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What should I do if I cough up blood?
If you cough up blood, call your doctor or nurse. Coughing up blood or blood-tinged sputum from the lower respiratory tract (below the throat) or lungs is called hemoptysis. Sometimes the phlegm (sputum) is tinged or streaked with blood, and at other times people cough up bright red blood. If possible, estimate the amount of blood that has been coughed up (e.g., one tablespoon, one-half cup), and note the colour (e.g., bright red, dark, like coffee grounds). There are many causes of a hemoptysis-a blood clot in the lung, tuberculosis, heart problems, and pneumonia-but the most common is an infection, such as bronchitis. In some instances, cancer can also cause hemoptysis.
Sometimes it is difficult to tell if the blood is coming from the lungs, the back of the mouth, or the stomach (vomiting of blood, or hematemesis). Describing other symptoms that you have and the colour of the blood can help the physician make a diagnosis.
The doctor may also:
• Order certain tests such as a complete blood count (CBC) (analysis of the blood components) or coagulation profile (analyzes the clotting ability of the blood).
• Want a specimen of your sputum to determine whether the infection is present.
• Order a chest x-ray or CT (commonly referred to as a “CAT” scan) to check for abnormalities in the lungs.
• Look at your lungs and air passages directly through a scope (bronchoscopy).
Treatment of hemoptysis depends on its cause and on the amount of blood coughed up.When hemoptysis is mild and infection is suspected, antibiotics are usually prescribed, along with a cough suppressant (codeine) because coughing can cause irritation and aggravate hemoptysis. For most patients, the conservative measures usually stop the problem.
NUTRITIONAL PROBLEMS
I never feel hungry and am concerned about losing weight. What can I do to increase my appetite and maintain my weight?
Weight loss, a common problem for people with cancer, can occur for many reasons. Having cancer changes your metabolism; so you need more calories each day than you usually consume. You may find that you have a poor appetite or that you feel full after eating only a few bites of food. Food may taste differently, and symptoms such as nausea, gas, constipation, pain, fatigue, or emotional distress can further decrease your appetite. Changes in your mouth from the disease or from the treatment may make it difficult to chew and swallow adequate amounts of nutrients and fluids.
Finally, changes in how you digest or absorb food may make it difficult for your body to use the nutrients and fluids you are able to take in. Try very hard to take in adequate amounts of food and fluids to provide energy to your body and to help you tolerate your treatment. Try to maintain your usual weight or minimize the amount of weight you lose. Even if you are overweight when you begin treatment, it is generally not recommended to diet at this time. You can do a number of things to improve your appetite and help maintain your weight. Medication may be helpful if you have symptoms that are affecting your appetite, like mouth sores, nausea, vomiting, diarrhoea, constipation, pain, or emotional distress. If you have any of these problems, ask your doctor for appropriate medication. Make changes in your diet to maximize the number of nutrients you take in each day. Here are some suggestions:
• Eat small amounts of food and fluids at a time. Eat six or eight snacks throughout the day rather than trying to eat three full meals. Always have food nearby to nibble on.
• Select foods high in protein and calories. Foods that many people find easy to eat when they are not very hungry are:
- Eggs
- Cottage cheese or yoghurt
- Peanut butter
- Sandwiches with sliced turkey or tuna fish
- Baked or broiled chicken, fish, or beef
- Soups
• Add a variety of things to recipes to add calories, such as butter, honey, jelly, sour cream, cheese, yoghurt, cream, and evaporated milk. Eating Hints for Cancer Patients: Before, During, and After Treatment, published by the National Cancer Institute, provides many helpful recipes (www.cancernet.gov/cancertopics/eatinghints).
• Limit the number of fluids you take with your meals so that you don’t fill up on the fluid.
• Have a limited amount of beverages with caffeine (e.g., coffee, tea, many sodas) because these dehydrate you.
• Have a limited amount of carbonated beverages because these make you feel full.
• Replace fluids with no nutritional benefit, like soda, with fluids that provide nutrients, like cream soups, shakes, and fruit smoothies.
• Try nutritional supplements that are available at your local drugstore: canned drinks, powders to be mixed with water or milk, or puddings. Experiment with different brands to find products you enjoy.
Your doctor or nurse may recommend specific supplements for you. You can also use Carnation® Instant Breakfast®, blending it with milk and adding ice cream, yoghurt, and/or fruit.
Other suggestions that may be helpful are as follows:
• Ask your doctor or nurse if it is safe for you to have a glass of wine or beer or a cocktail before your meal. Many people find that alcohol stimulates their appetite.
• Avoid eating alone. Having company can make eating more enjoyable, and we often eat more when eating with someone else.
