Three Simple Truths

Becoming Wiser Through Breast Cancer and Other Living Things

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Three Simple Truths Posted: 09 Feb 2016 07:15 PM PST So tomorrow I will be stopping by Cherry Hill East to talk to the girls’ basketball team about my experiences with Cancer. I will likely just tell them something similar to what I said to someone I was working with tonight. Life is supposed to be hard and we are not in charge of how life goes.  We cannot figure it all out in advance. The reasons for this are actually quite simple.  #1- Life is supposed to be hard. It is though our hardships that we are given opportunities to grow. If Life was easy all the time- we would stagnate and not develop to our full potential nor would we develop compassion for others.  #2- We are not in charge of how Life goes. Whether you believe in fate or the Lord, life is full of unexpected twists, turns and events. We are on this ride and do not get to choose much of it. Some of it, of course, but in comparison, not that much. However, we always do get to choose our response to each and everything that happens to us though. (after we become adults that is). That is the part that we are in charge of- We have the most control about our reaction to what life hands us and to the people in our world.  Each and everyone one of us chose how we treat ourselves and others, minute by minute, hour by hour, day by day. Knowing that is much better than being in charge anyway. Surrendering to the truth that we are not in charge of how life goes is a blessing and the path to freedom. The self-inflicted pain and weight is much less when you recognize you cannot control others, places or things. It takes the burden off one's back striving for the impossible. We can only be in charge of ourselves.  #3-We cannot figure it all out in advance. Life is just too unpredictable and our best needs to be good enough each and every time we try to do something. No matter what the outcome is, we need to be satisfied with our efforts. We are merely human beings doing our best and cannot know what we do not know and cannot do what we cannot do. We are all stuck being limited. Some of us are limited in one way and some of us are limited in another way but we are all stuck being only human, therefore, limited.   There is no shame in being human. Being Wonderful is Good Enough. And so is taking each and every opportunity to improve what we can learn, what we can do and what we can give. Keeping an open mind and heart is part of the challenge before us every day. But is only through honesty and openness that we can learn and become our best.  Which, I believe, is our greatest purpose in being human anyway; To Become Our Best While Living. I accept that I am dealing with something hard so I can develop to my fuller potential.  My cancer is just one of many events that occurred in my life that was unexpected and unplanned.  I chose to be kind to myself and to others through this process whenever possible so I can be proud of myself. No one will suffer especially me because I surrendered to the ride and am letting it unfold - one minute at a time, one hour at a time, and one day at a time....... like most things in my life.  The Lord has given me everything I need to take this ride.  With faith, there is nothing more to know.   So how do you think high school students will take to this type of information? Over their heads right????

Hopefully The Third Time Will Be A Charm

Yesterday was my 3 rd chemotherapy treatment. Dr. Gor, my oncologist is very smart. She decided to decrease the strength of my toxic concoction by 10% to reduce my chances of getting Neutropenia again. She reassured me that since I had one dose of the preferred course of treatment (TC) and a full dose of AC last time and I am still doing Dose Dense treatment, so it is okay for me to have 10 % less poison this time without anticipating a consequence in the long run.  I will go back this Friday also for a blood check to see how I am doing. I am to make sure the nurse does something which I now forget what that is. Maybe it will come to me and if not I will ask Dr. Gor. I learned that she will not be present for my last chemo- she will be away but I will see her March 4 for a full check up and to get my sailing papers so to speak. By then my port will have been removed. I still have medication to reduce my stomach upset to take for the next 3 days, I have rescue medication for nausea and I have already taken an Imodium to prevent diarrhea this time.   The toy on my arm went off today while I was in the movie theatre and I can now removed it from my arm. 

