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Any tips to help with the nausea from Cisplatin?

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

Good Morning!

I am hoping someone may have some suggestions if there is anything else I can do to help my husband,Sam, with some relief. He had his 1st of 3 chemo treatments on Tues - 7/12. We were told he would probably not feel any side effects till the next day or possibly even Thurs. Well he ended up being sick an hour after we got home - 4:00 pm till 5:00 the next morning. Not some much vomiting but terrible nauseousness & dry heaving during that time. The next day he felt much better but still very nauseous. He is taking 2 scripts to help - Zofran & Compazine. I have been giving both meds around the clock every 4 hours. Still no real relief - went to the health foods store & picked up ginger root capsules too. Those he said are giving him heartburn......
He is not eating much of anything but saltines here & there. I am pushing water & gatorade but now I am wondering if he is dehydrated?? He has pretty much been in bed since Tues- I did get him to take a short walk this week , but that did not seem to help either....
This morning he is saying he feels worse then yesterday...
I have read everything I could possibly find on Cisplatin & know it is a strong ass treatment & it is saying 7-10 days of this. I guess I am just concerned we have not seen any improvement since the 1st night. Do I call the Dr at this point or is all of this 'normal'??

Thanks

jim and i's picture
jim and i
Posts: 1608
Joined: May 2011

Samsangel,

Call doctor now! I just brought my husband home from the hospital after a week. Your husband is dehydrated and his kidneys are being effected. Anytime the meds do not stop the nausea you should call your doctor. Dry heaves are bad. If he has dry heaves he has no hydration. Also he needs nurishment which they can give interveneously. Dehydration and rapid weight loss are very dangerous.

Praying for you,
Debbie

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

He was only dry heaving the day of treatment - not since then. Now it's just being nauseous.

I will call.......

fisrpotpe's picture
fisrpotpe
Posts: 1335
Joined: Aug 2010

You can check for dehydration by grabbing/pinching the skin on back of hand and pulling up, let it go. If it pretty much stands up he is short of hydration, same if it goes down very slow like it looks close to normal. If it goes down quickly and looks normal like if you do to self then hydration is pretty close.

Welcome Samsangle! This is a wonderful place to be, lots of support, information, experience for those like you and your hubby.

Cisplatin is one of the biggest hitters of chemo.

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

Skin looked just like mine : )

CLRRN's picture
CLRRN
Posts: 126
Joined: Jun 2010

Hi SamsAngel,

I'm Chris and the caregiver of Mike who also had 3 cycles of Cisplatin. My suggestions comes from experience as an oncology nurse. Fortunately Mike did not have nausea w/Cisplat.

Keep hydrating-that is very important,if he is still vomiting, call the doctor. If he is just nauseated, keep pushing the fluids and the nausea eventually will subside. I know that's not what you want to hear but compazine and zofran are good meds keep doing what you are doing. There are a few others they can try but those are good. Phenergan is an option too. Sometimes Benadryl can help as an anti-nausea medication but check with your doctor. Try ginger ale -some say that helps but if he is getting radiation too, the carbonation may irritate therefor let the ginger ale get "flat" first.

Hopefully he will make the turn and start to feel better but my suggestions moving forward for round # 2 and #3 (and will even help if he is getting radiation)are:

1) Request EMEND to be prescribed (he takes 1 hour prior to chemo) and the morning of Day 2 and Day 3. Mike was prescribed EMEND along with 4 days of steriods.

2) Fluids Fluids Fluids-especially if he is getting radiation. As the medical oncologist or radiation oncologist if your husband can come in for IV fluids. We did this weekly and it really helped. It doesn't take long and its easier to be ahead hydration wise then try to play catch up once you get behind.

Hang in there....thoughts and prayers are with you both,
Chris

Daddisgrl's picture
Daddisgrl
Posts: 119
Joined: Feb 2011

I agree with the Emend & steroid.

The next time you see your Dr; ask them to give the Emend script so you will have it for chemo #2- insurance may not want to cover it; so getting it before hand is the way I would go. My hub used it for 7 days after chemo

The Compazine & Zofran are also important to keep up on; double them up if you have to. I would have to look but one is better to prevent; so you need to take it in the morning asap; then if dry heaves start; you double up with the other & make sure you keep up with both meds at least that 2nd day; then you gradually space the timing out.

