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#57934 - 03/09/06 01:38 AM Nausea and Vomiting
Vin Offline
Senior Member (100+ posts)

Registered: 10/12/05
Posts: 124
Loc: California
I know these are old issues but I would appreciate any help or your experiences.

I am the the caregiver to my spouse who was diagnosed in January 2005 with SCC left later tongue (T2N1M0). She is just about one year out from surgery (MRND) and about 8 months out from the end of chemoradiation (35 doses external beam rad+ 4 doses cisplatin).

She has stomach tube since unable to swallow due to a stricture. She lives on Jevity given through the tube.

To this day nausea/vomiting remains a big problem. She vomits at least once a day. Is this normal at this stage?

I give her a liquid anti-nausea medication throgh the tube. It is called Promethazine (10cc) but it seems to have no effect.

We have discussed this nausea/vomiting problem with both her ENT and radiation oncologist but have not gotten any sound advice or other medication to try to control this problem.

I would appreciate your experiences and input.

She is also still on painkillers: a 100 microgram Fentynal patch and liquid morphine.

Thank you for your help. We appreciate it.
_________________________
CG to wife; SCC Tongue T2N1MO Jan 2005; Surgery Mar 05; 35 XRT and 4 cisplatin doses completed Jul 2005. Dec 2006 additional tongue surgery. Feb 2010 neck biopsy. Eight esophagus dilations.

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#57935 - 03/09/06 03:22 AM Re: Nausea and Vomiting
Joanna Offline
Patient Advocate (1000+ posts)

Registered: 03/23/02
Posts: 1140
Loc: Pacific Northwest
Vin, when I had a PEG I occasionally felt strong nausea and was usually able to beat it back by putting oil of peppermint under my nose, either on the skin, or on a cloth which I then held to my nose. This old folk remedy had the effect of quieting my stomach more often than not. Perhaps this will help your wife. If it works, it is better than adding yet another drug to the mix.

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#57936 - 03/09/06 03:30 PM Re: Nausea and Vomiting
michele Offline
Gold Member (100+ posts)

Registered: 02/05/06
Posts: 115
Loc: Maryland
Hi Vin. I am going through the same thing with my husband, who is just halfway through chemo and radiation treatment. He has not been able to beat the nausea and vomiting, so we are in the process of trial and error to determine what the culprit may be. He also has been using Jevity and as of yesterday, we stopped that and started using Ensure, to see if the Jevity was the problem. He has gone about 18 hours now without vomiting, so I am keeping my fingers crossed. The problem is, I still won't be sure what the source is, because he also started a different anti-nausea med two days ago (Dexamethasone), and on top of that, I stopped the Zolfran med last night, as I started to suspect it as well. I guess if the vomiting stops, maybe he can try the Jevity again, to see if the nausea resumes, and so on. It is a vicious circle. Currently, my husband takes Ativan, Reglan, and Dexamethasone. As I stated, I stopped the Zofran last night, and am thinking it may have been the culprit....we'll see. I wish you luck. The constant nausea/vomiting sure gets in the way of trying to tolerate everything else. I actually ordered a product over the internet last night which was mentioned by one of the nurses in the oncology center, but that I couldn't find anywhere locally. Called "Queasy Pops." I am not really expecting that they will help, but you never know. We are searching for anything at this point. We did try the peppermint oil as Joanna had suggested to me in an earlier post. It helped me (ha ha) but not my husband. I hope you can find a solution.
Michele
_________________________
Michele, caregiver to husband, Jesse, SCC diagnosed 1/5/06 unknown primary, lf neck mass >6 cm. Chemo (Cisplatin 2x; Carboplatin & Taxol 2x) & XRT radiation 39X ending 4/4/06. Rad neck dissection 8.5 hrs 4/13/06. 30 HBO treatments Fall 2006.

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#57937 - 03/09/06 06:42 PM Re: Nausea and Vomiting
AngAk Offline
Supporting Member (50+ posts)

Registered: 03/08/06
Posts: 58
Loc: Alaska
My husband has a J-tube with pump because of a previous stomach surgery. We have to very carefully increase the rate of feeding to prevent nausea/bloating. He is at 180ml/hour now and it takes about 8 hours to finish his feeding, which we do at night. I know this may not be your method at all, but maybe if you cut down the rate/amount of liquid per feeding and do it one more time a day it might help, putting it in slower and a lesser amount. We were told to also remain upright and not lay down for at least an hour. Another old trick for nausea is to whif on alcohol swabs or just open the bottle and whif.
_________________________
Caregiver to husband David, non smoker. Dx 1/06 SCC Base of Tongue Stage IV, neck nodes involved. Surgery/Chemo/Rad. Treatment finished 5/06. Waiting. Recurrence in lung, Aug07. 6 months Cisplatin/Erbitux. Spots shrinking after 3 Cisplatin tx.

