.12% chlorhexidine solution, pharyngosept,
healing / enveloping agents: egg white, diluted in one glass of water, antioxidant vitamin E, applications with a 2% solution of methyluracil, derinat, granocyte or leukomax, in the form of rinses of 150 mcg in 150 ml of water,
local analgesics: 1-2% lidocaine solution, anesthesin solution, novocaine.

Other local influences include the treatment of the oral cavity with rosehip oil, sea buckthorn, propolis solution, vitamin B12.

Below are some tips on how to deal with stomatitis.

Avoid irritating the mouth with alcohol and spicy foods. Avoid exposing your mouth to high temperatures (by eating and rinsing), spicy, burning and acidic foods, dry foods, and very salty foods. Do not smoke or use chewing tobacco.
Brush your teeth while awake every 4 hours with a soft bristled toothbrush.
We recommend rinsing your mouth for 3-5 minutes every 2-3 hours at least 8 times a day. Between rinses, use sea buckthorn oil, solcoseryl, actovegin to lubricate mucous membranes and ulcers.
Rinse your mouth with a solution of baking soda (1 teaspoon for 1.5-2 cups of water) or a combination of 1 teaspoon of baking soda + 1 teaspoon of salt in 1000 ml of water. Warm decoctions of chamomile, sage, oak bark, St. John's wort, as well as a protein solution (one chicken egg white per 0.5 liters of water) have long become the usual rinses.
You can use ready-made rinsing medicines. Romazulan is a liquid containing chamomile extract. Apply 1 teaspoon to a glass of warm water (do not drink, but rinse). Rotokan - a mixture of chamomile, calendula and yarrow extracts - has anti-inflammatory, hemostatic properties and helps to restore damaged mucous membranes.
Rivanol (0.1% solution), furacillin (solution 1: 5000). The only argument in favor of rinsing the mouth with these ancient medicines is their low cost.
For ulcerative stomatitis, treatment is possible according to the following scheme: rinsing the mouth with a solution of hydrogen peroxide (1 tablespoon per glass of water), then a weak (pale pink) solution of potassium permanganate, then the use of various rinses and aerosols, and at the final stage - lubricating the ulcerative areas with sea buckthorn oil , juice of kolonhoye or more modern drugs: solcoseryl (gel, jelly), actovegin (gel, jelly) or mundizal (gel). Solcoseryl or Actovegin promotes the fastest healing of ulcers and the restoration of damaged mucous membranes, and mundizal gel has a pronounced analgesic, anti-inflammatory and antimicrobial effect. One centimeter of one of the gels is applied with a clean finger 3-4 times a day before meals, lightly massaging the sore spot.
For superficial and ulcerative stomatitis, it is possible to recommend rinsing with Tantum Verde - a solution for external use - 15 ml (1 tablespoon) every 1.5-3 hours. After rinsing, spit out the solution. For severe pain, rinse your mouth with painkillers: 0.25% novocaine solution, Almagel A.
If you are not allergic to bee products, you can spray your mouth with proposol aerosol. Irrigation is carried out for 2 seconds 3-4 times a day after rinsing the mouth with boiled water or a decoction of one of the aforementioned herbs. You can also use the drug "Hexoral". Geksoral is produced in aerosols and in the form of a liquid for rinsing: 10-15 ml of undiluted solution 2 times a day after meals.
Convenient to use lozenges for resorption - hexalysis. They are used 4-6 times a day. They have antibacterial activity and no side effects. The disadvantage is that it does not tolerate the simultaneous use of other antiseptics. Therefore, if the symptoms of stomatitis do not disappear within 5 days, the drug should be canceled. Lozenges for resorption - septolete - are used for moderate stomatitis, daily dose 6-8 times a day. Pharyngosept can be used in parallel.

Dietary recommendations for stomatitis:
Products that will help you in the treatment of stomatitis - ready-made mixtures for children (meat, vegetables and fruit), various types of cottage cheese, yoghurts, non-acidic jellies, soft mild cheeses, whipped cream.
Include the following foods and drinks in your diet: oatmeal, strained milk soup, soft-boiled eggs, mashed potatoes, puree soup, curd pudding (you can mash it with milk), egg and milk cream, and other non-irritating foods. It is not recommended to consume acidic fruits and citrus fruits, as they can increase the irritation of the oral mucosa. Use soft food when acute stomatitis has subsided. Cook stewed, boiled, mashed dishes (steamed meat, salads with rolled meat and poultry, casseroles, soufflés, puddings, soups and broths with a minimum amount of salt and, of course, without pepper). Eat tomatoes with caution, because they have the ability to increase irritation of the oral mucosa. Rose petal jam helps many people. It is highly recommended for stomatitis, cream and milk ice cream without any additives.
In cases where you have dryness or discomfort in the mouth or throat, when it is difficult to chew and swallow food, try drinking more fluids (up to 2 liters per day). Watermelon and melon should appear on your table regularly. Keep ice cubes or sugar-free hard candy and gum in your mouth for a short time.

DIARRHEA- (loose stools) caused by chemotherapy, in most cases, is due to the direct toxic effect of chemotherapy drugs on the epithelium of the small and large intestines or the development of pathogenic flora in the intestine. In addition, other causes of diarrhea may be exacerbation of concomitant diseases (chronic gastritis, enterocolitis, dysbiosis after antibacterial treatment).
Therapy for diarrhea consists initially of fluid and electrolyte replacement. For this purpose, you can use the drug Regidron or the following solution: ¾ a teaspoon of table salt + 1 teaspoon of soda + 4 tablespoons of sugar + 1 glass of orange juice in 1 liter of water, the prepared solution must be drunk within 24 hours.

In the drug treatment of diarrhea, drugs that affect intestinal motility are used:

loperamide hydrochloride (Immudium, Lopedium, Enterobene) - 4 mg orally every 4 hours initially, then 2 mg per episode of loose stools (no more than 32 mg per day);
attapulgite (kaopectate, neointestopan) - 1.5-2 g after each episode of loose stools (maximum daily dose 9 g). If an intestinal infection is suspected, these drugs are used for no more than 24 hours.

In addition, in the presence of pain, analgesics, antispasmodics (no-shpa, platifillin, baralgin) are prescribed
Additional factors for correcting diarrhea include: caloforming (cementing) complex powders based on calcium carbonate; infusions, decoctions, extracts of astringents of plant origin (St. John's wort, chamomile, oak bark, pomegranate bark, nutmeg, blueberries); biological products such as colibacterin, bificol, linex, etc.
Bactisubtil is also used to restore bowel function after chemotherapy and / or radiation treatment. The drug is used 1 capsule 3-6 times a day, the drug should not be taken with hot drinks and used simultaneously with alcohol. In the presence of a painful sensitive intestine, as well as for the prevention of diarrhea, enterol is recommended - 1-2 casoules a day.
Diarrhea that lasts more than 48 hours requires the administration of a synthetic analogue of somatostatin - octreatide (sandostatin) 150 mcg - 3 times a day subcutaneously, with the addition of fever - the appointment of antibiotics (intetrix) and infusion (intravenous) therapy to compensate for electrolyte disturbances, prevent hypovolemia and shock. These activities are usually carried out in a hospital under the supervision of the attending doctor.
Dietary measures for diarrhea are aimed at restoring water-mineral, vitamin and protein balance. In this case, food should spare the intestinal mucosa as much as possible. In the first stage of treatment, the intestines need rest, so the diet should include only soft and liquid foods (steamed or boiled). In addition, for 3-5 days, it is desirable to limit the calorie content of food by reducing carbohydrates and fats. Fatty meats and fish, smoked meats, pickles, canned food, hot spices and vegetables that irritate the intestinal tract (radish, onion, radish, garlic) are excluded from the diet. Legumes, sorrel, spinach, sour varieties of berries and fruits, strong broths, fried and stewed second courses, fresh whole milk, as well as soft bread, pastries, pancakes, and pies are prohibited.
More fluids should be taken. Drinks should be warm or at room temperature. Mineral water can only be taken without gas. Useful juices, jellies, jelly and mousses from four "Ch": blueberries, bird cherry, black chokeberry, black currant. The following dish is very popular among patients suffering from diarrhea: the crushed powder of one nutmeg is added to 0.5 liters of branded Cahors, boiled in a water bath at a temperature of 60-80 C. for 10 minutes, shaken. Take 1-2 tablespoons several times a day. Decoctions of dried pear, wild rose, St. John's wort, green apple peel are shown. With a large loss of fluid, the following solution can be recommended: 1 liter of boiled mineral water, 1 teaspoon of salt, 1 teaspoon of soda, 4 teaspoons of sugar, drink throughout the day. If diarrhea persists for a long time, it is necessary to make up for the lack of potassium. For this purpose, it is recommended to eat foods with a high content of this mineral - bananas, potatoes, apricots, peach nectar. If you cannot eat this food, take potassium supplements - asparkam or panangin.
Additionally, use the following practical tips:

On the first day of diarrhea, try to switch to a purely water diet to give your gut a rest.
Eat less fiber that is usually rough and difficult to digest. If the intestines are inflamed or irritated, even a small amount of rough food is an unbearable burden for it.
Try to eat more often, but in small portions.
Eat only peeled fruits and vegetables.
Drink plenty of fluids, but remember that frequent and large fluid intake during loose stools will wash out the salts that you need to replace. Mandatory recommendation: drink warm mineral water, only first you need to release the gas.
Useful juices from blueberries, bird cherries, pears, weak sweet tea. The liquid should be at room temperature, very hot and icy drinks are unacceptable.
Don't eat raw vegetables.
The following foods have a firming effect: boiled rice, bananas, toast without oil and potatoes.
Avoid gassing foods such as beans, peas, Brussels sprouts, cucumbers, grapes.
Eliminate spicy foods from your diet.
Avoid foods that can cause extra gut work, such as beans, nuts, sweets, asparagus, and coffee.
Eat slowly, chewing food thoroughly.
Do not take foods that can aggravate diarrhea: fatty foods, lard, carbonated drinks, milk and dairy products. Do not consume fruits and juices that promote fermentation processes (grapes, citrus fruits, plums).
If diarrhea persists or is accompanied by bloody discharge, be sure to see your doctor.

CONSTIPATION- (stool retention) - is a less frequent complication of chemotherapy, but no less serious.
Treatment of constipation, if it is not due to reasons requiring surgery, should begin with the appointment of a diet containing a sufficient amount of vegetable fiber, fermented milk products, vegetable oil. Smoked meats, pickles, pickles, cocoa, chocolate are excluded from the diet, fried foods, sausages, rye bread are partially limited. Try to eat less bread and bakery products made from premium wheat flour (especially fresh, soft), pasta, semolina dishes. Recommended food with a high content of fiber and ballast substances (found in plant products, especially in cereals). Foods that help normalize stool include: fresh kefir, yogurt, acidophilus. A positive effect is provided by prunes soaked in water, figs, infusion of them, plum juice, boiled beets, dried fruit puree. From the first courses, soups, borscht, cabbage soup on a strong vegetable broth are useful.
Nutritionists recommend pudding made from carrots, prunes, apples with lemon, beetroot puree, vinaigrette with vegetable oil. In the morning on an empty stomach, it is recommended to drink a glass of mineral water, fruit juice (plum, peach, apricot) or a hot lemon drink. Grated carrots, raw apple, yogurt, 5-7 prunes, washed and poured in boiling water overnight, have a laxative effect on an empty stomach.
A special mixture works well for constipation. To prepare it, you need to take dried prunes, dried apricots, figs in equal proportions (100 g each), rinse, pour over with boiling water and grind (meat grinder, mixer). Add 100 grams of honey and 5-7 grams of chopped Alexandrian leaf (hay) to the resulting mass. Mix everything thoroughly, put in a clean glass jar and store in the refrigerator. One tablespoon of the mixture, diluted in half a glass of cold water, is taken daily at bedtime.
In addition, with a general satisfactory condition, walks and minor physical activity are shown. Morning exercises, exercise with an emphasis on the abdominal muscles are helpful, brisk walking is recommended.
Drug therapy for constipation should be carried out with great care, in short courses, under the strict supervision of a physician.