I used to number water bottles- would leave 8 on the counter for him to drink. If he did not drink at least 6 it was bad news. He did pretty good; only need IV hydration 3 times I think

DrMary's picture
DrMary
Posts: 527
Joined: Nov 2010

I'm really surprised it was not prescribed - without it, nausea is indeed immediate. Emend (which is often co-prescribed with Dexamethasone, which boosts it, but sometimes causes hicoughs) very effectively prevents nausea for the first few days after Cisplatin. Talk to your doctor about using those both for the next cycle. Some doctors don't prescribe Emend because it is so expensive, but your insurance company should OK it, given the bad nausea he had with the first one. (Emend right now would not be effective, but the dexamethasone by itself might, so ask about that as well - the hiccoughs are annoying, but go away after a few days.)

Ask now about daily IV fluids - we were able to do this both in the radiation doctor's office and as outpatient in the infusion center. It really helps.

Also, if his digestive system is that bad, he might not be processing the antinausea pills - ask about the phenagren suppositories also (can be used with Zofran, but you might need to stop the compazine while doing phenagren).

I'd skip the ginger - it works by speeding gastric emptying, mostly by causing mild irritation of the stomach, so it really only helps with mild nausea (like motion sickness).

Lastly, I will sing my usual song. Compazine and dehydration cause constipation - if he has not had a bowel movement in 2 days (even though he has not been eating, he should be passing something) talk to the doctor - he will likely recommend stool softeners (like Miralax) and possibly stronger. Don't wait on this one - constipation can aggravate nausea and can get serious fast. Folks sometimes have to be hospitalized for it, and the longer it goes on, the less fun the treatment is.

Keep us updated - Doug had just about the worst nausea his doctors had ever seen; none of the standard antinauseas worked and it cut his chemo from 3 to 2 treatments. If his doctors hadn't been flexible about trying odd combinations of drugs, he would have lost more than the 40 lbs. Keep after your doctor until you get something that works.

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

He was taking Dexamethasone for the 3 days following chemo - but no Emend though...

And BM have been fine at this point.

Hondo's picture
Hondo
Posts: 5742
Joined: Apr 2009

I did not have any of these side affects so I am not much help here, but looks to me you already got a lot of answers, so I will just say Welcome to the Family here on CSN and hope you plan on staying.

Best wishes to you both
Hondo

Skiffin16's picture
Skiffin16
Posts: 8076
Joined: Sep 2009

Can't say enough good things about EMEND, I can't even imagine them not prescribing...it's expensive, about $150/capsul, but well worth the price... You take one the first day (about an hour before the chemo), the next two on the following two days.

I too had three rounds of Cisplatin, Taxotere and 5FU over nine weeks (three week cycles), then another seven weeks Carboplatin.......the Zofran & Compazine is more of an inbetween anti-nausea med given between the chemo and Emend....

As for the heartburn, they gave me a prescription of Protonix for that I beleive...I know it's for the acid reflux.

Dehydartion...a good check is called "tenting"...my wife loved it. You gentle lift or kind of pinch and lift the skin on the backs if his hands. If it stays up or "tents" for a few seconds, he needs foods... Try it on yourself as a comparison. Your skin should go immediately back to it's original position. If his stays "tented" for much longer, he needs fluids....

Dexamethasone, is a steroid...they give you that sometimes in helping with fatigue and energy boosting mainly. They only prescribed that once for me for fatigue. But it raised my blood sugar about 30 points. I wasn't that fatigued so I stopped it, didn't want more going on than needed if it wasn't necessarily needed.

Lastly, welcome to the forum...great people here, and tons of history and actual been there, done that experience.

Best,
John

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

So I have to ask - is it too late for the Emend at this point??

And thanks everyone for welcoming me - I plan on staying for the long haul ; )

Skiffin16's picture
Skiffin16
Posts: 8076
Joined: Sep 2009

I'd say yes as for the treatment he just had.... but definitely get it for the next few if you can.

It's mainly for the first three days, starting the hour or so before the chemo goes in...

Best,
John

Redbanker's picture
Redbanker
Posts: 33
Joined: May 2011

My boyfriend was knocked for a loop by Cisplatin and missed his second and third rad treatments. I hauled him in for his next treatment and he was unable to stay on the table. The doctor told him he was having a panic attack--this was not well received--and gave him an Ativan sublinqually. He tried again after 15 minutes and lasted just a little longer. Another Ativan was given and then he made it through.

