Vomiting up anything he swallows

kdempers

Hi, my dad was diagnosed with oesophageal cancer in September last year (as a result of Barretts disease). He had a round of chemo and radiation in preparation for surgery early 2011 but the PET scan in January showed the Cancer had moved to a node in his neck. He is no longer a viable patient for the surgery.

He is currently undergoing another round of chemo (EOX treatment).

He has had his oesphagus stretched twice as swallowing has become a real problem. Scopes indicate that it is not the tumour causing the blockage but the scar tissue caused by the radiation. He spent last week in hospital due to dehydration and weakness etc. and was released yesterday. However, within the last 24 hours he has literally started throwing up anything he attemps to swallow - including clear liquids like water (which he was managing to get down and keep down before). I have looked online for reasons as to why he might suddenly be vomiting up everything (he is not nauseas) but can find very little info.

Can anyone perhaps offer me some advice.
Thank you so much
KD

jojoshort

Our experience
My husband couldn't even keep saliva down as his esophagus had constricted so much. Despite possible complications with an esophageal stent (there are many and they are serious), he went ahead with a top-notch nationally known gastroenterologist and had one installed. He can now eat and drink easily with proper precautions. He is only a week with the stent, and we are hopeful it will remain problem-free.

The docs did a barium swallow to determine how constricted his esophagus was before recommending the stent. But note that my husband did not have any radiation. Also important is that he was done with chemo, so there was no further tumor shrinkage expected which can displace the stent--an important consideration.

Just our experience--so far.

Good luck,
Jo-Ann

kdempers

jojoshort said:

Our experience
My husband couldn't even keep saliva down as his esophagus had constricted so much. Despite possible complications with an esophageal stent (there are many and they are serious), he went ahead with a top-notch nationally known gastroenterologist and had one installed. He can now eat and drink easily with proper precautions. He is only a week with the stent, and we are hopeful it will remain problem-free.

The docs did a barium swallow to determine how constricted his esophagus was before recommending the stent. But note that my husband did not have any radiation. Also important is that he was done with chemo, so there was no further tumor shrinkage expected which can displace the stent--an important consideration.

Just our experience--so far.

Good luck,
Jo-Ann

Stent
Thank you SO much for coming back to me. My dad is back in hospital this evening. They apparently injected iodine into him and then did some sort of scan to try and understand why the oesophagus has suddenly closed completely. Our oncologist is very anti a stent. Says we should make that our very last resort. But, he is also anti a feeding tube which doesn't leave my father with too many options.
Am hoping these test results may give us more clairity as to what the next steps should be.
My heart breaks for my dad. He currently has no quality of life at all. It is incredibly sad.
I hope your stent stays 100% problem free.
All the best.
Karen

nancyann3

kdempers said:

Stent
Thank you SO much for coming back to me. My dad is back in hospital this evening. They apparently injected iodine into him and then did some sort of scan to try and understand why the oesophagus has suddenly closed completely. Our oncologist is very anti a stent. Says we should make that our very last resort. But, he is also anti a feeding tube which doesn't leave my father with too many options.
Am hoping these test results may give us more clairity as to what the next steps should be.
My heart breaks for my dad. He currently has no quality of life at all. It is incredibly sad.
I hope your stent stays 100% problem free.
All the best.
Karen

Hi Karen
Funny how docs differ so much in opinions. Our surgeon put the stent in first thing. He said it was important to be able to swollow your own saliva. Yes we did have some problems with the stent, but it did work and allowed Steve to eat. Later on in treatment the surgeon also placed a jtube. We then had two avenues to eat with. If Steve was eating the jtube just stood idle, but it was there if we needed it. Since the surgery in Feb, their is no need for the stent anymore, but we still have the jtube. Jtube has been in place for a year now.

I as a caregiver cant complain about either the stent or jtube. The stents took more managing, but gave Steve several month of the pleasure of eating. The jtube is just plain "old realiable". It is used to this day and provides him with hydration and calories, and me of peace of mind. Dehydration and starvation would have killed Steve a long time ago, if it wasnt for them. Way before the cancer would have.

