Personal Calendar Tracker - Kidney Cancer Canada · Questions For My Doctor 21 ... Visit the...
38
Personal Calendar Tracker
Transcript of Personal Calendar Tracker - Kidney Cancer Canada · Questions For My Doctor 21 ... Visit the...
Personal Calendar Tracker
The Personal Calendar Tracker was
created as a companion to the Patient
and Family Reference Handbook, which
was developed for people living with
kidney cancer and their families.
Please use this resource to keep track
of appointments and contacts, but
most importantly, to regularly monitor
your vital health information. If you
take it with you to your doctors’
appointments, your healthcare team
can use the information you’ve
recorded as a guide for setting future
healthcare goals.
Note: The information provided in this Personal
Calendar Tracker is for general use only and
is not a substitute for professional medical ad-
vice regarding your health or the medication(s)
and treatments you have been prescribed. If you
have questions, please contact your doctor.
Contents
Personal Information 2
Frequently Contacted
Healthcare Professionals 2
Additional
Healthcare Professionals 4
Other Important Contacts 5
Appointments At A Glance 6
Prescription Medications 9
Over-The-Counter Medications 10
Potential Side Effects 11
Side Effect Tracker 12
Tests And Treatments 13
Blood Test Tracker 14
Blood Pressure Tracker 15
Physical Activity Tracker 17
Keeping Track Of Your Diet
During Treatment 19
Questions For My Doctor 21
Year At A Glance &
Monthly Tracker 22
2
This Personal Calendar Tracker belongs to:
If found, please call:
Frequently Contacted Healthcare Professionals
Family Physician
Name
Address
Telephone
Notes
Medical Oncologist
Name
Address
Telephone
Notes
Urologist
Name
Address
Telephone
Notes
3
Frequently Contacted Healthcare Professionals
Oncology Clinic
Name
Address
Telephone
Notes
Imaging
Name
Address
Telephone
Notes
Pharmacist
Name
Address
Telephone
Notes
Nurse
Name
Address
Telephone
Notes
4
Additional Healthcare Professionals
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
5
Other Important Contacts
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
Name
Role
Address
Telephone
Notes
6
Appointments At A Glance
DatesName of Healthcare
ProfessionalLocation
Notes/Follow-up Appointments
7
Appointments At A Glance
DatesName of Healthcare
ProfessionalLocation
Notes/Follow-up Appointments
8
Appointments At A Glance
DatesName of Healthcare
ProfessionalLocation
Notes/Follow-up Appointments
9
Prescription MedicationsUse this chart to keep track of the prescription medications you’re
currently taking (medicines that have been prescribed by your doctor).
On the next page, there is a place to record all over-the-counter medications
that you’re taking.
Medication Name
Reason (kidney cancer, blood pressure, heart, etc.)
Starting Dose
How to Take It
Starting Date
Ending Date
10
Over-The-Counter MedicationsUse this chart to keep track of all over-the-counter medications you’re
currently taking, including herbal remedies, vitamins, laxatives, eye drops
and minerals.
Medication Name
Starting Dose
How to Take ItStarting
DateEnding
Date
Drug interactions can contribute to many potentially serious side effects. That’s why it’s so important to tell your doctor about ALL the medications you’re taking — including herbal remedies, laxatives, vitamins and supplements.
10
11
Potential Side EffectsRegardless of the therapy you are receiving to treat your kidney cancer,
there are a number of potential side effects that you may experience
during your treatment.
The following side effects are sometimes experienced by patients
receiving certain types of treatment for kidney cancer:
� Increased blood pressure
� Tiredness (fatigue)
� Low white blood cell count (neutropenia)
� Low platelets (thrombocytopenia)
� Low red blood cell count (anemia)
� Upset stomach, nausea or vomiting
� Loss of appetite or taste disturbances
� Mouth irritation
� Constipation or diarrhea
� Skin or hair discolouration
� Hand-foot syndrome (rash or blisters on the
palms of the hands and soles of the feet)
� Headache
12
Side Effect TrackerUse the chart below to keep track of any side effects you experience so
you can discuss them with your healthcare team.
Side Effect (SE)Severity (1 to 10)
Date NotesDoctor’s
Instructions
If you develop a side effect, it is essential that you discuss it right away with your healthcare team so that it can be managed quickly and appropriately and so that it is reported to Health Canada and/or the drug manufacturer. STOP taking your kidney cancer medication and call your doctor or pharmacist if you experience:- symptoms of a possible heart rhythm disturbance, such as dizziness, palpitations (sensation
of rapid, pounding or irregular heartbeat), fainting or seizures.- symptoms of brain swelling that can be associated with high blood pressure, headache, loss
of speech or vision and/or seizures.- swelling or difficulty breathing suggestive of an allergic reaction (hypersensitivity/
infusion) reaction.- severe bleeding in the digestive tract (stomach and intestine) or lung.- yellowing of the skin or eyes.
12
13
Tests And TreatmentsUse the chart below to keep track of any tests or treatments your healthcare
team asks you to undergo (e.g., cardiac or thyroid tests, CT or MRI scans,
radiation therapy, etc.). To record blood test results, use the convenient
Blood Test Tracker that is provided on the following page.
DateTest or Treatment
ReceivedDoctor’s Name and
InstructionsResults/Follow-up
14
Blood Test TrackerWhile you are receiving treatment for cancer, your healthcare team will
perform regular blood tests to monitor your progress. Common blood
tests can determine if you have: a low number of white blood cells
(neutropenia), low red blood cells (anemia), low platelets (thrombocytopenia)
or other important conditions. Use the chart below to record the results of
these tests.