What he found was that the Ativan was extremely effective in taking care of his nausea. He had tried the Compazine, the Emend, and, at my suggestion, also gave Marinol a whirl. Nada. But the Ativan was a godsend and had he not exhibited those panic attack symptoms we would never have had it offered. Out radiologist's nurse had been a medical oncology nurse and had a lot of experience with Cisplatin and was a big booster of the anti-nausea properties of this drug.

I should also mention that after his first Cisplatin treatment his medical oncologist reduced the dose and his next two treatments were easier to tolerate.

He's been out of treatment for almost three weeks now and is struggling with intense throat pain. Still uses the Ativan to lull himself into sleep.

You are going to get through this though I can guarantee that there are going to be many days when you'll wish you could volunteer to take it on yourself. Keep strong and don't take anything personally.

Nancy

SamsAngel's picture
SamsAngel
Posts: 7
Joined: Jul 2011

I have a few Ativan here that were mine - I would have never thought about using the Ativan for to help with the nausea either but this is not the 1st time I have heard of using it. Now he does have a script for Valium and we tried one of them last night to help him sleep - but it really didn't do much of anything...

The more I think about the Emend - I think they gave that to him thru an IV before treatment - I even remember the Social Worker being there at some point and asking his RN if she needed to check if our insurance covered some med & the RN said they don't give them out like that anymore - it's all in the IV and lasts up to 5 days in their system....I will have to call and ask her tomorrow about that so we do know for the next rounds.

I cannot thank you all enough for helping us through this. I knew it was going to be hard but being the 1st round - we both were still scared.....it's more of not knowing what is 'normal' side effects and when you should be concerned.....

Sam is bi-polar & that itself makes this an entire journey different from most.

Hugs to you all!

DrMary's picture
DrMary
Posts: 527
Joined: Nov 2010

The one that really caught my eye was Thorazine - it is similar to Compazine but can also help with hiccoughs (as well as with nausea and psychotic behavior). Many are also antihistamines (something that came in handy when Doug had a severe allergic reaction to IV feeding) - dramamine was originally prescribed for hay fever and someone noticed it cured his motion sickness.

I'd certainly give the Ativan a try (try to space it out from the Compazine, as they do have similar action and you don't want to knock him out). Everyone is different and you don't know what will work until you try it.

Dexamethasone (the steroid) can be prescribed for a lot of things - my brother-in-law the doctor called it "oldie but goodie" for chemo nausea, but it does also help with inflammation and fatigue. We were very lucky Doug had no side effects from it as it (in combination with Reglan) was the only thing that made it possible for him to eat.

The bipolar does bring another issue into the equation - I've been told that many bipolar folks (teens, especially) have different from "normal" results with many drugs.

I remember Doug getting Emend both IV on the infusion day and then as pills for 3 days after. Certainly something to check into.

You're on about Day 5 or so, right? Things should start to slowly improve for the next 5 days.

Skiffin16's picture
Skiffin16
Posts: 8076
Joined: Sep 2009

I had the 5FU strapped on me from Monday through Friday...so it took a little longer for me.

About the latter part of week two I would start feeling pretty good. All of week three I was completely old normal again.

Then it would start again the week after, but with a little more insite on what to expect.

My second cycle was actually the worse as I let myself become a little dehydrated..once and only once.

Best,
John

akbear49's picture
akbear49
Posts: 50
Joined: Jul 2011

I just completed the 35 radiation and 3 rounds of Cisplatin 7 days ago.

I was repeatedly told that each person is different, so keep that in mind, what worked for me may not for you.

My doc tolds me the anti-nausea drugs I got at the infusion center should last 72 hours - nope - I was pretty sick the next day, acid reflux, nausea, no dry heaves but very close to it. I laid down and that quelled the nausea each time with a little help from the drugs.

I found the Dexamethasone to be useless. I used Lorazepam and Ondansetron together - Lorazepam is an every 8 hour dosage, the other is every 12 hours. Hell with it I took both every 8 hours and it worked for me but the combination made me sleepy and I took 30 - 45 minute naps afterwards. Also I decided to take the drug combo ahead of symptoms, that is, I didn't wait to feel anyu nausea I just assumed I would be nauseous and took them both for a week or so after the next 2 rounds of chemo. I told my doc what I was doing and he said what ever works for you is OK with him.

