חוברת הדרכה למטופל במחלקה המטולוגית (אנגלית)

Dear Patient
This booklet has been compiled to provide you and your visitors with general information on recommendations during your stay in hospital.
We hope that the treatment will proceed as efficiently and easily as possible.
The information in this booklet does not revoke any instructions given to you by the treating physician nor does it replace consultations with the physician and the nurse coordinating the treatment.
We wish you a speedy and complete recovery and you are welcome to approach us if you have any questions or concerns.

In the age of the Internet, much information is published on the internet without any restrictions. It is recommended that you do not rely on this information for deducing anything about your medical condition without professional medical advice.

Preparation for chemotherapy
Before the treatment begins, several procedures need to be carried out in order to plan the treatment correctly. These include:

• Bone marrow biopsy – A sample is taken from the "factory" where the blood cells are formed in order to confirm the diagnosis, determine the extent of the disease and to gather genetic information which will help with deciding on the treatment plan. The sample is taken from the or using a local anesthetic along with any necessary sedation.
• Blood tests – These tests include a blood count, electrolytes, liver and kidney function tests, as well as tests to determine prior exposure to diseases. These allow the medical team to adapt the treatment to your needs, so as to prevent any complications.
• Echocardiogram – an ultrasound examination of the heart which provides us with information on the structure and function of your heart; information which allows the physician to determine the type and dosage of chemotherapy for you.
• CT scan or other diagnostic imaging – A precise examination which allows evaluation of internal organs for the presence of any disease or infection. Imaging will be carried out
• both before and after treatment in order to evaluate your body's reaction to the treatment you have received.
• Fertility preservation- the chemotherapy drugs administered may affect the fertility of both of men and women.

Women be able to preserve embryoes or ovaries but it must be emphasized that these possibilities do not always exist and are dependent on your medical situation. Decisions on fertility

preservation will be made in conjunction with the fertility unit of the gynecology department.
In many cases women will be administered hormones to stop menstruation so as to prevent heavy bleeding during the period of reduced platelets.

Men may freez sperm prior to being exposed to chemotherapy. Patients interested in this option can discuss its religious aspects with the Puah Institute or with a qualified Rabbi of their choice.

• Insertion of a central venous catheter, "PICC Line"- A PICC line is a central venous catheter made up of a thin long flexible tube inserted into the arm just above the elbow and end in a large central vein at the right hand upper atrium of the heart. The tube is fixed to the arm covered by a dressing.
  Accessing the vein through the catheter, chemotherapy, fluids, medications, and blood and its components, can all be administered more easily and more comfortably over a long period of time. The PICC line is also used for taking blood samples for laboratory tests. The catheter prevents the discomfort of repeated insertion of needles into the veins of the arms and ensures more accurate administration of the chemotherapy with no risk of leakage of the medication into the area under the skin. Because the catheter is
  inserted into a central vein, we take strict precautions to avoid exposure to infection.
  Care is taken to preserve maximum hygiene of the PICC line when taking blood or changing dressings. We try to minimize opening and closing the catheter and any contact with water so as to prevent the risk of infection. When taking a shower, it is possible to use plastic cling film to cover the arm in the area of the catheter so as to avoid exposure to water.

Regular maintenance of the PICC line is carried out by a nurse and consists of:

• Changing, bandaging and sterilizing the catheter exit point is performed twice a week while in the department, usually on Mondays and Thursdays, or whenever necessary, according to the judgment of the nurse coordinating the treatment.
• Changing the fixation mechanism ("butterfly") once a week.
• Continuous administration of fluids into the catheter to minimize the occurrence of a blockage.

The PICC line has many advantages but some problems may arise when using it:

• Blockage of the catheter by a blood clot inside the catheter is a common problem and is usually solved by injecting material to break up the clot in the catheter. In rare cases the catheter may have to be changed.
• Blood clots may sometimes develop in the vein around the PICC line due to the irregular flow of blood caused by the presence of the catheter, well as the prothrombotic effect of hematological diseases. A clot can cause swelling and
  sensitivity in the affected arm and can be diagnosed by ultrasound. Blood thinners usually administered until the clot dissolves. At times, the PICC line has to be removed.
• Infection – Despite the aforementioned precautions, the presence of a foreign body in the blood circulation system can have consequences, such as infection. In most cases the infection can be successfully treated with antibiotics, but at
  times the PICC line has to be removed in order to resolve the infection.
  
  Removal of the PICC line is a simple, painless procedure carried out the bedside.
  