Neutropenia {(noo-troe-PEE-nee-uh) is an abnormally low level of neutrophils. Neutrophils are a common type of white blood cell important to fighting off infections — particularly those caused by bacteria.} Those underlined in what I had within 5 days after treatment- it says in the good book of chemo treatment- it usually shows up 10 to 14 days after treatment. I got hit with the infection bomb quickly. 
What are the signs and symptoms of an infection? For patients with neutropenia, even a minor infection can quickly become serious. Call your doctor right away if you have: • Fever that is 100.4°F (38°C) or higher for more than one hour, or a one-time temperature of 101° F or higher. • Chills and sweats. • Change in cough or new cough. • Sore throat or new mouth sore. • Shortness of breath. • Nasal congestion. • Stiff neck. • Burning or pain with urination. • Unusual vaginal discharge or irritation. • Increased urination. • Redness, soreness, or swelling in any area, including surgical wounds and ports. • Diarrhea. • Vomiting. • Pain in the abdomen or rectum. • New onset of pain. • Changes in skin, urination, or mental status.

My mood was not the best - I was very impatient  and even told at social worker at a medical day program that I was in a bad mood- she hung up on me. She basically did not want to hear what I was telling her because it was contrary to her goal and I made it clear as to what she needed to do instead, which I later learned that 3 people from my office had told her the same thing the previous day. It was her 4 th try to manipulate our offices. ( so maybe my mental status changed too. ) I am usually not that rude to people. But I still did great work for my patients and with my team.

So we will see how the next 4 or 5 days go. This week is an exciting week in many ways. My friend Linda Goldberg gave my name to her daughter's Zoe, basketball coach. Every year, Cherry Hill East does a PINK OUT game and makes a donation for Breast Cancer Awareness etc . They have wanted someone to come talk to the girls which I am doing after practice on Wednesday February 10 at 5:15 pm. Linda will met me there of course and I will talk about 20 minutes about my experience so far. AND yes- breast cancer is still better than my clinical depression. BUT that does not make it good by any stretch of the imagination. AND then, the next day, Thursday, I will go there about 4:45 pm and receive a donation made out to CancerCare which is an organization dedicated to service people with cancer and their loved ones,  that need support, guidance and financial assistance during their cancer treatment. 

I don't believe in donating to medical research I believe in education and clinical support of patients. There is enough pharmaceutical companies and grant funded research and people shooting for the nobel prize that I rather put my money elsewhere. I will let you know what I  plan on saying to the team soon. 

Founded in 1944, CancerCare® is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All CancerCare services are provided by oncology social workers and world-leading cancer experts.

CancerCare programs and services help 180,000 people each year. We distribute 350,000 publications and welcome 2.2 million website visits annually. In the past year, CancerCare provided nearly $13 million in financial assistance. The size and scope of CancerCare has grown tremendously since 1944, but it has never wavered from its mission of providing help and hope to people affected by cancer.

To learn more, visit www.cancercare.org or call 800-813-HOPE (4673).

CancerCare’s New Jersey office was opened in 1982 to ensure that New Jersey residents have full access to all CancerCare services.

This chemotherapy treatment is a hardship. I am just sad.

It approaching 2 am and I just woke up after falling asleep on the living room sofa. I am not looking forward to getting more chemotherapy- This type of therapy sounds like it is poorly named. When I was in group therapy, I used to look forward to attending group. It was exciting and I was growing. This, not so much. I really like feeling well. I do not like feeling impaired. This makes me sick. How can something that makes me ill be called therapy? Whose idea was that? It does not feel like I am being made to feel "well".  Nothing about it feels "well".  I totally gets that somehow it works. But THERAPY? 

Even when I went to 12 steps meetings back in the 80's, I knew I was unhealthy- working on getting "well" or "healthy". I was riding myself of dysfunctional behavior, giving myself a chance for new experiences that challenged old beliefs, and changing the way I felt about myself. I guess I was also very actively involved. This is more like submitting to really bad sex that I just need to get over with. Somehow I need to force myself to go through it. I won't enjoy it but it is necessary. Yep That is how I will approach it. Unfortunately, I have had too many incidents when I did not want to have sex but felt coerced into it. There was no way out other than to give in. Wow- it feels good to have a way to relate to this experience- Sorry if this is "TMI" for most of you. Friday at 2 pm, I will be forced to do something I do not want to do but it is the only way to achieve what I want in the bigger picture so I will put up with something very unpleasant. I will submit to treatment. Just let them do it to me. Like all of my other forced experiences, this too, one day, will be a distant memory, that will make me very sad when I think about it. 

