Chemocare.com
Care During Chemotherapy and Beyond

Injury

What Is An Injury?

An injury occurs when there is damage, or trauma, to any part of your body.

All injuries should be evaluated by a health care professional, especially if you are undergoing chemotherapy. Your skin is the best fighter of infection you have, especially if there are no cuts or break in your skin integrity. An injury that creates a break in your skin will put you at risk for developing an infection.

People who bruise easily may have problems with how their blood clots, and have a tendency of bleeding easily as well. If you notice that you are bruising or bleeding easily, notify your health care provider to be evaluated for potential bleeding problems.

Common Types Of Injury Include:

  • Bruising or Hematoma: Bleeding into the skin from damaged blood vessels causes bruising. The color of the bruise will fade from a "black and blue mark" to a more yellowish color, from days to weeks. This is as the body reabsorbs the blood under the skin. A hematoma is a larger collection of blood, which will usually reabsorb into the body. However, depending on the size, location and cause of the hematoma, the area may need to be drained surgically, or take longer to resolve.
  • Cut or Laceration:  A cut or laceration is when the skin is broken (such as cutting with a knife when slicing vegetables).  If you have low blood platelets or problems with blood clots, it could be challenging to stop the bleeding, especially if the cut is large or deep.
  • Fracture: A fracture occurs when a bone is broken due to trauma or injury. A fracture may also be pathologic, meaning, it may have been caused by invasion of tumors in to the bone that had caused it to break.
  • Sprains: Which are results of stretches or tears in the bands of tissue that connect the bones to one another, called ligaments. Knee and ankle sprains, caused by a twisting injury are common.

What Are Some Symptoms To Look For?

  • You may have been performing a certain activity, where you felt a pull of a muscle or ligament. You may not have pain immediately. 
  • If you have a fracture, you may have fallen down, or been struck by an object. If the fracture is pathologic, or caused by tumor invasion into the bone, the bone may have broken on its' own, with little or no trauma. 
  • You may be overly tired, or very weak (fatigue), if you have anemia due to your bleeding problems, or another underlying disorder. It may be hard for you to do any of your normal activities.
  • You may begin bleeding easily, and susceptible to nosebleed, for example. It may take you longer to form a blood clot.  This may be a sign of a blood  disorder, or low blood platelets. For many individuals, frequent, unexplained bruising or bleeding is the first sign of a bleeding disorder.
  • You may have tiny red dots on your skin, called petechiae (pe-TEEK-ee- ay). These are commonly found on your lower legs. This may be a sign of low blood platelets.

Things You Can Do To Avoid and Treat Injuries If You Have Bleeding Problems:

  • If you have sustained an injury from falling down, such as a fracture or a broken bone, or if you have hit your head, even if you feel all right, you should be evaluated immediately. This is especially if you have low blood platelets, blood disorder bruising, are on a blood thinner such as enoxaparin (Lovenox®), or Warfarin Sodium (Coumadin®), or if you are deficient in your blood clotting factors.
  • If you are helping an injured person, before transporting the injured person to the emergency department in the event of a bone fracture: Use any kind of flat object possible, to "splint" the affected joint, and provide support. 
  • For sprains or mild injuries: during the first 24 to 48 hours, the RICE (Rest, Ice, Compression and Elevation of the injured area) method is the best intervention. This includes:
    • Rest the area
    • Ice - apply an ice bag for 20 to 30 minutes at a time to the affected area, and every 4 hours
    • Compression - tightly wrap an ace or an elastic bandage around the area. Don't wrap the area too tightly, however, to restrict blood flow. 
    • Elevate - the affected knee, or ankle as much as possible. 
    • If you have pain, you may take Acetaminophen (Tylenol®) up to 4000 mg per day (two extra-strength tablets every 6 hours).
    • If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, or accentuate your bleeding problems.  
    • After 24 hours, you may perform activity as tolerated. However, as mentioned before, a health care provider should evaluate all injuries - especially if you are undergoing chemotherapy.

If You Are At Risk For Falling Down Due To Bleeding Problems:

  • Remove throw rugs from the floor that could be unstable, or cause you to loose your balance.
  • Wear well-fitting shoes at all times when you walk. 
  • Be aware of medications that may make you dizzy, or drowsy. Take these at bedtime, if possible, to minimize daytime sleepiness. 
  • Change positions from a lying to standing position slowly. Allow your body - and your blood pressure - to adjust. 
  • Clear a path in your home, free of clutter.
  • Use "track lighting" on the floors, or simply make sure that the area where you are walking is well lit. 
  • Use a walker or an assistive device, such as a cane, to maintain your balance. Install handrails if you have stairs, so that you can "grab on", to steady yourself as you climb up and down.
  • Walk with a friend, if possible, if you are concerned about falling down. 
  • Always have a communication device close to you. Keep a cordless phone in your pocket when you walk, so that you can call for help if you fall down.
  • Keep yourself well hydrated, by drinking 2-3 liters of fluid per day. This will prevent dehydration, and potential dizziness. 
  • Eliminate or minimize alcohol in your diet.  
  • Discuss with your health care provider about physical therapy. Try to perform exercises, as tolerated, to maintain or achieve your optimal level of functioning.