Recommendations:

Bowel Movements
Constipation often occurs as a result of chemotherapy. Apart from the discomfort, constipation increases the chances of developing hemorrhoids and may cause a wound in the anal area which can become infected.
Hemorrhoids (protruding veins) and fissures (painful cuts) in the anal region are common.
Diarrhea occurs frequently because of the toxicity of chemotherapy and from different infections. If diarrhea does occur, report to the staff so that they can treat it as necessary.


Preventing Hemorrhoids
Preventing hemorrhoids, fissures and infections in the anal region is easier than treating them and therefore it is important to ensure regular and soft bowel movements.
It is recommended to:

• Add dietary fiber to your nutrition.
• Drink prune juice (cooked!!).
• Be sure to drink a large amount of water.
• Be sure to keep the anal region clean by rinsing with running water after every bowel movement.
• Take medications such as paraffin oil and laxatives as needed, in consultation with the treating staff.

During your stay in hospital you can request a consultation with a dietitian in order to get nutritional advice on how to avoid constipation.

Do not use enemas or suppositories without instructions from a doctor so as not to cause infection or bleeding.

Treating Hemorrhoids – Pain Relief

• The pain of a wound in the anal region is worse when having a bowel movement. Prolonged constipation and a lot of exertion also make the wound worse and consequently there is more pain. In order to break this cycle a combined treatment of laxatives and pain relief is prescribed. It is important to note that some of the medications for pain relief can themselves cause constipation, which increases the importance of also taking medication to alleviate constipation.
• A local anesthetic, such as Esracain, can be rubbed in to reduce local pain. It can be applied before bowel movements to ease the motions and if there is pain during the day. During your hospital stay the medical staff will provide it on request.
• During your hospital stay you will be given guidance on how to take a sitz bath: a pot has to be filled with warm water and anti-bacterial soap (septal scrub) which can be found in every room. You should sit in the pot, soaking the anal region for 10 minutes at least twice a day and after every bowel movement. Baths soften the anal area, ease the pain and contribute to the cleanliness and healing of the wound.
• After a sitz bath and in accordance with doctor's instructions, cream for hemorrhoids can be applied, such as Proctozorin or Nifedipine. These reduce the pain and infection caused by hemorrhoids and help recovery. The cream must only be applied to the anus externally.
• A sterile pad can be frozen and, when needed, the packet can be opened and the pad applied to the area of the hemorrhoids. The cold
• contracts the blood vessels and relieves pain. Do not apply any non-sterile material because of the risk of infecting the area.
• Special wipes (PROCTO wipes) can be bought at a pharmacy. The wipes are soothing and help to ensure the hygiene of the anal region and help recovery.

Hygiene:
Personal hygiene is especially important at times of low blood counts. The main areas of the body which are potential sources of infection are the oral cavity, the hands and the anal region.

Nutrition:
You must be vigilant about food hygiene by taking the following precautions:

• Before preparing food wash your hands with soap and water.
• Rinse fresh fruit and vegetables with soap before eating.
• Eat animal products from reliable sources and cook them well.
• You can drink pasteurized fruit juices or juices prepared at home from fresh fruit that has either been rinsed well, peeled or canned.
• Do not leave food outside the refrigerator for more than 2 hours.
• Food in the refrigerator must be well covered.
• Avoid eating away from home (restaurants, coffee shops etc.)
• Do not eat dried fruit, nuts and seeds and mixtures of spices (to avoid fungal infection).

Loss of appetite, or changes of taste, are common during chemotherapy.

These side effects can be reduced by:

• Eating small, light meals several times a day.
• Drinking a lot.
• Sucking sweets to improve the taste in your mouth.
• Sucking ice, sour sweets, or ice pops to reduce nausea and dryness in the mouth.

It is recommended to keep your regular balanced diet, unless given other instructions. There are no specific

recommendations about taking dietary supplements or vitamins during chemotherapy. You should remember that some vitamins and supplements may contain different active drugs that may lower the effect of the chemotherapy medications and therefore you must consult with the treating physician before using them.

Resistant Bacteria:
Most germs which cause infection come from within the patient's body. The air around us is not sterile and contains bacteria, viruses, funguses, mold etc. At any point in time, there are millions of microorganisms in our bodies. A prolonged stay in hospital causes the population of microorganisms in the body to change and sometimes the patient is infected by germs which are resistant to some antibiotics. The best way to deal with these germs is prevention. In other words, contact between the carrier of such a germ and other patients must be prevented.

Every Wednesday, or when you are admitted, the nurse coordinating the treatment will test whether you are carrying any resistant bacteria. This is done by taking a rectal swab. This test is carried out on all the inpatients. Carriers of resistant germs are unlikely to be in danger themselves but it can be very dangerous for other patients around them. Anyone who is found to be a carrier has to be moved into an isolation room in order to prevent contact with other patients. Any time you leave an isolation room you have to wear a special gown and gloves. We are aware that this is very uncomfortable and apologize for it, but there is no alternative way to protect the health of the patients who are hospitalized with you.