If you still have trouble with your appetite despite these measures, ask your doctor if an appetite stimulant would be safe for you to take. Megace® ES, a medicine approved for people with severe weight loss from AIDS, is also used for people with cancer who have lost a lot of weight and are having trouble gaining it back. Family members and friends often have suggestions and want to give you advice. They may recommend special diets, high-protein drinks, or supplemental megavitamins and antioxidants. Do not take these without first speaking with your doctor or nurse because they may interfere with your treatment or may be dangerous for you.
Family members, who work hard to prepare special foods only to have you push it away after only a few bites, can become frustrated. To avoid conflicts, remind them that you are able to eat only what your appetite allows. Eating should be pleasurable; eat what you want when you want it. You may find it helpful to speak with a nutritionist, that is, a registered dietitian who is certified by the American Dietetic Association. Ask your doctor or nurse for a referral to a nutritionist with expertise in working with people who have cancer.
Call your doctor if, for any reason, you are unable to eat or drink for more than a day.
Nothing tastes the way it used to, and sometimes I have an awful taste in my mouth.What can I do for this?
Pete’s comment:
I have been on chemotherapy for over a year. For several days following treatment, most food tastes very bland and unappetizing. I also have the sensation of feeling slightly queasy. For this period, I have changed my diet to include spicy foods, drink plenty of ginger ale, switch from coffee to tea, and eat smaller, more frequent meals. This approach has enabled me to maintain my weight and actually get more variety into my diet. I also take Prilosec twice a day to help digestion. Changes in how food tastes and smells can be caused by certain medicines (e.g., antibiotics), some types of chemotherapy, radiation therapy to the head and neck, and surgery in the mouth or head and neck area. Cancer itself can also cause changes in taste. Changes for any reason can be a problem if, as a result, you decrease your food intake and lose weight. If you are getting treatment for your cancer, you have to maintain your weight based on good nutrition.
Most people have four taste sensations: salty, sweet, bitter, and sour. These sensations may be exaggerated by the treatment for your cancer, making foods taste differently than they normally would. In addition, some people note a persistent metallic or bitter taste, and some people note a lack of taste. These changes can be worse if you have a dry mouth for tips on handling a dry mouth) or a change in your sense of smell. Chemotherapy medicines that most often cause alterations in taste are cisplatin, cyclophosphamide, doxorubicin, fluorouracil, paclitaxel, and vincristine.
For most people, these changes in taste are temporary and go away when the treatment is finished, but they may persist for weeks to months.
You can try several things to improve the flavour of your food. One of the most important is to maintain good oral hygiene. This measure includes brushing your teeth on a regular basis and using a mouthwash four to five times a day. Rinsing your mouth immediately before eating, to moisten the taste buds on your tongue, is particularly helpful. Solutions people use include plain water, table salt and water, baking soda and water, or commercial mouthwashes like Biotène.
Do not use a mouthwash that contains alcohol because it causes dryness and may worsen the problem. Your doctor or nurse can recommend a mouth care regimen. You can also ask your dentist for recommendations. You can do several other things to enhance your appetite and food flavour.
• Always eat foods that look and smell good to you.
• If you have an aversion to the smell of food in general, ask a family member to cook or grill outdoors for you.
• Use a fan in the kitchen to eliminate or reduce cooking odours.
• Eat foods that are cold or at room temperature to reduce the smell.
• If food has a metallic taste, use plastic utensils to prepare and eat food.
• Try marinating or basting meat or poultry with fruit juices or wine to improve their taste.
• If food is bland, add herbs or other seasonings to enhance the flavour.
For more suggestions, the National Cancer Institute has a booklet entitled Eating Hints for Cancer Patients: Before, During, and After Treatment (www.cancernet.gov/cancertopics/eatinghints). This booklet addresses changes in sense of taste and smell, as well as the management of other eating problems. You can also order the booklet over the phone by calling the Cancer Information Service. Your doctor or nurse can suggest other eating hints or refer you to a registered dietitian. Some studies have shown that taking zinc can improve the taste of food in people who’ve had radiotherapy to the head and neck area. Zinc may also be beneficial in people getting other treatments for cancer. Before taking any medication to improve the flavour of food or enhance your appetite, including zinc, check with your doctor or nurse.
Terms:
Hemoptysis-Coughing up blood or blood-tinged sputum from the lower respiratory tract (below the throat) or lungs.
Coagulation profile – A blood test that analyzes the clotting ability of the blood. Take great care when oxygen is in the home.
Select foods high in protein and calories.
If you cough up blood, call your doctor or nurse.
One of the most important things you can do is maintain good oral hygiene.
