The two nearly universal complications of cancer treatment are nausea and vomiting. While these symptoms are unpleasant, they are usually short-lasting, and disappear entirely when treatment is stopped. Over a period of months, however, even short bouts of digestive upset take a tool, and prolonged vomiting can even provoke a health emergency.
Why Vomiting is a Serious Symptom
Vomiting, referred to in the medical literature as emesis, is the way the body gets rid of food that should not be in the stomach. Sensory receptors lining the wall of the stomach, such as the chemoreceptors that detect possible poisons and the stretch receptors that tell the brain the stomach is too full, trigger the emetic reflex.
There are two ways vomiting can be dangerous to health. The first is the immediate loss of fluid and mineral electrolytes. Even one day of vomiting can cause dehydration and electrolyte imbalance. After two days of vomiting, many people getting cancer treatment will need to intravenous fluids to rehydrate tissues and correct mineral imbalances.
Why Nausea is a Serious Symptom
Nausea is the feeling that vomiting is about to happen. During recovery from cancer, this unpleasant condition is sometimes a signal that the body is defeating cancer. The immune system releases a tumor-killer known as interleukin-6 (IL-6). As IL-6 does its work, the central nervous system releases higher than normal levels of the well-known mood regulator serotonin.
The nerves lining the stomach and colon can produce levels of serotonin approaching the amounts made in the brain. As the brain and digestive tract release this chemical, there can be a feeling of happiness even while there is ongoing nausea. The nausea stops eating that would provide nutrients to the cancer the immune system is destroying, but it can also stop drinking that keeps the body hydrated. Moreover, the foods eaten or smelled during this kind of nausea become permanent triggers for a "nausea flashback," leading to feeling nauseous all over again.
So what can you do to stop nausea and vomiting? Here is what you need to do at least the week before you have chemotherapy:
- Plan for relief. Any drug you take to stop nausea and vomiting has to be administered before chemotherapy. If your physician does not volunteer information about the potential for digestive upset from your treatment, be sure to inquire and to ask for something to control the side effects.
- Practice avoiding stress. Fear can cause nausea and vomiting. If you are phobic about blood, needles, IVs, hospitals, or chemotherapy (and I am), consider simply keeping your eyes closed during treatment. Breathe slowly and deeply. This is often enough to reduce stress and prevent stomach upset. A skilled and caring nurse can help you deal with stress. Let them. If the emotional upset of cancer treatment is an ongoing problem, a medical hypnotist may be able to help.
- Make out a bland menu. Avoid sour, spicy, sugary, pungent, or strongly flavored foods the week you have chemotherapy. Do not prepare food the weeks you receive chemotherapy. Either have someone else prepare your food, or make single-serving bags to put in the freezer until you are ready to eat them. This will help prevent nausea flashbacks later.
- Stock electrolyte replacement to use in case you become dehydrated. Pure water is not enough to treat dehydration. Whether you use Pedialyte or popsicles, you colon needs at least a small amount of mineral salts and sugar to absorb water efficiently. Most products actually give you too much salt and sugar (although they are better than distilled water); the best option is a product based on rice syrup. Rice-based products such as Natural CeraLyte and CeraSport (not their Splenda-sweetened versions) release glucose and electrolytes slowly and offer the best approximation of electrolyte balance in the body. But if you cannot find Natural Cera products, consider diluting Gatorade or even sugar-sweetened Koolaid or a sugar-sweetened soft drink, or Pedialyte, for fluid replacement.
On the day you have chemotherapy:
- Avoid fragrant personal care products. These odors can also trigger nausea and, even months or years later, they can cause nausea flashbacks.
- Avoid high-fiber, high-fat, high-sugar, and vinegary foods. Fiber, even though it is normally good for you, fat, and vinegar all slow down the passage of food through the stomach, making it more likely to be lost through vomiting. Fat from almost any source also slows down the passage of food. Chips, dips, butter, oil, peanut butter, tahini, and whole milk can also cause nausea on the day you have chemotherapy. It is also important to avoid sourdough, cinnamon, and any product sweetened with xylitol, since all of these also slow down the emptying of the stomach into the small intestine.
- Avoid foods with strong flavors or strong odors, such as barbecue, broccoli, Brussels sprouts, cauliflower, curry, fish sauce, garlic, hard cheeses, hot peppers, ketchup, kimchee, onions, soy sauce, or Tabasco.
- When you do eat, eat sitting up. Do not lie down for at least 30 minutes afterward. This will keep food from backing up from the stomach into the esophagus.
- Most experts advise eating crackers, dry toast, and soft bread on the day you receive chemotherapy. This is OK for the days you get chemo, but on an ongoing basis you need much more protein and even some fat, along with vitamins, minerals, and plant nutrients.
To relieve nausea once it has started:
- Apply a cold pack or ice pack to the back of your neck.
- Open the windows and let in fresh air, if it is cool enough outside. Stuffy rooms and second hand smoke aggravate nausea.
- If you do not feel like eating, don't, at least for the day you receive chemotherapy. Try to wait until the nausea passes.
- If you mouth is not sore, brush your teeth and tongue. This keeps objectionable flavors and odors from accumulating.
- Even if you don't feel like drinking, you must stay hydrated. Small sips of ice water, ice chips, iced herbal teas, or iced tea, or small bites of all-fruit sorbets sometimes settle the stomach.
- Ginger capsules usually help relieve nausea, but they will not work if you are vomiting.
- Clear liquids and salty liquids are easy to keep down. If you choose miso, be sure not to eat the kombu (seaweed) usually served with it. Peppermint tea may be helpful if you have.
- If you take ondansatron to control nausea and vomiting, make sure you read the considerations for any herbal supplement to make sure they do not counteract the ondansatron.
Numerous scientific studies confirm the usefulness of acupressure in controlling nausea. This technique involves applying gentle pressure to the Neiguan (literally, "Inner Gate") or P6 acupoint to relive nausea after surgery, during surgery with a spinal tap, during and after chemotherapy, and well as during pregnancy. Applying pressure at this point works in children as well as adults.
To find your "Inner Gate" or P6 point, move two or three widths of your middle finger up your arm from the crease of your wrist to a point in between the two tendons. Take your thumb and index finger and press firmly on both sides of your arm (one side with your thumb, one side with your finger) for 5 to 30 seconds at a time whenever you feel nauseous.
Alternatively, you can rub your wrists together at the P6 point, or buy an acupressure wristband, available from www.travelband.com and many other vendors. There is usually a video on how to use acupressure for nausea on YouTube. Just be sure to use light pressure, and to stop if you feel pain in your wrist.
For Further Reading:
- Rebecca Katz with Mat Edelson. The Cancer-Fighting Kitchen: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery. Celestial Arts, 2009.
