Food Help for 78-year-old w/ Cancer, on Chemo--can't eat anything : (

[Jonathan_Byron]

" of course, she's only managed to get a pill down once so far, tho it did seem to help at the time."

I had an anti-nausea medication once that I only needed to use a couple of times, it was dissolved on the tongue.  Very expensive too, like $20 per pill.  At any rate maybe marinol comes in a form that can be dissolved on the tongue so it won't be vomited up before it can do any good.

Oh, wait, here's something: "g. 5-HT3 receptor antagonists. This class of drugs is the most effective treatment available for prevention of severe vomiting due to cancer chemotherapy and cause little toxicity; about 85% of patients attain complete control of emesis and nausea. Usually given in combination with dexamethasone. Also widely used for PONV, but less effective (20% reduction, Tramer et al, Anesthesiology 87:1277-89, 1997). Although animal studies suggest it should not work for vestibular problems, empirically it is also often effective in this context. Unfortunately, this is a very expensive drug (about $20-$40/dose or even more). It is very convenient and can be taken as a sublingual preparation. http://www.dizziness-and-balance.com/treatment/drug/emesis.html

ondansetron
tropisetron
granisetron (approved for IV injection only)
dolasetron (investigational) "

I'm pretty sure what I had was ondansetron.  It's an excellent, fast acting antiemetic.

Ginger also works on the serotonin-3 receptors.  Unfortunately, if a person can't hold down food, they have a hard time getting enough. Not sure if a compress on the skin works, or holding a piece in the mouth (hot-hot) will do the trick.

[Broil]

...... There are plenty of drugs for lung cancer these days.  Sounds like she is getting cisplatin, which is THE most barfogenic drug known to man.  100% of patients will vomit, repeatedly, 100% of the time.  Acts directly in the vomiting center of the brain.  Also causes renal insufficiency which means you can't clear the metabolites of other drugs, like opioids, thus contributing to the nausea.  And it will cause anorexia, which tumors do all on their own.

You are on the right track with 5 H3T blocking drugs like zofran, but these are used for preventing acute nausea and vomiting, that is, around the time of the chemo.  This lady is experiencing delayed effects which is better treated with drugs like phenergan, which you can give as a suppository.  Marinol is good but usually you need 15 mg dose for nausea and many people get spacy.  ......

........ I find patients like cool sweet foods like ice cream.  I have them take 2 scoops of Blue Bell ice cream and 1 can Ensure and make a milk shake.  If they can get 2 of those down it is like 1800 cals, at least......

This is so cool to have an actual cancer specialist see the thread and be able to give professional advice, based on long experience!

[Librarian]

Ginger also works on the serotonin-3 receptors.  Unfortunately, if a person can't hold down food, they have a hard time getting enough. Not sure if a compress on the skin works, or holding a piece in the mouth (hot-hot) will do the trick.

hey, we'll try it in a warm foot-bath if nothing else! my friend's mom is having trouble getting into/out of the tub, so she's afarid to do full baths, but we're trying foot-baths and the massage/lotion idea.

i know, any actual absorption of nutrients may be miniscule, but if it feels nice, and there is some chance it is helping, then i'm quite happy to make full use of any placebo effects we can stir up!

and yes, Broil, it is amazing to not only get some advice from the professional side, but also all the caring information from those who've walked others through this! with no local support group out where they live, and barely any internet, this means a lot.

i think possibly the most helpful thing for them immediately has just been the advice to slow down, take a deep breath, and be *pleased* with those two-bite meals! in that respect, they've been doing as well as many patients can, but they just didn't know it!

i remain thankful to all.

[BurghGirl]

...been down that same road with my hubby who had lung cancer.  A good hospice is a godsend.
We tried marinol but he couldn't keep it down.  We bought some MJ and it really helped.  It needs to be legalized in PA as a useful drug.

Ice Cream.  That was all he could tolerate.  I remember standing at the ice cream case in Walmart reading every label so I could get the brand with the most calories crammed into it.  Natural ingrediants only.  Anything artficial made him vomit.


Meat wasn't tolerable with chemo or any foods with a strong smell.  Think cool, sweet, and bland.