I hope your dad gets his eating trouble taken care of.

Take care
Nancy

kdempers

nancyann3 said:

Hi Karen
Funny how docs differ so much in opinions. Our surgeon put the stent in first thing. He said it was important to be able to swollow your own saliva. Yes we did have some problems with the stent, but it did work and allowed Steve to eat. Later on in treatment the surgeon also placed a jtube. We then had two avenues to eat with. If Steve was eating the jtube just stood idle, but it was there if we needed it. Since the surgery in Feb, their is no need for the stent anymore, but we still have the jtube. Jtube has been in place for a year now.

I as a caregiver cant complain about either the stent or jtube. The stents took more managing, but gave Steve several month of the pleasure of eating. The jtube is just plain "old realiable". It is used to this day and provides him with hydration and calories, and me of peace of mind. Dehydration and starvation would have killed Steve a long time ago, if it wasnt for them. Way before the cancer would have.

I hope your dad gets his eating trouble taken care of.

Take care
Nancy

Stents and jtubes
Hi Nancy, thanks so much for your post. Interesting to hear such a different opinion around stents. Did the stent result in severe reflux and heartburn problems? Besides possibly rupturing the oesophagus, our doctor told my dad that oanother problem with stents is that once they're inserted he would never lie down again (as his valve would be permanently open). My dad already suffers from severe reflux so that has made him very weary of having the procedure done. That having been said - he will most definitely die of deydration/ starvation unless something is done so I am not sure we have too many choices.
All the best and take care
Karen

jojoshort

kdempers said:

Stents and jtubes
Hi Nancy, thanks so much for your post. Interesting to hear such a different opinion around stents. Did the stent result in severe reflux and heartburn problems? Besides possibly rupturing the oesophagus, our doctor told my dad that oanother problem with stents is that once they're inserted he would never lie down again (as his valve would be permanently open). My dad already suffers from severe reflux so that has made him very weary of having the procedure done. That having been said - he will most definitely die of deydration/ starvation unless something is done so I am not sure we have too many choices.
All the best and take care
Karen

We're 9 days with the stent
And it's been problem free so far. But Steve sleeps in the recliner anyhow. He sleeps with his head/upper body elevated. He doesn't eat 2-3 hours before bedtime. He is on a "magic mouthwash" maalox swallow after eating (contains lydocaine, too). He takes 40 mg pantoprazole 1/2 hour before eating twice a day. He eats small bites, chews it well and rinses it down with plenty of fluids.

Last night he had cream of broccoli soup and ground hamburger in gravy. Ate it all up, well, mostly.

But don't forget that he isn't on chemo and his tumor won't shrink and dislodge the stent. We would more likely have to worry about tumor ingrowth. We decided it was worth the try, and had a highly respected gastro guy put it in (Gastroenterologist working out of Mass General, and he's an instructor at Harvard Medical School, plus lots of research articles).

Please feel free to email me anytime. As I said earlier, though, we are only just over a week with it so perhaps others like Nancy have longer-term experience.
Jo-Ann

rose20

KD..
I hope they find out what is causing the problem. My brother has had this very same trouble from almost since the time of his diagnosis.
He had trouble eating and throwing up before diagnosis and so when he was diagnosed they immediately placed a stent.
Funny how doctors say different things about the stent, they told my brother the stent was not to help with eating but just to keep the esophagus from closing up completely.
And true enough my brother has only been able to eat very small portions of anything and mainly only soft foods, but now he got to the point of not being able to eat anything at all and not even drink.
He was severely dehydrated and had to be placed in the hospital and after being hydrated he felt like a new person.
A very nice lady here name Sherri had given some advice as to what worked with her husband and that is hydration at least 3 times a week and Mucinex (OTC) for the phlegm.
Well I just heard from my sister-in-law yesterday that they began my brother on a new med MU GUARD, and Mucinex and after only one day he has stopped the throwing up and had taken in 1000 calories without throwing up!!!
He will now go every Friday for hydration as well. So today he goes for fluids.
The stent never helped my brother to eat. So wished he never had that placed, it has caused most of all his pain, but they will not remove it because they said it is still in place and has not moved.
I am confused as to why your dad's doctor is not considering a feeding tube.
I will pray your dad gets some relief soon. I know how helpless you feel seeing him in this condition.