See your doctor and find out which of the above tips you can use.
Drink 4-8 glasses of liquid a day.
Your diet should include foods that promote bowel movement (peristalsis). We recommend coarse bread, bread with bran, cereals - buckwheat, oatmeal, wheat, pearl barley with milk or vegetable oil, cereal dishes. Include in your diet foods containing fiber (as nutritionists recommend adding raw vegetables and fruits, nuts, sprouted wheat to milkshakes). Try oatmeal cookies, cornflakes.
For some patients, apples, figs, dates, tea with lemon help well.
A decoction of prunes in the morning and at night is useful.
Be sure to add bran to your food, starting at one teaspoon a day. Then this amount should be increased to 4-6 spoons per day. Increasing the dose too quickly may cause loose stools and bloating. Try adding bran to cereals, rice or potato casseroles, and dairy products.
Take laxatives only as a last resort during treatment with anticancer drugs.

TOXIC EFFECTS OF CHEMOTHERAPY ON BLEEDING
Most anticancer drugs affect the bone marrow, reducing its ability to produce blood cells. These include blood cells - erythrocytes, leukocytes, platelets. The effect on hematopoiesis is the most important side effect of chemotherapy. Most often, leukocytes are affected, to a lesser extent platelets, and even less often the red blood lineage - erythrocytes - is damaged. Why is there such a big difference in the toxic effects of chemotherapy on various blood elements? Antineoplastic drugs act most actively on rapidly dividing tumor cells. Since leukocytes have the shortest life span, they are affected much more often and to a greater extent than other blood elements. Due to the slower division and the long (compared to leukocytes) life span of red blood cells, anemia due to suppression of red blood cells is rare and does not have serious clinical significance.
What are the factors responsible for leukopenia - the most common and dangerous side effect of chemotherapy? First of all, this is the drug itself, the dose used and the mode of administration. Note that with standard doses and usual regimens, severe leukopenia does not develop.
Liver or kidney disease can alter metabolism and slow elimination of the drug, thereby increasing toxicity and leading to more severe leukopenia. Many factors affect the bone marrow reserve: in young patients, the bone marrow is richer in cellular elements than in elderly patients, therefore, their leukopenia will be less severe. Previous courses of chemotherapy or radiation therapy may result in more severe leukopenia. The nutritional status of the patient is also important: malnourished patients with protein or vitamin deficiencies are more vulnerable to the action of anticancer drugs and have less ability to recover from chemotherapy.
Usually, leukopenia, often accompanied by thrombocytopenia, occurs 7-14 days from the start of treatment, followed by a rapid recovery of the number of leukocytes by 21-28 days. With the use of certain drugs (lomustine, mutamycin), leukopenia and thrombocytopenia occur later, and recovery occurs more slowly (6-8 weeks). Therefore, it is advisable to continue monitoring blood parameters for some time after the end of the administration of drugs (sometimes up to 4-6 weeks). The planned next course of chemotherapy may be postponed until the number of leukocytes recovers. It is generally accepted that more than 4,000 white blood cells are usually required to safely resume chemotherapy. With a lower number of leukocytes, chemotherapy is possible, provided that the absolute number of neutrophils is at least 1500. Therefore, when performing a clinical blood test, it is necessary to count not only the total number of leukocytes, but also the leukocyte formula.
During the course of chemotherapy, your doctor will monitor your white blood cell count. If the white blood cell count is too low, your doctor may interrupt your treatment or reduce the dosage of your anticancer drugs.
The main danger of leukopenia is the possibility of developing infections. During this period, microbes that are both inside the body and in the environment become the source of infectious diseases. The gates are wide open for an external and especially aggressive hospital infection. But the inner enemy does not sleep either. Focuses of latent infection are activated, which smoldered imperceptibly somewhere in a sick tooth, lungs, appendages or prostate gland. Antibiotics, of course, come to the rescue, but they fulfill the mission of mercenary soldiers and themselves create problems in the form of allergic reactions, fungal stomatitis and other side effects. The bleak picture is aggravated by severe weakness, impaired appetite, dizziness and the possible addition of thrombocytopenia.
A low white blood cell count can mask the classic symptoms of inflammation, in particular a lack of high fever, making it difficult to diagnose an infection. What are the signs of infection?

The temperature is over 38.
Cold phenomena (cough, runny nose, sore throat).
Excessive sweating, especially at night.
Loose stools.
Burning sensation when urinating.

If any of these symptoms appear, tell your doctor. Do not take aspirin, analgin and drugs containing these substances (baralgin, trigan, spazgan, etc.) or any other antipyretic drug to reduce the temperature until you talk to your doctor or nurse. During chemotherapy, taking any medications should be agreed with your doctor, as some drugs can reduce the number of leukocytes and other blood cells, regardless of the effect of chemotherapy. At high temperatures, the doctor will usually order a chest x-ray, blood test, and cultures of sputum (if any), saliva, urine, and blood for microbial flora and antibiotic sensitivity. If an indwelling catheter is installed in the vein for administering drugs, cultures are taken from the catheter canal.
Try to prevent introducing infection by the following measures:

Wash your hands during the day; wash them especially thoroughly before eating. Remember the words of V. Mayakovsky: "To avoid meeting a disaster, wash your hands before eating." Be sure to wash your hands after using the toilet.
Try to avoid close contact with people who are a potential source of infection. Do not increase the crowd by yourself - do not appear in places where there are many people (meetings, sales, wholesale markets). If possible, do not use the metro - besides people, there are also drafts. Do not even communicate with loved ones if they have the flu or some kind of cold illness. Stay away from children (even your own) if they have chickenpox (chickenpox).
Cut your nails very carefully. Once again, we remind you that it is strictly not allowed to stick your fingers in your mouth, bite your nails and hangnails. The first time you were told about this when you were 2 years old. Do not pluck or cut the burrs. Use a special cream and tweezers for this.
To prevent injury to the oral mucosa, do not use hard-bristled toothbrushes. It is preferable to use solutions containing disinfectants when rinsing the mouth.
To avoid cuts when shaving, use an electric shaver. If you do cut yourself, disinfect your skin.
Do not squeeze out blackheads (this advice has been known since adolescence and has not lost its relevance now).
Take a warm daily shower and towel dry your skin instead of roughly drying it off.
If your skin is dry and cracked, use special creams to soften it and help it heal.
If you get cut or scratched, wash the affected area with warm water and soap and disinfect the skin.
After each bowel movement, gently and thoroughly clean and wash the anal area. If irritation or hemorrhoids develop, seek the advice of your doctor.

The tactics of treating leukopenia requires a differentiated approach. If a week after the end of the course of chemotherapy the number of leukocytes is 2500-3000, then with the appointment of special stimulants for the development of leukocytes, you can not rush. It is likely that by the beginning of the next course, the number of leukocytes will be restored. If leukopenia persists a week before the start of chemotherapy, drugs that slightly stimulate the growth of leukocytes should be used. If by the planned day of the start of chemotherapy the number of leukocytes to the required for this course has not yet recovered, then, in agreement with the doctor, take the medication for another week, adding hormonal agents. Delaying the next chemotherapy course by 1 week due to leukopenia is a good reason.
Grade 4 leukopenia is a formidable danger, whenever they appear - during chemotherapy or after it ends. Leukopenia of grade 4 requires extraordinary attention, since with the development of these complications, it is necessary to use stimulants for the development of leukocytes, vitamins, antibiotics, drugs that increase immunity.
For a long time, there were no highly effective means for increasing the number of leukocytes. Until now, leukopenia is still used leucogen, a drug more than thirty years ago, slightly increasing leukocytes, low toxic and very inexpensive. We recommend using leucogen for minor leukopenia with a leukocyte count of 2000-3500, 1 tablet before meals 3-4 times a day. About the same age, but not as popular as leucogen, is methyluracil. The drug weakly stimulates an increase in the number of leukocytes. Its advantage is that it is effective against gastric ulcer and duodenal ulcer and chronic gastritis. In addition, methyluracil is used for inflammatory processes in the pancreas (pancreatitis) and colon (colitis). In milder forms of leukopenia, you can take 1 tablet 4 times a day during or after meals (if necessary, the dose can be increased to 6 tablets per day).
With more pronounced leukopenia, prednisolone is used, 4-6 tablets per day, with an emphasis on the maximum dose of the drug in the morning. For example; 3 tablets after breakfast, 2 tablets after lunch, 1 tablet after dinner or 2 tablets after breakfast, 1 tablet after lunch and 1 tablet after dinner. Do not forget to consume dairy products while taking prednisolone, which protects the gastric mucosa from the irritating effects of prednisolone: milk, milk jelly, cottage cheese, sour cream cheese mass, kefir, yoghurts, etc.
Most patients after standard doses of chemotherapy do not develop leukopenia with a leukocyte count below 2000. However, if severe leukopenia still occurs, then in subsequent courses, you can reduce the dose of drugs. With a threatening (4 degree) leukopenia, a whole system of therapeutic measures is introduced. Antibiotics, hormonal drugs are prescribed - prednisolone, dexamethasone, or medrol (not to be confused with diphenhydramine). The treatment includes stimulants of leukopoiesis - leucogen or methyluracil, batylol. Transfusions of fresh blood or leukomass are performed.
However, in the first place should be put a special group of modern drugs that have completely changed the view on the prevention and treatment of leukopenia. These include drugs under the general name colony-stimulating factors - granocyte, leukomax, neupogen. They accelerate the maturation of leukocytes, increase their lifespan and release leukocytes from the bone marrow. The use of colony-stimulating factors reduces the overall duration of leukopenia, which leads to a decrease in hospitalization time and the duration of antibiotic treatment.
Your doctor decides which of these drugs to recommend, taking into account the urgency of the restoration of leukocytes, the presence or absence of infection. Your financial condition is also taken into account, since the cost of drugs is different. The doctor will also determine the duration of drug use, which depends on the dose, chemotherapy regimen, and the degree of expected leukopenia. The use of these drugs significantly reduces the incidence, severity and duration of leukopenia. There are several options for when to start using these drugs: at the end of the course of chemotherapy, 1-2 days after the end of treatment, and less often when leukopenia occurs.
There are many tips for treating leukopenia with diet. However, there are no official, scientifically proven recommendations indicating the ability of any diet to increase the number of leukocytes. Therefore, one has to focus on the experience of doctors and patients who use certain products that, in their opinion, contribute to the treatment of leukopenia. Some patients believe that caviar and walnuts contribute to an increase in the number of leukocytes. There is no need to defend the opinion that sturgeon and salmon caviar is an extremely tasty and nutritious product. However, in terms of chemical composition, an ordinary chicken egg is quite comparable with it. Let caviar lovers not be upset, but an egg is even richer in some vitamins and other substances. Due to the optimal combination of iron, copper, manganese, cobalt and a number of other substances in chicken egg proteins, it may well be used for violations of blood parameters.
By the way, you will do the right thing if you eat an egg or caviar for breakfast after a portion of muesli: cholesterol will no longer enter the bloodstream completely. After all, the ballast substances contained in muesli become an obstacle on the way of cholesterol to the place of its absorption. And its very content in the blood can be reduced with the help of ballast substances. The German Society for Nutrition claims that there is nothing healthier than a plate of muesli for breakfast. True, for some patients, too many different grains can become a "heavy burden" for the stomach and intestines.
As for nuts, without denying their pleasant taste, qualities and high-calorie nutritional properties, it should be noted that their effect on hematopoiesis is significantly exaggerated. However, they can play a role in general dietary therapy aimed at restoring blood counts.
Try to eat raw vegetables and fresh fruits. From our point of view, juices from fresh vegetables and fruits are useful: carrot, tomato, currant. There is official information on the high stimulating effect of papaya juice, although it is unclear which is worse, for example, guava or mango. The juices contain not only vitamins that have already set the teeth on edge, but also many minerals and trace elements that performed protective functions, in particular, supporting the immune system.
A diet with the inclusion of the bran of sprouted wheat grain seems to be expedient and useful from the point of view of improving hematopoiesis. Recently, such bread has appeared in stores. When grinding the shell, the grains end up in the bran, along with the embryo of a failed spike. Wheat germ is 50 times richer in vitamin E, 12 times richer in vitamin B6, 2-4 times richer in vitamins B1, B2, B3, PP. Compared to whole grains, it contains 2-3 times more iron, magnesium, copper, potassium, phosphorus. The protein content in a grain of wheat is almost twice as much, and carbohydrates are 70 times less.
All this gives the germ of wheat, as well as the germ of corn and oats, high biological, nutritional and, therefore, dietary properties.
In combination with ground walnuts and wheat bran, you can prepare very useful broths and cereals that help improve hematopoiesis. For the same purpose, a decoction of beef liver, green peas, oatmeal, rye bread, chicken, milk and other foods containing protein vitamins B1 and B2 are used. Some doctors believe that lentil extract is a drug that is extremely active in the process of hematopoiesis, in particular, stimulates the growth of the number of leukocytes.
In general, good nutrition is, if not reliable, then, in any case, a diligent assistant in the treatment of leukopenia.
Platelets play an important role in stopping bleeding: when blood vessels are damaged, platelets accumulate at the site of injury, as if sticking together, while releasing substances that constrict the vessels and cause the formation of a blood clot, which prevents further bleeding. After the operation, in case of injuries and other unpleasant moments that caused bleeding, a protective reaction of the body is observed: the number of platelets in the blood increases. However, in some cases, an increase in the number of platelets can lead to the formation of blood clots in the lumen of the vessels. Often this phenomenon is observed with varicose veins or with their inflammation.
A decrease in platelet count is called thrombocytopenia.
What is the main danger of thrombocytopenia? This is, first of all, the possibility of bleeding. The first signs appear in the form of painless hemorrhages into the skin (bruises), then bleeding from the mucous membranes - gums, nose, gastrointestinal tract - join.
In blood tests, with these phenomena, a decrease in the number of platelets to 25,000-50,000 is observed. Be sure to tell your doctor if you develop bruising or blemishes under your skin. Any "unreasonable" bleeding from the gums or nose is a reason to see a doctor. Also report bloody urine or stools, as well as black tarry (black) stools.
Therapeutic measures for thrombocytopenia consist in the active prevention of bleeding and boil down to the following:

Avoid taking aspirin and medications containing aspirin.
Use a rinse or cotton swab to brush your teeth, not a toothbrush. Try not to use dental floss.
Men are better off using an electric shaver.
Avoid actions and movements that could lead to injury.
If you need to blow your nose, do it with extreme caution. Clean your nose with light blowing: never use your finger while doing this.
Avoid using enemas and suppositories.
Apply pressure bandages after injections, especially intravenous ones, until the bleeding stops.
Women should discuss with their healthcare provider about the use of birth control pills or drugs to prevent menstruation. (Danger of severe bleeding).
Surround yourself with soft things that won't hurt you, bruises, etc.
Be very careful when handling knives, scissors or other sharp tools.
Be careful not to burn yourself, especially when working with the iron and preparing food. Wear a thick-lined mitt if you need to get into the oven or oven.
Avoid gymnastic and sports exercises, as well as other vigorous activities that can lead to bodily harm.
Use heavy-duty gloves when digging in summer cottages or working with garden plants. Watch out for roses and plants with thorns and thorns.
Walk with extreme caution on slippery roads; in the ice it is generally better not to leave the house.
It is undesirable to use candles. Except for styptic suppositories for bleeding hemorrhoids.

As we have said, the main danger of thrombocytopenia is bleeding. Therefore, most of the therapeutic measures are aimed at preventing or stopping bleeding. When the platelet count drops below 25,000, platelet transfusion is desirable. There are few medications for platelet recovery. These are hormonal drugs: hydrocortisone, dexamethasone, triamcinolone. Doses depend on the degree of thrombocytopenia. Reduces bleeding and has a weak stimulating effect on platelet growth, the drug dicinone (etamsylate). He is prescribed 1 tablet 3 times a day before meals for 7 days. If a longer use is necessary, blood tests for a coagulogram should be regularly taken. Another drug, Erythrophosphamide, in addition to increasing the platelet count, is also used for anemia (anemia). To enhance blood clotting, it is administered intramuscularly at 150-300 mg for 1-2 days. If necessary, injections are made 2-3 times a day for 2-3 days.
Aminocaproic acid helps with bleeding. It is best to take it in powder, 1.0 gram, 3 times a day after meals with a little sweet liquid. If there is no powder, take a ready-made solution of aminocaproic acid 2 tablespoons 3 times a day after meals. Vicasol tablets also have a hemostatic effect. We recommend taking 1 tablet 3 times a day before meals for 3-4 days in a row, then take a break for 4 days. Ascorutin tablets strengthen the walls of blood vessels and are also used for bleeding. From herbal preparations, nettle leaves are used to stop bleeding: briquettes are produced from crushed nettle leaves, divided into 10 slices. One slice is poured with a glass of boiling water, infused for 10 minutes, filtered, cooled. Take 1 tablespoon 3 times a day. Tablets and tincture of lagochilus, in addition to the hemostatic effect, in some patients cause a laxative effect. The tincture is taken 25-30 drops before meals 3 times a day. Your doctor may recommend other herbs for you.
For cuts, a hemostatic sponge should be used in addition to pressure bandages. In case of hemorrhoidal bleeding, "Biological antiseptic suppositories" are recommended, which include hemostatic, antiseptic and analgesic agents. If the blood "has gone" from the nose, in addition to the aforementioned hemostatic agents, drip naphthyzine - it causes narrowing of the nasal vessels.
Dietary measures for reducing platelets are poorly understood. Information about the benefits of certain products is sporadic and extremely vague. We recommend consuming more fruits and fresh vegetables containing vitamin C in combination with a complete protein diet.

