a patient’s guide

East

an

d N

ort

h H

ertf

ord

shir

eN

HS

Tru

st

Usi

ng

mo

xa

to r

edu

ce t

he

sid

e ef

fect

s o

f ch

emo

ther

apy

Patie

nt In

form

atio

n Se

ries

PI81

2Co

nta

cts

If a

t an

y ti

me

du

rin

g y

ou

r co

urs

e o

f ch

emo

ther

apy

you

bec

om

e u

nw

ell y

ou

mu

st c

on

tact

on

e o

f th

e n

um

ber

s b

elo

w:

Che

mot

hera

py S

uite

.....

......

......

......

......

.....

020

3826

223

6[M

on -

Fri,

8am

- 5

pm]

War

d 10

(mai

nly

for

men

) ...

......

......

......

.... 0

20 3

826

2022

[24

hour

s]

War

d 11

(mai

nly

for

wom

en)

......

......

......

.. 02

0 38

26 2

040

[24

hour

s]

For

urg

ent

med

ical

ad

vice

24 h

ou

r A

cute

On

colo

gy

Serv

ice

Mo

un

t V

ern

on

Can

cer

Cen

tre:

078

25 0

2885

5

3

Usi

ng

mo

xa t

o r

edu

ce t

he

sid

e ef

fect

s o

f ch

emo

ther

apy

Co

nte

nts

Con

tact

s 2

Intr

oduc

tion

5W

hat

is m

oxa?

5

How

can

hav

ing

mox

a he

lp m

e w

hile

I am

hav

ing

chem

othe

rapy

? 5

How

do

I use

mox

a?

7G

ettin

g re

ady

to u

se m

oxa

8H

ow d

o I c

arry

out

the

dai

ly p

roce

dure

? 9

Why

is it

impo

rtan

t to

do

this

dai

ly?

10W

hat

time

of d

ay s

houl

d I a

pply

mox

a?

10W

hat

if I m

iss

a da

y?

10Sa

fety

tip

s fo

r us

ing

mox

a 11

Aft

erca

re a

dvic

e 12

Kee

ping

you

r D

aily

Mox

a D

iary

13

Oth

er h

elp

and

supp

ort

14If

you

norm

ally

pay

for

NH

S pr

escr

iptio

ns

14C

onse

nt

15Id

entifi

cat

ion

15

4

Zus

anli

ST-3

6

shin

bon

e

botto

m o

f kne

ecap

little

toe

Illus

trat

ion

adap

ted

from

‘A M

anua

l of

Acu

punc

ture

’ by

Pete

r D

eadm

an a

nd M

azin

Al-K

hafa

ji,

with

Kev

in B

aker

(ww

w.a

man

ualo

facu

punc

ture

.com

). U

sed

with

per

mis

sion

.

5

Intr

od

uct

ion

Mox

a is

an

easy

and

ple

asan

t tr

eatm

ent

that

has

bee

n us

ed

for

cent

urie

s to

impr

ove

heal

th. M

oder

n re

sear

ch s

tudi

es a

nd

clin

ical

pra

ctic

e su

gges

t it

can

be h

elpf

ul f

or p

eopl

e ha

ving

ch

emot

hera

py f

or c

ance

r.

This

leafl

et

is w

ritte

n fo

r pa

tient

s w

ho a

re t

akin

g pa

rt in

the

m

oxa

rese

arch

stu

dy. I

t w

ill h

elp

to r

emin

d yo

u ho

w t

o us

e m

oxa

ther

apy.

Wh

at is

mo

xa?

Mox

a (t

he s

hort

wor

d fo

r m

oxib

ustio

n) is

a t

echn

ique

use

d in

tr

aditi

onal

Chi

nese

med

icin

e. It

use

s he

at t

o st

imul

ate

poin

ts

on t

he b

ody

calle

d ac

upun

ctur

e po

ints

.

The

mox

a st

ick

is m

ade

from

a p

lant

cal

led

‘mug

wor

t’ a

nd is

sh

aped

like

a c

igar

.

