Hello - I have not posted before but have been reading from the site on almost a daily basis since I found it. You are a truly wonderful, knowledgable and resourceful group of people. Thank you for all the information and insights you have so generously provided.


My husband has stage III/IV of the left tonsil and is just past the halfway mark of his scheduled treatment - 35 doses IMRT and 3 chemo cycles (cisplatin). I know from reading the postings of others that there is a whole litany of potential problems that can rear their head during treatment. However, I haven't really seen much about heartburn. My husband had his second cycle of cisplatin on Tuesday afternoon ( just over 2 days ago) and has been having terrible heartburn all day.

He has a feeding tube and has only been able to take 3 cans today because he feels so uncomfortable.

Has anyone experienced heartburn related to some aspect of the treatment? If so, did you find a way to relieve it?

Thanks a lot.
Mary

Hi, Mary --

I too had some problems with heartburn and chemo, though I had another platinum drub, carboplatin. Turns out it wasn't the chemo but the steroid that they gave me concurrently that was causing it and I was prescribed protonix. Worked like a charm!

Talk to the medical oncologist. It is a pretty common side effect.

Tim

He should be on industrial stregnth Pepcid AC (Famotidine or some other antacid) as Cisplatin does a number on the stomach lining.

Thanks a lot for your feedback Tim and Gary. It's very helpful.

Mary

Another drug to try is metroclopramide (Reglan) -- it would have to be delivered by tube so not sure if there is a liquid form or if it can be ground up -- this moves materials through the stomach faster. My husband had terrible heartburn at the beginning of treatment (possibly reltade to the insertion of the PEG or perhaps,his body's reaction to the chemo) but the Reglan helped. He also used Prevacid before eating a few times (he ate all the way through). Also, if your husband is taking Oxycodone, that causes a lot of heartburn and to avoid it, my husband started using the Duragesic patch so he could continue to swallow and eat despite a very sore throat and mouth (mucositis).

Re the latter, try to encourage your husband to swallow (even if only water) during the treatment as his throat and tongue muscles can lose their ability to work due to disuse, as well as to radiation damage. Admittedly, this may have to wait until you cure the heartburn but then he should try. Our ENT and RO said continuing to swallow is very important, not to hesitate to use pain meds as needed to get past the pain.

Gail

---------------------------------------------------------------Husabnd Barry 66, dx SCC right tonsil, base of tongue, 2 nodes 6/21, stage III/IV, HPV-16+ tumor, tonsillectomy 6/21 (no other surgery), treatment at Johns Hopkins started 8/10, 33x tomo-IMRT radiation (66 gy), 7x carboplatin, completed 9/28. Initial exams show good response, full exam will be 12/6.

Mary, sorry that John is experienceing that discomfort. When I had my PEG put in, my gastro doc asked what chemo drug I would be getting. When I told him it was Cisplatin, he wrote me a script for Carafate in a suspension. I took it four times a day throughout the course of treatment and never had one single onset of indigestion.

Good luck to both you and John. I hope you find some relief for him soon.

Bill

Carafate also works at treating lip sores from dry lips from the rad if you swab it on every few hours--I used it for both indigestion/heartburn and the lip sores. I'm pretty sure I got Reglan --but I was thinking it wsa through my port (via IV) on the days I got chemo.

Thank you everyone for your interest and your terrific practical suggestions! Because of your responses I was able to encourage John to phone the doctor today and ask about getting help for something he thought he just had to endure. He was given a prescription for ranitidine, something that reduces the production of excess stomach acid and it did the trick. Some of our drugs may be different in Canada- not sure.

anyway. Thanks so much.
Mary

Hi Mary...

John is fortunate to have you on his side and I am glad he found relief with the Rentidine. Hopefully it will be a good long term solution.

I wanted to just add to the pile here and let you know that your husband is not alone with the heartburn. I too developed it about mid-treatment.

Although I think it may have started from the Cisplat, more and more I think it is from the radiation now.

I still have DAILY bouts of heartburn, and I used to almost never ever get it before.

Usually in the mid to late afternoon, and my diet has zero impact.

The only thing that works (worked) for me long-term was liquid Zantec. You might look into it as an alternate. It is easy to take via the PEG and offers nearly immediate relief, even for slight upset (sour) stomache in some cases.

Since I am not a Dr, I recommend that you and/or John discuss this and remember that there is no such thing as a stupid question of them.

He doesn't NEED to suffer ALL the effects to get the affects of treatment. If he is sick to his stomache, has heartburn, dry mouth or other side effects, be sure he let's his care team know since they can mitigate many of them

Good luck and please keep us posted.

Quite a while prior to discovery of my tongue tumor, I was starting to suffer from GERD aka heartburn and was doing the usual recommended things like not eating or snacking for a few hours before bedtime and also putting a couple of 2x4s under the head of my bed so my head end was higher (actually, I live in a small RV, so I put the 2x4s under one wheel to get the same effect).