Yes, I am just sad. Not sorry for myself at all. No pity here. Just sad that I need to have this experience that is so unpleasant. I wanted to stop pain and suffering from being in my life.

OKAY-this really is not that. After all, my heart is not broken. I understand what is happening to me.  This has a greater purpose. I am just so sad. There is a part of me wondering ...... I could use less wisdom in my life and be a little happier. I do not want to grow anymore through these type of experiences. I don't do this well anymore. My soul wants none of this. It is not what I wished for in my life. I only wished for PEACE. 

In my surrender, there is sadness with peace. Maybe this is how Jesus felt when he was walking to to his death on the cross. Accepting that his destiny was beyond his control and that his path was chosen for him. Except I do bear some responsibility. I  have chosen to remain obese these last few years. I did not know that meant that I would get breast cancer though. Isn't being fat punishment enough. 

I am not a fighter. I am not brave. I am not being courageous. I am just willing to accept God's will for me.   I am sad for all my hardships. For never having a life partner. For loosing my mother at the age of 12. For loosing my father soon afterwards. For being abandoned by Iris and later Nancy Jewell. For loosing Eleanor and the Abdellah family. For Phil's addiction and how it tormented us both and robbed us of a family life. For having to leave South Florida the way I did for Madison's safety and welfare. For breaking his  heart as well as my own in doing so. So many hardships. So many looses. For falling inlove when he was not ready for me and to be rejected and left unseen. And the grand daddy of them all, for my major clinical depression, where existing became unbearable. And walking away was so brave. Fleeing Florida with my child was courageous. Taking 45 pills felt courageous. This chemotherapy treatment is a hardship and I am just sad. 