Ho

w c

an h

avin

g m

oxa

hel

p m

e w

hile

I am

hav

ing

ch

emo

ther

apy?

Che

mot

hera

py c

an a

ffec

t th

e bl

ood

cells

whi

ch a

re m

ade

in y

our

bone

mar

row

cau

sing

you

r bl

ood

cell

coun

t to

dr

op d

urin

g yo

ur t

reat

men

t. T

his

is c

alle

d bo

ne m

arro

w

supp

ress

ion.

Bloo

d ce

ll co

unts

may

dro

p to

o lo

w if

the

y do

not

hav

e en

ough

tim

e to

mul

tiply

pro

perly

and

for

thi

s re

ason

the

tr

eatm

ent

has

rest

per

iods

. Che

mot

hera

py m

ay h

ave

to b

e de

laye

d if

your

blo

od c

ell c

ount

s ar

e to

o lo

w t

o gi

ve y

our

body

ext

ra t

ime

to r

ecov

er.

6

The

kind

s of

blo

od c

ells

whi

ch m

ay b

e af

fect

ed b

y th

e ch

emot

hera

py a

re:

Wh

ite

blo

od

cel

lsTh

ese

cells

hel

p yo

u to

fi gh

t in

fect

ion.

If y

our

whi

te b

lood

ce

ll co

unt

drop

s af

ter

chem

othe

rapy

, you

are

mor

e lik

ely

to

get

an in

fect

ion

and

your

bod

y m

ay n

ot b

e ab

le t

o de

al w

ith

it no

rmal

ly.

Sign

s of

infe

ctio

n m

ay b

e a

rais

ed t

empe

ratu

re (o

f 38

ºC o

r hi

gher

), sh

akin

g ch

ills,

fee

ling

hot

and

swea

ty o

r a

gene

ral

feel

ing

of b

eing

unw

ell.

If yo

u ha

ve a

ny o

f th

ese

sign

s, c

on

tact

th

e h

osp

ital

im

med

iate

ly a

s a

bloo

d te

st a

nd/o

r an

tibio

tic t

reat

men

t m

ay b

e ne

eded

(see

the

con

tact

det

ails

on

your

Ale

rt c

ard

or

use

the

urge

nt m

edic

al a

dvic

e lin

e nu

mbe

r on

pag

e 2

of t

his

book

let)

. Do

no

t be

tem

pted

to

leav

e th

is u

ntil

the

next

day

.

If po

ssib

le d

urin

g yo

ur c

ours

e of

che

mot

hera

py, t

ry t

o av

oid

peop

le w

ith c

ough

s, c

olds

or

obvi

ous

infe

ctio

ns.

Plat

elet

sPl

atel

ets

help

you

r bl

ood

to c

lot.

If y

our

plat

elet

cou

nt f

alls

, yo

u m

ay n

otic

e th

at y

ou b

ruis

e m

ore

easi

ly t

han

usua

l. Sm

all

red-

purp

le s

pots

may

app

ear

unde

r th

e sk

in, o

r yo

ur n

ose

or

gum

s m

ay b

leed

. Ple

ase

let

your

tea

m k

now

if y

ou e

xper

ienc

e th

ese

sym

ptom

s (s

ee C

onta

cts

on p

age

2 of

thi

s bo

okle

t).

Red

blo

od

cel

lsTh

ese

cells

car

ry o

xyge

n to

all

part

s of

you

r bo

dy. I

f th

ey a

re

affe

cted

by

the

drug

s, y

ou m

ay f

eel t

ired

and

look

pal

e or

you

m

ay b

e sh

ort

of b

reat

h. P

leas

e le

t yo

ur t

eam

kno

w u

sing

the

co

ntac

t nu

mbe

rs o

n pa

ge 2

of

this

boo

klet

. Som

etim

es t

his

may

mea

n yo

u w

ill n

eed

to h

ave

a bl

ood

tran

sfus

ion.

