Safety and warning signs
Twicewell is a personal record. It is not a medical device, it does not diagnose anything, and nobody watches your check-ins as they come in. If something worries you, contact your care team. In an emergency, call 911.
Call 911 now if the person
- has a seizure (uncontrolled shaking or stiffening of the body);
- is suddenly confused or disoriented, has trouble speaking or slurred speech, or is very hard to wake up;
- has sudden numbness or weakness in the face, arm or leg, especially on one side; sudden trouble seeing; sudden trouble walking or loss of balance; or a sudden severe headache with no known cause;
- has chest pain or discomfort.
Sources: Memorial Sloan Kettering, CDC stroke signs, CDC heart attack symptoms (links below). Do not drive the person yourself: Memorial Sloan Kettering asks that they travel with emergency medical services.
Call your care team or treatment center right away if there is
- a fever of 100.4 °F (38 °C) or higher. After CAR-T cell therapy, fever can be a sign of cytokine release syndrome, and treatment programs ask you to call them immediately;
- new or worse confusion or memory problems, or changes in behavior;
- trouble writing simple words or sentences, or trouble concentrating or understanding others;
- shaking or tremors, headaches, or being sleepier than usual;
- a fall, or vision changes;
- anything new that worries you. You do not have to be sure: ask.
If you cannot reach them, or things get worse, call 911. Write down what you noticed and when it started, and do not leave the person alone if their symptoms are getting worse.
After CAR-T cell therapy, people are usually given their treatment center's own instructions and phone number. Follow those first: they are written for you.
How Twicewell responds
Each check-in asks early on whether any of these signs happened since the last one. The moment you tick one, or answer "No" to "Do you feel OK?", the guidance (call 911, or call your care team) appears on that same screen, with a button that saves what you have answered so far. You do not have to finish the check-in first. After you save, the done page and your Today page keep the guidance visible for a day. (In a browser with JavaScript turned off, the questions are all on one page; a short line under the warning signs gives the same guidance.) Twicewell does not call anyone or alert anyone for you: please make the call yourself.
The thinking questions are not a clinical test and give no score. They are not a substitute for the checks your care team does.
Sources (checked October 30, 2026)
- Memorial Sloan Kettering Cancer Center: ICANS, Know the Signs, Act Quickly
- National Cancer Institute: CAR T Cells, Engineering Patients' Immune Cells to Treat Their Cancers
- Cleveland Clinic: Immune Effector Cell-Associated Neurotoxicity Syndrome
- London Health Sciences Centre (a CAR-T treatment program): Important Contact Information for CAR-T Cell Therapy Patients (fever of 38 °C or higher: call the CAR-T team immediately)
- CDC: Signs and Symptoms of Stroke
- CDC: About Heart Attack Symptoms, Risk, and Recovery
Movement self-checks
Only do this if your doctor or physical therapist has said it is OK for you. Use a sturdy chair against a wall, have someone nearby, and stop at once if you feel pain, dizziness or short of breath. Twicewell does not suggest exercises: the movement page is for the ones your own physical therapist gave you.