With Cisplatin it is a cumulative effect like radiation so the side effects are going to become more intense the farther into treatment you go.
Here is a great article from Consumer Reports pertaining to anti nausea meds for the cancer patient, a very good read.
http://www.consumerreports.org/heal...drugs/Drugs_to_Treat_Nausea_Vomiting.pdfIt does list Cisplatin, as having a high rate of nausea and vomiting risk, something that is amplified with radiation. The nausea will get worse as you are ramping up on the pain medications as the opiates also cause nausea and vomiting as well.
"An excerpt:the evidence that is available indicates that granisetron, ondansetron, and palonosetron help alleviate those conditions in 47 percent to 62 percent of the peo- ple. Only granisetron and ondansetron are avail- able as pills, and the evidence does not indicate that one drug in pill form is clearly superior to another in this class. So again, we would recom- mend generic ondansetron tablets based on cost.
Radiation-induced nausea and vomiting
Both granisetron and ondansetron have been shown to be similarly effective in preventing nau- sea and vomiting following radiation therapy for cancer. Generic ondansetron tablets would save you $50 or more over granisetron, so we recom- mend it as our Best Buy choice if you�re undergo- ing radiation therapy and your doctor has decided that an antiemetic is appropriate for your situation."
One thing that the article states is that Ginger has been used favorably to ease nausea in studies as well. I will testify to the effectiveness of this however I wouldn't recommend this for anyone in treatment as Ginger is also a natural blood thinner and can have interactions with other medications, as will other herbs and natural remedies so talk to your Oncologist before exploring natural alternatives.
What we've noticed on the boards is that those patients who've focused on hydration and nutrition have an easier (relatively speaking) time through treatment and seem to "hold up" better. Hydrating is going to ease the nausea and help reduce the strain to your kidneys that all of these drugs are causing.
To emphasize the importance of nutrition, over 20% o all cancer patients die of malnutrition, not the cancer or treatment of. My guess is that that figure is most certainly higher in Oral Cancer patients due to the nature of our disease and the difficulty of delivering said nutrition. Due to the bodies natural response to both the cancer and the stress associated with the cancer experience your body is already not absorbing nutrients the way it should and is being put into a hyper metabolic state trying to heal itself from the effects of treatment. This creates a dangerous situation and usually leads to cachexia, or cancer related wasting syndrome where the body begins to catabolize it's lean muscle mass into energy and amino acids to throw at the immune response.
The hormones that trigger the immune response in the body also have the unfortunate side effect of reducing digestion and absorption, in addition the bodies cortisol levels become elevated (the hormone the body produces as a reaction to stress) furthering digestion/absorption issues as it counteracts insulin which is important in the metabolism of carbohydrates and fats for energy. To add to the problem, most of the medications that are prescribed to the cancer patient also constrain testosterone levels (opiates, anti-depressants etc) which is important in maintaining lean muscle mass and protein synthesis in the body.
So, the question is what steps can we take to give ourselves the best chance at surviving treatment and the effects of cancer? The few things we can control and the most important really after choosing our medical professionals is our attitude and our nutrition.
There are few ways outside of the harsh drugs used to treat Cushings Syndrome to control Cortisol in the body, however the ways to do it are easy stress management techniques. Stretching (I love Yoga or Tai Chi), walks, music, deep breathing, prayer, meditation, reading, movies etc. Your bodies cortisol is highest in the morning, lowering it then helps control it throughout the day so do something before you start the day to relax and lower your cortisol.
Limit your caffeine intake as well as it boosts cortisol, and can hinder sleep patterns, an issue you'll have also due to opiates (insomnia is a common side effect of opiate pain meds)...getting around 9hours of solid sleep reduces cortisol. Nutritionally Omega 3 fatty acids have been shown to reduce cortisol, which leads me to nutrition...a favorite subject of mine.
Now most of the Dr's and people on these forums will recommend liquid meal replacements like Ensure Plus or Boost (Carnation VHC is now Boost VHC) and they'll recommend 2500-5000 calories of whatever you can get down to help maintain weight, and in many cases this is actually part of the problem due to what these meal replacements are made of.
All of these meal replacements use corn syrup, and oil (canola, corn & soy) to deliver their calories, soy protein for protein, and then chalk them full of isolate vitamins and minerals, which are more difficult for the body to absorb. The issues with this are many so I'll explain in detail with the hopes of it making sense. Due to elevated cortisol levels and their effect on insulin, it's important to control blood sugar levels, which means limiting simple sugars and starches. Soy protein is one of the slowest proteins for uptake making it a poor choice for top level athletes and cancer patients alike due to their systems need for quick absorbing proteins. Lastly the oils used to increase calories in a mixture of Canola, Corn and Soy.
Now I'm a fan of getting your calories from fat (higher percentage of fat in the diet ups testosterone in the body that helps maintain and build muscle) but understand this is also a contributing factor for nausea as high fat diets actually cause nausea. Oils are a great way to add calories too and Canola is considered the healthiest due to it's the highest in unsaturated fat, however it's lower in monounsaturated fat then Olive Oil. My big issue here is that these are all Omega 6 fatty acids without the balance of Omega 3's which still leads to insulin resistance and metabolic syndrome, which your body is already experiencing due to the cancer experience as described above. It's estimated that western culture's diet now has a disproportionate ratio of Omega6/Omega3 by 20-30/1 where our ancestors were about 1/1, to 2/1.
Ketogenic Diets, or high protein diets have had success treating insulin resistance and "trick" the body into using fat as energy (both stored fat and fatty acids) by breaking them down to keytones. High protein diets though are usually are very high in saturated fats (bad) and puts an added strain on the kidneys, which when going through cancer treatments are already strained due to chemo, opiates and other drugs.
Where I haven't seen a study on this, I believe from my research that using a Ketogenic Diet focusing on high fat (poly and mono unsaturated fats with a balance of Omega6/Omega3 fatty acids of no more then 6/1, preferably lower), fast uptake protein (whey is the fastest) ,plenty of fresh fruits and vegetables(studies show organic fruits and veggies contain higher concentrations of vitamins and minerals, unlike isolates these are easily absorbed by the body), and coupled with relaxation techniques that help lower cortisol would significantly improve survival rates and how patients stand up to the brutal treatments we have to endure.
My thoughts are to use a liquid/blenderized diet high in good fats as described above, fast uptake whey protein and juiced/blended fruits and vegetables divided into 6 "meals" per day to stabilize blood sugars and counteract the metabolic syndrome patients experience to increase survival rates simply by making sure they have the proper nutrients their body needs to maintain lean muscle mass.
Wow that's almost a book...I told you nutrition was my favorite subject.
Anyway if you need thoughts, recipe ideas etc I'd be glad to share. Keep hitting the anti nausea meds and keep the nutrition rolling, in whatever form you can keep down.
Eric