31 Truths About Breast Cancer

31 Truths About Breast Cancer

Compiled by the Breast Cancer Coalition of Rochester    www.bccr.org

1. Nearly 3 million women in our country are now living in the aftermath of a breast cancer diagnosis.According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, in 2012 there were approximately 2,975,314 women alive who had a history of cancer of the breast in the United States.
2. Excluding skin cancer, breast cancer is the most commonly diagnosed cancer among women in the United States. Breast cancer represents 14.0% of all new cancer cases in our country.
3. The biggest risk factors for breast cancer are being a woman and growing older. The median age of diagnosis is 61.
4. A woman in the United States has a 1 in 8 chance of developing breast cancer during her lifetime. It is estimated that a woman age 30 has about a 1 in 227 risk of developing breast cancer in the next 10 years; for a woman age 40, it is about 1 in 68; for a woman age 50, it is about 1 in 42; and for a woman age 60, it is about 1 in 28.
5. Breast cancer awareness campaigns have helped move the disease from behind closed doors but have not had a significant impact on the incidence of Stage 4 disease or on mortality. The incidence of Stage 4 breast cancer disease has not changed since 1975. In 2015, an estimated 40,290 women in our country alone will die as a result of breast cancer.
6. True prevention means stopping breast cancer before it develops. As a result of early detection awareness campaigns, which do not prevent breast cancer, there has been an increase in over-diagnosis and over-treatment for many women, involving surgery, radiation, and chemotherapy to treat non-life threatening cancers.
7. It is estimated that 231,840 new cases of invasive breast cancer (cancer that has spread from where it started in the breast into surrounding, healthy tissue) will be diagnosed among women in the U.S. in 2015. In addition to invasive cancers, more than 60,000 cases of non-invasive (in situ) breast cancer will be diagnosed.
8. Men do get breast cancer. While less than 1% of new breast cancer diagnoses occur among men, it is possible for men to develop the disease. It’s estimated that about 2,350 new cases of breast cancer will be diagnosed in men in 2015. For males, the lifetime risk of getting breast cancer is about 1 in 1,000.
9. The overwhelming majority (approximately 85%) of women diagnosed with breast cancer have no relatives with the disease. A family history is only one risk factor. Other risk factors include getting older, benign breast problems, early exposure to ionizing radiation, having children later in life or not at all, longer exposure to estrogen and progesterone, lack of exercise, and drinking alcohol.
10. An estimated 155,000 Americans are currently living with metastatic breast cancer, which occurs when cancer in the breast spreads to other parts of the body, most often the lungs, liver, bones, and brain. Approximately 20% to 30% of people first diagnosed with early stage disease will later develop advanced or metastatic breast cancer.
11. Complementary therapies are often used in addition to medical treatments such as surgery, radiation, chemotherapy and hormonal therapy. These may include nutrition and exercise, Traditional Chinese Medicine, Ayurveda, homeopathy, mindfulness meditation, yoga, massage, Feldenkrais, Reiki, Qi Gong, Tai Chi and support networking groups. Before using any complementary therapy, patients should talk with their care team to make sure all aspects of their cancer care work together.
12. White women are more likely to receive a diagnosis of breast cancer, but African American women have a higher mortality rate. The mortality rate for breast cancer for African American women is about 31 per 100,000 women compared to 22 per 100,000 white women. Comparatively speaking, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women have lower mortality rates compared to white women.
13. All breast cancers are not the same, just as breast tumors do not all grow at the same rate or spread in the same way. It is not the size of a tumor that determines the aggressiveness of breast cancer but rather the tumor biology and microenvironment (the normal cells and molecules that surround cancer cells). Some breast cancers are small, found early, and yet are deadly. Some are fast growing. Some grow slowly, are found by mammograms and are treated, but would never have been life threatening.
14. We know that there are several types of breast cancer based on the biology of the tumors. These subtypes respond to different treatments and have different prognoses. Breast tumors are currently classified using three primary immunohistochemical (IHC) tumor markers: Estrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER-2/Neu). The term “Triple Negative” indicates none of these markers are prevalent.
15. There is a possibility that environmental estrogens play a role in diseases such as cancers of the breast, uterus, and ovaries. Environmental estrogens are a variety of synthetic chemicals and natural plant compounds thought to mimic estrogen in the body. They may behave like estrogen in the body or may block the natural hormone. These include pesticides such as the now-banned DDT; polychlorinated biphenyls (PCBs), Bisphenol-A (BPA), natural plant products in our diet, and a host of other chemicals.
16. When it comes to decreasing risk of breast cancer, become an informed consumer. Look around your environment. Read product labels and don’t purchase a product that may be harmful to you or your family.
17. When it comes to breast cancer, help lower your risk by making responsible health choices: Eat a healthy diet, learn how to cope with increasing stress, integrate exercise into your life, identify and eliminate your exposure to environmental risk factors as much as possible, and advocate for evidence-based change.
