Neuropathy (Tingling, numb toes or fingers)

(May be severe)

What to look for?

• Numbness or tingling of your fingers and toes may happen after starting oxaliplatin.
• Sometimes it can be painful and feel like a burning sensation, which may be severe.
   

What to do?

• Talk to your health care team if you have symptoms of neuropathy.
• Numbness may slowly get better after your treatment ends.
• Avoid exposure to cold as it can trigger this side effect.
• Do not use ice packs on your body.
• Dress warmly and cover all of your skin if you must go outside in cold temperatures.
• Wear gloves to touch cold objects.
• Avoid breathing deeply when exposed to cold air.
   

For some people, symptoms of neuropathy may continue long after treatment ends. The sensations in the throat usually go away after a few hours; if they last longer, or if you have trouble breathing, contact your doctor right away.

If you continue to have bothersome symptoms, talk to your health care team for advice.

Talk to your health care team, especially if you  have trouble doing tasks like doing up buttons writing, moving, or if you have severe pain or numbness

Low neutrophils (white blood cells) in the blood (neutropenia)

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.
 

What to look for?

• If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. 
• Do not take medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen).
• Do not eat or drink anything hot or cold right before taking your temperature.
   

You have a fever if your temperature taken in your mouth (oral temperature) is:

• 38.3°C (100.9°F) or higher at any time

OR

• 38.0°C (100.4°F) or higher for at least one hour.

What to do?

If your health care team has told you that you have low neutrophils:

• Wash your hands often to prevent infection.
• Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
• Keep a digital thermometer at home so you can easily check for a fever.
   

If you have a fever:

If you have a fever, try to contact your health care team.  If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact your health care team.  If you are unable to talk to the team for advice, you MUST get emergency medical help right away

Low platelets in the blood

When platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.

What to look for?

• Watch for signs of bleeding:
  • bleeding from your gums
  • unusual or heavy nosebleeds
  • bruising easily or more than normal  
  • black coloured stools (poo) or blood in your stools (poo)
  • coughing up red or brown coloured mucus
  • dizziness, constant headache or changes in your vision
  • heavy vaginal bleeding
  • red or pink coloured urine (pee)

What to do?

If your health care team has told you that you have low platelets:

• Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
• Check with your healthcare team before you go to the dentist.
• Try to prevent cuts and bruises.
• Ask your health care team what activities are safe for you.
• Your treatment may need to be delayed if you have low platelets.  Your health care team may recommend a blood transfusion.
   

If you have signs of bleeding:

• If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that doesn’t stop or is severe (very heavy), you must get emergency medical help right away.

Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency medical help right away

Nausea and vomiting

May occur in hours to days after your treatment. 

If you have nausea or vomiting:

• Take anti-nausea medication(s) as prescribed to you by your doctor. 
• Drink clear liquids and have small meals. Get fresh air and rest.
• Do not eat spicy, fried foods or foods with a strong smell.
• Limit caffeine (e.g. coffee, tea) and alcohol.
• Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.
 

Abnormal liver lab tests

• Your doctor will monitor these regularly. Call your doctor if you have yellowish skin or eyes, or unusual dark urine.

Talk to your health care team if it does not improve or if it is severe

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

• Take anti-diarrhea medication if your health care team prescribed it.
• Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
• Eat many small meals and snacks instead of 2 or 3 large meals.
• Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.
 

Fatigue (Tiredness)

What to look for?

• Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep.
   

What to do?

• Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days.
• Check with your health care team before starting any new exercise.
• Pace yourself, do not rush. Put off less important activities. Rest when you need to.
• Ask family or friends to help you with things like housework, shopping, and child or pet care.
• Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less).
• Avoid driving or using machinery if you are feeling tired.

Ask your health care team for the Fatigue pamphlet for more information.

Mouth sores

You may have round, painful, white or gray sores inside your mouth. They can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard swallow, eat or to brush your teeth. They usually last 1 to 2 weeks.

To help prevent mouth sores: 

• Take care of your mouth by gently brushing and flossing regularly.
• Rinse your mouth often. Do not use mouthwashes with alcohol.
• Instead, try a homemade mouthwash: Mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water.

If you have mouth sores:

• Check with your health care team as soon as you notice mouth or lip sores or if it hurts to swallow.
• Avoid hot, spicy, acidic, hard or crunchy foods.  Your doctor may prescribe a mouthwash to relieve mouth sores and prevent infection.