General Advice Regarding Injuries:

  • If you notice that you are bruising or bleeding easily, notify your health care provider so you can be evaluated for potential bleeding problems.
  • Make sure you tell your doctor, as well as all health care providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  Do not take aspirin or products containing aspirin unless your health care provider permits this. 
  • Remind your doctor or health care provider if you have a history of diabetes, liver, kidney, or heart disease. 
  • Occupational therapy (OT) may be ordered for you by your health care provider, after an injury.  You may be taught in OT how to do many tasks that you normally do, in a more effective manner. 
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Drugs or Recommendations That May Be Prescribed By Your Health Care Provider:

  • Depending on your age, overall health status, and the cause of your injury, your health care provider may prescribe certain medications or treatments. For those with a muscle or joint sprain, or a broken bone, you may be prescribed narcotic pain relievers, in addition to or in place of Tylenol. 
  • If you have a sprain, you may be instructed to initially rest the joint, and then participate in a physical therapy program. 
  • If you have a fracture, you may have the affected bone fixed either surgically, or by the doctor in the office. It is often then placed in a cast, so that your bone may repair itself.

Medications That May Be Prescribed Include: 

  • Bisphosphonates - Bone loss increases with aging in both men and women, although due to many factors, women are more at risk.This is called osteoporosis. 
Bisphosphonates, such as Pamidronate (Aredia®), and Zoledronate (Zometa®) may be given intravenously (IV), every 3-6 weeks, to treat Hypercalcemia (high blood calcium), strengthen your bones (called bone remodeling), and to decrease pain. Pain can be decreased by preventing bone destruction or damage and preventing bone from being "eaten away", which will also prevent bone fractures or breaking.
A bone density scan will show the amount of bone loss you have. You may fracture your bones more easily from trauma, than someone with stronger bones.

You are at risk for osteoporosis if:

  • You are a woman that has experienced menopause (the stopping of your monthly period or bleeding cycle), are thin or slender, smoke cigarettes, and have less than the recommended daily calcium intake of 1000 - 1500 mg per day of calcium with 400 IU of Vitamin D (vitamin D helps calcium be absorbed).
  • You are a man over the age of 65 years, depending on your diet or other factors; you may be at risk for osteoporosis.
  • If you have certain forms of cancer, and have fractured a bone due to injury, you may need to be evaluated with a bone survey, to determine if your bones are thinned due to cancer.
  • Cancer cells that spread to the bone can secrete (or produce) substances that cause other cells found in the bone, called osteoclasts, to dissolve or "eat away" a portion of the bone.  These tumors or lesions weaken the bone and may lead to complications.  Some of the complications resulting from this bone breakdown are bone pain, fractures and less commonly,  Hypercalcemia (increased levels of calcium in the blood).
If you have osteoporosis not related to your cancer, you may be prescribed a bisphosphonate in the pill form, to treat your osteoporosis. These include alendronate sodium (Fosamax®), or risedronate sodium (Actonel®). Fosamax may be taken once a week. Bisphosphonates in the pill form must be taken with at least 8 oz. of fluid, early in the morning, and you must sit up at least for 30 minutes to decrease stomach upset.
  • Analgesics (Pain Medication) - If you have pain at the site where your bleeding problems occur, you may take Acetaminophen (Tylenol) up to 4000 mg per day (two extra-strength tablets every 6 hours). It is important not to exceed the recommended daily dose of Tylenol, as it may cause liver damage. As with all medications, you should discuss this with your health care provider before taking any medications.
  • Narcotics - The central nervous system (CNS) is a way for our brain to send messages to our body in a timely manner. It is highly alert, especially when we are experiencing pain.  Many narcotic analgesic (pain medicines) work by blocking these messages, such as Morphine Sulfate and Oxycodone. You may be prescribed narcotics if you have severe pain as a result of trauma, or as a result of your cancer. Make sure you discuss with your health care provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.
  • If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, and accentuate bleeding problems. 

When To Call Your Doctor or Health Care Provider:

  • Bleeding that does not stop after a few minutes, or new, unexplained bruising.
  • Any head trauma.
  • Any new rashes on your skin, especially if you have been taking a new medication.
  • Pain that is unrelieved within 2 days of taking prescribed medication.

Other Common Bleeding Problems:
Bruising (Hematoma) | Injury | Nosebleeds (Epistaxis)Rectal BleedingVaginal Bleeding

Note: We strongly encourage you to talk with your health care professional about your specific bleeding problems, including blood  disorder bruising and epistaxis. The information contained in this website about bleeding problems and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.  

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