Thermometer basics: Taking your child's temperature

If your child feels warm or seems under the weather, you should probably take his or her temperature. Sounds simple enough — but if you're new to it, you probably have a few questions. Which type of thermometer should you use? Is an armpit temperature good enough? Are the thermometer rules different for babies and older children? Here are answers to these questions and more.

Who's at risk of nausea and vomiting during and after chemotherapy?

Whether you'll experience nausea and vomiting as a result of chemotherapy depends on what chemotherapy drugs you receive, whether you receive other cancer treatments, such as radiation, during your chemotherapy treatment, and whether you've experienced nausea and vomiting in the past.

Chemotherapy drugs that cause nausea and vomiting
Certain chemotherapy drugs are more likely to cause nausea and vomiting than are others. If you're receiving one of these chemotherapy drugs, preventive measures are available to help you avoid these side effects.

Whether a drug will cause nausea and vomiting also depends on the dosage you receive. Some drugs may be less likely to cause side effects at lower dosages. Ask your doctor whether your particular treatment is likely to cause nausea and vomiting.

Personal factors that may increase your risk
Not everyone reacts to treatment in the same way. Certain factors may make you more vulnerable to treatment-related nausea and vomiting. You may be more vulnerable if one or more of the following apply to you:

• You're a woman.
• You're younger than 50.
• You've experienced nausea and vomiting with previous treatments, or you have a history of motion sickness.
• You have a high level of anxiety.
• You experienced morning sickness during pregnancy.

In addition, if you expect that your treatment will cause nausea and vomiting, there's a chance that it will. You can become so convinced that nausea and vomiting will occur that it does occur. This might happen if you think, like many people do, that all cancer treatments cause these side effects, which isn't true. Your doctor can tell you specifically whether the treatment you'll receive is likely to cause nausea and vomiting.

What additional measures can you take to prevent nausea and vomiting?

You can take steps to reduce your risk of nausea and vomiting. For example:

• Eat small meals. Stagger small meals throughout the day rather than eating fewer, larger meals. If possible, don't skip meals. Eating a light meal a few hours before treatment also may help.
• Eat what appeals to you. It's best, however, to avoid foods that are sweet, fried or fatty. In addition, cool foods may give off less-bothersome odors. Cook and freeze meals in advance of treatment to avoid cooking when you're not feeling well. Or have someone else cook for you.
• Drink lots of fluids. Try cool beverages such as water, unsweetened fruit juices, tea or ginger ale that's lost its carbonation. It may help to drink small amounts throughout the day, rather than larger amounts less frequently. Try to drink about 48 ounces each day.
• Avoid unpleasant smells. Pay attention to what smells trigger nausea for you. For some, a specific smell, such as the smell of something frying or a greasy smell may cause nausea. Other people may experience nausea when smelling any strong odor. Limit exposure to unpleasant smells. Fresh air may help.
• Make yourself comfortable. After eating, rest, but don't lie flat for a couple of hours. Try wearing loosefitting clothing and keeping yourself distracted.
• Use relaxation techniques. Examples include meditation and deep breathing.

These self-care measures may help you prevent nausea and vomiting, but they can't take the place of anti-nausea medications. Take your anti-nausea medications as directed by your doctor.

If you begin to feel nauseous despite the medications, call your doctor. Treatments may include medications, such as those used to prevent nausea and vomiting, though your individual treatment will depend on what's causing your signs and symptoms.

Chemotherapy can serve varying goals

One of chemotherapy's main advantages is that — unlike radiation, which treats only the area of the body exposed to the radiation — chemotherapy treats the entire body. As a result, any cells that may have broken away from the original cancer are treated.

Depending on what type of cancer you have and whether it has spread, your doctor may use chemotherapy to:

• Eliminate all cancer cells in your body, even when cancer is widespread
• Prolong your life by controlling cancer growth and spread
• Relieve symptoms and enhance your quality of life

In some cases, chemotherapy may be the only treatment you need. More often, it's used in conjunction with other treatments, such as surgery, radiation or a bone marrow transplant, to improve results. For example, you may receive:

• Chemotherapy before other treatments (neoadjuvant chemotherapy). The goal of neoadjuvant therapy is to reduce the size of a tumor before surgery or radiation therapy.
• Chemotherapy after other treatments (adjuvant chemotherapy). Given after surgery or radiation, the goal of adjuvant therapy is to eliminate any cancer cells that might linger in your body after earlier treatments.

How your doctor chooses a chemotherapy regimen

Chemotherapy may not be limited to a single drug. Most chemotherapy is given as a combination of drugs that work together to kill cancer cells. Combining drugs that have different actions at the cellular level may help destroy a greater number of cancer cells and might reduce the risk of your cancer developing resistance to one particular drug. Your doctor will recommend drug combinations that have been tested in people with similar conditions and have been shown to have some effect against your particular type of cancer.

