Nausea

QUESTION: I am currently undergoing chemotherapy and having a very difficult time with it. I am working with my doctor on the side effects. I have severe nausea for two weeks after my treatments. It subsides for the third week and then we start all over again. I have tried Zofran, Kytril, Compazine, Prevacid, and Carafate. Nothing seems to help. Can you suggest something else? I relish the last week because I feel so "normal," but the two weeks after my treatment are very debilitating.

ANSWER: I am sorry that you are suffering from nausea after your chemotherapy. It's a rotten way to feel! I'm hoping that the following background information and practical tips will help you and your doctor find ways to help YOU feel better.

Delayed nausea and vomiting is defined as nausea occurring or persisting for more than 48 hours after treatment. Thankfully, delayed nausea is a problem in less than 10% of women receiving the chemotherapy typically used for breast cancer. Unfortunately, delayed nausea is more difficult to treat. Here are some suggestions that have helped other patients with this difficult problem:

• Return to your oncologist's office for additional intravenous fluids and anti-emetics on the first two days after chemotherapy. Dehydration also causes nausea, leading to a "downward spiral" of nausea, then dehydration, and then more nausea.
• Make regular use of Decadron (dexamethasone) and Reglan (metoclopramide) for the first four days after each treatment. Reglan increases the motility of your gastrointestinal tract and keeps things "moving forward" in the right direction. Decadron decreases inflammation and decreases your brain's sensitivity to nausea.
• Although Ativan (lorazepam) wasn't on your list, it can help decrease "anticipatory nausea"—that is the nausea you may experience even before chemotherapy started. It comes from remembering bad experiences from previous treatments, and then expecting to have them again the next time. It can also help with the delayed nausea.
• A early pilot study of Zyprexa (olanzapine), a new drug used for some psychiatric illnesses, was very encouraging for nausea, with nearly all patients having significant relief of delayed nausea (typical dose was 5 mg twice a day starting two days before each treatment). A follow-up trial is just getting under way to confirm the results, but it might also be worth a try if your doctor agrees.
• Ask your doctor or his/her nurse about relaxation and visualization exercises that may help you combat nausea before it starts.
• Drink and eat small amounts more frequently, rather than trying to eat a full meal.
• Above all-remember this is only temporary. Your doctor can help sort out my recommendations and work with you to figure out your best options. Good luck with this difficult problem! We hope you feel better sooner than later.

—Kathy Miller, M.D.