nancyann3

kdempers said:

Stents and jtubes
Hi Nancy, thanks so much for your post. Interesting to hear such a different opinion around stents. Did the stent result in severe reflux and heartburn problems? Besides possibly rupturing the oesophagus, our doctor told my dad that oanother problem with stents is that once they're inserted he would never lie down again (as his valve would be permanently open). My dad already suffers from severe reflux so that has made him very weary of having the procedure done. That having been said - he will most definitely die of deydration/ starvation unless something is done so I am not sure we have too many choices.
All the best and take care
Karen

Dont remember much heartburn
When the stents went in, we elevated the bed and took precautions that way. Also he took prilosec or some kind of acid reducer to keep the acid down in the belly. When the esophagus is held open it can cause things to wash back. Steve's stents did move and cause some bleeding, but that was due to the tumor shrinking. I have heard many stories about the stents becoming embedded into the tissues of the esophagus, but Steve's were metal surrounded in plastic so that couldn't happen. And again, he was in treatment and cancer was shrinking, not growing. Steve has two different kind of stents. The very first was all plastic and had a lot of force outward. It did cause a lot of pain. The second two were metal with the plastic surrounding them and they didn't cause pain when in place.

I agree with a lot of people here that the best supportive care to have is the jtube. If I would have known in the beginning what I know now, I would have insisted on one at time of diagnoses. Their is nothing more to say about the jtube, other then its just plain "ole reliable". In Steve's case if it would have been there in the beginning, it would have saved some weight loss and dehydration issues we had. Weight loss and dehydration just taxes the body more. The body already has so much to go through. Feeding the body and keeping it hydrated helps things and makes the patient feel better. Its really no different then putting on a pair of glasses if you cant see right. It is a aid to help you eat. We have used ours to feed, to drink, to give meds. When he was in treatment and dehydration was a issue and we couldn't get iv fluids, we would hang a bag of water and let it drip. We have used ours with a pump and without. We also push liquid with a syringe. I have crushed meds and put in it. Anything that is liquid will go. You just have to remember that it is the small intestine that you are going into, so small amounts at a time.

We have been using the jtube for a year now. Steve would not still be here if wasnt for it. We know it will not cure him and the cancer will win someday, but the tube will help him feel better. Some may say that the jtube shouldn't be used on a terminally ill person and that is their right, but Steve got to see his son turn 13 yesterday. He got to see him get his first pellet gun and give him pointers on how to take care of it. Priceless moments to both Steve and our son. He wouldn't have seen that without the jtube. My goal now is that he can see his daughter turn 16 on Oct. 9th. Seems like a long shot right now, but who knows.

Take care

JohnJB

nancyann3 said:

Hi Karen
Funny how docs differ so much in opinions. Our surgeon put the stent in first thing. He said it was important to be able to swollow your own saliva. Yes we did have some problems with the stent, but it did work and allowed Steve to eat. Later on in treatment the surgeon also placed a jtube. We then had two avenues to eat with. If Steve was eating the jtube just stood idle, but it was there if we needed it. Since the surgery in Feb, their is no need for the stent anymore, but we still have the jtube. Jtube has been in place for a year now.

I as a caregiver cant complain about either the stent or jtube. The stents took more managing, but gave Steve several month of the pleasure of eating. The jtube is just plain "old realiable". It is used to this day and provides him with hydration and calories, and me of peace of mind. Dehydration and starvation would have killed Steve a long time ago, if it wasnt for them. Way before the cancer would have.

I hope your dad gets his eating trouble taken care of.

Take care
Nancy

Stent Info
When swallowing became difficult, I had a PEG Tube installed. That was about 6 weeks ago and has not been a problem at all. Right now I have no problem swallowing fluids and my favotite meal has become mashed potatoes and gravy, but it's hard to eat enough mashed potatoes and gravy! :-) Boost and Ensure are good and are easy to swallow . I use the feeding tube to feed myself the canned liquid nutrient prescribed by the Nutritionist - "Jevity". My target has been set at 2800 calories/day and I routinely achieve that.