I gave up on solid food about a month into treatment and am still on a liquid diet of fortified Carnation breakfast drinks, Ensure and some soup comsommes. The extreme salty taste in my mouth turns food into crap and my stomach signals me that if I send it down its sending it right back up. I've been on a liquid diet for around 5 weeks now.

I've lost 18 pounds ( I started at 217 ) so far and my docs tell me the worst will be over in another week or so

Good luck and I hope this helps somewhat. get plenty of rest, skip the exercise if you're not eating well you'll need those extra pounds

Hal61's picture
Hal61
Posts: 656
Joined: Dec 2009

Jo SamsAngel, I had Cisplatin, and use Zofran--but only on infusion days and it worked well but not long, Ondansatron, another I can't remember, and medical marijuana. The marijuana worked best for me. There is a pill called "marinol" I believe you can ask your doctor about, it has the active ingredient. I just smoked a little bit with substantial relief. Ask you doctor first of course, he may not want to talk about it. It presents no risks in controlled settings, but it still taboo.
Hal61

adventurebob's picture
adventurebob
Posts: 691
Joined: Jun 2010

Hi SA,

I'm with Hal here. Everything worked a little but nothing worked as well as marijuana. I'm from California and it was prescribed and legally purchased so nothing controversial here but most states it is still illegal. Second best was Ativan. Fennel seed tea came in third as did ginger root tea. Also, like everyone said Emend should have been prescribed and taken just before infusion. I hope you guys find some relief. Docs should be willing to do anything to make sure nausea isn't an issue.

AB

sue5749
Posts: 170
Joined: Dec 2010

My husband will start is 1st round of cemo tomorrow morning, they said that he will be there about 5 hours the first day and then the next 2 days he will be there for 2 hours for hydration? We went today but we were not prepared for the 5 hours. We were told that the first visit was 3 hours. My husband is on tube feedings and has to have a can every 2 hours and did not bring with us any of the cans. He will be getting Cisplatin once a week for 6 weeks. He has a track, so I am very worried about the nausea. Does it ever get any better? We have been going through all this for 9 months now. He had all the rad treatments and 7 Eurbatux, sorry about the spelling. I did not know that the Eurbatux was not the same as Cisplatin. So we were not prepared for all the side effects of the Cisplatin, the nurse said that if it was one of her family members that she would advise to at least try the Cisplatin. I guess we don't have any other options here. This is our last chance. I just hope he does not get so sick! As he has other health issues also. I guess all we can do is hope he can take this new drug, Thanks for listening Sue

Skiffin16's picture
Skiffin16
Posts: 8076
Joined: Sep 2009

I can understand, but Cisplatin seems to be one of the baseline chemo's for H&N Cancer.... You can see if they can get you a prescription for EMEND...it's for the day of and next two days after Cisplatin...very good for nausea.

They do have a lesser form of Cisplatin called Carboplatin, I had both. Cisplatin, Taxotere and 5FU (pumped for five days)...during a nine week cycle, then seven weekly doses Carboplatin and daily (35) rads.

They usually have a cooler with drinks of differing kinda or did at my Chemo Center...

Yes the first day is long...if he has a port, the first day is for figuring out how much and fast they can infuse the chemo...the next treatments are faster as they'll speed up the pumping process as long as he doesn't get nauseaous or have reactions...

Thoughts and Prayers,
John

sue5749
Posts: 170
Joined: Dec 2010

Will, Husband had his first Cisplatin treatment this morning. Was there 4 hours we go back in the morning for re-hydration for 2 hours then again the same the next day. He has Cisplatin every Monday for the next 6 weeks. So far he is doing pretty good. He said he felt a little nausea this evening the doctor gave him a pill that he puts on his tong and he saids that helped him.

ldguerra's picture
ldguerra
Posts: 41
Joined: Jul 2011

Hi SamsAngel

My husband went through that about 9 months ago, what I found help a lot was a Bioplus yogurt, this is fortified with Zinc and vitamin C, the one I had available was from Dos Pinos Costa Rica, so I don't know if it is available in the USA, he drank it 3 times a day and that control his nausea from cisplastin, after a week on this product he started to eat and throughout the treatment, of almost 3 months, he never stopped eating which helped a lot with the weight factor

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