Caring for the Patient With Cancer at Home

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Blood in stool

Blood counts

Blood counts measure 3 important parts of blood:

    The hemoglobin percentage measures the ability of the red blood cells to carry oxygen. A normal hemoglobin range is about 14.5 to 18 for men and 12 to 16 for women. Most people still feel well with a hemoglobin percentage as low as 10. A low hemoglobin level is called anemia.

    The white blood cell count measures your body’s ability to fight infection. A normal white blood cell count is about 5,000 to 10,000. A low white blood cell count can put you at higher risk of infection. You will want to watch for signs of infection so that you can go to your doctor for treatment right away. A high white blood cell count might be a sign of an infection, or it might come from certain types of disease.

    The platelet count looks at the cells that help your blood clot. A normal platelet count is about 150,000 to 450,000. Normal clotting is still possible with a platelet count of 100,000. Dangerous bleeding may occur when the platelet count goes below 20,000.

After cancer treatment, it may take a few weeks for your counts to get back to normal. If you see any dentists or other doctors during this time, make sure they know your blood counts are low. Some very common treatments may cause problems for you. Call the American Cancer Society at 1-800-227-2345 and ask for a copy of Understanding Your Lab Test Results, or read it on our website, www.cancer.org, if you would like to know more about what your lab values mean.

Low hemoglobin

What to look for

  • New or worsening tiredness that makes it harder to do your regular activities
  • Chest pain or shortness of breath
  • Pale skin, nail beds, or gums
  • Dizziness
  • Weakness
  • Bright red, dark red, or black stools (blood in stools)
  • Dark brown or bright red vomit

(The last 2 are signs of bleeding, which can cause anemia.)

What the patient can do

  • Balance rest and activities.
  • Tell the doctor if you’re not able to get around as well as usual.
  • Plan your important activities when you have the most energy.
  • Eat a balanced diet that includes protein (meat, eggs, cheese, and legumes such as peas and beans), and drink 8 to 10 glasses of water a day, unless you are given other instructions.

What caregivers can do

  • Schedule friends and family members to prepare meals, clean the house, do yard work, or run errands for the patient. You can use websites that help organize these things, or appoint another family member to look into this for you.
  • Watch for confusion, faintness, or dizziness, as noted below.

Call the doctor if the patient:

  • Has chest pains
  • Has shortness of breath when resting
  • Feels dizzy or faint
  • Becomes confused or cannot concentrate
  • Has not been able to get out of bed for more than 24 hours
  • Has blood in their stool
  • Has dark brown or bright red vomit

Low white blood cell count

What to look for

  • Temperature of 100.5° F or higher when taken by mouth
  • Any new area of redness, tenderness, or swelling
  • Pus or yellowish discharge from an injury or other location
  • New cough or shortness of breath
  • New abdominal (belly) pain
  • Shaking chills that may be followed by sweating
  • Burning or pain when urinating
  • Sore throat
  • Sores or white patches in the mouth

What the patient can do

  • Check your temperature by mouth (or under your armpit if you can’t keep a thermometer in your mouth).
  • Take acetaminophen (Tylenol®) for a fever after getting your doctor’s OK.
  • Keep warm.
  • Take antibiotics or other medicine as prescribed.
  • Drink fluids, but do not force more than you can tolerate.
  • Avoid anything that can cause cuts, scrapes, or other breaks in the skin.
  • Wash cuts and scrapes with soap and water every day, apply antibiotic ointment, and keep them covered until healed.
  • Bathe every day, and wash your hands after using the bathroom.
  • Avoid crowds, and don’t visit with people who have infections, coughs, or fevers.
  • If you eat raw foods, wash them carefully and peel them to avoid germs.
  • Brush your teeth twice a day, and floss once a day (unless you were told not to floss).
  • Drink 2 to 3 quarts of liquid each day, if your doctor approves.

What caregivers can do

  • Watch for shaking chills, and check the patient’s temperature after the shaking stops.
  • Check the patient’s temperature using a thermometer in the patient’s mouth or under his armpit. (Do not take a rectal temperature.)
  • Encourage visitors who have diarrhea, fever, cough, or the flu to visit the patient only by phone until they are well.
  • Offer extra fluids.
  • Help the patient take medicines on schedule.

Call the doctor if the patient:

  • Has a temperature of 100.5° F or higher when taken by mouth
  • Has shaking chills
  • Feels or seems “different” to others
  • Cannot take fluids

Low platelet count

What to look for

  • Bleeding from anywhere (such as mouth, nose, or rectum)
  • Bloody or dark vomit that looks like coffee grounds
  • Bright red, dark red, or black stools
  • More than the usual amount of vaginal bleeding during monthly periods
  • New bruises on the skin
  • Red rash that looks like pinpoint dots, usually starting on feet and legs
  • Bad headaches, dizziness, or blurred vision
  • Weakness that gets worse
  • Pain in joints or muscles

What the patient can do

  • Use only an electric razor (not blade) for shaving.
  • Avoid contact sports (such as wrestling, boxing, or football) and any other activities that might result in injury.
  • Protect your skin from cuts, scrapes, and sharp objects.
  • Use a soft toothbrush.
  • If your mouth is bleeding, rinse it out with ice water.
  • Talk to your doctor or nurse about whether you should put off flossing your teeth until platelet counts improve.
  • Do not blow your nose or cough with great force.
  • Keep your head level with or above your heart (lie flat or stay upright).
  • Use a stool softener to avoid constipation and straining during a bowel movement. Do not use enemas or suppositories of any kind. (If you’re constipated, see the section called “Constipation.” Check with your doctor before using laxatives.)
  • Do not put anything in your rectum, including suppositories, enemas, thermometers, etc.
  • Stay away from anti-inflammatory pain medicines, such as aspirin, naproxen, or ibuprofen (Motrin®, Advil®, Naprosyn®, Aleve®, Midol®) and medicines like them unless your doctor tells you to use them. Check with your pharmacist if you’re not sure whether a medicine is in this class of drugs, or if it contains one of them.
  • If bleeding starts, stay calm. Sit or lie down and get help.

What caregivers can do

  • For nosebleeds, have the patient sit up with head tilted forward, to keep blood from dripping down the back of the throat. Put ice on the nose and pinch the nostrils shut for 5 minutes before releasing them. Ice on the back of the neck may also help.
  • For bleeding from other areas, press on the bleeding area with a clean, dry washcloth until bleeding stops.

Call the doctor if the patient:

  • Is bleeding or has any of the symptoms listed in the “What to look for” section
  • Has trouble speaking or moving

Last Medical Review: 11/05/2013
Last Revised: 11/05/2013