💊 Managing Treatment Side Effects

Fatigue

When: Usually starts week 2-3, worst at end, may persist months

• Rest when needed — don't fight it
• Short walks help more than total rest
• Prioritize activities — save energy for what matters
• Nap early afternoon, not late
• Stay hydrated

Hair Loss (Radiation Area)

When: Starts 2-3 weeks in, may be permanent in treatment field

• Get a soft hat or head covering ready
• Use gentle shampoo (baby shampoo)
• Protect scalp from sun
• Hair outside treatment area usually regrows

Scalp Irritation

• Aloe vera gel (pure) soothes skin
• Avoid hot water on head
• No harsh products
• Doctor may prescribe steroid cream

Brain Swelling (Edema)

Symptoms: Headaches, nausea, neurological changes

• Dexamethasone (steroid) is standard treatment
• Boswellia may help reduce dose needed (ask doctor)
• Report new/worsening symptoms immediately

Nausea & Vomiting

Frequency: Common during concurrent phase, less during adjuvant

• Take TMZ at night before bed
• Take on empty stomach (or with light snack)
• Ondansetron (Zofran) 30 min before TMZ
• Ginger tea, ginger candies
• Small, frequent meals
• Avoid strong smells

Low Blood Counts

What: TMZ suppresses bone marrow

• Low platelets: Easy bruising, bleeding
• Low white cells: Infection risk
• Low red cells: Fatigue, weakness

Management:

• Regular blood tests (CBC)
• Dose may be reduced if counts too low
• Avoid crowds during nadir (lowest point)
• Report fever >100.4°F immediately

Constipation

• Anti-nausea meds cause this
• Fiber supplements (psyllium)
• Stool softeners (docusate)
• Stay hydrated
• Gentle exercise if possible

Fatigue

• Cumulative — gets worse with each cycle
• Usually improves after treatment ends
• Light exercise paradoxically helps
• Protein-rich diet

Hyperglycemia (High Blood Sugar)

• Very common — even in non-diabetics
• Monitor blood sugar regularly
• Low-carb diet helps significantly
• May need temporary diabetes medication

Insomnia

• Take steroids in morning (not evening)
• Ask about sleep aids (trazodone, melatonin)
• Sleep hygiene — dark room, no screens
• Magnesium may help

Increased Appetite & Weight Gain

• Extremely common
• "Moon face" — facial swelling
• Try to choose healthy foods despite cravings
• Weight usually normalizes after stopping

Mood Changes

• Anxiety, irritability, even euphoria
• Depression when tapering off
• Warn family to expect this
• If severe, psychiatric support available

Muscle Weakness (Steroid Myopathy)

• Especially legs — difficulty climbing stairs
• Protein-rich diet
• Light resistance exercise if able
• Usually improves after stopping

Immune Suppression

• Increased infection risk
• Avoid sick contacts
• PCP prophylaxis (Bactrim) often prescribed

Seizures

• May need anti-seizure medication (Keppra common)
• Take medications consistently
• No driving if seizures occur
• Know seizure first aid

Cognitive Changes ("Chemo Brain")

• Memory issues, difficulty concentrating
• Use lists, calendars, reminders
• Brain exercises (puzzles, reading)
• Often improves after treatment
• Occupational therapy can help