7

Usi

ng m

oxa

ever

yday

may

hel

p yo

u by

:

aidi

ng y

our

body

to

mak

e en

ough

blo

od c

ells

to

red

uce

the

chan

ce o

f th

ose

cond

ition

s

re

duce

oth

er s

ide

effe

cts

such

as

fatig

ue, a

nxie

ty, f

eelin

g lo

w, n

ause

a an

d vo

miti

ng

Ho

w d

o I

use

mo

xa?

Mox

a is

use

d ov

er a

n ac

upun

ctur

e po

int

on e

ach

leg,

ju

st b

elow

the

kne

e, a

s sh

own

on p

age

4. Y

ou w

ill n

eed

to

fi nd

thes

e po

ints

. Mak

e su

re y

ou h

ave

mar

ker

pen

read

y.

To fi

nd t

his

poin

t yo

u w

ill n

eed

to fi

nd y

our

knee

cap

and

shin

bone

. You

r kn

eeca

p is

a b

one

at t

he t

op o

f yo

ur k

nee.

It

is a

bout

tw

o in

ches

in d

iam

eter

. You

r sh

in b

one

is t

he lo

ng

bone

on

the

fron

t of

you

r le

g be

low

you

r kn

ee.

To fi

nd t

he p

oint

on

your

rig

ht le

g, u

se y

our

right

han

d:

Step

1: S

it w

ith y

our

feet

on

the

fl oor

.

Step

2: Y

our

knee

cap

is t

he a

rea

on y

our

knee

tha

t st

icks

ou

t. F

eel d

own

this

to

the

plac

e w

here

it e

nds.

Thi

s is

th

e bo

ttom

of

the

knee

cap

and

belo

w it

the

re is

a s

light

in

dent

atio

n.

Step

3: H

old

your

fou

r fi n

gers

fi rm

ly

toge

ther

and

pla

ce y

our

inde

x fi n

ger

horiz

onta

lly a

cros

s th

e bo

ttom

of

your

kn

eeca

p (F

igur

e 1)

.

Step

4: U

se y

our

mar

ker

pen

to m

ake

a sm

all h

oriz

onta

l mar

k on

you

r le

g lo

ng t

he e

dge

of w

here

you

r lit

tle

fi nge

r no

w s

its.

Figu

re 1

8

Step

5: U

se y

our

inde

x fi n

ger

to r

un d

own

the

shin

bone

to

the

leve

l you

hav

e ju

st

mar

ked.

Rol

l thi

s fi n

ger

to t

he r

ight

and

us

e yo

ur m

arke

r pe

n to

mak

e a

vert

ical

lin

e on

you

r le

g do

wn

the

outs

ide

of

your

fi ng

er (F

igur

e 2)

.

Step

6: T

he p

oint

for

you

r m

oxa

trea

tmen

t is

whe

re t

hese

tw

o lin

es m

eet.

Mar

k th

is

poin

t w

ith y

our

mar

ker

pen

(Fig

ure

3).

Repe

at t

hese

ste

ps t

o fi n

d th

e ac

upun

ctur

e po

int

on y

our

left

leg,

rol

ling

your

left

fi n

ger

to t

he le

ft in

ste

p 5.

Rem

embe

r th

at t

he a

cupu

nctu

re p

oint

on

eac

h le

g is

on

the

sam

e si

de a

s yo

ur

little

toe

, as

show

n on

pag

e 4.

Get

tin

g r

ead

y to

use

mo

xaBe

fore

usi

ng m

oxa

you

will

nee

d to

ha

ve t

he f

ollo

win

g ite

ms

to h

and:

mox

a st

ick

mox

a ex

tingu

ishe

r

m

oxa

light

er

tim

erLi

ght

one

end

of t

he m

oxa

stic

k w

ith t

he li

ghte

r. It

may

tak

e ab

out

a m

inut

e to

bui

ld u

p a

good

hea

t. W

hen

the

stic

k is

co

rrec

tly li

t, y

ou w

ill b

e ab

le t

o ho

ld t

he li

t en

d ab

out

two

to t

hree

cen

timet

res

from

you

r ha

nd. Y

ou w

ill f

eel

a pl

easa

nt r

adia

ting

war

mth

.