Warm baths helped because he sort of oozed brownish-yellow stuff from his pores after a treatment.  Touch is important, much more than you can even realize right now.  The massage idea is a good one, it helped.

And the hospice...it's all a lot easier with hospice to help.  And they'll help in ways you haven't even thought of.

[Xenopus]

And the hospice...it's all a lot easier with hospice to help.  And they'll help in ways you haven't even thought of.

YES! ++

[Librarian]

thanks BurghGirl, and my sympathies to what you went through--i'm so sorry. as well as my admiration that you did it--i'm only dealing with this second hand, mostly long-distance, and honestly my concern is as much for my friend, as it is for his wonderful mum. i won't even try to imagine how it feels, when you are the only person there to help face-to-face, and it is someone that close to you.

thanks also for the reminder about checking the ice cream label, we actually were talking tonight on the phone, and i suggested he try the ice cream again, but be more careful about what is in it. he hasn't got the best options out there, but he's going to see if he missed anything. if only i could buy fresh, milk-only ice cream and ship it to them through Amazon...we're trying to schedule a shopping run here in the city, but he's afraid to leave her for too long, and i don't have a car to get things and run them out there.

we're still looking for a hospice outfit close enough to them to be helpful, too, Xenopus.


UPDATE: they've had to post-pone the next round of chemo, as her blood work is all off, despite IV potassium and such.

she's not *under* weight yet, even with all the upset, so at least she is still working off some fat reserves--a good reason to never let yourself get TOO thin, because you never know!

but of course she's all out of whack now from having so much trouble keeping anything down. it seems currently that celery is what she can tolerate, but even that does not stay down long. after reading the posts here about chewing and digestion, that at least gave me something else *hopeful* to say, that if she's chewing it long enough, she is still getting *some* tiny amount of nutrients from it, even if she throws it up half an hour after she swallows it.

we've moved into some more emotional territory now, too...the physical trauma and lack of nutrition/hydration is affecting her mental state and how she's responding to those around her, and i guess she is getting "snippy" and having some dramatic mood swings. to watch that in a parent...and to have to be the "strong" one...i don't know how he is doing it, but he is. i hope at least that it helps when he can talk about it with someone, and then maybe have more ability to help her get through those rough patches, and not lash out at neighbors or friends who are only trying to help, however inexpertly?

i swear at this point, if it were me, i wouldn't even want to know i was dying, much less deal with the treatment that can't fix it anyway.

[Broil]

thanks also for the reminder about checking the ice cream label, we actually were talking tonight on the phone, and i suggested he try the ice cream again, but be more careful about what is in it. he hasn't got the best options out there, but he's going to see if he missed anything. if only i could buy fresh, milk-only ice cream and ship it to them through Amazon...we're trying to schedule a shopping run here in the city, but he's afraid to leave her for too long, and i don't have a car to get things and run them out there.

  Can't help you with the emotional stuff, but as for ice cream Haagen Dazs and Breyers have no chemical additives and are available at any supermarket, and I believe vanilla would probably be the easiest to keep down.

Sometimes grocery stores will deliver.

[kopperhead]

can the marinol be ground up and put into a suppository form with glycerin?

back...way back further than i care to remember, because of the big C i do not claim anymore,  a local compounder took some of my meds and did this for me.

 ....now i jus smoke it like a dragon when nobody but y'all are lookin..

[FilterFeeder]

So we're talking about the mother of a friend of a board user's confidential medical management on a public forum without any knowledge of what conversations and decisions have been made between the patient and her Doctor? And we even have her name, age and location. And all of this without the patient's consent or knowledge. Doesn't that strike anyone as inappropriate?

Lung cancer has a poor prognosis, especially in the elderly. I find it hard to believe that this patient hasn't had a discussion with her oncologist as to how she wants to treat it, be that palliatively or via aggressive treatment. She appears to have chosen the aggressive treatment option. Chemo is a very bitter medecine, and patient's are told that before they're given it - to assume that evil Doctors are torturing her is misguided at best.