Visitors:
We encourage visits by relatives and friends, however certain rules must be kept:

• You must ask every visitor to wash their hands with the solution containing alcohol, found outside every room.
• You must prevent any visitor who is coughing or sneezing from coming near you.
• No more than two visitors may come into the room at one time. If you have more visitors you should wear a face mask, located in every room by the sink, and sit with them in the family room.
• You must avoid contact with anyone who has been vaccinated with weakened live viruses, such as, the oral polio vaccine, for 6 weeks after the vaccination. This applies especially to babies who receive the vaccine orally excrete the virus for a prolonged period .
• You must limit, as much as possible, time spent in enclosed crowded places, such as shopping malls and synagogues.

Because the chemotherapy is eliminated from the body by body fluids, you must instruct family and visitors not to use
Your toilet so that they are not exposed to the chemotherapy and you are not exposed to their germs.

Do not bring any flowers into the ward because of the danger of spreading fungi.

Intimate Relations:
There is no restriction on carrying out sexual relations during chemotherapy, as long as they are protected and hygienic. It is advisable to avoid relations on the day of treatment itself in order to avoid exposure of your partner to any medication which may be discharged from your secretions.
It must also be emphasized that all relations must be protected for a period of two to three years, depending on the illness and type of treatment, because both the sperm and the eggs are affected genetically as a result of chemotherapy. Do not rely on the treatment's negative effect on fertility as a means of birth control. Pregnancy must particularly be avoided during the course of treatment as the chemotherapy medications may cause damage to the developing embryo.

It is important to note that some patients will feel a drop in sexual desire during the course of the treatment. This is a known side effect and solutions can be found. The Israel Cancer Association offers expert advice and guidance. Call 03-5721643.

Blood Components:
During the course of the treatment you will sometimes have to receive units of blood and platelets, as indicated by blood tests. These components are matched to your blood type. Every time you receive a blood component, the doctor or nurse will check your personal details (name and identity number) to prevent any error in matching. During administration of these components you may experience hot flushes or shivering. Please inform the staff of any unusual sensations during the blood transfusion so that they can react quickly as needed.
In order for us to be able to supply the required blood components in the best way possible, we ask family and friends to donate blood for you to the blood bank of Hadassah Ein Kerem.

Donors should go to the donors' room of the blood bank on Floor 1 (ground floor) of the main building.
Opening hours:
Sunday-Thursday8:00 – 15:30
Friday 8:00 – 12:00

Donors must have with them their identity card or any other photo identification.

Social Benefits:
Understanding that your new medical situation presents you and your family with emotional, familial, social and financial challenges, the social service of the hospital is there for you, and, in particular, the department social worker.

The social service will accompany you in fully exploiting your social benefits, both emotionally and practically.
For example:

• Emotional support.
• Organizing free parking in the hospital.
• Benefits awarded by Social Security, the Income Tax Authority, Health Funds, etc. The department social worker will give a detailed explanation of all services and benefits.
• There are many non-profit organizations helping patients and their families, which you can approach, such as the Israel Cancer Association, Ezer Mizion and others.
  

For more information on patients' benefits and how to obtain them, and to get the necessary forms and help with filling them in, you can consult "Kivunim", an information center for health benefits.
"Kivunim" Ein Kerem is located in the lobby of the Davidson Building.
Opening hours:
Sunday – Thursday 10.00-17.00

Tel: 02-6779711

[email protected]

We are aware of the difficulties and challenges facing you and your families and will be happy to help you as much as we can.
The staff of the hematology department has much experience in supporting and dealing with any emotions and doubts you may have. We invite you to approach us with any problem or question. If necessary, we will refer you to the relevant professional.


Wishing you a successful and speedy recovery
The staff of the department


Telephone number of the department:
02-6776686 or 02-6776685 / Fax: 02-6776755
Hematology Outpatient Clinic:
(Sunday- Thursday 8.00-15.00)
02-6776701
Admissions office: 02-5842111


Authors:
Written by: Tovi Dimentman, Dr Adir Shaulov, Chani Itinberg
Advisor: Prof. Dina Ben Yehuda
Edited by: Tal Atzmon


The information appearing in this publication is for educational purposes only and does not constitute a medical opinion and in any event, is not a substitute for professional medical advice. All rights reserved to Hadassah © Do not photocopy, duplicate or make any commercial use without written permission from Hadassah. The booklet is intended for both men and women. 2017. Additional informational material can be viewed at the Hadassah web site: www.hadassah.org.il :