Caring For The Patient With Cancer At Home (Symptom- Constipation)

Constipation is one of the symptoms a patient with cancer can have. It is defined as the infrequent or difficult passage of hard feces (stools), which often causes pain and discomfort.

It could be caused due to any of the following reasons :

• poor food and fluid intake
• not enough movement in the bowel
• lack of activity
• weakness
• ignoring the urge to have a bowel movement
• intake of certain medicines

What To Look For :

• small, hard bowel movements
• leakage of soft stool that looks like diarrhea
• stomach ache or cramps
• passing a lot of gas or frequent belching
• belly appears blown up or puffy.
• no regular bowel movement within the past three days.
• vomiting or nausea.
• feeling of fullness or discomfort.

What The Patient Can Do :

• Drink more fluids. Fresh fruit juices and warm or hot fluids in the morning are especially helpful. 

• Increase the amount of fiber in the daily diet by eating foods like whole grain breads and cereals, fresh raw fruits with skins and seeds, fresh raw vegetables, fruit juices, dates, apricots, raisins, prunes, prune juice and nuts.

• Avoid foods and drinks that cause gas such as cabbage, cauliflower, broccoli and carbonated drinks.

• Try to avoid any foods that cause you to be constipated such as cheese, eggs, products made of refined flour such as white bread, biscuits, naans, roomali roti etc

• Get as much light exercise as you can.

• Do not use enemas or suppositories. Use stool softeners or laxatives only after talking with your doctor or nurse.

• Go to the bathroom as soon as you have the urge to have a bowel movement.
• Keep a record of your bowel movements so that problems can be noticed quickly.

What Caregivers Can Do :

• Offer the patient prune juice, hot lemon water, or tea to help stimulate bowel movements.

• Encourage the patient to drink extra fluids.

• Help keep a record of the patient's bowel movements.
• Offer high fiber foods such as whole grains breads and cereals, dried and fresh fruits, vegetables, and bran.

• Consult the doctor before giving the patient laxatives.

Call the doctor if the patient :

• Has not had a bowel movement in 48 hours.
• Has blood in or around anal area or in stool.
• Cannot move bowels within one or two days after taking a laxative.
• Has cramps or vomiting that won't stop.

Reference: Caring for the Patient with Cancer at Home - a Guide for Patients and Families   

Caring For The Patient With Cancer At Home (Symptom- Poor Appetite)

Today more people with cancer are being cared for at home. Caregivers or family members are taking on roles that, just a short time ago, were carried out by trained health professionals.

This article lists some common problems that a patient with cancer can have, warning signs to help spot these problems early and how to take care of the patient with those problems.

Some of the common problems a patient with cancer can have are : Poor appetite, anxiety & fear, confusion, constipation, depression, diarrhea, difficulty in moving, fatigue, fever, fluids & dehydration, blood in urine or stool, itching, leg cramps, mouth bleeding or dryness or sores, nausea and vomiting, pain, skin dryness, sleep problems, swallowing problems,etc

Poor Appetite

A person with a poor or no appetite may eat much less than he or she normally does, or may not eat at all. Poor appetite can have a number of causes, such as swallowing problems, anxiety, depression, pain, or nausea and vomiting. It can also be due to a changed sense of taste or smell, feeling full, tumor growth, dehydration, or side effects of chemotherapy or radiation. Poor appetite is most often a short- term problem.

     What to look for:

• Lack of interest in food
• Refusing to eat favorite foods
• Weight loss

  What the Patient can do:

• Ask your doctor what may be causing your poor appetite.
• Eat as much as you want to, but don't force yourself to eat.
• Think of food as a necessary part of treatment.

• Start the day with breakfast.
• Eat small, frequent meals of your favorite foods.
• Try foods high in calories that are easy to eat (like pudding, gelatin, icecream, sherbet, yogurt and milk shakes)

• Add tasty, high-calorie sauces and gravies to your food, and cut meat into small pieces to make it easier to swallow.
• Use butter, oils, syrups, and milk in foods to raise calories. Avoid low-fat foods unless fats cause heartburn or other problems.
• Try strong flavorings or spices.
• Plan meals that include your favorite foods.
• Create pleasant settings for meals. Soft music, conversation and other distractions may help you eat more comfortably.
• Eat with other family members.

• Drink liquids between meals instead of with meals. (Liquids at mealtime can lead to early fullness.)
• Try light exercise one hour before meals.
• Hard candies, mint tea, black tea with lime, lemon barley or ginger ale may help get rid of strange tastes in the mouth.
• With your doctor's approval, enjoy a glass of beer or wine before eating.
• Eat a snack at bedtime.
• When you don't feel like eating, liquid nutritional supplements like Ensure, Resource etc could be taken. Using a straw may help.

      What Caregivers/ family members Can Do:

• Try giving the patient six to eight small meals and snacks each day.
• Offer starchy foods (like bread, pasta and potatoes) with high protein foods (like fish, chicken, meats, turkey, eggs, cheeses, milk, tofu, nuts, peanut butter, yogurt, peas and beans)
• Keep cool drinks and juices within patient's reach.

• If the smell of food bothers the patient, offer bland foods cold or at room temperature.
• Create pleasant settings for meals and eat with the patient.
• Offer fruit smoothies, milk shakes, or liquid meals when the patient doesn't want to eat.

• Try plastic forks and knives instead of metal if the patient is bothered by bitter or metallic tastes.
• Don't be upset or impatient when the patient refuses food or can't eat.
• If the patient can't eat, you could offer to read to them, sit with them or give them a back or foot massage.

