The best advice I got about chemotherapy came from a cousin who is a breast cancer survivor. She said, “Ask for the EMLA cream.”

EMLA cream is a numbing cream that you can use for painless port access (see https://thrivingwithlungcancer.com/2014/01/11/what-its-like-to-have-a-port-inserted/ for more about ports). The active ingredients are lidocaine and prilocaine. You can dab some on top of your port about an hour before treatment, cover it with a dressing to hold the cream in place, and then when the nurse inserts the needle into your port you will hardly feel the needle, if at all.

You probably won’t hear about EMLA cream from your doctor, who will most likely be thinking about the supercharged chemotherapy drugs and their side effects, not the relatively minor pain of the needle in the port or the mild topical medication that can ease it. You are more likely to hear about EMLA cream from a nurse or another patient. However, when you ask your doctor to prescribe it, he or she should not hesitate. I think EMLA cream for port access is standard of care in pediatric medicine, but adults have to know to ask.

Ask for the prescription several days or a week before your first infusion. You will have to get it filled at the pharmacy.

When you put it on, the goal is not to rub it into the skin, but to let it rest on top of the skin. Don’t use an absorbent dressing like gauze, because an absorbent dressing will soak up the cream and less of it will be in contact with your skin. Some people use a Tegaderm dressing – a clear plastic dressing with Band-Aid-like sticky surfaces around the edges – to hold it in place. Some people cover it with plastic wrap, taped down with first-aid tape.

The chemotherapy nurses at Rutgers Cancer Institute of New Jersey Hamilton suggested a neat trick: placing a plastic cap from a medicine bottle, concave side down, over the cream, then taping the bottlecap down with first-aid tape. It sounds so weird: a bottlecap? As a medical device? It’s very clever and functional, though. If you stand still, the bottlecap actually sticks to the cream for a moment or so, and you have both hands free to unroll the tape and tape it down. The tape comes off the skin painlessly, unlike a Tegaderm dressing. Most of the nurses at Sloan-Kettering have been impressed with this RCINJ trick.

Things work differently for different people, but the EMLA cream works really well for me. When I use it, the needle going into the port is completely painless for me.

These days I’m often fine without the EMLA cream; the needle going into the port is really only a brief and minor pain, compared to everything else I’ve been through. However, when you are going through all the discomfort, fatigue, and emotional turmoil of chemotherapy, why not spare yourself the extra pain of a needle stick if you can?