18. At least 900 synthetic compounds in industrial and commercial products have been identified as Endocrine disruptors (EDCs) – compounds that mimic or interfere with natural hormones. Many have been specifically shown to make estrogen-dependent human breast cancer cells grow in lab tests. EDCs that mimic estrogen cause concern because of their potential links to women’s health. These compounds are found in everyday products: some pesticides, detergents, and plastics.
19. Epigenetics studies the processes regulating how and when certain genes are turned on and turned off. Cancer affects these processes. Nutrigenomics looks at how foods and nutritional supplements influence gene expression. Different foods may interact with specific genes to increase or decrease risks of common diseases such as Type II Diabetes, obesity, heart disease, stroke, and certain cancers by modifying gene expression.
20. Breast cancer is ultimately a disease of malfunctioning genes. Lifestyle factors can generate growth-promoting signals to cells already primed to become cancerous because of changes in these genes. Most people are born with normal genes but during the course of a lifetime, genes can become damaged (mutated) in various cells and lead to cancer.
21. A growing body of evidence links synthetic chemicals to the rising incidence of breast cancer. Parabens, phthalates and other hormone disrupting chemicals are found in cosmetics, beauty products, and in women’s bodies. You have a right to know if the products you use contain compounds that may increase your risk of disease, including breast cancer.
22. To end breast cancer, we need more focus on preventing its development to begin with. We need a greater understanding of how to stop the aggressive cancers that are not detected with mammography, how to stop breast cancer from recurring, and how to prevent it from metastasizing to other parts of the body and becoming lethal.
23. Most women who find their own breast cancer do so as part of normal routines (showering, getting dressed, etc.) and not during systematic monthly breast self-exams. About 80% of breast cancers not discovered by mammography are discovered by women themselves. Knowing the landscape of your body and noticing slight changes is always wise. Becoming familiar with one’s breasts can help detect breast cancers that mammograms may miss.
24. If you are diagnosed with breast cancer, ask questions. Ask about all treatment options for your specific tumor type. Ask about costs and side effects of treatments. Ask how and why a particular treatment option has been recommended for YOU.
25. Women in their 20’s and 30’s should have a clinical breast exam by a health care provider every three years, especially if they are from a high risk family. After age 40, women should have a clinical breast exam every year, or more frequently if there is a strong family history of breast cancer.
26. Detection is not prevention. If you have a personal history of breast cancer, never rely on technology as your sole method of surveillance. Knowing what is normal for you is important. Have clinical breast exams. Early detection of a recurrence can almost double survival outcomes.
27. The current infrastructure and focus in breast cancer has not led to significant progress in ending the disease or in preventing deaths from the disease. This is true for research and health care and also advocacy: more of the same will not produce different results.
28. Five year breast cancer survival rates do not give an accurate picture of progress against breast cancer. Because breast cancer takes many years, sometimes even decades, to develop and spread throughout the body, breast cancer survival statistics, particularly five-year survival data, do not accurately portray the impact of breast cancer, or the progress or lack of progress over time.
29. Hormone Replacement Therapy (HRT) may increase your risk of breast cancer. The Women’s Health Initiative (WHI) clinical trials, launched in 1991, studied a group of 161,808 generally healthy postmenopausal women for the effects of HRT, diet modification and calcium and vitamin D supplement use on heart disease, fractures, and breast and colorectal cancer. Results from the trial on HRT, published in 2002, found that while the estrogen-only replacement therapy did not increase breast cancer risk, the risks far outweighed the benefits in the estrogen-plus-progestin arm. Overall, there was a 24% increase in the risk for breast cancer due to estrogen-plus-progestin.
30. In many cases, more treatment is not necessarily better treatment. Many of the advances in recent years have not been discoveries of new treatments, but rather discoveries that less invasive treatments are as effective as more invasive and/or more toxic standard of care. There is a growing recognition that more treatment is not necessarily better treatment. And, in fact, less is often better because of the reduction in long-term side effects, which are sometimes severe and occasionally fatal.
31. No one needs go through breast cancer alone. If you or a loved one receives a diagnosis of breast cancer, the Breast Cancer Coalition of Rochester is here to help. The Coalition offers education and support programs, as well as advocacy for those uninsured or underinsured. The Coalition is a full-scope, grass-roots breast cancer organization serving survivors and families throughout the Finger Lakes Region of Central and Western New York. We can help you find resources in your own community.
32. In New Jersey, Founded in 1944, CancerCare® is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All CancerCare services are provided by oncology social workers and world-leading cancer experts.