ANEMIA

Anemias- a group of diseases characterized by a decrease in the number of erythrocytes and blood hemoglobin. It is important for you to know that anemia is often accompanied by a deficiency of iron, which is necessary for the vital activity of the body. Iron is a constituent of hemoglobin, which is responsible for the delivery of oxygen by the blood to all parts of the body.
In patients with neoplasms, anemia is quite common. Therefore, a decrease in the number of red blood cells and the amount of hemoglobin that arose as a result of chemotherapy is sometimes difficult to distinguish from anemia caused by the disease itself. Some drugs have toxic effects on the bone marrow, affecting red blood cells (red blood cells). Nevertheless, severe anemia as a result of the use of anticancer drugs rarely develops.
When the number of red blood cells decreases, the tissues of your body do not receive enough oxygen, and you may feel dizziness, flashes of flies in front of your eyes, chills, and headache.
If chemotherapy has led to a decrease in hemoglobin below 80 g / liter, special measures must be taken. If possible, free yourself from household chores, rest more, keep your strength. Try to move around and especially change your position slowly to avoid dizziness. For example, when you wake up, instead of getting out of bed right away, sit on your bed for a while. Change your lifestyle: the body needs a lot of oxygen, so try to increase your stay in the fresh air - walking, relaxing on the balcony, sleeping with an open window.
Therapeutic measures for anemia caused by anticancer drugs include the mandatory use of iron preparations and erythropoiesis stimulants. A whole group of drugs, including different types of iron (ferrous gluconate, ferrous lactate, ferrous fumarate, and, even impossible to pronounce, ferrous protein succinylate) fills the shelves in pharmacy kiosks. Your doctor decides which one to choose. Below is information about some of them.
Tardiferon- contains ferrous sulfate, ascorbic acid and enzyme; replenishes iron deficiency in the body and stimulates hematopoiesis. Take 1 tablet 1 hour before meals, 2 times a day. The drug is not compatible with Almagel and other drugs that lower the acidity of gastric juice. We do not recommend using tardiferon together with tetracycline (it complicates absorption) and with iron preparations for intramuscular use.
Multivitamins should be used during or after chemotherapy 1-2 times a day (depending on which drug you purchased).
Aktiferin- an iron preparation containing ascorbic acid, which is necessary for the absorption of iron by the body. Take 1 capsule 3 times a day.
Totem- liquid iron preparation, produced in ampoules, is taken orally (drink the contents of the ampoule), 1 ampoule per day. This drug is highly effective for increasing hemoglobin, especially in cancer patients.
When taking all medicines containing iron orally, it should be borne in mind that in some patients there is a violation of the absorption of iron from the stomach, which makes the use of drugs meaningless. Such a patient can even suck on an I-beam, all the same, hemoglobin will not increase.
Therefore, intramuscular or intravenous administration of iron preparations is sometimes necessary, for example, a drug called ferum lek. The drug is administered at 100 mg intramuscularly or intravenously (written on the ampoule) once a day for 10 days. This period is usually enough to increase the amount of hemoglobin by 5 g / l.
If the hemoglobin count and the number of red blood cells are significantly reduced, the doctor may prescribe a blood or red blood cell transfusion.
PREVENTION AND TREATMENT OF THE TOXIC EFFECTS OF CHEMOTHERAPY ON THE INTERNAL ORGANS
The direction of the first, but far from the main blow of chemotherapy drugs is the liver. It is the largest, most complex and most functionally diverse organ, consisting of a myriad of individual microscopic lobules. Just listing the functions of the liver would take quite a few pages. Three types of liver activity are related to chemotherapy: active participation in metabolism, neutralization of toxic agents (protective function) and elimination of various substances from the body with bile (excretory function). The interaction between anticancer drugs and the liver is manifold: 1) the conversion of most drugs into an active form, 2) a decrease in the toxic effect of drugs, 3) the effect of liver diseases on the therapeutic and toxic effects of drugs, 4) the damaging effect of drugs on the liver.
It is clear that the maximum burden falls on the liver to reduce the toxicity of anticancer drugs. On the one hand, chemotherapy imposes on the liver increased requirements for its detoxifying function, and on the other hand, it is necessary to ensure the maximum protection of the liver from the toxic effects of drugs.
Before starting chemotherapy, a biochemical blood test is usually done. In the majority of patients who did not have jaundice before, did not abuse alcohol, did not work in chemically harmful industries, the indicators of liver function should be normal.
Many drugs taken for a long time cause liver damage. Some drugs act as direct liver poisons; their toxic effect is predictable. Other drugs affect the liver only in susceptible patients. The severity of liver dysfunctions in these cases is unpredictable and does not depend on the dose of drugs administered.
After several courses of chemotherapy, abnormalities in liver function often occur, which, in moderate severity, are not dangerous and sometimes only cause the need to reduce the doses of drugs. A remarkable property of the liver is the ability to repair its damaged cells during the break between chemotherapy courses.
But with significant damage to the liver cells, the liver function does not have time to recover. This can be a reason to interrupt and sometimes to cancel chemotherapy.
Severe liver failure is not difficult to identify: yellowness of the skin and mucous membranes of the mouth and eyes appears, especially clearly visible in natural light. Vascular "asterisks" and hemorrhages appear on the skin. There is a variety of changes in the biochemical blood test. The initial stage of liver dysfunction is detected only with the help of a biochemical blood test, therefore it is advisable to examine the blood for bilirubin and enzymes before each course and after chemotherapy.
With highly toxic chemotherapy, it is recommended to use drugs that protect the liver at the very beginning of treatment. Mild hepatoprotectors (drugs that protect the liver from the harmful effects of chemotherapy) include vitamin B12 (calcium pangamate), which is usually prescribed 2 tablets 3-4 times a day before meals. A more pronounced protective effect of the drug Carsil (Legalon). It is taken 1 tablet 3 times a day with meals. Multiple multivitamins will also make the liver's hard work easier. These drugs are prescribed before chemotherapy to all patients who have previously suffered from jaundice (Botkin's disease) and in the past or present suffering from chronic alcoholism.
If, before starting the next course of treatment or during chemotherapy, violations of biochemical parameters are detected, Essentiale is added to the above drugs. The popularity of this drug is slightly higher than it deserves. The drug is long-term, you need to take it for 2-3 months; its effect does not appear immediately, but several weeks after the start of treatment. Essentiale is prescribed 1-2 capsules 3 times a day and is taken after meals. If you need a quick effect, the drug is administered intravenously, daily, 5-10 injections.
Sirepar also finds its niche in treating the side effects of chemotherapy on the liver. It is injected intramuscularly in 2-4 ml daily for 20 days.
Hepatoprotector Heptral is widely used today, which is administered intravenously for 10 days.
With severe violations of liver function, hormonal drugs are sometimes used. Usually, prednisolone is used at 4-6 tablets per day. The drug is taken after meals with dairy products: milk, kefir, porridge, milk jelly, low-fat sour cream, yogurt, curd cheese. The daily dose is divided into 3 unequal parts, using the maximum number of tablets in the morning. Considering that prednisone removes potassium from the body, do not forget to add potassium orotate, which also has a positive effect on the liver and is available without a prescription in pharmacies. Potassium orotate is prescribed 1 tablet 3 times a day 2 hours after meals.
Vitamin B15 (calcium pangamate) is a good inexpensive domestic drug that is actively used for various liver diseases. It is used 2 tablets 4 times a day before meals.
Concluding the review of the drug treatment of liver disorders, it is necessary to pay tribute to the old medicines. These are methionine, lipoic acid, cocarboxylase and ATP, the therapeutic activity of which is inferior to modern drugs. Nevertheless, they are all very affordable, low-toxic and can be used today.
An equal partner of drug therapy for liver damage is a diet in which fried foods are prohibited and stews are sharply limited. Avoid fatty meats and fish, lard, lamb and beef fat. Smoked meats, pickles, marinades, sausage, fat ham, loin, mushrooms are excluded. Cholesterol-rich foods (brains, egg yolks, fish and mushroom soups, broths). In the acute period of the disease, turnips, radishes, rhubarb, spinach, onions, beans, peas are not recommended. Very cold drinks are prohibited.
Nutritionists allow vegetarian soups, borscht, fresh cabbage cabbage soup, milk soups. Recommended second courses: steamed meat and fish cutlets. Boiled lean meats, beef, chicken, turkey, tongue. Low-fat varieties of fish: cod, pike perch, carp, navaga, pike (also boiled).
The vegetable menu in this diet is varied: carrots, beets, cauliflower, pumpkin, zucchini - all fresh and boiled. It is impossible to do in our country without boiled potatoes and mashed potatoes. Many nutritionists decide the controversial issue of tomatoes in favor of the latter. Milk porridges are recommended: oatmeal, rice, semolina. Various additives give porridge different flavors. We recommend adding washed raisins to porridge during cooking. With liver damage, the saying that you cannot spoil porridge with butter is unfortunately inappropriate. Porridge made for baby food is very useful. In general, if you ignore the taste and be guided only by useful properties, then in baby food stores you will find a wide variety of cereals and ready-made products.
Milk is especially useful. If you cannot stand it, do not be upset, there are still many lactic acid products: kefir, fermented baked milk, acidophilus, yoghurts. Liver balm is low-fat cottage cheese with milk or honey, mild cheeses, milk creams and other dairy products filling supermarkets and grocery stores.
For liver diseases, the menu includes ripe fruits, berries and melons, as well as soaked dried apricots, prunes, baked apples, fruit and berry juices, rosehip broth, wheat bran, yeast drink with sugar and milk.
The daily diet includes 90 g of protein, 80-100 g of fat, 350-400 g of carbohydrates (2800-3000 kcal).
We specifically dwelled on this diet in such detail, since we recommend it not only to patients with impaired liver function, but also to almost all patients over 50 years old. The specified diet, according to long-term observations of experienced nutritionists, is also beneficial for healthy people over the age of 60.
DAMAGE OF THE URINARY SYSTEM
Platinum preparations have a pronounced toxic effect on the kidneys. Given the active use of these drugs for cancer, kidney damage is likely.
In humans, an average of 1200 ml of blood flows through the kidneys per minute, and per day all the blood contained in the body passes through them about 350 times. The kidneys are involved in metabolism and perform endocrine and excretory functions. Violation of the latter is the main danger for patients receiving chemotherapy.
In case of impairment of the excretory function, anticancer drugs, instead of timely breaking free with urine, circulate freely in the blood for a long time, continuing to carry out their destructive effect on the body. You may argue that at the same time drugs have a stronger therapeutic effect. This is not entirely true. The antitumor effect of chemotherapeutic drugs is manifested only in the maximum tolerated doses, and it is in such doses that they are administered. Therefore, any increase in the residence time of the drug in the blood increases its toxic effect on the body so much that it leads to dire consequences, in particular, to those when the reduction or even complete disappearance of the tumor no longer matters. What will be the degree of toxic damage to the kidneys (they will completely fail, partially or completely remain unaffected) depends on the dose of the drug, the full functioning of the kidneys before the start of chemotherapy and some other reasons. In order to prevent toxic effects on the kidneys in patients, a general analysis of urine and blood biochemical parameters is periodically conducted. When there are changes in the urine or a significant increase in the level of creatinine and urea in the blood, the administration of many drugs is contraindicated: cisplatin, carboplatin, mutamycin, methotrexate, prospidin.
The toxic effect of platinum preparations on the kidneys can be prevented or significantly reduced by using a very large amount of fluids with intravenous administration of the drug and drinking plenty of fluids throughout the course of treatment. The doctor may prescribe diuretics and an additional intake of potassium and magnesium.
In case of impaired renal function, in order to protect them, a low-protein diet with a limited amount of salt is prescribed. When drawing up the menu, you need to be especially careful about the variety of dishes so as not to cause aversion to food. Recommended: vegetable caviar - eggplant and squash, ghee, vegetable oil - olive, soy, refined sunflower. For lovers of dairy dishes, this diet has an immense space: milk, milk jelly, condensed milk, cream, sour cream, yogurt, kefir, yoghurts, cottage cheese, curd spreads, unsalted milk cheeses, milk soups. In addition, borscht, beetroot soup, fresh cabbage soup with apples, fruit and cereal soups can be recommended as first courses. Meat of various types (beef, veal, lamb, chicken, turkey) should be consumed in limited quantities. If there are no problems with being overweight, feel free to cook dishes from various cereals and pasta. However, if you love pasta, you can eat them, not paying special attention to the weight. Some nutritionists claim that pasta does not contribute to obesity.
But the benefits of raw vegetables are beyond doubt: carrots, cauliflower, green peas, lettuce, tomatoes, parsley, green onions. The exceptions are radish, radish, spinach and sorrel. Fruits and berries of various varieties in natural, boiled or baked form are very useful; as well as jelly, jelly, compotes, juices, rosehip decoction.
In severe cases, a potato and egg diet without meat and fish is recommended, which must be boiled during cooking, and then baked and fried without salt. Inflammation of the bladder (cystitis) is sometimes seen as a result of holoxan or high doses of cyclophosphamide. The main symptom of cystitis is frequent, painful urination. There may be blood in the urine.
Treatment of medicinal cystitis consists in an enhanced water regime, which in a simple way means drinking plenty of fluids, the use of anti-inflammatory and analgesic drugs. The abundance of drugs used in the treatment of cystitis makes it difficult to choose the best remedy, even for urologists. We believe that with mild forms of cystitis, one should not use super-strong drugs that have side effects. Useful use of herbal decoctions (kidney tea, bearberry, corn silk). Of the drugs, we call urobesal the first - despite the presence of antique components (salola, belladonna and urotropin for over 100 years), this is a very inexpensive and effective drug. A medicine called gentos will help just as much. It should be taken in 10-20 drops of 1 tablespoon of water 3 times a day 30 minutes before meals. Finally, the homeopathic preparation of the company Neel (Germany) - mucose compositum, practically has no side effects, it is applied subcutaneously or intramuscularly, 3-5 times a week. With sharply increased urination, some relief is caused by no-shpa. Usually prescribed 2 tablets 3 times daily before meals. More potent and more toxic drugs (quintor, 5-Nok, palin, etc.), if necessary, will be prescribed by a doctor.
The peculiarities of the diet for cystitis caused by chemotherapeutic drugs, as we have already said, are characterized by abundant drinking. We recommend milk, tea with milk, warm non-acidic compote, alkaline mineral waters (Borjomi, Smirnovskaya, Sairme, Jermuk). The use of spicy foods, sauces, pickles, seasonings, canned food, smoked meats is prohibited. It is necessary to exclude alcoholic beverages. Vegetables, fruits, dairy products are recommended. Watermelons and melons are especially useful. When preparing dishes, it is better to forget about salt, at least in the acute stage of the disease.
RARE SIDE EFFECTS
The toxic effect of chemotherapy on the heart is infrequent, mainly with doxorubicin (also called doxolem, adriamycin, adriablastin) and, to a lesser extent, pharmacorubicin. In people without heart disease, these drugs usually do not cause changes in heart activity. Risk factors are age over 65 years, very high blood pressure, as well as receiving a significant total dose of these drugs, which is usually achieved after 8-10 courses of chemotherapy. At lower doses, the incidence of heart failure does not exceed 0.1-0.2% (in 1 patient per 1000). There is a drug called Cardioxan that protects the heart from the toxic effects of anticancer drugs. However, its cost is quite high, and the likelihood of a toxic effect of anticancer drugs on the heart is so small that only your doctor decides on the appointment of cardioxan. People with chronic heart disease should take heart medications during chemotherapy, which they receive at the usual time.
Impact on which organ have we not discussed yet? That's right, the lungs. But the incidence of pulmonary toxicity is very rare, the danger arises after prolonged use of bleomycin, in patients over 70 years of age. It manifests itself as cough and shortness of breath, which complicates the diagnosis, especially in patients with lung disease. In any case, if signs of respiratory failure appeared during treatment with bleomycin, the use of bleomycin should be abandoned (at least temporarily) and an X-ray of the lungs should be taken.
Side effects from the muscular and nervous system are expressed in increased weakness, fatigue, or soreness in the muscles or joints. These phenomena can be a consequence of both anemia (anemia) and a side effect of some anticancer drugs. Changes in the nervous system are usually insignificant, but they are manifested very versatile.
Parasthesia is a tingling or burning sensation in the hands or feet, similar to when you "sat" a leg or "lay down" your arm. Sometimes quickness disappears, and you become more clumsy in your movements and actions. Do not forget to inform your doctor about this. You should be calm about the occurrence of these violations, and try to reasonably calculate the time, taking into account the fact that now you are doing everything more slowly. These phenomena will pass, but they can be troublesome if forgotten. For example, if your fingers are numb, you should be very careful when handling hot, sharp or other dangerous objects; the amount of broken dishes you break these days will significantly replenish the trash bin. Therefore, with the use of expensive sets and cleaning the sideboard, it is better to wait. But rubbing your palms is not in anticipation of something pleasant, but to reduce the feeling of tingling, you should more often. There is no need to postpone taking medications to reduce discomfort.
You must inform your doctor about the occurrence of the above symptoms, who will prescribe the treatment you need. Usually, in such a situation, glutamic acid is prescribed 0.5 g 3 times a day. Also used are intramuscular injections of the preparation vitamin B12 500-1000 GAM / day, 2 injections per week, the total number of injections is 5-10.
Impaired balance, dizziness that occurs during chemotherapy should not be attributed to the action of anticancer drugs - they have enough of their own toxic reactions. However, this does not negate the attentive attitude to these phenomena. In case of severe muscle weakness and dizziness, observe, as they say, personal safety measures: move slowly, carefully stick to the railing when you have to climb or descend the stairs, or for your companion when walking down the street. You will save yourself the possibility of falling, and the chemotherapy from undeserved accusations.
Treatment of these disorders should be started with vasodilators. The doctor may prescribe 1 tablet trental after meals 3 times a day (with normal blood pressure), Cavinton 1 tablet 3 times a day before meals (with reduced or normal pressure), sermion 1 tablet 3 times a day before meals (with high or normal pressure). Of the available medicines, vitamins B1 and B6, 1-2 ml each, can be recommended. subcutaneously or intramuscularly. You can take vitamins inside, but then the therapeutic effect is weaker and comes much later. Proserin helps well, 1 tablet 3 times a day 30 minutes before meals. In more serious cases, proserin is prescribed in injections. The course of treatment is from 3 days to 3 weeks, depending on the severity of side effects. A good aid in the treatment of muscle weakness is glutamic acid, which is used before meals for 1 g. 3-4 times a day. If during treatment with glutamic acid, loose stools or vomiting appear, you can use it during or immediately after a meal.
Another manifestation of the toxic effect on the nervous system is a temporary weakening of attention and memory impairment. Therefore, when going to the doctor's appointment, take care of the pen and paper in advance and write down the questions you are going to ask. If memory impairment seriously complicates your life, take Nootropil 2 capsules 3 times a day with meals. The drug is well tolerated, and the only contraindication is severe renal dysfunction. A relatively new herbal preparation tanakan, which is taken 1 tablet, also with meals 3 times a day, improves cerebral circulation and memory. When taking tanakan, headaches, dizziness, irritability, apathy are reduced, sleep is normalized. Disadvantages of nootropil and tanakan in a delayed effect - the first signs of improvement appear after 2-4 weeks, and their treatment should be carried out under medical supervision for a rather long time.