    Call the Doctor if the patient:

• Feels nauseated and cannot eat for a day or more.
• Loses five pounds or more.
• Feels pain when he or she eats.
• Does not urinate for an entire day or does not move bowels for two days or more.
• Does not urinate often or, when he or she does, the urine comes out in small amounts, smells strong, or is dark colored.
• Vomits for more than 24 hours.
• Is unable to drink or keep down liquids.
• Has pain that is not controlled.     

Reference: Caring for the Patient with Cancer at Home - a Guide for Patients and Families    


       

Hypoglycemia In Diabetics

India, today leads the world with the largest number of people with diabetes in any given country.

The International Diabetes Federation (IDF) reports that in 2007 there were 46.5 million people in India with diabetes and that this number is expected to go to 80.3 million by 2025. (IDF, 2006).

Diabetes is mainly characterized by elevated blood glucose levels. But, hypoglycemia (low blood glucose) is one of the most feared complications of diabetes treatment. Hence, it is very necessary for a diabetic patient to understand all the facts and treatment for hypoglycemia. 

Following is what a diabetic patient should know or be educated about hypoglycemia:

         What is hypoglycemia?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose.

Hypoglycemia is a common side-effect of well-managed diabetes. As people improve their management to achieve target blood glucose levels, the risk of hypoglycemia increases. Because hypoglycemia is such an uncomfortable feeling, people often over treat it, resulting in high blood glucose levels. 

At what level of blood glucose is a person considered hypoglycemic?

For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia.

Normal and Target Blood Glucose Ranges
Normal Blood Glucose Levels in People Who Do Not Have Diabetes
Upon waking—fasting	70 to 99 mg/dL
After meals	70 to 140 mg/dL
Target Blood Glucose Levels in People Who Have Diabetes
Before meals	70 to 130 mg/dL
1 to 2 hours after the start of a meal	below 180 mg/dL

Source: American Diabetes Association. Standards of Medical Care in Diabetes—2008. Diabetes Care. 2008; 31:S12–S54.

What are the symptoms of hypoglycemia?   

Hypoglycemia causes symptoms such as:

• Hunger
• Shakiness
• Nervousness
• Sweating
• Dizziness or light-headedness
• Sleepiness
• Confusion
• Difficulty speaking
• Anxiety
• Weakness

Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include:

• Crying out or having nightmares
• Finding pajamas or sheets damp from perspiration 
• Feeling tired, irritable, or confused after waking up.

                                                                Image Courtesy: www.magazine.ayurvediccure.com

What causes hypoglycemia in people with diabetes?

Hypoglycemia occurs due to a relative excess of insulin in the blood, which in turn lowers the blood glucose to below normal levels. This relative excess of insulin can be due to:

► Too much medication causing higher than needed insulin levels.     

► The prolonged action of certain medications.

► Not eating enough food to match the insulin level in the bloodstream.  

► Not eating at the proper time (skipping or delaying meals).

► Unplanned or excessive exercise, leading to lower blood glucose.

How can hypoglycemia be prevented?

Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulin or other medication that increases insulin levels but then skipping a meal could result in hypoglycemia.

To help prevent hypoglycemia, people with diabetes should always consider the following:

Their diabetes medications

A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine.

Their meal plan

 

A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Following one’s meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks.

Their daily activity

To help prevent hypoglycemia caused by physical activity, health care providers may advise -

►Checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL)

►Adjusting medication before physical activity

 

►Checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed

►Checking blood glucose periodically after physical activity

Their use of alcoholic beverages

 

Drinking alcoholic beverages, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan.

Their diabetes management plan

Intensive diabetes management helps keeping blood glucose as close to the normal range as possible to prevent long-term complications that can increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs.

Prompt Treatment for Hypoglycemia : “The Rule of 15” 

The rule of 15 is a helpful way to remember the treatment regimen for mild-to-moderate hypoglycemia. For example,

► 15 gms of quickly absorbed carbohydrate such as 1 tablespoon of sugar or honey,

     1/2 cup, or 4 ounces, of any fruit juice

      1/2 cup, or 4 ounces, of a regular (not diet) soft drink

      1 cup, or 8 ounces, of milk

      5 or 6 pieces of hard candy

► Wait 15 minutes.

► If not better, or blood glucose is not above 60 mg/dl, treat with another 15 gms of quickly absorbed   carbohydrate.

► As this quickly absorbed carbohydrate will not last long in the body, it is important that the person is given something to eat within a short time.

► If the next meal is more than 1 hour away, the person should be given some food rich in carbohydrate and protein, such as sandwich with sprouts, a fruit with milk or a small chapatti (Indian bread) with dal (lentils) or a fistful of murmura (puffed rice) and roasted chana (whole Bengal gram). This will ensure that the blood sugar will not drop again before the next meal.

Hypoglycemia When Driving

Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.

    Thus, in conclusion, important points a diabetic has to remember are :

•  Hypoglycemia can occur from time to time to everyone who has diabetes;
• Check blood glucose levels to determine when your level is low; 
• Learn to identify the symptoms of hypoglycemia so you can treat it quickly;
• Treat hypoglycemia by raising your blood glucose level with some form of sugar;
• If misdiagnosed or untreated, hypoglycemia can be fatal;   

References

1. Briscoe VJ & Davis SN (2006).Hypoglycemia in Type 1 and Type 2 diabetes: physiology,   pathophysiology and management. Clinical Diabetes. 24(3):115-121

2. http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/) retrieved on 21/11/09