    Our Mission  CancerCare® is the leading national organization dedicated to providing free, professional support services including counseling, support groups, educational workshops, publications and financial assistance to anyone affected by cancer. All CancerCare services are provided by oncology social workers and world-leading cancer experts.

                       Main Office

                    141 Dayton Street 
                    Ridgewood, NJ 07450 
                    201‑444‑6630 or 
                    800‑813‑HOPE (4673) 
                    njinfo@cancercare.org

I could learn to hate chemotherapy, besides I still have hairy legs.

I could learn to hate chemotherapy, besides I still have hairy legs.  What is up with that? I was counting on having smooth legs without shaving because I gave up shaving several years ago. I got lots of random hairs on my head too and still have my eyebrows which is quite lovely.

It is going to be hard walking into chemo on Friday. It is like asking to be made sick.  Not really what I had in mind. I learned something. I do not know when I am really sick. It would have been good of me to call the doctor when I felt so lousy. Even though I knew I was seeing her on Friday-  I was prepared for pain and when I did not get it but got horribly sick with chest and head cold, frequent diarrhea, weakness, I did not recognize that I was going downhill from the chemotherapy hard and fast. Like what the heck is the matter with me, I do not know when I need to call a doctor and report my symptoms, I think oh well, this is what's suppose to happen and I am meant to suffer. What a wake up call. No wonder I did not catch my depression. I had no idea I needed help until I was really really sick then too. I just take it in stride -like it will go away all on its own until the alarms are loud and violent that is.  Asking ot be poisoned is a new experience. I once took a illegal substance by mistake in college and got violently sick. I thought I could have died. Caren stayed with me until we knew I was going to be alright. Scared the crap out of me (maybe even both of us). I have kind of stayed away from drugs that can make me sick ever since. And chemo is not fun even a little bit and I have to voluntarily go in there and let them hook me up to it. And sit there willingly. Gosh - can't believe kids have to do this. There is my blessing- I am not a child and this is NOT happening to my child.

I am not strong, I am not brave, I am not special, I am not a fighter, I am just a woman with breast cancer who trusts medical science to fix this problem the only way they know how. I surrender.

The antibiotic seems to be working

Sunday afternoon and I am feeling a little bit better-

Less coughing, no more diarrhea or cramping. I might be able to talk tomorrow at work as my voice is a little bit stronger and less scratchy. And I got caught up with  almost all my paperwork. (Thank You Emie) Ordered a new Ezpass for new car- Made payment schedule for new car- Balanced check book. Took 2015 papers out of folders to make room for 2016 papers.  Started adding expenses of 2015 for doing taxes later this month,  Have new folders for oncology, surgeon and family leave papers from work for Cancer. You know- only I have a folder called "Traffic Violations"- It has my receipt for my last traffic infraction in Lawnside NJ and my defensive driving course completion paperwork that Madison and I both did for insurance discounts.

Interestingly enough, My doctor was going to order one kind of antibiotic for me and then decided that would not be the best type so she sent in a different one and the pharmacy gave me both anyway. For those who know me really well, I was too sick to even be excited about getting 2 kinds of antibiotics at once. I knew I felt lousy but I did realize how lousy until now as I am starting to feel better.  I carry with me a "Camp Harlam" small tote bag that belonged to Madison to carry all my medications with me at once as I never know what I will need and when. They travel with me back and forth to work and upstairs at night and back down in the morning.

And I understand Dr. Gor a little bit better.  She is really managing all my side effects while killing the cancer cells. She is doing an analysis of this and that - looking into my mouth. Getting details of my side effects, Blood results, Weight loss or gain, sleeping, fatigue etc.... Telling how to stay healthy and reduce my risk of further infection. Watch my temperature. She is working getting me well enough to keep me on track for my next treatment. Get me well before making me sick with chemotherapy. She now refers to me as "the one with the cruise".  I was so sick, I did not even push her on sending an email about getting out my port the Monday after my last chemo because I understood that everything is up in the air until I am well enough and strong enough to get sick all over again. Last time, she gave me new medication to reduce my experience with nausea and allergies. She told me not to take any OTC pain medicine for headaches etc while I have this condition too. And now I am using a different rescue medication for nausea since I have neutropenia.  All this was mentioned in a fire rapid pace which I was able to catch- I deliberately chose to stay focused on her every word.

