Nausea and Vomiting
Dear OncoLink "Ask the Experts,"
What is nausea and vomiting? What can I do to prevent it? When should I call my doctor about it? How is it treated?
Karen Bruchak, RN, MSN, MBA, of the Abramson Cancer Center of the University of Pennsylvania responds:
What is Nausea and Vomiting?
Nausea means being sick to your stomach and vomiting means throwing up. Nausea can happen even when a person is not thinking about food, and a person can vomit even when they have not eaten. The most common causes of nausea and vomiting are eating something that disagrees with you, or an infection or virus. In cancer patients, nausea and vomiting can also be caused by the cancer itself (especially cancers of the gastrointestinal tract such as the stomach, liver, and colon), by cancer treatments, especially chemotherapy and radiation therapy, or by other medications that may be given to cancer patients.
What Can I Do to Prevent Nausea and Vomiting?Unlike many other side effects of cancer and its treatment, there are specific actions that you can take to prevent or minimize nausea and vomiting. These include:
- Make changes in your diet
- Eat small amounts of food 5-6 times throughout the day, instead of three large meals.
- Keep crackers or bread within reach or at the bedside.
- Realize that taste changes may occur. Seek out both food preferences and foods that don't agree with you.
- DO NOT force yourself to eat favorite foods when you are nauseated. This could cause a permanent dislike of those foods.If you develop a distaste for red meats and meat broths, substitute with other high protein foods such as cheese and eggs.
- Eat foods at room temperature to decrease the aroma, whichoften contributes to the nausea and vomiting.
- Eat foods with long lasting, pleasant aromas such as lemondrops or mints.
- Avoid foods that are sweet, fatty, salty, and spicy or have strong odors as they may make the nausea and vomiting worse.
- DO NOT eat for 1 to 2 hours before treatment if nausea occursduring or within a few hours after your radiation or chemotherapy treatment.
- Increase fluid intake. Try to drink about 3 quarts of fluid per day, unless your doctor or nurse tells you not to do so. This will help to prevent dehydration and malnutrition. Specific points to keep in mind include:
- Drink clear liquids (liquids that you can see through when in a glass), including clear fruit juices (apple, cranberry, grape),ginger ale, and water. Sip the fluids slowly.
- Popsicles, jello, ice chips and frozen juice chips are also excellentfluid sources that tend to be tolerated well because they areabsorbed slowly.
- Drink sports drinks, such as Gatorade, which help to replace certain electrolytes lost when vomiting.
- Avoid exposing yourself to any unnecessary stimulation or excitement.
- Whenever possible, stay in an area with close access to a bathroom, if needed in a hurry.
- If nausea and vomiting occur in anticipation of a visit to the doctor, or to receive a treatment, such as radiation therapy or chemotherapy, you may be experiencing something called "anticipatory nausea and vomiting". This means that you have formed a connection in your mind between the event (seeing the doctor or receiving a treatment) and the nausea and vomiting. If this occurs, talk to your doctor or nurse. They will be able to recommend a therapist skilled in hypnosis or other relaxation techniques to help prevent this from happening again.
- Stay in a quiet, restful environment.
- Rest after meals. Sitting up for about an hour after meals is usuallyvery helpful to lessen nausea.
- take rest periods and naps throughout the day.
- Try a distraction, such as soft music, television, or reading.
- Use good mouth care frequently, especially after episodesof vomiting.
- DO NOT force foods or fluids if you are vomiting.
- DO NOT lie flat on your back. If you arebedridden, be sure to have someone help you to turn onto your side so that you do not inhale it into your lungs.If you are vomiting frequently, do not eat for 4 to 8 hours, then start with clear liquids.
- DO NOT use over-the-counter anti-nausea medications (Pepto-Bismol, Emetrol) unless instructed to do so by your doctor ornurse. If you have tried the measures described above and your arestill having nausea or vomiting, discuss the situation with your doctor or nurse, who will give you further instructions.
When Should I Call My Doctor?Call your doctor immediately if you have any one or more of the following:
- If the vomiting episodes occur more than 3 times per hour for 3 or more hours.
- If there is any blood in the material vomited.
- If the material vomited looks like coffee grounds.
- If you are concerned that some of the material vomited has been inhaled into your lungs.
- If you are unable to take more than 4 cups of fluid or ice chips in 24 hours, or unable to take more substantial foods for more than 2 days.
- If the you are unable to keep their medications down.
- If the you are noticeably weak or dizzy.
- If the patient loses consciousness.
How are Nausea and Vomiting Treated?Prevention of nausea and vomiting is always the best. If, however, the actions on your part as described above are not successful, your doctor may order the following:
- Over-the-counter anti-nausea medications such as Emetrol. If the patientis unable to keep medications down, the doctor may prescribe the medication in a suppository form.
- IV fluids and/or nutrition to replace the fluid and electrolytes being lost through vomiting.
- Prescription anti-nausea medications such as Compazine.