hi all,

i'm in l.a. with my sister who came home 2 days ago from a second round of chemo at the hospital.

it's day 5 since end of this round. she's having nausea and diarrhea for which she's taking reglan and peptobismol. she's been eating less than 2 cans of Isocal (Ensure type thing) per day through the peg tube. that's about 450 calories. she's getting hydrated through iv. she's down to 95 lbs (lost 6 lbs since chemo, 20 since beginning of treatment).

she's going back for another round of chemo in less than 2 weeks and we're wondering how she's going to pull through if this trend continues. the nutrition therapist at the hospital also said this was a serious concern but had no concrete suggestions. her oncologist thinks she's not yet at a stage to require TPN feeding and so we shouldn't expose her to the risks of that.

my sister has had a PEG tube since february (can't believe she's gone this long without eating through the mouth). she has very sore mouth and throat and has stopped even drinking the little bit of water through the mouth that she did before chemo.

questions:

1- is what she's experiencing "mormal"? how long does it take for nausea and diarrhea to pass after a chemo treatment?

2- any suggestions re getting more calories into her? does anybody have experience mixing other high-cal supplements with Isocal or Ensure? or,

3- any higher-cal products to use instead of these two so she can get more calories in as much volume?

thanks for your advice.

good thoughts, healing and peace.

gita

Gita,

It sounds like your sister is going through the same as all of us. I think she has probably lost more weight than she should but it sounds like they are already telling you this. You are keeping her hydrated via IV and that is good. The calorie count is low. I went up almost ten times that much after I kept losing weight. I am not sure of risks of TPN feeding. I did that for many weeks via a mediport and was not aware of risks specific to TPN. We did it at home and my wife accessed my port when needed.

Everyone is different with chemo and my nausea never subsided until weeks after it was all completed. Is there any reason why she can't take more than 2 cans a day. She should be about four times that amount with the weight she is losing. Any calorie boosting at this point would be fat or sugar. Boost has an over the counter high fat version that is almost twice the calories she is getting now.

Ed

she doesn't feed more because of nausea and vomitting and other complexities. because of the location of the tumor, her breathing is already very difficult. every time she throws up she feels like she's choking. also, her mouth and throat are quite sore and they get worse when she throws up. so, part of it might be her reluctance to put herself through that pain. and, when she caughs (quite frequently), she becomes nauseous.

her oncologist said TPN has high risk of infection and we should use it as last resort only. i'm not sure why this situation does not yet seem really critical to him. today she's only had about 130 calories. i'm very concerned.

gita

Hey Gita,
Dan had trouble taking his BoostPlus during treatment so a friend told me to talk to a nutritionist. I did and found out that there are many different kinds of nutrition that can be obtained. Dan started taking Nutren 2.0 and we got it from our local NeighborCare and it was covered under insurance. It had 500 calories a can, so he had to take in less thru the PEG. I hope you can get something via PEG that has much more calories per can. Dan used his PEG for about 6 months, and for about 4 of those months he took nothing by mouth, not even water. So I think that part is fairly normal. I will keep you and your sister in my prayers. Things do get better after treatment ends. Dan was not even able to talk at all for about 6 weeks...that was very hard, but he is talking good again now.

Take care and God bless,
Debbie

Gita,
Your sisters condition sounds pretty normal to me. Most of us had similar experiences.

There are many reasons for nausea - be sure to let the doctors know so they can try different things. I got nauseated from practically everything -it really wore me out at times - but I am living proof that human beings are more resiliant than you think. I also spent a lot of time choking. Eating became a science into itself and I had to experiment a lot with different techniques, particularly since I HAD to eat orally. Coupled with burns, blisters, thick mucous, constipation, no taste buds, elevated sense of smell. I spent a lot of time laying on the bathroom floor. It sucked and I am GLAD that is all past now.

My doctors also gave me industrial strength antacids and they helped as well. Chemo does a number on the stomach lining and acid balance.

There are some tricks to using the PEG tube optimally as well - like slow feeding, etc. I didn't have a PEG so some of the PEGsters can help you.

I couldn't stand Boost and Insure and puked it up everytime I tried it. I settled with Carnation Instant Breakfast (I could tolerate milk ok) and Hagen Daz milkshakes and it worked well enough.

Sorry you're having trouble with City of Hope. Cancer is in epidemic proportions in this country today. All of the CCC's are very busy. Be persistent. She's already in treatment so that may be a factor as well.

Gita,

You can also use an enteral feeding pump and slowly trickle the liquid through the PEG. This allows the body to process versus loading up the stomach with liquid and regurgitating it. I was a lot like Gary only I was on all fours just before laying on the floor. I eventually went with anti-nausea suppositories since I couldn't even keep the medicine down.

Ed

Sounds like what I went through after my 2nd round of chemo. Vomiting was every hour on the hour for 4 days straight. So once I figured the timing of when I got sick I would PEG about a

These posts are scaring the hell out of me. What type of chemo drugs make you that Ill? I had my 1st treatment last Monday and I don't feel any different than before treatment. Is this something where I should be waiting for the other shoe to drop? I hope not. I go for round two this coming Monday. I'm on Taxol & Carboplatin. Tell me this doesn't happen to everyone!!!

Dan

Dan, I had several rounds of Carboplatin and Taxol and was not sick for one minute. Relax - no shoes will drop. You will not get sick on this regimen.

Joanna, who would not kid you

Dan, don't be scared by others' experience since our response to chemo can vary and I don't think all of us go through the same chemo side effect. Take myself as an example. I had chemo once a week for four consecutive weeks. I could drive back home after the treatment and still ate some soft food. There were mouth sores but with the pain medicince, they were tolerable.Nausea was a problem expected and so before the chemo, I was given an injection to prevent that and before the two meals, there were some anti-nausea drugs to take. I managed going through the whole treatment with only one time vomitting at the dinner table.I threw up the second time when I was in the hospital, a week after I had finished all the chemo.It was easy to think of vomitting when I smelt the cooking of food in the kitchen. So I would stay away from the kitchen when it was meal time. Diarrhea was not my problem at that time and in fact it was constipation that I experienced because of the pain medicince I took. But again the doctor prescribed some medicine to ease the problem. Most of the time it worked but when I couldn't eat fruit or veggies, the problem got more serious.So Dan, if you didn't feel any different for your first time, don't worry about it getting worse the second time. It may or may never happen. Who knows? We are all unique.

Karen