I am getting tired and nausea so I am going to end but just wanted to mentioned that my summer swim style caps all came and they are just beautiful from a new website I found that is heads above the rest I saw.   I can wear them to dinner and on all of our excursions or at the beach.

http://www.curediva.com/   Stunning fashionable hats and cancer accessories.

I hope you all like the new blog- Selene did a great job of setting it up for me. Talk more soon.   http://wiserthroughcancer.blogspot.com/

More work created by chemo -It is more than it appears- to be on the surface-

OH MY GOODNESS- I have been sick all week with diarrhea and and a cold started bad Wednesday evening- It is  more than it appears-

Germs are now a problem and I always prided myself on being able to tolerate germs- so my diarrhea and chest cold ain't what I thought -- I need to avoid getting infection and I kind of already have one so I am taking an antibiotic-  No sores in my mouth! using Imodium now too - Been keeping my hands covered in lotion and ointments but now it is even more important that I do not allow them to crack open. 

Took a shower and washed really good- all the  blankets that I been suing have been washed also today. I hate Purel though and all that anti bacteria crap- will keep washing with hot water and mild soap 

Neutropenia (Low White Blood Cell Count)

This information explains how to avoid getting an infection while you have neutropenia (low white blood cell count), and how to recognize the signs of infection.   Neutrophils are a type of white blood cell. They help your body fight infection. When your neutrophil count is low, you’re at risk for infection. To prevent infection, you must follow the instructions below until your neutrophil count returns to normal. Watch for any signs of infection and report them to your doctor or nurse. Be sure to take your temperature orally (by mouth), as directed by your doctor or nurse. Call your doctor or nurse if it is 100.4° F (38° C) or higher.

General Hygiene 

• Shower or bathe daily. Wash carefully under your arms, in your anal and genital areas, and in skin folds.
• Wash your hands using soap that can kill germs. Look for the words “antibacterial” or “antimicrobial.” Dial® is one example, but there are many others. Wet your hands with warm water and then rub your hands with soap for at least 15 to 20 seconds. Rinse your hands well under warm running water. Dry your hands with a paper towel.
• Perform mouth care after each meal. Use an ultra-soft toothbrush and brush and rinse as directed by your doctor or nurse.

• Use an alcohol-based hand sanitizer (such as Purell®) after shaking hands and after contact with young children.                                                                         

Ways to Prevent Infection
• Avoid having visitors to your home who have a cold or recently had an infection.
• Wear a mask if you have to go out in public places, use public transportation, or are in crowded areas.
• This will help protect you from catching a cold or other respiratory infection.
• Do not have any dental work or procedure done that is not urgent. Speak with your doctor or nurse first.
• Ask your doctor or nurse if you can:
  • Use tampons
  • Use suppositories
  • Have enemas
• Do not eat raw meats, raw fish, or raw eggs. Ask your nurse or dietitian for the resource Low Microbial Diet, if you have not already received it.
• Do not share eating or drinking utensils.
• Do not get a manicure, pedicure, wax, or tattoo without the approval of your doctor or nurse.
• Do not shave your scalp. Try to avoid shaving any other part of your body. If you must shave, use an electric razor.
• Do not touch any animal waste products (i.e., litter boxes, fish tanks, pet cages).
• Do not garden or handle soil. Avoid flowers, live plants-                                                  Call Your Doctor or Nurse if You Have Any of the Following Signs of Infection:

• A temperature of 100.4° F (38° C) or higher
• Shaking chills
• Nausea and vomiting that is not getting any better
• Flushed face
• Sweats
• Cough
• Diarrhea
• Mouth sores
• Headache
• New onset of pain
• Irritability
• Pain or burning during urination
• Feeling tired, especially if you also have flu-like symptoms