Interestingly, on GP Doc's advice I went on a low-carb diet to reduce cholesterol (it did) and I noticed that my GERD also went away, but if I slipped off the low-carb diet, the GERD came back immediately -- I happened to be talking to another RV couple, one of whom had recently been diagnosed with diabetes, so they both went on low-carb diet -- The other person, a GERD sufferer, also noticed that the GERD went away as long as he stuck to the diet.

I haven't yet gotten into the nitty-gritty details of the various meal replacement concoctions that are available, but one of my goals will be to choose ones with lower carb percentages. Food for thought.

Pete

I've personally been on and off the Atkins diet a few dozen times over the last 10 years.

Since I had no history of GERD prior to the radiation tx, I have made that the connection.

Besides, I noticed the main side-effect of a low to zero carb diet was constipation.

Seems like there's no such thing as a free lunch

at my 4 yr check last week, my ENT asked me about GERD. i have a high pain threshold, so said that it didn't seem to be a real problem...
actually i've put up with it for quite awhile.

he told me that he could see signs that GERD was winning and perscribed ranitidine 300mg @ 1 per day. he also said that he had read a report that linked GERD to an increased risk of cancer recourrance. who knows? anyone else read that?

anyway after a week on the stuff, my life is much more comfortable. there was no need for me to suffer in silence.

cu,
larryb

larryb, statistically, one of the risk factors for esophageal cancer is being a head and neck cancer patient/survivor. A couple of others, which we have heard before, are smoking and alcohol consumption. Untreated GERD can damage cells in the esophagus, leading to a condition known as Barrett's Esophagus, in which cells are classified as pre-cancerous. Some damage can be healed by the ingestion of proton pump inhibitors (Prilosec is one). The generic Zantac you are taking will definitely relieve symptoms, but is a step down from the PPIs in treatment terms. This is a highly simplified overview. For more specific and detailed information do a search on http://www.medlineplus.gov

Just one more thing to keep on top of.

Hello Mary,

Sounds like you resolved the problem you were asking about. Thats one of the best benifits of belonging to this forum. Someone with similer treatment will always respond when asked.
He will need more than three cans to maintain, heal and gain weight. You can mix in a whey protein powder (GNC) along wit CIB(Carnation Imstant breakfast) to boost his nutrient intake.
I was at 126 lbs three weeks ago and have gained 10 pounds since than. I do have a peg tube and have no problems with it at all. If he can swallow food that should be the first choice for him. I have swallowing issues.

Welcome again, Danny Boy

Something I was reading recently mentioned the fact that normal saliva has components that help to neutralize stomach acid. This made me wonder whether the impaired salivary function that often follows radiation is enough by itself to create a greater risk of GERD and esophageal problems. I haven't found anything that specifically addresses this -- does anyone know whether this is true?

Cathy

Cathy, I think that may be entirely possible, as it is recommended that people with heartburn chew gum to increase saliva production. It makes me wonder if H&N patients with impaired salivary function should routinely take antiacids, as I do know that GERD can exist with no symptoms. All of which does not answer your original question, I am afraid.

Please be aware that if you are having an acid stomach problem 2 days a week or more, that you need to get on a proton pump inhibitor like Nexium, Prilosec OTC, etc. The long term consedquense is the possible development of Barrett's esophogus which can transform into esophogeal cancer, and is the primary precursor to it. Chronic use of conventional anti-acids instead of a PPI will mask the symptoms of Gerd and allow Barrett's to develop over years. I like others, have a upper endoscopy every two years and are on long term use of PPI's to keep things in line. When in doubt visit a GI doc to have a chronic situation evaluated and a diagnosis of GERD determined.

My RO did tell me that the reduced saliva fucntion might cause problems with acid in the stomach. I never had a problem until I had the laryngectomy 4 years later and was put on rantidine 150mg 2Xs a day. This was supposed to make certain that I had no acid reflux after the operation. While I do not feel I have GERD, I do have a massive amount of intestinal gas and bloating so after two years on ranitidine switched to Prevacid 40mg 1X a day. Seems to work better, but still have intestinal gas. All this may be totally unleated to rad and simply irritable bowel symdrome. I'm still trying to figure it out. Drs haven't.

If I have GERD, I have it with no heartburn. Is that possible? I have mild hiatal hernia, but rarely experience any reflux that I am aware of unless you stand me on my head and repeatedly tell me to drink barium because I am doing it wrong until I can't take anymore. GI doctor says esaphagus is all clear.

The thing I wonder is if the Prevacid is reducing the acid level in my stomach so much that I am not properly digesting food. ie. Maybe I don't need it all and it is only causing problems. I'm tempted to try a month without it to see what happens with the stomach bloating/intestinal gas, but haven't had found a good time to do it. Right now keeping a journal of all food eaten and all gas/diarrhea problems to see if I can establish any pattern. Will see what happens.

Take care,
Eileen