HAIR AND CHEMOTHERAPY

We conclude the description of side effects by talking about the effect of chemotherapy on hair loss. Without a threat to health, hair loss is a severe mental trauma for many patients, so severe that some patients refuse treatment after learning that hair may fall out. Indeed, hair loss from the head, face or body is not easily tolerated. Severe depression, severe irritation, or irascibility often occur. These emotional reactions are not unusual, and we do not in the least condemn them, but rather encourage them. Unfortunately, doctors, without attaching serious importance to this complication, do not always warn patients about its possible occurrence. Thus, for a psychologically unprepared patient, hair loss occurs suddenly, increasing mental trauma.
Let's talk calmly and try to treat this complication with humor. "Do all patients receiving chemotherapy lose hair?" No, patients who have become bald before chemotherapy are not threatened with hair loss. "Does hair loss always occur?" Hair follicles on the head and body are made up of cells that grow and divide rapidly and are therefore susceptible to the damaging effects of many anticancer drugs. The ability of various anti-cancer drugs to induce hair loss ranges from 0 to 100%. Nothing depends on you here. The only advantage, as we have already said, is that patients who are bald before chemotherapy have nothing to lose. Most chemotherapy drugs cause hair loss in 20-30% of patients. When treating with these drugs, it is very difficult to predict whether hair will fall out or not before starting chemotherapy, but in cases where the drug causes baldness in 100% of patients, there is no point in going to a fortune-teller.
"Does hair fall out everywhere?" - No, they stay in places where the need for them is small, for example, on the legs. If you are an adherent of the quantitative characteristics of baldness, then the minimum is the loss of 25% of the hairline. With average baldness, from 25% to 50% of hair falls out, and with significant baldness, more than 50% of hair is lost. Increased hair loss begins several days or several weeks after the end of the first course of chemotherapy. You notice severe hair loss when brushing or washing your hair. You can try to reduce the amount of hair loss. True, it is possible to influence this unpleasant process only with drugs that cause slight hair loss. If an anticancer drug causes 100% baldness, as many modern chemotherapy drugs are, it is very difficult to resist. Hair cutting is only a hygienic measure that reduces the possibility of hair falling into bed, on clothes, behind a collar, in soup.
Hypothermia (freezing) of the scalp can be used to prevent hair loss. A special cooling helmet is used, which is put on for 20-30 minutes before the start of chemotherapy and removed 40-60 minutes after the end of the drug administration. There are techniques in which the contact time of the hair with the helmet is reduced by three times. Unfortunately, the effectiveness of this procedure is not very high, and the possibility of causing hypothermia of the head is quite large. In addition, this method is not suitable for those anticancer drugs, the administration of which lasts more than 30 minutes. Your doctor will tell you about cranial hypothermia and whether it is right for you or not.
Excessive shampooing and constant brushing should be avoided by using mild shampoos and hair conditioners.
Some people with significant hair loss prefer to cover their head, while others try not to. You can wear a hat, headscarf, scarf, or turban. Get a wig or patch before starting chemotherapy or at the beginning of your course, before hair loss. Thus, it becomes possible to choose a beautiful wig that makes you even more attractive in the color of your hair.
Hair loss from the head or face is not easy to tolerate and requires some mental preparation. In such cases, the phrase that the bald man should comb his hair less, but wash longer, and dozens of anecdotes about bald ones will not calm him down. It is advisable to visit psychological support groups if you find them.
Remember that your hair will start to regenerate after the end of the treatment and very often it will be better than it was. They can become curly, change hardness, slightly differ in color. Full restoration of the hairline usually occurs in 5-6 months from the moment when you have only a comb left of your hair, i.e. from complete hair loss. You will look more attractive, feel better, more cheerful. You should not dye "young" growing hair, you can not use "chemistry" and hair spray. When drying with a hair dryer, avoid excessively hot and strong air jets. It is possible to accelerate hair growth by using special medicines, for example, "banfi".

SIDE EFFECTS OF CHEMOTHERAPY ON THE SKIN

Treatment with almost any medication, especially antibiotics, can cause skin rashes. Naturally, antitumor antibiotics, like other anticancer drugs, are no exception. Although rare, possible toxic skin reactions are recognized quickly and easily. They manifest as rashes, redness, dryness, pimples, or brown spots. In most cases, you will be able to cope with these manifestations on your own. If you have acne or acne-like rash, remember your youth, try to care for the whole body the same way as for your face - keep it clean, dry, use the numerous acne creams that have appeared recently. On dry areas of the skin, use special creams or lotions for dry skin. The anti-tumor antibiotic bleomycin can cause brown spots, which should be lubricated with anti-pigmentation creams. Exposure to the sun increases the toxic effect of chemotherapy on the skin. We do not recommend sunbathing, but if you still need to be under the sun, use lotions or sunscreen creams (protective factor 15 or more). In the rare cases where full sun protection is required, sun protection creams are used. Most of the problems related to the skin are not serious. However, certain symptoms may indicate an adverse reaction to chemotherapy. Therefore, if you have an unexpected or severe rash, tell your doctor. Severe reactions lead to interruption of the course of chemotherapy. To eliminate side effects on the skin, drugs such as diphenhydramine, diazolin, tavegil, pipolfen, suprastin, claritin, and kestin are used. Which medicine you take depends on your doctor and which of these medicines you prefer. To enhance the action, you can combine diazolin or claritin with tavegil. Medicines are administered in both injections and tablets. Doses depend on the severity of skin changes. In case of severe skin reactions or if the above drugs are ineffective, the doctor can connect the hormonal drugs prednisolone or dexamethasone to the treatment, which usually very quickly lead to the elimination of skin rashes.
TOXIC REACTIONS WHEN INJECTING ANTITUMOR DRUGS
It is not intravenous administration of the drug that can cause serious problems, but administration under the skin or into the muscles. Problems arise from improper or carelessly performed intravenous injection technique. Sometimes the vein is pierced through, sometimes it does not get into it at all and the drug partially or completely ends up in the surrounding tissues. There are people with very fragile or very thin veins. Such veins are easily torn or, as they say, "burst" under the pressure exerted on the walls of the vessel by the injected drug.
Intravenous injections of anticancer drugs should be given by a nurse or doctor with experience with these drugs. In practice, chemotherapy is often given in general hospitals. Therefore, the following recommendations apply to medical personnel who have taken responsibility for administering chemotherapy drugs.
We always tell nurses that in the slightest doubt that the needle is in the vein, it is better to re-inject. Recall that if you inject a patient even 5 times, he will harbor a grudge against you for 1-2 weeks, but with the subcutaneous administration of drugs that cause necrosis, he will remember you all his life.
The severity of local toxic reactions depends on which drug and how much got past the vein. Drugs causing blistering action, up to tissue necrosis (necrosis), include adriablastin, pharmacorubicin, vincristine, vinblastine. dactinomycin, mitomycin C, navelbin, taxol, taxotere. Inflammation and irritation of the surrounding tissues occur when cisplatin, carboplatin, decarbazine, and vepezide come into contact with the skin. Cyclophosphamide and fluorouracil can cause mild soreness. If a small amount (up to 2 ml) of a skin blister is injected past the vein, then a slowly healing ulcer occurs. When a significant part of the drug is in the subcutaneous tissue (i.e., the dose is half or more of the planned dose for this administration), a very serious lesion can develop. It requires the mandatory use of antidotes (antidotes), and sometimes surgery with a possible skin graft.
During the infusion of anticancer drugs, it is recommended to periodically retract the syringe plunger and check if blood is shown, that is, if you are in a vein. If blood is drawn in the syringe, but swelling appears near the injection site, it means that the needle is in the vein, but the vein is damaged, punctured, you cannot risk it. Need to take out the needle and re-pin. If swelling, swelling, feeling of pressure or soreness at the injection site appears, it is necessary to stop administering the drug and try, without removing the needle, to pull the drug back into the subcutaneous tissue. If nothing can be sucked off, then the needle must be removed. If you manage to suck the medicine, then the needle can be left for the introduction of funds that neutralize the effect of the drug.
An unsuccessful injection of anticancer drugs is difficult to cure. When most drugs get under the skin, the most important thing is to cover the ill-fated area with pieces of ice. Application with ice or a heating pad, previously placed in the freezer, is carried out for 20-30 minutes, 4 times a day during the first day. It is necessary to inject the lesion with dexamethasone or hydrocortisone, and in their absence, prednisolone. In the intervals between ice applications, it is good to apply a compress with flucinar, sinaphlan, with hydrocortisone or prednisolone ointment. However, if vincristine, vinblastine, navelbine, etoposide, wumone get under the skin, it is forbidden to cover the affected area with ice and inject with hydrocortisone, etc. On the contrary, hot compresses and injecting with hyaluronidase or 8.4% sodium bicarbonate solution are recommended. Mix 300 units. hyaluronidase with 3 ml. saline solution. Inject into the infiltrate in a volume approximately equal to the amount of the anticancer drug injected under the skin. Then inject the remainder into the subcutaneous tissue.
With the extravascular administration of the so-called "red chemistry" - adriablastin, pharmacorubicin, rubomycin, application to the affected area of Dimexidum may have some effect. The latter is also useful when mutamycin is found under the skin. Hyaluronidase helps with extravascular taxol administration. However, with regard to compresses when taxol gets under the skin, the recommendations differ. Some instructions recommend hot compresses, while others recommend ice packs. Therefore, it is better not to inject taxol under the skin. This applies equally to the rest of the drugs. All these activities are carried out on the first day.
The further tactics of treating injuries caused by extravascular administration of anticancer drugs depends on which drug got under the skin. To eliminate toxic reactions caused by irritating drugs, treatment with compresses with chamomile decoction, 70% alcohol, butadion ointment begins from the second day. From the fifth day, rubbing with troxevasin ointment is carried out. With a more pronounced lesion, indovazin and esaven gel help well.
For drugs of skin blistering action, a longer and more serious treatment is required. From the second day, compresses with Vishnevsky ointment, applications with Dimexide. Inside, Wobenzym is used 10 pills 3 times a day for 10 days and Detralex in a daily dose of 2 tablets for a month. After the acute symptoms subside (after about five days), indovazin, heparin ointment or heparoid are used and, necessarily, solcoseryl or actovegin ointment.
Despite the measures taken, some patients still develop severe tissue damage with possible loss of function. The key to the problem is to prevent extravascular infusion of drugs by administering intravenous injections by sufficiently skillful and attentive nurses. Patients with poor veins should have a catheter inserted into the connected vein.
With numerous courses of chemotherapy, inflammation of the veins often occurs - phlebitis. This leads to the fact that the veins become dense, low elastic and it becomes a problem to inject the medicine into them. Sometimes there is a complete blockage of the veins - thrombosis. In these cases, the drug clexane, injected strictly subcutaneously into the abdominal wall, at the level of the belt, helps well. (After injection, the site of clexane injection should not be rubbed). Clexane is also recommended for the prevention of deep vein thrombosis. When using clexane, daily monitoring of blood clotting is necessary. The drug should not be administered without a doctor's prescription.

ROLE OF PSYCHOLOGICAL SUPPORT IN CHEMOTHERAPY

Chemotherapy drastically changes the lifestyle and character of a person. The following factors are of greatest importance: the general effect of chemotherapy on the body, which causes numerous side effects and mental changes associated with the need to take difficult treatment. Social action - long hospital stays, the need to purchase expensive dietary products, material difficulties caused by disability, the purchase of expensive medicines, trips to consultations and treatment in other cities. Anxiety, tension, fear, excitement, depression, hope are common reactions in many patients. These mental disorders are not pleasant, but you can cope with most of them by tuning in to your own optimistic attitude towards them and the correct behavior.
You will have to adapt your normal (calm or hectic) life to your treatment schedule. It must be remembered that you are not alone and the vast majority of patients have successfully coped with similar feelings and problems. During chemotherapy, expecting that something will happen to you now and watching how the drugs work on you, you may well be pleasantly surprised that you did not feel anything.
Do not hesitate to ask questions about what is happening to you, and if, after being explained to you, you do not understand again, continue asking questions until you understand or bring the doctor to hysterics. Remember, your emotional well-being is just as important as your physical health.
Distraction helps a lot. Many people do not even realize that when they watch TV or listen to the radio, they distract their thoughts from anxiety or discomfort. Knitting, making models of airplanes or ships, painting, parsing newspaper clippings you've been making for decades (finally, you can safely do this), looking at old photographs are good distractions.
Reading an interesting book is another way to distract yourself from thinking about illness. Any distracting activity should be used. If you are tormented by fear or frustration, try to find help from those around you. Talking to an understanding friend or reasonable family member is helpful. Sometimes it is helpful to talk about your problems with other patients with whom you are pleasant and comfortable to communicate. Every person needs psychological support in difficult times and you should not hesitate to seek help during chemotherapy.
There are a number of things you can do to make chemotherapy easier.