DateBlood Test Performed
Test ResultDoctor’s Name
and Instructions
15
Blood Pressure TrackerYour healthcare team may ask you to take your blood pressure on a regular
(or daily) basis and record the results. Use the chart below to keep track of
your blood pressure readings and compare them to the target that your
doctor has set for you.
My doctor has determined that for me, a normal blood pressure range is:
Systolic (top number) of _________ to __________.
Diastolic (bottom number) of _________ to __________.
DateTime of
DaySystolic Reading
(mmHg)Diastolic Reading
(mmHg)Notes
16
DateTime of
DaySystolic Reading
(mmHg)Diastolic Reading
(mmHg)Notes
17
Physical Activity TrackerUse these pages to keep track of your goals and the physical activities
you perform each day. Before starting on any exercise program, you MUST
check with your healthcare team to establish a level of activity that is safe
and beneficial for you. Have your planned activity program approved
by your healthcare team and reviewed periodically.
Following a thorough assessment of my health and fitness, my health-
care team has determined that these activity goals are appropriate for me:
Short-term goals Long-term goals
18
Record of Daily Physical Activity:
Date Activity Notes
19
Keeping Track Of Your Diet During Treatment
Eating a healthy diet while managing the side effects of treatment can sometimes be a challenge. Use these pages to record the types of foods you have found work well for your particular circumstances. During cancer treatment, it is a good idea to seek the advice of a qualified dietician — one who has experience with cancer management — to help you set goals and guide your nutritional choices.
What are your dietary goals?
(e.g., gain weight, manage nausea, increase fluids, limit protein,
heal mouth sores, etc.)
20
Type of Food Effects Notes
21
Questions For My DoctorMake note of any non-urgent questions as you think of them, so that you’ll
remember to discuss them with your doctor at your next appointment.
Year At A Glance & Monthly Tracker
Year
At A
Gla
nce
& M
onth
ly T
rack
er
Use the pages that follow to keep track of your appointments and to record when you have taken your medications each day. Fill in the month and the dates in the spaces provided. Using the legend, enter any appointments or other consultations your healthcare team has scheduled for you.
Januarysun mon tue wed thu fri sat
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 31
Februarysun mon tue wed thu fri sat
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28
Marchsun mon tue wed thu fri sat
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31
Aprilsun mon tue wed thu fri sat
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30
Octobersun mon tue wed thu fri sat
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 30 31
Septembersun mon tue wed thu fri sat
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30
Novembersun mon tue wed thu fri sat
1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
Decembersun mon tue wed thu fri sat
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31
Junesun mon tue wed thu fri sat
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30
Maysun mon tue wed thu fri sat
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 31
Julysun mon tue wed thu fri sat
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30 31
Augustsun mon tue wed thu fri sat
1 2 3
4 5 6 7 8 9 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
2013 Year At A Glance
Visit the Resources section at www.kidneycancercanada.ca to download printable calendars for other years.
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
January 2013
31
7
14
21
28
4
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
4
11
18
25
1
8
5
12
19
26
2
9
6
13
20
27
3
10
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
February 2013
28
4
11
18
25
4
29
5
12
19
26
5
30
6
13
20
27
6
31
7
14
21
28
7
1
8
15
22
1
8
2
9
16
23
2
9
3
10
17
24
3
10
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
March 2013
25
4
11
18
25
1
26
5
12
19
26
2
27
6
13
20
27
3
28
7
14
21
28
4
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
April 2013
1
8
15
22
29
6
2
9
16
23
30
7
3
10
17
24
1
8
4
11
18
25
2
9
5
12
19
26
3
10
6
13
20
27
4
11
7
14
21
28
5
12
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
May 2013
29
6
13
20
27
3
30
7
14
21
28
4
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
4
11
18
25
1
8
5
12
19
26
2
9
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
June 2013
27
3
10
17
24
1
28
4
11
18
25
2
29
5
12
19
26
3
30
6
13
20
27
4
31
7
14
21
28
5
1
8
15
22
29
6
2
9
16
23
30
7
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
July 2013
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
4
11
18
25
1
8
5
12
19
26
2
9
6
13
20
27
3
10
7
14
21
28
4
11
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
August 2013
29
5
12
19
26
2
30
6
13
20
27
3
31
7
14
21
28
4
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
4
11
18
25
1
8
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
September 2013
26
2
9
16
23
30
27
3
10
17
24
1
28
4
11
18
25
2
29
5
12
19
26
3
30
6
13
20
27
4
31
7
14
21
28
5
1
8
15
22
29
6
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
October 2013
31
7
14
21
28
4
1
8
15
22
29
5
2
9
16
23
30
6
3
10
17
24
31
7
4
11
18
25
1
8
5
12
19
26
2
9
6
13
20
27
3
10
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
November 2013
28
4
11
18
25
2
29
5
12
19
26
3
30
6
13
20
27
4
31
7
14
21
28
5
1
8
15
22
29
6
2
9
16
23
30
7
3
10
17
24
1
8
Month: Mon Tues Wed Thur Fri Sat Sun
Legend
C Chemotherapy
R Radiotherapy
T Tests
E Exams/Scans
U Urologist
O Oncologist
D Dietician
SW Social Worker
PSYCH Psychologist
December 2013
25
2
9
16
23
30
26
3
10
17
24
31
27
4
11
18
25
1
28
5
12
19
26
2
29
6
13
20
27
3
30
7
14
21
28
4
1
8
15
22
29
5
This Personal Calendar Tracker was prepared in collaboration with Kidney Cancer Canada, a patient-led support organization with the purpose of improving the quality of life of patients and families who are living with kidney cancer.
KidneyCancerCanada
Toll Free: 1-866-598-7166
This Personal Calendar Tracker was supported by Pfizer Canada.
© 2013 Pfizer Canada Inc. Kirkland, Quebec H9J 2M5 CA0113SUT001E