My next concern is the possibility of getting to the point where I can't swallow saliva, so I have a consultation next week with a GI specialist to discuss the stent options.

One problem is that I don't know what questions to ask!
Are there different types of stents?
What are the possible downsides of a stent?
Things like that.

I have had one round of chemo, no surgery, no radiation, but am trying to gain some weight and stength back before my next round of chemo.

Any and all information gratefully accepted!

Regards,

John

jojoshort

JohnJB said:

Stent Info
When swallowing became difficult, I had a PEG Tube installed. That was about 6 weeks ago and has not been a problem at all. Right now I have no problem swallowing fluids and my favotite meal has become mashed potatoes and gravy, but it's hard to eat enough mashed potatoes and gravy! :-) Boost and Ensure are good and are easy to swallow . I use the feeding tube to feed myself the canned liquid nutrient prescribed by the Nutritionist - "Jevity". My target has been set at 2800 calories/day and I routinely achieve that.

My next concern is the possibility of getting to the point where I can't swallow saliva, so I have a consultation next week with a GI specialist to discuss the stent options.

One problem is that I don't know what questions to ask!
Are there different types of stents?
What are the possible downsides of a stent?
Things like that.

I have had one round of chemo, no surgery, no radiation, but am trying to gain some weight and stength back before my next round of chemo.

Any and all information gratefully accepted!

Regards,

John

Some stent info
Hi John,
I'll throw out some problems with stents first:
They can cause unremitting pain for some patients
Breakthrough bleeding
Tumor ingrowth into the stent
They can migrate into the stomach if they place the stent and then your tumor shrinks

since you are going for more chemo, I'd be concerned about the possibility of migration.

My husband had a stent placed by someone who placed a whole bunch of them. I don't think you want your local gastro guy who places only a few a year to do it. Once placed, they can be difficult or impossible to remove. Steve had a metal stent, partially coated with plastic. The ends are left uncoated to reduce the incidence of migration. They expand to wedge itself in the esophagus. For people with tumors in the higher portion of their tract, it can also then push the tumor "out" into the lungs, not a good thing at all.

So you will have to have a barium swallow to see how your tract looks before they can recommend anything, if anything. We were quite hesitant to do it with the record of problems reported on this website, but we did our homework and got a Harvard instructor working at Mass General who had a lot of experience with this sort of thing. It worked like a charm for Steve, (after a day or two of discomfort). He was able to swallow his own saliva and eat comfortably right up to his last days. He needed to chop his food, particularly proteins like chicken or beef, up finely or else just avoid such things and enjoy more porous foods, like soups and ground beef instead. Washed each bite down with plenty of fluids. Once you have a stent, that is your M.O. for eating, always.
But also, Steve was "done" with chemo, so his tumor wasn't shrinking and the odds of migration were quite slim. Also, his tumor really wasn't the kind that grew into his esophagus, so the ingrowth problem wasn't a concern, either.
I wish he had done it a month earlier; it would have allowed him to enjoy a few more fun family dinners that he had trouble with before it. But caution is advised, and ask those questions before committing.
Jo-Ann

LeeinLondon

choking?
Hello KD;

Sorry for what your dad is going through. I recently had a feeding tube installed after increasing difficulty swallowing. I would vomit almost anything except soup, and I wasn't nauseous, it was my gag reflex and the simple fact that food was backing up in my esophagaous. Can your father stomach liquids?

JohnJB

jojoshort said:

Some stent info
Hi John,
I'll throw out some problems with stents first:
They can cause unremitting pain for some patients
Breakthrough bleeding
Tumor ingrowth into the stent
They can migrate into the stomach if they place the stent and then your tumor shrinks

since you are going for more chemo, I'd be concerned about the possibility of migration.