Shift your most important things to the days when you feel good.
Try to find yourself a new hobby, interest yourself in an interesting job, master the skills of some skill.
Set realistic goals for yourself. Failure to complete tasks too quickly can lead to a loss of courage.
Strive to do morning exercises, and if you cannot do it, then at least strive. Exercise can help release tension and anxiety and improve appetite. Check with your doctor about an exercise program.
Engage in auto-training: use the relaxation method that will help you fall asleep, give you strength, and reduce anxiety; distraction and other techniques such as meditation and relaxation.
Make yourself a four-legged friend and walk with him 2-3 times a day. Fresh air and walks have not hurt anyone yet.
Remember that proper nutrition is very important. Your body requires enough food to keep your body alive and to repair tissues damaged by chemotherapy.
Keep the ultimate goal of your treatment in mind to help you maintain a positive chemotherapy attitude.
Find out everything that interests you about the treatment of your disease. This will help reduce the anxiety and fear of the unknown.
Keep a journal or diary for the duration of your treatment. A record of your changes during or after chemotherapy will remind you of the questions you wanted to ask your doctor.
Do not sink even during the most difficult periods of treatment. Pay more attention to your appearance. Master the skill of self-care. Everything that you do for yourself helps to feel your capabilities in overcoming life's barriers.
If you get tired quickly, limit your activities. Try to do only those things that matter most to you. Don't let chemotherapy or its side effects take away your privacy.

Your doctor can provide great psychological support. Along with high professional knowledge, a chemotherapist appreciates the art of a psychologist. Compassion, a benevolent, affable facial expression is already the beginning of treatment.

"A gloomy doctor will never succeed in his craft", - argued M. Montaigne.

Saadi said 800 years ago:
Never be treated by sour-faced doctors.
You will see them - and life is reduced by three times!
I will give worthy advice - he is only being treated,
Whose face and smile gives you health.

When the poet Yaroslav Semlyakov wrote "If I get sick, I will not go to the doctors, I will go to my friends ...", he was a little cunning: according to the testimony of his contemporaries, all his friends were doctors. Still, what kind of help can your friends, family and acquaintances provide? Family and close friends usually worry as much and sometimes more than you. During chemotherapy, you are not always able to evaluate and comprehend different situations. Therefore, you need comprehensive household, material and psychological support. But even very good people are not always well versed in oncology and can diligently avoid you for fear of your illness. Others are embarrassed, afraid to upset and upset you by saying something wrong. If you feel that someone is eager to come to your aid, try to take the first steps yourself. Try to be open with others when talking about your illness, treatment, thoughts and feelings. Once people are convinced that you are able to discuss your medical condition and treatment, it will be easier to communicate with you. The frankness and availability of your behavior will help correct many misconceptions about your illness.
In turn, when communicating with other patients, also try to encourage them: help each other during all difficult times.

CHEMOTHERAPY AND GENDER FUNCTION

It is undoubtedly correct that during chemotherapy, blood tests are regularly performed, the lungs, liver and kidneys are periodically examined. At the same time, the stepdaughter of oncology, a sexual function, remains on the sidelines of chemotherapeutic attention. Patients are traditionally embarrassed to discuss topics related to sexuality, and doctors, due to lack of time, avoid discussing issues of a secondary nature. The lack of attention to sex in our country has led to the fact that neither chemotherapy reference books nor oncology manuals address questions about the effect of anticancer drugs on the sexual sphere. Meanwhile, the deterioration of reproductive abilities and changes in sexual function can be the result not only of the disease itself, but also of the toxic effects of chemotherapy, hormone therapy, and also some drugs. It didn't matter much in the old days. Now, when the survival rate of cancer patients has increased significantly, the importance of sex life in the ranking of their interests is taking a higher place.
In case of violations of sexual function, first of all, it is necessary to exclude factors related to the disease. The diagnosis itself is alarming, often leading to depression and insomnia. These violations have a negative impact on sexual desires. First of all, changes in sexual activity can occur in patients with neoplasms located in the testes, prostate gland, ovaries, uterus, and bladder. Operations on these organs, as well as radiation therapy of the small pelvis, are often the cause of sexual dysfunctions.
Intensive chemotherapy often affects the sexual function of both men and women. The nature of the effect depends on the drugs used, the simultaneous administration of other drugs, age, as well as the general condition of the patient. Treatment with anticancer drugs as usual usually does not cause a decrease in the ability or desire for sex. Patients who do not have sexual problems before starting chemotherapy are more likely to have normal sexual intercourse during chemotherapy as well.
Different drugs used in chemotherapy affect the genital area in different ways, and patients respond to them in different ways as well. In some patients, chemotherapy does not affect sexual function; in others, changes occur in both desires and in the level of activity. For some, this is very frustrating; others do not consider the decline in sexual function to be of any importance. No people are alike, no standard responses to treatment.
"Fatigue" from chemotherapy, anxiety about the course of the disease, deterioration in material condition can cause a cooling of sexual desire. If you are concerned about the effects of chemotherapy on sexual function, try to discuss them with your doctor before starting treatment. You will learn about possible sexual dysfunction and how to cope with problems that may arise during treatment with anticancer drugs. Some patients report that thoughts of illness and treatment and the need to follow the chemotherapy schedule cause feelings of fatigue and emotional lethargy. In case of severe fatigue, it is better to postpone the time of physical intimacy - after rest or postpone it until the end of the course of treatment.
Women often pay attention to changes in the menstrual cycle. In some patients, menstruation often becomes irregular. For some, they stop altogether for the duration of chemotherapy. Many patients complain of hot flashes, insomnia, and other symptoms of menopause. The hormonal changes caused by chemotherapy lead to itching, burning, or dryness of the vaginal tissues. Your doctor or gynecologist will recommend a cream or ointment to relieve these symptoms. With prolonged use of anticancer drugs, depending on age, temporary or permanent infertility may occur.
Despite the possibility of these complications, pregnancy may occur during chemotherapy. Pregnancy during treatment is highly undesirable, and it is strongly discouraged to allow it. In addition to increasing the possibility of disease progression, some anticancer drugs may well cause a child's defect. Women of childbearing age (from adolescence to the end of the menstrual cycle) should pay attention to the possibility of conception and avoid pregnancy during the entire course of treatment. Talk to your gynecologist or your doctor about your contraception, contraception, and pregnancy control methods. If neoplasms are found when the woman was already pregnant, the question of terminating the pregnancy, surgery or prescribing chemotherapy is decided by a council of doctors. Sometimes you have to terminate a pregnancy at any time. In any case, chemotherapy is only possible after twelve weeks of pregnancy, when the risk of fetal defects is somewhat reduced.
If possible, it is best to postpone chemotherapy until the puerperium.
In men, anticancer drugs can decrease sperm count, reduce sperm motility, or cause other changes in the germ cells. As a result of chemotherapy, men can become temporarily infertile. In addition, there is no guarantee that a child conceived during cancer treatment will be healthy. After a certain (by the doctor) time, a man can start conceiving a child without worrying about the consequences of chemotherapy for his health. This period depends on the anticancer drugs used, the nature and effectiveness of chemotherapy and is usually 1-2 years after the end of treatment. If the urge to have a baby drowns out your sense of reason, talk to your doctor about it before starting chemotherapy. Talk to him about the possibility of storing semen frozen until artificial insemination in the future. There are sperm banks for men and an oocyte bank for women.
People around them should show special attention and tactful participation to patients who, in addition to neoplasms, also suffer from sexual dysfunctions. A visit to a sex therapist for cancer patients is a rare phenomenon and causes surprise in the latter: as if a person who fell from the third floor, broke his arms, legs and ribs, worried about the state of his hair. Disappointed in the services of folk healers and sorcerers of all stripes, having lost hope of healing on TV (remember Kashpirovsky and Chumak with their soulful eyes and hand passes) and, having met a sympathetic smile or indifference at the attending physician, many patients gave up their sex life.
Meanwhile, there are a large number of different drugs and methods of treatment, including psychotherapy, which is especially useful for a cancer patient. Modern and not very well-known medicines can help both with mild violations of potency, and with severe disorders. In this case, you must always remember that the use of any drugs must be coordinated with your doctor.

Lymphostasis of the legs or otherwise referred to as lymphatic edema today occurs in 10% of all people on earth. This disease is characterized by lymph retention in tissues, as well as impaired lymph circulation. Is developing lymphostasis of the lower extremities in oncology before the onset of elephantiasis and further leads the patient to disability. With lymphostasis, there is a violation of the outflow of lymph. Because of this, the legs swell, which causes complications. As a rule, this condition occurs after the damaged lymph nodes are removed during surgery, which help the outflow of fluid from the lower extremities. Oncologists advise using compression hosiery. In addition to everything, it is useful to use a special decongestant therapy, but this can only be done if there is no active oncological process. The best option would be to contact a doctor, a lymphologist, who can conduct the necessary examination, take blood test for oncology and establish effective treatment.

The degree of lymphostasis of the lower extremities

In the first degree, which is called lymphodermatitis, an incurable disease occurs. It is capable of affecting the lymphatic system, and after this, all other systems of the human body are affected. In this case, the waste of cellular metabolism is collected in the intercellular space. The patient develops swelling of the ankles, as well as the toes. However, this process proceeds without significant pain or there is practically no pain, and after a person has rested a little, everything goes away.

Second stage of development lymphostasis of the lower extremities in oncology Is fibrodermatitis. With this disease, edema appears, which does not go away. In addition, the skin is stretched so much that it is not possible to make the slightest fold, because of this, a sensation of pain appears, especially when pressure occurs.

In the third degree, the so-called elephantiasis occurs, and the edema cannot be removed. The patient's leg is deformed and enlarged. In the event that this disease is started, but warts may appear, the stratum corneum of the epidermis increases, and spots appear. With such a disease, the patient is assigned a disability, due to the fact that it is not possible to move normally and bend the joints.

Causes of lymphostasis of the lower extremities

Lymphostasis of the legs can appear with cardiac or renal pathology. In addition, such a disease may appear due to the fact that there is an insufficient development of the lymphatic system, which subsequently leads to obstruction of the capillaries, which are responsible for the outflow of excess tissue fluid. Compression of blood vessels occurs.

In the event that lymphostasis is an acquired disease, then it can occur in the presence of venous insufficiency, which occurs along with decompensated varicose veins. The reason for this is the expansion of the vessels that drain the lymphatic fluid. You can read more about the causes of leg lymphostasis.

Lymphostasis is observed most often in women, but all people are susceptible to this disease, regardless of age. Lymph congestion in young girls manifests itself closer to the night, in the absence of any reason.
Limostasis of the legs makes the body weak and vulnerable to any kind of infection. In this case, there is a danger of developing erysipelas. The disease can be recognized by such signs as short-term chills or fever, the increase in the patient's body temperature can rise to 39 ° C. In this case, the pain is accompanied by tingling and redness of the skin.

If you find a disease, then you need to contact leading specialists as soon as possible. Remember that the last stage of lymphostasis of the lower extremities cannot be treated surgically; medication is needed here. In the initial stages, this disease is curable, the main thing is to come to the doctor on time.

Breast cancer is the most common cancer in women. In most cases, official medicine offers complete removal of the breast together with a group of axillary lymph nodes - radical mastectomy. Most patients develop primary and later secondary edema of the affected arm (lymphostasis), which brings a lot of trouble. Why does edema appear, how can it be reduced or avoided? As a doctor and healer, I offer my own solution to this problem.

