My husband is having trouble with vomiting 2 weeks into his chem/rad treatment. How long should he wait after vomiting to try to get something else down, and any suggesstions on things that might stay down? He has no trouble swallowing yet, thankfully.
What sort of anti-emetic medication is he taking? It sounds as if he needs to revisit this with his oncology nurses. Most people have to use one of the newer serotonin drugs (Kytril, Anzemet, Zofran) plus often another medication as well, usually Compazine. Some folks who have had real problems keeping things down have had to resort to a Compazine suppository. Intractable nausea may need a concerted effort on the part of your husband's team to control -- loss of fluids and nutrition will make his treatment harder to get through. At Hopkins (where my husband was treated they are using acupuncture as an adjunctive therapy for intractable nausea due to chemotherapy.
Gail
He takes compazine, I'll ask about acupuncture, thank you
My husband has a lot of trouble with nausea as well. He has tried various meds, and more than one at a time. For instance, he was taking Zolfran, Compazine and Ativan on a rotating basis, as the doc explained that they all help with nausea, but they work in different ways from each other, so it is not as you are overlapping. But one of the things we didn't realize at first was that he should take the meds on schedule, i.e. every 4 hours or whatever the recommended allowance is, versus waiting until a nausea spell came on. This may seem a simple thing that we should have known but we didn't. He still has nausea problems but they seem to subside a little on the third week after the chemo, which he gets once every 3 weeks. Right now he taking Reglan and Ativan only but may start back taking the Zolfran next week after he gets chemo on Tuesday.
Wish you luck.
Michele
Deborah --
Bluntly speaking, your husband is not getting adequate anti-emesis medication if all he is being given is Compazine. Compazine just will not cut it for most of the chemotherapy drugs (nor for amifostine, if he's getting that). It is an older medication, it did nothing for my husband except as a mild "back-up" to the "real stuff", in his case Zofran or Anzemet. Sometimes it's given because it is cheap and the serotonin drugs are definitely not! However, they are worth every penny in relieved suffering and distress. I will quote our chem nurse, "With the new serotonin-uptake anti-nausea drugs, there is no excuse for a patient to suffer long bouts of nausea as a result of chemotherapy. For the patients who do not respond to these drugs, and there are a few, we have to take additional measures, among which might be acupuncture or a drug combination."
The protocol at most CCCs for chemotherapy is first an infusion of Anzemet (or similar drug) given IV in the hydration line. Then after about 1/2 hour, the chemo infusion is started. Anzemet lasts for 24 hours. Almost exactly, in fact -- Barry would get his chemo about 2:30 pm and by 3 pm the next day he would start feel a queasiness, this could be relieved in most cases by Compazine but towards the end, not that and he would take a Zofran. (Zofran lasts for about 8 hours) This was all exacerbated by his having amifostine 4x a week.
You should ask what anti-nausea drugs your husband is being given -- check to see if he's getting one of the high-powered drugs with his chemo treatments, this is given IV so may not be obvious. However usually the nurses are careful to explain what they are doing and what each infusion or injection (hydration, anti-emetic, chemo) is for.
It is imperative that the drugs be given (and taken) *before* the treatment which may induce nausea. Once it has started, it is much harder to stop (as anyone whose had sea-sickness can attest to). Also, the stomach should not be empty going into chemo, things like crackers or ginger ale can help. This is hard if the mouth is sore from radiation but does help reduce nausea. Ask the chemo nurse for advice.
The cancer patient has a right to proper pain and anti-nausea management, and to information about what is being done and why. It is a very difficult treatment and does not have to be made worse by inadequate oversight of medication. The caregiver and patient both must be proactive on their own behalf, something most of us learn through painful experience!
Gail
Thank you both so very much for the helpful information, we didnt know he should be taking the compazine every 4 hrs, like you said, once it grabs hold of you it's hard to get ahead of it. All he's had is water and he throws that up. We go back to the doctor tomorrow and we'll be armed with information and questions. Be well.
My husband also started on the compazine, it didnt do anything but make him horribly constipated. The nausea was horrible with the compazine, we just went and talked to our nurse and she gave us samples of kytril and Zofran. Zofran is what our insurance approved and it works wonderfully. Compazine is for pregnant women, and really sick kids, not people getting chemo!!!
Erik is right on -- forget the Compazine, it isn't working well enough to handle your husband's nausea. If his doctors and nurses do not have him on one of the effective anti-emetics, he is being ill-served and you need to go to bat for him in this. Insist that he be prescribed effective medications. Now, if he does take these (Kytril, Zofran or Anzemet) and they don't seem to work when taken as directed, then go back and ask for more help. Sometimes despite everything nausea is hard to control but right now he needs a cannon and sounds like he's been given a BB gun.
Gail
Just an update they gave him zofran and he's much better, it's so helpful to have the forum and people like you willing to help, thanks again.
Well I hate to jar all of you but the manufacturer of Zofran states in their literature that it is only effective 60% of the time and I would imagine that the number would be similar for Anzemet as well. Zofran also has a maximum effectiveness of about a week or less anyway so different antiemetics must be tried and rotated.
Compazine was a life saver for me because I couldn't keep anything else down and it came in suppository form.
I vomited so much and often at one point in treatment I polished my teeth like glass from the stomach acid. It is very tough watching loved ones go through this and feeling helpless. Like others have said, keep the docs and nutritionist informed. The fluids and nutrients lost will have to be replaced as well.
There are many other reasons for nausea as well. Constipation can cause it from opioids. Opioids themselves can cause nausea, especially when you are first adjusting to them). Too rapid a feeding with PEG tubes. Chemo does a number on the stomach mining and anti-acids are a must, like Pepcid AC (AKA Famatodine). The smell of food cooking or perfume can trigger it as well.
I am a little shocked that they would give him compazine as a primary anti-emetic. As Gail and others mentioned, they typically infuse the anti-emetic, after hydration, prior to the chemo.
It should get better the further he gets from the chemo (unfortunately that's usually just before the next one).
Hurray that the Zofran is helping! It is an expensive little pill, around 35 bucks each I think - probably why they tried compazine at first.
My husband used Zofran the entire 7 weeks of radiation and chemo (plus amifostine) and it worked as well at the end as at the beginning. When it didn't seem to do the job was two days after chemo treatment (which was weekly, Wednesday afternoon) -- when the Anzemet he was given that afternoon had worn off and he had to deal with the amifostine Friday morning. Then the Zofran (taken 90 minutes before the ethyol/amifostine) was not enough, he would get very queasy and nauseated. Adding Compazine did zip and Anzemet wasn't much better so he eventually dropped amifostine on Fridays. It didn't seem to reduce effectiveness much.
It appears that people can respond differently to these medications, some report being helped a lot by compazine, some not at all and so on.
Garry is quite right about the other factors triggering nausea. Barry had to stop taking oxycodone as it gave him gastric reflux and some nausea --- he went to the Duragesic patch (25 mg) and that caused him no serious issues.
Zofran is expensive, but Barry said it was worth every penny. Luckily he had some state prescription coverage but we just did our tax forms and were appalled at how much he spent last year on medications. But that's a different topic...
Gail