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#57938 - 03/09/06 08:52 PM Re: Nausea and Vomiting
michele Offline
Gold Member (100+ posts)

Registered: 02/05/06
Posts: 115
Loc: Maryland
Does anyone have any knowledge about the rate of feeding into a G-tube? My husband prefers to have his feeding done slowly, through an automatic pump versus bolus feeding. Consequently, he gets fed anywhere from 70ml/hour up to 120 ml/hour about 18 hours of the day. Most of this time he is laying down. Does anyone have an opinion as to if this (slow feeding and laying down) would contribute to nausea? We figured with the slower rate it wouldn't matter if he were laying down.
Michele
_________________________
Michele, caregiver to husband, Jesse, SCC diagnosed 1/5/06 unknown primary, lf neck mass >6 cm. Chemo (Cisplatin 2x; Carboplatin & Taxol 2x) & XRT radiation 39X ending 4/4/06. Rad neck dissection 8.5 hrs 4/13/06. 30 HBO treatments Fall 2006.

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#57939 - 03/09/06 11:44 PM Re: Nausea and Vomiting
Vin Offline
Senior Member (100+ posts)

Registered: 10/12/05
Posts: 124
Loc: California
Joanna,

Thank for your reply and suggestion about the peppermint oil. I will suggest it to her and we may want to try it. Can I ask a question. How long after the end of your treatments did the nausea go away?

Thank you,
Vin
_________________________
CG to wife; SCC Tongue T2N1MO Jan 2005; Surgery Mar 05; 35 XRT and 4 cisplatin doses completed Jul 2005. Dec 2006 additional tongue surgery. Feb 2010 neck biopsy. Eight esophagus dilations.

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#57940 - 03/10/06 12:03 AM Re: Nausea and Vomiting
Vin Offline
Senior Member (100+ posts)

Registered: 10/12/05
Posts: 124
Loc: California
Michele,

Nausea and vomiting was also a problem for us during the radiation/chemotherapy treatments. We also used several meds such as Zofran, Ativan, Compozine, Enzement (spelling ?) but we were not able to control the nausea/vomiting.

We also had reglan but we did not use it since we had too many other meds. From end of July 2005 we decided to stick to the Jvity 1cal which has about 265 cal per can. Jevity was the liquid food she seemed to tolerate the best. Plus we were able to get via prescrition and our insurance plan covered it.

The nausea/vomoting after the end of treatments does get better but it seems to go in cycles. There are periods of no nausea/vomiting when we used no meds for weeks and and then there are periods of constant nausea and vomiting when we are using Promethazine several times daily.

Thanks about sharing the info on the Queasy Pops I will look that up on the internet.

Thank you for sharing your experience and I do hope that you will find a solution. Please let us know if you do as we are interested and grateful.

Hang in there as things do begin to get better with time. Best wishes to you and your husband.

Vin
_________________________
CG to wife; SCC Tongue T2N1MO Jan 2005; Surgery Mar 05; 35 XRT and 4 cisplatin doses completed Jul 2005. Dec 2006 additional tongue surgery. Feb 2010 neck biopsy. Eight esophagus dilations.

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#57941 - 03/10/06 07:54 AM Re: Nausea and Vomiting
Nelie Offline
Patient Advocate (old timer, 2000 posts)

Registered: 02/18/05
Posts: 2019
Loc: Upstate NY
Vin, I'm so sorry to hear your loved one is still having problmes with nausea and vomiting. I had some problems with that semi-regularly through October, which was about 5 months out. And still VERY rarely (maybe once a month) I have a problem.

For me, after the nausea of the chemo wore off, I think the main problem that triggered the vomiting (and still can) is phlegm caught in my throat right around where it triggers my gag reflex. I think this becomes more of a problme when you can't swallow your own phlegm easily (which is also true for me) and I still do a fair amount of throat clearing and spitting each day to prevent it building up in the back of my throat and making me queasy.

As others here have mentioned, after feeding with Jevity, I was (and am) a little more vulnerable to being queasy for about 1/2 an hour too. Until recently, I fed myself one can at a time using the syringe but just letting it go in from the syringe at the rate it wanted to--not using the plunger to push it in. Now I can do two cans at a time three times a day as well as a can late in the evening--basically it's more like having regular meals and my stomach seems to have adjusted quite well.