Nev

er a

llow

th

ere

to b

e d

irec

t co

nta

ct b

etw

een

yo

ur

skin

an

d t

he

lit e

nd

of

the

mo

xa s

tick

.

Figu

re 3

Figu

re 2

9

Ho

w d

o I

carr

y o

ut

the

dai

ly p

roce

du

re?

Your

mox

a tr

eatm

ent

shou

ld t

ake

less

tha

n 10

min

utes

a

day.

Find

a s

pace

whe

re y

ou c

an b

e co

mfo

rtab

le a

nd w

ill n

ot

be d

istu

rbed

.

Loca

te t

he a

cupu

nctu

re p

oint

on

each

leg.

You

can

mar

k th

ese

with

you

r pe

n. T

he m

arks

may

rem

ain

visi

ble

for

seve

ral d

ays.

Yo

u ca

n us

e th

e pe

n at

inte

rval

s to

kee

p th

e m

arks

vis

ible

.

Ligh

t th

e m

oxa

stic

k. T

est

it, a

nd w

hen

it is

war

m e

noug

h,

set

your

tim

er f

or 3

min

utes

, the

n:

hold

the

mox

a st

ick

over

the

mar

k on

one

leg

– ab

out

two

to t

hree

cen

timet

res

away

fro

m y

our

skin

appl

y fo

r 3

min

utes

(use

you

r tim

er f

or t

his)

if it

feel

s to

o ho

t, m

ove

the

mox

a st

ick

furt

her

from

yo

ur s

kin

it it

feel

s to

o co

ol, m

ove

it cl

oser

to

the

skin

. You

may

w

ish

to c

heck

tha

t th

e m

oxa

stic

k is

giv

ing

off

enou

gh

heat

. If

not,

app

ly t

he li

ghte

r to

it f

or a

bout

a m

inut

eFr

om t

ime

to t

ime,

bru

sh o

ff a

ny a

sh t

hat

form

s on

the

end

of

the

stic

k. D

o th

is b

y ge

ntly

bru

shin

g th

e tip

aga

inst

the

mox

a ex

tingu

ishe

r. Th

is h

elps

the

mox

a st

ick

stay

hot

. The

ash

will

dr

op in

to t

he b

owl s

hape

d cu

p of

the

ext

ingu

ishe

r.

The

sens

atio

n sh

ould

alw

ays

be o

ne o

f a

ple

asan

t,

radi

atin

g w

arm

th.

Aft

er 3

min

utes

, the

ski

n sh

ould

red

den

slig

htly.

Thi

s re

dnes

s w

ill g

o aw

ay s

hort

ly a

fter

the

tre

atm

ent

has

fi nis

hed.

Do

not

incr

ease

the

tim

e to

mor

e th

an 3

min

utes

.

Repe

at t

his

proc

edur

e on

the

oth

er le

g.

10

At

the

end

of t

he s

essi

on, p

lace

the

lit

end

of t

he m

oxa

stic

k in

the

cen

tral

hol

e of

the

ext

ingu

ishe

r. M

ake

sure

th

e m

oxa

is e

xtin

gu

ish

ed.

You

can

re-li

ght

the

mox

a st

ick

for

repe

ated

tre

atm

ents

. O

ver

time,

as

it bu

rns

dow

n, it

will

bec

ome

unco

mfo

rtab

le

to h

old.

Whe

n th

is h

appe

ns, u

se a

new

mox

a st

ick.

Plea

se b

ring

your

bur

nt d

own

stic

ks b

ack

to t

he H

ealth

Im

prov

emen

t Pr

actit

ione

r at

Mou

nt V

erno

n C

ance

r C

entr

e fo

r di

spos

al.

Wh

y is

it im

po

rtan

t to

do

th

is d

aily

?Th

e ef

fect

of

mox

a is

tho

ught

to

peak

at

arou

nd s

ix h

ours

af

ter

trea

tmen

t. It

s ef

fect

sta

rts

to w

ear

off

afte

r 20

hou

rs.