And then we have someone who claims to be an oncologist, without any opportunity to review this patient or her history and with precious few solid facts about ANYTHING, suggesting to the patient's daughter's friend that her team should change her chemotherapy protocol. WTF???!!! 

Nutrition in chemotherapy is a very large subject which some folk spend their entire careers on - if you want to talk about that then fine, but please strip out all the personally identifying information and allegations of poor medical care unless you have the patient's consent and all the facts at your disposal. It's a breach of trust, and you could probably be sued for it too if anyone could be bothered to.

[Librarian]

i don't think this is innapropriate, and my friend knows i've asked for advice on an online forum without giving too much detail about them. i've said her age, a first name, and the state we live in--i teach journalism students how to track people, and i know i'm not giving enough for that to happen here.

i've said enough on this forum about myself that a determined person could make a good guess as to MY actual name and job and anything else (or at least to track down someone else who fits those criteria,) but you don't know that i've given anything exact enough about the rest of it. and they are not anywhere near where i live, nor would there be anything to connect me to them that anyone could dig up online.

i appreciate your concern, but i'm not breaking any laws, and as i've said, he (or for all you really know, SHE) knows i'm doing this, to try and help with his/her "family".

call me naive, but i'm trusting 99% of the people here to take the *situation* as real, and give me their honest advice.

i don't think her doctors are "evil"...but that does not mean that maybe they also can't sometimes miss some things, or not really know about the small things that family can do at home to help.

and some of the advice we've gotten here *has* helped. that is no small thing.

if you feel the need to sue me over asking for help, i'll be happy to give you my home address, okay? because personally i have nothing to hide, and i don't care.

i came on tonight after getting off the phone with my friend, and was going to post an update (good news and bad news) but now i  feel like i shouldn't, as we've attracted some negative attention, of unknown motivation or intent.

i'm still thankful for all the ideas and suggestions given here.

i hope you never have to deal with anything like this yourself.

[FilterFeeder]

I have absolutely no interest in suing you or anyone else, this woman's health care providers may feel differently.

The bottom line is that despite your citing of journalism experience, she would be easy to identify from the information you have given her. A combination of name, age, area and diagnosis is plenty enough information to do this.

I suggest your friend talks to his/her mother and her care team about the dilemma of palliative care versus aggressive treatment rather than strangers on the net who variously are calling her caregivers torturers or advocating changes in treatment protocols, which is NEVER something you change lightly.
I suggest your friend talks to his/her mother's specialist oncology nutritionist regarding options and strategies to ensure continuing nutrition, rather than listen to strangers who are inappropriately suggesting TPN.
I suggest your friend talks to his/her mother's doctors about pain relief and perhaps asks for a referral to a pain team.
I suggest your friend talks to his/her mother's doctors about antiemetics.
This would be a far more appropriate way to proceed in this situation.

[paracelsus]

Why should she listen to you? You're just some troll on a forum.

[eric1]

Amateurs, rank amateurs. This is clearly a job for Dr. I. "Will" Kilpashent. 

All kidding aside, my first advice would be to get her off the chemo. You see what it did for Patrick Swayze.
As per her not eating, I can tell you from personal experience that our food supply is so tainted(worse than I had ever imagined), that the less she eats, the better off she actually is. A lot of people die from overeating---more than those who undereat.

[FilterFeeder]

my first advice would be to get her off the chemo.

Unless the chemo has a realistic chance of saving her life... In which case you've just advised that treatment should be withdrawn for this stranger effectively ending her chance of surviving her cancer.

Are you qualified to make that advice? I know I'm not. And I don't believe anyone else is who hasn't got the opportunity to make a full clinical assessment of this woman's health status and who has the training to act upon it.

This is a perfect example of my problem with this entire thread.

[Hope@ZeroKelvin]

Filterfeeder, none of what was discussed on this forum isn't otherwise available on patient oriented cancer websites on the web.  That was the spirit in which it was offered.  I am a full time-plus practicing oncologist and my advice was strictly given as if it was a friend of a friend asking, not professional advice.  No healthcare profession would presume to give a professional opinion without being face to face with the patient.

I get these kinds of "curb sides" all the time.

Chill out, dude.  I'm sure Librarian knows what to keep and what to ignore.