I also think the queasiness was aggravated a lot when I was on prescription painkillers. They totally killed my appetite and just made me way more vulnerable to nausea I think. I know when I went off those was also around the time it became very rare for me to get nauseated enough to vomit. I'm wondering why your loved one is still on such strong painkillers 8 months out. It seems to me if she could get off of those (which may unfortunately involve more nausea temporarily as she cuts down--you should definitely ask her doctor about how to do that, not just do a cold turkey thing), she might be way better off in terms of the nausea. She's also almost guaranteed to have more appetite which makes the whole tube feeding thing lots easier.

Nelie
_________________________
SCC(T2N0M0) part.glossectomy & neck dissect 2/9/05 & 2/25/05.33 IMRT(66 Gy),2 Cisplatin ended 06/03/05.Stage I breast cancer treated 2/05-11/05.Surgery to remove esophageal stricture 07/06, still having dilatations to keep esophagus open.Dysphagia. "When you're going through hell, keep going"

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#57942 - 03/10/06 11:02 PM Re: Nausea and Vomiting
michele Offline
Gold Member (100+ posts)

Registered: 02/05/06
Posts: 115
Loc: Maryland
Vin - Yesterday we stopped the Dexamethasone as well as the Zofran, because my husband has continual problem with hiccups as well, and I read that the Dexamethasone can cause hiccups. They are almost as aggravating and frustrating as the vomiting! There doesn't seem to have been any difference with nausea after stopping it, hiccups are still occurring as well. I am beginning to wonder about all of it! I think you have a point about the phlegm, Nelie, as numerous times my husband's vomiting seems to be brought on when he is trying to clear his throat. Plus all of the meds would almost have to make a person nauseated. And if it's the phlegm causing it (at the point when it's not or shouldn't be the chemo causing it), then the meds won't help with that problem. I still wonder about the slow, continual feeding by pump - maybe that is a problem too, I don't know. It is very exasperating as everything is a guess. I'm sorry to sound so crabby, I guess my nerves are starting to show through. I just wish there was a clear cut solution just one time to at least something. If we come up with anything, I will surely pass it on. One other question though - can the radiation itself cause nausea? The RO says no, unless it is the stomach area being treated.
Thanks and best wishes to all of you as well.
Michele
_________________________
Michele, caregiver to husband, Jesse, SCC diagnosed 1/5/06 unknown primary, lf neck mass >6 cm. Chemo (Cisplatin 2x; Carboplatin & Taxol 2x) & XRT radiation 39X ending 4/4/06. Rad neck dissection 8.5 hrs 4/13/06. 30 HBO treatments Fall 2006.

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#57943 - 03/10/06 11:07 PM Re: Nausea and Vomiting
Vin Offline
Senior Member (100+ posts)

Registered: 10/12/05
Posts: 124
Loc: California
Hi Nelie,

I am happy to hear from you. I hope you are doing well. I had been away from the forum for while tending to my wife. She has still alot of problems with phlegm and she chockes because she is unable to swallow the phlegm and it does trigger her gag reflex.

Likewise she does a lot of throat clearing and spitting evary day to get rid of some of that very thick phlegm. I spoke to her GI doctor today and seems to think that the phlegm is the cause of the nausea.

He suggested that she bend her head down when the phlegm backs up in her throat to make the phlegm easier to swallow. Because of swallowing problems she had her second esophagus dilation today because she had a stricture which was found through a swallowing test a couple of months ago.

The GI doctor says she should be able to eat soft foods now. We will try and see.

We also feed her one can of Jevity at time through the siringe without using the plunger so that the Jevity flows at its own rate. Sometimes I mix the Jevity with a 1.5 ounce container of Benecalorie so she gets another 350 cal per feeding. But sometimes she vomits right after the feeding.

I also think that the nausea is aggravated by the pain killers. According to her ENT she still has a lot of irritation in her mouth from the chemoradiation and the pain is still a 4 on scale on 1 to 10 while she is on the painkillers. Her pain management doctor says to continue to use the painkillers.

We are going to see the pain management doctor in a couple of weeks and we will see what he recommends about continuing the use of the painkillers at this stage.

It has been a rough road for us both physically and mentally. I still have to fight bouts of depression. I count my lucky blessings to have found this site and the very caring and wonderful people here that are so kind and willing to help.

Nelie, I really appreciate your help and input.

Vin
_________________________
CG to wife; SCC Tongue T2N1MO Jan 2005; Surgery Mar 05; 35 XRT and 4 cisplatin doses completed Jul 2005. Dec 2006 additional tongue surgery. Feb 2010 neck biopsy. Eight esophagus dilations.

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