It is

impo

rtan

t to

app

ly it

eac

h da

y to

kee

p th

e ef

fect

as

cont

inuo

us a

s po

ssib

le.

Wh

at t

ime

of

day

sh

ou

ld I

app

ly m

oxa

?Yo

u ca

n ap

ply

mox

a at

any

tim

e of

the

day

. Fin

d a

time

that

su

its y

ou, a

nd t

ry t

o ge

t in

to a

rou

tine.

Thi

s w

ill m

ake

it ea

sier

for

you

to

mak

e su

re y

ou a

pply

it e

very

day

.

Wh

at if

I m

iss

a d

ay?

If yo

u m

iss

a da

y, m

ake

sure

to

carr

y ou

t th

e pr

oced

ure

as

early

the

nex

t da

y as

pos

sibl

e.

11

Safe

ty t

ips

for

usi

ng

mo

xaPl

ease

fol

low

the

se s

afet

y tip

s w

hen

you

use

mox

a:

ther

e sh

ould

nev

er b

e an

y di

rect

con

tact

with

the

ski

n

al

way

s m

ake

sure

to

use

mox

a ov

er b

are

skin

, not

ove

r tig

hts

or c

loth

ing

alw

ays

mak

e su

re s

kin

is c

lean

and

oils

and

moi

stur

iser

s ha

ve n

ot b

een

appl

ied

avoi

d dr

oppi

ng m

oxa

stic

ks, o

r ta

ppin

g th

em w

hen

rem

ovin

g th

e as

h. T

his

can

crea

te s

mal

l hai

rline

cra

cks,

cr

eatin

g a

risk

for

a pi

ece

to f

all o

ff a

nd b

urn

carp

et,

furn

ishi

ngs

or y

ours

elf

neve

r to

uch

the

light

ed e

nd o

f a

mox

a st

ick

even

if it

no

long

er a

ppea

rs t

o be

glo

win

g

us

e th

e ex

tingu

ishe

r to

ext

ingu

ish

the

mox

a. D

o no

t tr

y to

ext

ingu

ish

it us

ing

wat

er

ke

ep t

he m

oxa

and

extin

guis

her

out

of t

he r

each

of

chi

ldre

n an

d an

imal

s

Avo

id u

sing

mox

a at

the

se t

imes

:

befo

re o

r af

ter

a ho

t ba

th

w

ith e

xtre

me

phys

ical

fat

igue

or

emot

iona

l dis

tres

s

if

too

hung

ry o

r to

o fu

ll

af

ter

alco

hol c

onsu

mpt

ion

or d

rug

use

(suc

h as

ve

ry s

tron

g pa

inki

llers

, or

recr

eatio

nal d

rugs

tha

t m

ay in

terf

ere

with

you

r pe

rcep

tion)

12

Aft

erca

re a

dvi

ceIt

is u

nusu

al f

or b

urns

to

occu

r. H

owev

er, i

t is

impo

rtan

t to

kn

ow h

ow t

o de

al w

ith t

hem

.

1. In

rar

e ca

ses,

som

e pe

ople

fi nd

tha

t th

e ar

ea w

here

mox

a w

as a

pplie

d ha

s be

com

e re

d an

d a

little

sor

e af

ter

trea

tmen

t.

This

may

com

e as

a s

urpr

ise,

esp

ecia

lly if

the

y fe

lt no

di

scom

fort

dur

ing

the

trea

tmen

t.

If th

is is

the

cas

e w

ith y

ou a

fter

any

app

licat

ion,

you

may

be

at r

isk

of d

evel

opin

g a

smal

l bur

n. P

leas

e fo

llow

the

se s

impl

e st

eps

to p

reve

nt in

jury

to

your

ski

n:

appl

y co

ld w

et c

ompr

esse

s to

the

are

a. C

ontin

ue t

his

for

10-2

0 m

inut

es. T

his

will

rel

ieve

any

sor

enes

s an

d st

op a

bu

rn d

evel

opin

g

w

hile

you

coo

l the

aff

ecte

d ar

ea, w

rap

up a

nd m

ake

sure

th

at y

ou k

eep

war

m s

o th

at y

ou r

emai

n co

mfo

rtab

le

cove

r th

e bu

rn w

ith c

lean

, non

-fl u

ffy

mat

eria

l to

prot

ect

it fr

om in

fect

ion.