The leading cause of the development of hand edema after radical mastectomy is the surgical interruption of the main pathways for lymph drainage from the limb. The occurrence of edema is not an inevitable and not a natural result of every operation. Suffice it to say that in 25% of those operated on, lymphostasis does not appear, and in most of those who develop edema, it disappears within 2-3 months. Late lymphostasis of the hand may not occur at all if the patient performs a certain exercise, takes anti-cancer decongestant herbs, does not overload the hand, monitors the viscosity of the blood, etc. Conversely, if the patient believes that all the problems are behind and does not take appropriate measures to prevent edema, secondary edema of the hand occurs, which is very difficult to treat, entailing impaired hand mobility, impaired lymphatic circulation with all the consequences.

So what to do if you have surgery to remove your breast.

Start treatment with anti-cancer herbs (aconite, hemlock, fly agaric, milestone, etc.) to reduce possible metastasis before and especially after surgery ... For patients with low blood pressure or normal, but prone to lowering, it is recommended to take hemlock tincture, as the most available and studied. For a weakened organism, you can use the technique of the healer Tishchenko, in which the hemlock tincture is taken once a day from one drop to 30 and back. For such a common tumor as adenocarcinoma of the breast, I recommend a more active hemlock treatment method (see HLS Bulletin No. 3, 2002. "Once again about a new look"). Firstly, the tincture must be taken three times a day before meals, and secondly, the maximum dosage of taking hemlock tincture is brought to that which a person can withstand. For each person, this dosage is individual, but it is desirable to rise to 50, and even better to 80 drops 3 times a day, it is these dosages of hemlock tincture that have a destructive effect on such an aggressive tumor as adenocarcinoma of the breast, especially its edematous form. It is recommended to reach the maximum well-tolerated dosage and drink at this dose for several months, reducing the dosage only in case of weakness, decreased blood counts or to cleanse the body. At the same time, you can gradually reduce the dosage to 15-20 drops 3 times a day and at this dosage start cleansing the body. Those women who take a complete break from taking hemlock to cleanse the body note that during the break, the tumor in the breast begins to increase sharply. Therefore, when taking a hemlock in a dosage of 15-20 drops, the body is also cleansed at the same time, i.e. are accepted, a decoction of flax seed, oats, sour juices (sea buckthorn, pomegranate, cranberry), a decoction of the mixture: fir needles, rose hips, onion husks, etc. 7-10 days after the end of the body cleansing, you need to increase the dose again to the maximum. For patients with concomitant high blood pressure, it is better to take tincture of Dzhungarian aconite, a stronger drug than hemlock tincture. Aconite is taken "with a slide" from one to 10 drops 3 times a day and vice versa, followed by a seven-day break to cleanse the body. If the patient is in good condition, you can go up to 20 drops 3 times a day (for more details see HLS No. 3, 2003. “Do not change methods like gloves.”) Any operation for a person is stressful, during which adrenal hormones are produced by the body 3 times more norms and are strong stimulators of metastasis. According to statistics, 84% of operated patients return to cancer again, so one should not hope for an operation, but start treatment with herbal poisons. You should also start taking drugs that enhance the immunity and protective properties of the lymph nodes - thymalin injections (10 ml for 10 days), extracts of Leuzea safflower or Eleutherococcus (25 drops 3 times before meals), echinacea juice (30 drops 3-5 times a day) and dr.
At least 1 - 2 weeks before the proposed operation, simultaneously with the intake of anti-cancer herbs, begin to exercise, especially for the muscles of the shoulder girdle. The human body has unique compensatory and restorative capabilities, but if a person does not lead an active lifestyle, then more than 70% of the lymphatic capillaries responsible for the excretion of lymphatic fluid and decay products are at rest. On the contrary, in athletes, the circulatory and lymphatic systems are so well developed that postoperative edema disappears quickly. To restore full circulation of lymph and blood through the diseased side, it is usually enough for about two weeks, while it is necessary to increase physical activity gradually, preventing the occurrence of swelling of the hand from overexertion. On the lymph nodes damaged by metastases (usually hard, mobile, painless), you can additionally apply dressings:

with a mixture of baked onions and ichthyol ointment (3: 1) for 12 hours.
with a mixture of 90 gr. pork fat and 30 gr. powder of crystalline camphor for 24 hours.
infusion of horseradish garden on water. Drink 1 teaspoon 3 times before meals. Dressings with the same infusion on the lymph nodes.

Within a week, gradually reduce the consumption of salt and salt-containing products, including sausages, cheeses, salted caviar, pickles, tomatoes, lard, etc. lymph nodes and blood vessels dramatically increases swelling. In addition, a significant content of water and sodium in the tumor tissue, it needs for enhanced growth. Therefore, limiting the intake of salt and salt-containing foods in the diet to the point of completely eliminating them will provide you with additional help in reducing swelling and reducing tumor growth. Salt can be replaced with a salt replacement mixture or washed seaweed, which not only has a rich composition of trace elements, but also has a slight anti-edema effect.
A cancer cell, developing and metastasizing through the vessels, releases a substance into the blood that stimulates an increase in blood clotting and the formation of blood clots. At the third stage of cancer, the process of thrombus formation reaches its maximum value, which also significantly increases lymphostasis. According to statistics from the Moscow Research Institute of Oncology. Herzen for 30 years, the death toll from thrombosis was 10% of the total number of deaths from cancer. We can say that patients with malignant diseases are potentially thrombotic and require timely correction of hemostatic disorders. Reducing thrombus formation and, accordingly, reducing edema is a difficult and lengthy process, therefore, all patients with existing edema or with the threat of future edema need to use not one or two, but a whole complex of decongestant herbs. For example, I will give a list of the most effective herbs, of which it is recommended to choose at least 5-6 herbs:

Leuzea safflower extract(pharmaceutical preparation). One of the few drugs that increase blood pressure. Take 25 drops 3 times before meals.
Horse chestnut tincture(pharmaceutical preparation - escuzan). Reduces blood pressure. Apply 25 drops 3-5 times after meals.
Medicinal sweet clover(grass). Reduces blood pressure. Pour two tablespoons of herbs with a glass of hot water, simmer in a water bath for 15 minutes, leave for 45 minutes, take 1/3 cup 3 times a day.
Sowing garlic... In 1 - 2 hours after eating fresh garlic, a pronounced thrombocyte-dissolving effect is observed. Various preparations of garlic in this regard are completely useless. Better to take a few cloves with food.
Hellebore(root powder). Stored only in a dark place. The root, ground into powder, completely loses its properties after a year. It is used in the amount of 2-3 powder match heads (on the tip of a knife) 3 times a day.
Siberian prince(grass). Raises blood pressure, restores the liver. Pour 100 ml of a teaspoon of herbs. boiling water, wrap with a towel, leave for 1 - 2 hours, strain, store in the refrigerator. Take 2 tablespoons of the infusion 3 - 5 times a day.
Tincture of hawthorn or hawthorn fruit. Rose hip... Reduce blood pressure. Rosehip together with hawthorn help to strengthen blood vessels, have an antiemetic effect.
Meadowsweet, meadowsweet... Pour a tablespoon of dried flowers with a glass of boiling water, leave for 1 hour, drain. Take 100 ml. 3 times a day.
"Fir legs", camphor... The syrup made from fir tops can be drunk like tea. Crystalline camphor has a stronger effect, the powder from which is taken at the tip of a knife 3 times a day.
Ginkgo biloba, leaves, ground into powder (in the memoplant pharmacy, 10 tablets 3 times). The dosage of taking the drug for a cancer patient should be increased 4-5 times compared to the dosage for ordinary people.

In addition to the previous group of herbs, the use of diuretics can be recommended, which will not only reduce swelling, but also enhance anti-cancer treatment. In my article (Bulletin of healthy lifestyle No. 3,2003 "Do not change methods like gloves") I mentioned that the use of the drug Aevit, 2 capsules 3 times a day after meals, has not only an anti-cancer effect, but also dramatically reduces the excretion of potassium with urine. According to scientific data, vitamins: A, E, B1, B2, C, selenium reduce thrombus formation, stimulate normal blood and lymph flow. With concomitant heart diseases, it is advisable to use not only potassium-saving, but also potassium-supplying diuretics: honeysuckle (decoction of branches, fruits), birch buds, green carrot tops, rhododendron leaves, goldenrod, asparagus, juniper (fruits), bean shells, oats, pumpkin , eggplant. When choosing diuretic herbs, you should exclude herbs that have a hemostatic effect, such as nettle, mountaineer or horsetail. The above herbs can be used both as single preparations and as a complex in the form of fees. Here are some examples of anti-edema charges:

Yellow bedstraw, maiden tansy, medicinal sage, marsh cinquefoil herb are mixed in equal quantities. Brew 2 tablespoons of the collection for 0.5 liters of boiling water, leave for 2 hours, strain, take 1 sip every 20-30 minutes.
Birch buds, wild strawberry grass, Siberian prince, yellow sweet clover - mix in equal amounts, brew a tablespoon of the collection in a glass of boiling water, boil in a water bath for 15 minutes, strain, cool, take 1/3 cup 3 times before meals.

After the operation, already on the second day it is necessary to start physical therapy (Fig. 1). Exercise 1-2: active swings of the arm bent at the elbow to the side, followed by extension of the arm. Exercise 3: leaning your sore hand on a door or wall, try to raise your arm as high as possible while sliding along the wall. Exercise 4: Smoothly raising the arms up through the sides. Exercise 5: Put the sore hand behind the head and hold it there for a few seconds, while lifting, you can use the help of your healthy hand. Exercise 6: The same is true only to put the sore arm behind the back. Exercise 7: Sit down, holding on to the high back of the chair. Such active and passive movements in the wrist, elbow and shoulder joints are necessary to restore the operated lymphatic system.

I pay special attention if you haven't done any exercises before removing the stitches, you have missed the most valuable time! After removing the stitches, patients are prescribed a warm shower (38-40 degrees) on the forearm, shoulder, chest wall to improve circulation and expand blood and lymphatic vessels - by this time, due to regular charging, you should already have formed a new lymphatic system instead of the old destroyed one ... If you followed all the recommendations listed above, then as the hand functions recover, the early edema usually disappears. The faster the primary edema disappears, the more favorable forecasts can be made for secondary edema, for example, if the primary edema has passed in a month, then there may not be a secondary edema.

It should be noted that after any operation thrombus formation increases sharply, which, as noted above, increases edema. Therefore, we must not forget about the complex of decongestant herbs. After the primary edema subsides and the functions of the diseased arm are restored, regular exercise therapy should be continued, in a slightly expanded version (Fig. 2). Various exercises are added to the complex to strengthen the shoulder girdle, a large number of exercises with high raising of arms, in a sitting position it is always recommended to lean your elbow on a stack of books or a high stand to improve the outflow of lymph from the hand. It is recommended to do such a complex at least 7-8 months after the operation, then the likelihood of late lymphostasis will be minimal. Daily warm baths and showers are recommended, limiting the load on the "sore" arm, preventing cuts and injuries, especially in the area of the hand.

If you have late lymphostasis has already appeared, it is recommended that the obligatory long-term intake of decongestant herbs, stroking massage from the hand to the shoulder with elastic banding, moderate exercise therapy are recommended. It is imperative to donate blood from a vein for a coagulogram, followed by a consultation with a hematologist to determine the state of the blood coagulation system. With the existing lymphostasis on the area of the axillary lymph nodes and the shoulder, it is recommended to apply fresh melilot flowers (can be steamed dried), compresses from a decoction of the thistle of the field (pink sow thistle), 2-3 tbsp. boil spoons of herbs in 200 ml. water for 2-3 minutes. You can rub tincture of horse chestnut into your shoulder and arm. Improves lymph flow, softens blood clots.

The surgical method for the treatment of breast cancer is used as an independent method only in the early stages of cancer development. For patients with three or more enlarged lymph nodes, i.e. with a high risk of relapse, 2-3 courses of chemotherapy must be prescribed before the operation to reduce the size of the tumor and prevent metastasis. After the operation, it is also possible to prescribe chemotherapy or radiation therapy to destroy possible metastases in the operation area or lymph nodes. The fact that long-term courses of chemotherapy and radiation have a negative effect on the body and what to do in this case is described in detail in the "Bulletin of healthy lifestyles" No. 24, 2003. in the article "Chemistry: how to protect yourself and enhance the effect."

