TINA: Mr. Hines, good to see you today.
JOE: Thanks. (good naturedly) And call me Joe. Mr. Hines is my father.
TINA: Alright, Joe. So, what's your understanding of why you’re here today?
JOE: Well, ahh… to prepare for my chemo next week?
TINA: That’s right. I know your oncologist reviewed some of this on your last visit. Do you have any specific questions, or would you like me to review a few things with you?
JOE: Uh, I remember some, I think? But a refresher would be nice. It was all a little...much.
TINA: I understand. You've had a lot of new information thrown at you. It's a lot to process.
JOE: So much. So, so much.
TINA: I know it can be overwhelming. We'll make sure you feel comfortable with everything and have all your questions answered before you leave today. We'll send some materials home with you, too.
JOE: That'd be great.
FEEDBACK: Good job! Empathizing with Joe sets up a respectful and friendly tone for the conversation.
TINA: During chemo, your white blood cells can get really low. The fancy medical term for that is called neutropenia.
JOE: That doesn't sound good…
TINA: You're right, it's not.
TINA: Your white blood cells fight infections and when they get low, you're much more likely to get an illness your body can't fight off. That's why an infection during chemo is so serious. It could mean getting sick, a hospital stay, an interruption of treatment, or--worst case--even death.
JOE: Yikes.
TINA: Right. So I want to make sure you know what to do to protect yourself and lower your chances of getting an infection.
JOE: Yeah, me too.
FEEDBACK: Good job! Using plain language helped Joe understand what you're saying.
TINA: Our goal is to get you through treatment and on to living your life.
JOE: Thanks. That's what I want, too.
TINA: Glad to hear it! Good news is, there are some things you can do to protect yourself during chemo, when your immune system is vulnerable.
JOE: Oh, good. More to have to think about... but I can do this. I... I have to.
TINA: During each chemo cycle there'll be a time when your white blood cell count will be the lowest. That's called your 'nadir.'
JOE: Okay...
TINA: Different chemo meds have different nadirs. We'll check the chemo ordered for you so we know when yours is, but generally the nadir starts 7-12 days after chemo treatment and lasts for 5-7 days.
TINA: Any kind of infection during chemo can lead to something called sepsis. Sepsis is your body's response to an infection, and it can lead to some really serious issues, like tissue damage, organ failure, and -- worst case -- even death.
JOE: Yikes!
TINA: Right. So avoiding infection during chemo -- especially during your nadir -- is incredibly important.
TINA: So, as an example, if you were to get your chemo treatment on the first of the month, your nadir would begin 7-12 days later. That's somewhere between the 8th and the 13th. And it would last for 5-7 days.
JOE: Ok, I think I've got it.
TINA: It could also help to set reminders in your phone or let your wife and daughter know when your nadir is so they can help you remember.
JOE: They do love "helping me remember things." We, uhh... we won't call it nagging. (laughs at his joke)
FEEDBACK: Good job! Providing an example is an excellent way to help a patient understand difficult or confusing information.
TINA: So, tell me, Joe, what's a good plan for tracking your nadir?
JOE: Well... I'll check with Dr. Collins about exactly when my nadir-thing will be based on the chemo I'm getting. And then... uhh... well, my wife has this calendar in the kitchen where she writes down our appointments and things. When my chemo dates are added to it, I can mark those nadir days, too.
TINA: Perfect. And the nadir starts... when?
JOE: Seven to twelve days after chemo day?
TINA: That’s right.
FEEDBACK: Good job! By providing an example you helped Joe understand and retain the details of his nadir.
TINA: During treatment--and especially during your nadir -- you'll want to take steps to avoid an infection, and there are three main ways we recommend for staying safe.
JOE: Well lay 'em on me.
TINA: They're all pretty simple, which is nice. You'll want to wash your hands often, be sure to have gotten the flu shot and any other recommended vaccines, and try to avoid being around people who are sick.
JOE: Okay. Well... flu shot's already done, so... there's that.
TINA: Great!
TINA: Let's talk a little about how to keep your hands clean. Washing your hands - and I mean a lot- is one of the best ways to help avoid germs and bacteria that can cause infection. Especially during your nadir. You'll definitely want to wash with soap and water after using the restroom, being out in public, and before eating
JOE: Alright...
TINA: To make sure your hands get really clean, we recommend scrubbing-- a really good, sudsy scrub -- for at least as long as it takes to sing Happy Birthday, twice.
JOE: Well, my grandson will love helping me with that!
TINA: I'll bet he will! And if soap and water aren't available, you can use an alcohol-based hand sanitizer.
JOE: Can do.