Use

a s

teril

e dr

essi

ng s

uch

as M

elol

in™

, or

cove

r th

e w

ound

with

ord

inar

y ki

tche

n fi l

m2.

If t

he a

rea

is b

urne

d m

ore

deep

ly, b

liste

red

or p

ale

and

blac

kene

d, y

ou w

ill n

eed

to s

eek

som

e m

edic

al h

elp

afte

r fo

llow

ing

thes

e st

eps:

star

t co

olin

g th

e bu

rn b

y ap

plyi

ng c

ompr

esse

s or

ho

ldin

g un

der

runn

ing

wat

er f

or a

t le

ast

10 m

inut

es

co

ver

the

burn

as

deta

iled

abov

e

se

ek m

edic

al a

dvic

e im

med

iate

ly

For

ALL

bu

rns:

do n

ot u

se lo

tions

, oin

tmen

ts, c

ream

s or

ess

entia

l oils

do n

ot u

se a

dhes

ive

dres

sing

s

do

not

bre

ak b

liste

rs

13

IMPO

RTA

NT:

Any

bur

n la

rger

tha

n a

post

age

stam

p re

quire

s m

edic

al a

tten

tion.

All

deep

bur

ns o

f an

y si

ze w

ill n

eed

urge

nt

hosp

ital t

reat

men

t.

Kee

pin

g y

ou

r D

aily

Mo

xa D

iary

Mak

e su

re t

o ke

ep a

n ac

cura

te r

ecor

d in

you

r D

aily

Mox

a D

iary

. Thi

s in

clud

es m

arki

ng a

ny d

ays

that

you

mis

s.

Kee

ping

an

accu

rate

rec

ord

will

hel

p us

ass

ess

the

effe

cts

of u

sing

mox

a.

Plea

se r

emem

ber

to

bri

ng

yo

ur

Dai

ly M

oxa

Dia

ry

and

th

e u

sed

mo

xa s

tick

s to

yo

ur

chem

oth

erap

y ap

po

intm

ents

.

The

Hea

lth Im

prov

emen

t Pr

actit

ione

r w

ill m

eet

you

and

colle

ct t

hem

. She

will

giv

e yo

u th

e ne

xt d

iary

to

com

plet

e,

and

will

giv

e yo

u m

ore

mox

a st

icks

if y

ou n

eed

them

.

Ad

dit

ion

al s

up

po

rtW

e ha

ve a

lso

mad

e a

shor

t vi

deo

dem

onst

ratin

g ho

w

to u

se m

oxa.

This

can

be

view

ed a

t th

e fo

llow

ing

url:

ww

w.y

outu

be.c

om/w

atch

?v=

KK

tTvH

PGzy

Y&

feat

ure=

yout

u.be

A li

nk t

o th

is c

an b

e fo

und

on t

he R

esea

rch

page

s of

the

LJ

MC

web

site

: at

ww

w.lj

mc.

org

OR

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se a

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or a

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r us

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from

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eatm

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If yo

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ve a

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en g

iven

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thes

e fo

rms,

ple

ase

brin

g th

e co

mpl

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for

m w

ith y

ou w

hen

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com

e fo

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ur fi

rst

appo

intm

ent.

If yo

u ha

ve n

ot b

een

give

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form

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s w

ill b

e di

scus

sed

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u at

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r fi r

st a

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ntm

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Iden

tifi

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Plea

se n

ote

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gal r

equi

rem

ent

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staf

f to

che

ck

your

nam

e an

d de

tails

aga

inst

you

r tr

eatm

ent

reco

rds

ever

y tim

e yo

u at

tend

.

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licat

ion

has

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duce

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rmat

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