My husband had a stent placed by someone who placed a whole bunch of them. I don't think you want your local gastro guy who places only a few a year to do it. Once placed, they can be difficult or impossible to remove. Steve had a metal stent, partially coated with plastic. The ends are left uncoated to reduce the incidence of migration. They expand to wedge itself in the esophagus. For people with tumors in the higher portion of their tract, it can also then push the tumor "out" into the lungs, not a good thing at all.

So you will have to have a barium swallow to see how your tract looks before they can recommend anything, if anything. We were quite hesitant to do it with the record of problems reported on this website, but we did our homework and got a Harvard instructor working at Mass General who had a lot of experience with this sort of thing. It worked like a charm for Steve, (after a day or two of discomfort). He was able to swallow his own saliva and eat comfortably right up to his last days. He needed to chop his food, particularly proteins like chicken or beef, up finely or else just avoid such things and enjoy more porous foods, like soups and ground beef instead. Washed each bite down with plenty of fluids. Once you have a stent, that is your M.O. for eating, always.
But also, Steve was "done" with chemo, so his tumor wasn't shrinking and the odds of migration were quite slim. Also, his tumor really wasn't the kind that grew into his esophagus, so the ingrowth problem wasn't a concern, either.
I wish he had done it a month earlier; it would have allowed him to enjoy a few more fun family dinners that he had trouble with before it. But caution is advised, and ask those questions before committing.
Jo-Ann

Some Stent Info
Jo-Ann -
Thank you very much for your input! It is exactly the type of help I am looking for.
I have found that unless you ask specific questions, the doctors do not provide very much info.

The GI specialist I will see has installed many stents. He is with Jefferson University Hospital in Philadelphia. Philadelphia is the only place in SE Pennsylvania where stent specialists are found. I have pretty good insurance and can afford the luxury of shopping for capability, not price.

Thanks to you, I now have the beginings of a list of questions.

Thanks again,

John

JohnJB

jojoshort said:

Some stent info
Hi John,
I'll throw out some problems with stents first:
They can cause unremitting pain for some patients
Breakthrough bleeding
Tumor ingrowth into the stent
They can migrate into the stomach if they place the stent and then your tumor shrinks

since you are going for more chemo, I'd be concerned about the possibility of migration.

My husband had a stent placed by someone who placed a whole bunch of them. I don't think you want your local gastro guy who places only a few a year to do it. Once placed, they can be difficult or impossible to remove. Steve had a metal stent, partially coated with plastic. The ends are left uncoated to reduce the incidence of migration. They expand to wedge itself in the esophagus. For people with tumors in the higher portion of their tract, it can also then push the tumor "out" into the lungs, not a good thing at all.

So you will have to have a barium swallow to see how your tract looks before they can recommend anything, if anything. We were quite hesitant to do it with the record of problems reported on this website, but we did our homework and got a Harvard instructor working at Mass General who had a lot of experience with this sort of thing. It worked like a charm for Steve, (after a day or two of discomfort). He was able to swallow his own saliva and eat comfortably right up to his last days. He needed to chop his food, particularly proteins like chicken or beef, up finely or else just avoid such things and enjoy more porous foods, like soups and ground beef instead. Washed each bite down with plenty of fluids. Once you have a stent, that is your M.O. for eating, always.
But also, Steve was "done" with chemo, so his tumor wasn't shrinking and the odds of migration were quite slim. Also, his tumor really wasn't the kind that grew into his esophagus, so the ingrowth problem wasn't a concern, either.
I wish he had done it a month earlier; it would have allowed him to enjoy a few more fun family dinners that he had trouble with before it. But caution is advised, and ask those questions before committing.
Jo-Ann

Some Stent Info
Jo-Ann -
Thank you very much for your input! It is exactly the type of help I am looking for.
I have found that unless you ask specific questions, the doctors do not provide very much info.

The GI specialist I will see has installed many stents. He is with Jefferson University Hospital in Philadelphia. Philadelphia is the only place in SE Pennsylvania where stent specialists are found. I have pretty good insurance and can afford the luxury of shopping for capability, not price.

Thanks to you, I now have the beginings of a list of questions.

Thanks again,

John