What chemicals your doctor recommends is generally based on the type, stage and grade of your cancer, as well as your age, general health and your willingness to tolerate certain temporary side effects.

Chemotherapy side effects

Because chemotherapy drugs can affect healthy cells, one of their disadvantages is that you may experience chemotherapy side effects, some temporary and some longer term. Not every drug will cause every side effect. Your doctor can tell you what to expect from the drugs you're receiving.

Temporary side effects might include:

• Hair loss
• Dry mouth
• Mouth sores (stomatitis)
• Difficult or painful swallowing (esophagitis)
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Fatigue
• Bleeding
• Susceptibility to infection
• Infertility
• Loss of appetite
• Changes in the way food tastes
• Cognitive impairment, sometimes referred to as "chemo brain"
• Liver damage
• Heart damage
• Nerve damage
• Lung damage

How long these temporary side effects last depends on what drug or combination of drugs you're taking and for how long. Most chemotherapy side effects will subside shortly after you stop your treatments. And most short-term side effects can be minimized with medication. For example, your doctor can give you medications to help relieve nausea or build up your blood counts. If side effects make you uncomfortable, tell your doctor. If you find that the side effects are more than you're willing to endure, you can change treatments.

Long-term or late chemotherapy side effects
As people with cancer live longer after treatment, doctors are discovering that some treatments cause long-lasting side effects or side effects that become apparent long after treatment ends. These long-term side effects are rare. Before you begin treatment, discuss with your doctor what long-term effects you might experience. Some chemotherapy drugs can cause:

• Organ damage, including problems with your heart, lungs and kidneys
• Nerve damage
• Blood in your urine (hemorrhagic cystitis)
• Another cancer, including Hodgkin's disease and non-Hodgkin's lymphoma, leukemia and some tumors

Your doctor can tell you what signs and symptoms to watch for after treatment. Knowing what long-term side effects to watch for can help you stay healthy after treatment.

What is chemobrain?

The terms "chemobrain" and "chemofog" refer to cognitive changes during and after cancer diagnosis and treatment. Though these terms imply a relation to chemotherapy, it isn't clear that chemotherapy is responsible. Women with breast cancer who underwent chemotherapy were the first group to bring these symptoms to light, as more started mentioning their symptoms to their doctors. It isn't clear whether chemotherapy, or other factors such as stress and hormonal fluctuations, cause the changes in memory and thinking. What is clear is that some people with cancer do notice increased difficulties with certain mental tasks during and after cancer treatment.

In general, researchers have found that chemotherapy can affect your cognitive abilities in the following ways:

• Word finding. You might find yourself reaching for the right word in conversation.
• Memory. You might experience short-term memory lapses, such as not remembering where you put your keys or what you were supposed to buy at the store.
• Multitasking. Many jobs require you to manage multiple tasks during the day. Multitasking is important at work as well as at home — for example, talking with your kids and making dinner at the same time. Chemotherapy may affect how well you're able to perform multiple tasks at once.
• Learning. It might take longer to learn new things. For example, you might find you need to read paragraphs over a few times before you get the meaning.
• Processing speed. It might take you longer to do tasks that were once quick and easy for you.

About 20 percent to 30 percent of people undergoing chemotherapy will experience cognitive impairment, though some studies report that at least half the participants had memory problems. One study found 35 percent of women with breast cancer had memory problems before beginning chemotherapy, so it's not clear how or if memory changes are related to cancer treatment. Signs and symptoms of these memory changes can last for a year or two after your treatment.

Changes in memory during and after treatment may be very subtle. You might notice changes during your everyday tasks and as you start working again after treatment. The memory changes are often so subtle, in fact, that researchers find that people who report having memory difficulties tend to score in the normal ranges on tests of their cognitive ability. That makes it more difficult to understand, diagnose and treat the memory changes.

What other types of cancer treatment might cause cognitive impairment?

Chemotherapy isn't the only cancer treatment that may cause memory and thinking problems. Other treatments that might affect your brain include:

• Hormone therapy. It isn't clear whether women undergoing hormone therapy that alters the amount of estrogen in their bodies experience memory problems. Some studies link memory function to the amount of estrogen in the brain. Other studies haven't found this link.
• Immunotherapy. This experimental therapy stimulates your body's own defenses to fight your cancer. Treatment with cytokines — a type of protein that causes inflammation in your body — may cause problems with memory, multitasking and processing information.
• Radiation therapy. Radiation to your brain can impair your memory and your motor function, as well as your ability to learn new things and to multitask. Older adults and people receiving high doses of radiation are at a greater risk of memory problems. If you receive both chemotherapy and brain radiation, your risk is also higher.

As research continues, doctors expect to better understand which cancer treatments cause cognitive impairment and what they can do to limit their side effects.