Nausea

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Nausea

by Chasers04 on Fri Mar 23, 2007 12:00 AM

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My dad has had a PEG tube for about 8 days and for the past several he gets extremely nauseous and has been vomiting frequently.  His doctor ordered Reglan for motility and Phenergan for nausea to be administered with his tube feedings.  They don't seem to be helping much.  He just sleeps all the time most likely due to side effects of the Phenergan and not sleeping well at night. 

Anyone have any suggestions for dealing with the nausea that just doesn't seem to go away?  He keeps losing weight and just has no energy.

His tube is due to a fistula in his esophagus that was probably caused by radiation treatment from 2 years ago.  Until that heals or can be surgically repaired, he is not allowed ANYTHING by mouth.

 

RE: Nausea

by Dr_Kim on Fri Apr 06, 2007 12:00 AM

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On 3/23/2007 Chasers04 wrote:

My dad has had a PEG tube for about 8 days and for the past several he gets extremely nauseous and has been vomiting frequently.  His doctor ordered Reglan for motility and Phenergan for nausea to be administered with his tube feedings.  They don't seem to be helping much.  He just sleeps all the time most likely due to side effects of the Phenergan and not sleeping well at night. 

Anyone have any suggestions for dealing with the nausea that just doesn't seem to go away?  He keeps losing weight and just has no energy.

His tube is due to a fistula in his esophagus that was probably caused by radiation treatment from 2 years ago.  Until that heals or can be surgically repaired, he is not allowed ANYTHING by mouth.

 


My hope is that your father's nausea and vomiting has subsided by now. Sometimes, when a tube feeding if first administered, it can be difficult for the patient to tolerate. The registered dietitian, nurses and physician in charge of your father's care can work together to alter the delivery method, frequency of feedings, formula composition, etc. to increase the tolerance. As a registered dietitian who was board certified in delivering nutrients via tubes and veins to intensive care unit patients, I can attest to the value of "trying and trying again" when it comes to feeding someone like your dad. Here are some of my suggestions below. Please confer with your father's healing team before you begin any of my suggestions:

1) Consider changing the type of formula - if your dad is not on an isotonic formula, that is the first place to start. The dietitians will know which formulas are isotonic and can make a good selection for your dad. Isotonic formulas are easier to digest and therefore, may reduce the burden placed on an already compromised digestive system.

2) Consider changing the delivery method - if your father getting tube feeding formula by bolus injection, it would make sense to change the feeding to a continuous drip. They may wish to start the drip at 20 cc per hour and see how that is tolerated before increasing the volume.

3) Digestive enzymes and ginger have been used with great success in reducing nausea; however, their use and applicability need to be carefully evaluated by the medical staff there prior to use (drug interactions, safety of delivery given the gut's physical limitation or inflammatory state) may not make this suggestion feasible.

 You are right to be concerned. It is estimated that forty percent of cancer patients die from malnutrition related causes. Healilng of the fistula, or healing in general, can be halted without supplying the body with the proper nutrients. You need to get this tube feeding formula into your dad and it needs to stay in long enough to allow the nutrients to be absorbed and utilized by his body.

 One final comment: often sleeping disorders can stem from clinical depression. I would ask that you consider having your father evaluated for, and treated if appropriate, by a qualified health care professional in this area of expertise.

 Best wishes,

 Kim Dalzell, PhD, RD, LD, Author Challenge Cancer and Win! www.challengecancer.com

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