See the Mouth Care pamphlet for more information.

Sensation that you are not breathing properly

• This is can be caused by drinking cold fluids or inhaling cold air.
   

What to look for?

• Trouble swallowing or talking.
• Tightness in your jaw.
• Unusual feelings in your tongue.
• Feeling like it is hard to breathe or pressure in your chest.
   

What to do?

• Avoid the cold as much as possible.
• If you must go outside in the cold, protect your face and mouth with a scarf or high-neck sweater.
• Only eat and drink things that are room temperature or warmer. Do not drink cold drinks or put ice cubes in anything you drink. Do not eat cold foods, such as ice cream.
• Avoid direct exposure to air conditioning, such as in your car.
• Take shallow breaths when you are exposed to cold air (such as from a freezer or when you are outside in winter).
• Do not use an ice pack on any part of your body.

Problems with breathing and swallowing can be unpleasant. They should only last a few minutes. 

Hair thinning or loss

What to look for?

• Your hair may become thin or fall out during or after treatment.
• In most cases, your hair will grow back after treatment. The texture or colour may change.
• In very rare cases, hair loss may be permanent.
   

What to do?

• Use a gentle soft brush.
• Do not use hair sprays, bleaches, dyes and perms.

Constipation

What to look for?

• Having bowel movements (going poo) less often than normal.
• Small hard stools (poo) that look like pellets.
• The need to push hard and strain to have any stool (poo) come out.
• Stomach ache or cramps.
• A bloated belly, feeling of fullness, or discomfort.
• Leaking of watery stools (poo).
• Lots of gas or burping.
• Nausea or vomiting.

What to do?

To help prevent constipation:

• Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains.
• Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less.
• Be Active. Exercise can help to keep you regular.
• If you take opioid pain medication, ask your health care team if eating more fibre is right for you.

To help treat constipation:

• If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do.

Ask your health care team for the Constipation Pamphlet for more information.

Pains or cramps in the belly

What to look for?

• Pain or cramps in your belly.
• Constipation and diarrhea can cause pain in your belly.
   

What to do?

If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.

Mild swelling in arms and legs; puffiness

What to look for?

• You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.
   

What to do?

To help prevent swelling:

• Eat a low-salt diet.
   

If you have swelling:

• Wear loose-fitting clothing.
• For swollen legs or feet, keep your feet up when sitting.

Rash

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

To prevent and treat dry skin,

• Use skin moisturizer.
• Protect your skin from the sun and the cold.
• Use sunscreen with UVA and UVB protection and a SPF of at least 30.

High blood sugar

• You may feel thirsty and pee more often.
• Your doctor may check your blood sugar level. You may be advised to change your diet or take medication to treat high blood sugar.
• Check your blood sugar regularly if you have diabetes.

Mild joint, muscle pain or cramps

What to look for?

• New pain in your muscles or joints, muscle cramps, or feeling achy.
   

What to do?

• Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
• Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?” before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
• Rest often and try light exercise (such as walking) as it may help.

Ask your health care team for the Pain pamphlet for more information

Low Appetite, weight changes

What to look for?

• Loss of interest in food or not feeling hungry.
• Weight change.
   

What to do?

• Try to eat your favourite foods.
• Eat small meals throughout the day.
• You may need to take meal supplements to help keep your weight up.
• Talk to your health care team if you have no appetite.

Ask your health care team for the loss of appetite pamphlet for more information.

Taste changes

What to look for?

• Food and drinks may taste different than usual.
   

What to do?

• Eat foods that are easy to chew, such as scrambled eggs, pasta, soups, cooked vegetables.
• Taste foods at different temperatures, since the flavour may change.
• Try different forms of foods, like fresh, frozen or canned.
• Experiment with non-spicy foods, spices and seasonings.

Pain, burning, redness, or swelling on skin where drug was injected

Let your health care team know right away when this happens, since this drug can irritate tissues if it leaks from the vein during injection.

Salt imbalances

It may cause muscle twitching, severe weakness or cramping, confusion and irregular heartbeat.

Allergic reaction

What to look for?

• Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness.
• It may happen during or shortly after your treatment is given to you and may be severe.
   

What to do?

• Tell your nurse right away if you feel any signs of allergic reaction during or just after your treatment.
• Talk to your health care team for advice if you have a mild skin reaction.