These toxic treatments destroy not only bone marrow cells, intestinal mucous membranes, hair follicles and cells of the immune system, but also lymph vessels and nodes. In this case, stagnation of blood and lymph occurs, followed by edema. In the case of mastectomy, for example, postoperative irradiation of a surgical suture of the breast or a group of axillary lymph nodes can cause local edema, which increases postoperative lymphostasis of the arm. Therefore, the above recommendations for the elimination of edema must be followed during chemotherapy and radiation therapy, after chemotherapy and radiation therapy, and even better before them.

Then, perhaps, you will be able to significantly reduce or completely get rid of lymphostasis. In conclusion, it can be noted that the fight against various types of edema in cancer patients is, first of all, the fight against the tumor, so you do not need to calm down after surgery and chemotherapy, you only need to start more actively treating yourself, being treated with herbs, fighting for your life. After all, as often there are cases when metastases enter the cured hand, re-affecting the lymph nodes, causing a new lymphostasis.

Dear women, if your treatment is proceeding well and quickly, do not relax, continue to be treated, so that later with a smile you will remember your hard days. Health to you.

It is a fairly common cancer treatment method. Recovery after chemotherapy is a mandatory procedure, as it greatly inhibits the work of the body as a whole, as a result of which the patient may feel unwell.

Chemistry treatment improves the patient's condition, but at the same time the body is depleted, immunity weakens. Chemotherapy entails many consequences for the body, therefore, after the procedure, it is necessary to undergo a course of recuperation under the supervision of a doctor, or at home.

How to recover from chemotherapy at home?

Cancer cells that die during chemotherapy are not able to be excreted from the body on their own, but form dead tissue. The cells of dead tissue enter the bloodstream and other structures of the body, which leads to a deterioration in the patient's health.

After undergoing chemotherapy, people usually experience a feeling of nausea, vomiting and dizziness, a rise in body temperature and a decrease in performance. Also, the patient may notice that the voice has disappeared, eyes are watery, hair falls out and nails weaken.

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How long does chemotherapy last and how many courses can a person take?

On average, the duration of the chemistry course is 3 months. The number of courses is determined by the doctor depending on the patient's condition and the stage of cancer. In some cases, treatment should be interrupted, as the patient may feel unwell or even fall into a coma.

Post-chemotherapy medications

To restore and maintain the body after chemotherapy, cancer patients are prescribed a number of specific drugs, depending on the consequences of the procedure.

After the procedure, the body is poisoned by toxins, resulting in nausea and vomiting.

To remove intoxication, drugs such as:

Cerucal;
Dexamethasone;
Metoclopramide;
Gastrosil.

The liver also suffers from therapy. To restore liver cells, drugs are prescribed - hepatoprotectors:

Essentiale;
Carsil;
Hepabene.

Another unpleasant consequence of chemotherapy is stomatitis. Inflammation affects the oral mucosa and tongue. To eliminate them, it is recommended to rinse the mouth with medicinal solutions. These include:

Chlorhexidine;
Hexoral;
Corsodil.

With a more advanced form, Metrogyl Denta ointment is prescribed.

Blood should also be restored. It may develop after treatment. Medicines such as:

Granocyte;
Leucostim;
Neupogen;
Leucogen.

In case of problems with the gastrointestinal tract, the appearance of diarrhea, drugs Smecta, Loperamide, Octreotide are prescribed.

A common side effect after chemotherapy is anemia due to decreased production of red blood cells during the procedure. The cause of anemia can be myelosuppression - the red bone marrow stops producing the required number of red blood cells. To eliminate it, hemo-stimulating therapy is required.

To increase the level of red blood cells, drugs are prescribed such as:

Erythrostim;
Epoetin;
Recormon.

Nutrition after chemotherapy

Proper nutrition will also help to remove chemistry from the body of a sick person. The diet should include foods that contain all the essential vitamins and minerals that enhance immunity. Food should include the required amount of protein, fat and carbohydrates.

To quickly return to its previous form, the following rules must be observed:

Eat fractionally small portions;
Track the calorie content of consumed foods;
Eat more fruits and vegetables
Walk more in the fresh air to increase appetite;
Eliminate sweets if possible;
You should not overeat and starve.

Often, the first thing that happens to a person after a chemotherapy session is diarrhea. Toxins cause malfunction of the gastrointestinal tract. Steamed foods and avoiding raw vegetables and fruits will help alleviate symptoms and bring the intestines to normal.

Porridge and mashed soups will help great.

The following foods improve body function and restore strength:

Fruits and vegetables;
Lean meat, steamed cutlets;
Lean fish;
Dairy products;
Pastry products, with the exception of various cakes;
Omelette;
Natural butter.

The consumption of legumes, nuts, rich in protein, vitamins and iron helps to improve the well-being of a cancer patient.

Consumption of water also helps the body recover. Water helps to flush out toxins faster. It is recommended to drink 1.5 - 2 liters of water a day, or replace it with weak tea, compote.

You should refuse soda, alcoholic drinks and coffee.

Boost immunity

To restore all functions of the body, it is necessary to raise the immune system. Rehabilitation therapy should include therapeutic exercises and a physiotherapy session, if possible, a trip to a rehabilitation center, sanatoriums or resorts.

These measures help the patient to recover faster, eliminate poor health, weakness, and give the body the opportunity to work as before.

What medications to take to strengthen the immune system? Antioxidant preparations and vitamin complexes contribute to an increase in immunity. Also, the drug Immunal has a good effect on raising immunity.

Chemistry is removed from the body when the patient is engaged in physiotherapy exercises. You need to exercise regularly. Therapeutic gymnastics relieves swelling, pain in cancer patients and helps to get rid of.

Before starting sports, it is necessary to consult with your doctor, since after chemotherapy, tachycardia may occur - an increase in heart rate, which, even without physical exertion, inhibits the activity of the cardiovascular system.

Vitamins after chemotherapy

After undergoing chemotherapy, the body needs vitamins to increase strength. With the intake of vitamins, the body recovers faster, normalizes its previous activities.

Taking vitamin B9, folic acid, carotene contributes to the rapid restoration of mucous membranes. Thrombocytopenia is also eliminated with their help. For this, such vitamin complexes as Neurobeks, Calcium folinate are usually prescribed.

If thrombocytopenia occurs, it is urgent to take measures to eliminate it, as it can lead to a stroke.

Supplements can also help the body recover - Coopers, Antiox, Nutrimax, etc.

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* Only on condition that data on the patient's illness is received, a representative of the clinic will be able to calculate the exact price of treatment.

Traditional medicine to restore the body after chemotherapy

Supportive therapy does not exclude treatment with folk remedies at home. To cleanse the intestines of toxins, such folk remedies as collecting herbs St. John's wort and yarrow help. The infusion is done as follows: it is necessary to mix the herbs in equal proportions, pour a tablespoon of the mixture with a glass of boiling water and use it twice a day.

Cleansing the body from chemistry is also carried out by collecting herbs such as nettle, wheatgrass, mint, St. John's wort, meadow clover and oregano. All herbs are mixed in equal proportions, then pour a spoonful of the mixture with a glass of boiling water. The infusion is taken three times a day, half an hour before meals, 2 tablespoons.

Flax seeds remove dead cancer cells and products of their activity from the body. Flaxseed is rich in fatty acids, thiamine and many other elements. It is necessary to pour 60 g of seeds with boiling water and leave overnight. The finished infusion is diluted with another glass of boiling water and taken 1 liter per day. Duration of the course is 14 days.

Kidney recovery after chemotherapy

After a course of chemotherapy, the kidneys especially need treatment. Chemotherapy has a detrimental effect on their work, there is a suspension of the production of hormones. You cannot do without medication.

Cleansing therapy is carried out with drugs such as:

Kanephron - relieves inflammation and spasms. Take 1 tablet twice a day;
Nephrine is a syrup that restores kidney function. It is taken once a day for a teaspoon;
Nephrophyte is a preparation based on herbal ingredients. It has a diuretic effect. It is used to treat inflammation of the urinary tract;
Trinephron - treats cystitis, urolithiasis and normalizes kidney function. Take 1 capsule twice a day.

Before using medicinal products, you should consult with your doctor, since each patient may have a certain reaction to the drug or to its components.

Recovery and protection of the liver after chemotherapy

After chemotherapy sessions, the liver and spleen suffer, as they are the body's original filters that remove toxins. Cleansing the liver is often carried out using a decoction of oats, which promotes the regeneration of liver cells in a short time.

You can cook oats by boiling it in milk. To do this, pour a tablespoon of seeds with a glass of milk and cook for 25 minutes. Then the broth is infused for about a quarter of an hour.

Stomach treatment after chemotherapy

Gastrointestinal malfunction is a fairly common side effect of chemotherapy. Diarrhea or constipation occurs - what to do in this situation? You can protect the stomach from these unpleasant consequences both with the help of medicines and with the help of traditional medicine.

Of the drugs, probiotics are most often used:

Linex is a probiotic that restores microflora and eliminates diarrhea. It is applied three times a day, 2 tablets;
Actovegin - strengthens the vessels of the stomach and brings it to normal functioning. It is used three times a day, 1 tablet;
Omeprazole - improves the functioning of the stomach, is also used for peptic ulcer disease. The drug is taken 2 tablets per day;
Bifidumbacterin is a probiotic available in powder form. It is better to consult your doctor about the dosage.

From traditional medicine to eliminate constipation and diarrhea, recipes are used such as:

A decoction of hogweed, fennel, anise and hay against constipation;
Decoction of clove root, bergenia and marsh cinquefoil for diarrhea.

Also, after chemotherapy, pancreatitis is possible - an inflammation of the pancreas. You should consult a specialist about its treatment. Activated carbon will also help to remove toxins from the gastrointestinal tract and to improve the work of the intestinal microflora. It is necessary to consult with your doctor about which drug to use to treat the effects of chemotherapy, as an allergy to drugs may occur.

Strengthening veins after chemotherapy

After chemistry, phlebitis often occurs - inflammation of the walls of blood vessels. It occurs when, during a procedure, doctors accidentally burned a vein with a chemical solution. Chemotherapy makes the veins hard to see, and as a result, there are problems with the delivery of tests. It is also difficult to put a dropper with saline, with the help of which the body is flushed from chemistry. Bruises appear at the injection site, they itch and cause discomfort.

To eliminate this problem, alcohol compresses are made, cabbage and plantain leaves are applied at the location of the vessels. In some cases, it is possible to use ointments in the absence of allergies.

Daily routine after chemotherapy

A healthy lifestyle, sports, and proper nutrition will help you recover from chemotherapy.

The following rules should be followed:

Eat 5 times a day every 3-4 hours. This will allow you to soon establish the activity of the digestive tract;
Observe the sleep schedule, rest. If insomnia develops, you should consult your doctor;
Exercise if you have a healthy heart and blood pressure, and depending on your overall health;
It is recommended to go for a walk before meals and before bed.

If possible, you can go to a sanatorium to restore the body's strength.

How to lose weight after therapy?

You need to revise your diet and enrich it with vegetables and fruits. Daily walks in the fresh air will not interfere. The excess weight will go away immediately after the body regains its strength.

If you gain weight after chemotherapy, you should never go on a diet.

Can you die after chemotherapy? How long do you live after the procedures?

Chemotherapy makes the life of cancer patients much easier. It is worth starting to treat cancer with chemistry as early as possible, since at the terminal stage, chemotherapy can only prolong the patient's life. In case of late detection of oncology with the help of chemistry, the patient can live on average 5 years.

The use of radiation therapy as an addition to the course of chemistry is considered a frequent occurrence. Irradiation allows you to even faster overcome the growth of cancer and return the patient to his old life. It is necessary to consult a doctor about combining the two methods of therapy.

While patients are undergoing chemotherapy treatment for oncology, they need help and support from their relatives. Patient care may be required.

From the foregoing, we can conclude that, although chemotherapy treatment is effective and the patient feels relief after it is carried out, nevertheless, after it, health should be restored. Rehabilitation can take place both in the clinic and at home. Relatives should support the patient during recovery, since the psychological attitude plays an important role in the treatment of the disease.

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Nutrition after chemotherapy

Boost immunity

Vitamins after chemotherapy

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Traditional medicine to restore the body after chemotherapy

Kidney recovery after chemotherapy

Recovery and protection of the liver after chemotherapy

Stomach treatment after chemotherapy

Strengthening veins after chemotherapy

Daily routine after chemotherapy

How to lose weight after therapy?

Can you die after chemotherapy? How long do you live after the procedures?