What can I do to manage the nausea I feel ?
Nausea is the feeling of being queasy or sick to your stomach. It can happen with or without vomiting (throwing up). Nausea can be caused by your cancer, or it may be a side effect of chemotherapy or radiation therapy. Other causes of nausea and vomiting include pain, fatigue, illness, medications, constipation, and the stress of coping with cancer. Feeling nauseous for a long time can affect your appetite and could cause you to lose weight. If you vomit a lot, you can become dehydrated (lose too much fluid). The best treatment for nausea or vomiting will depend on what is causing the problem.
Nausea that is chemotherapy-induced includes: acute nausea, occurring within the first 24 hours after your treatment; delayed nausea, occurring in the 6 days following your treatment; or anticipatory nausea, occurring 1 week prior to your treatment.
If you have nausea due to chemotherapy or radiation therapy, you may need to take prescription anti-nausea medication on a particular schedule to control your symptoms and better tolerate meals and specific foods. Examples of this type of medication include: Zofran/odansetron or Aloxi/palonosetron for acute nausea; metoclopramide, lorazepam, or diazepam/Ativan for delayed nausea.
If your nausea is a side effect of medications or supplements, you may feel better when you take the medications with food instead of on an empty stomach, or when you make other adjustments to your eating or medication plan. If one anti-nausea treatment does not work for you, another one might. Your health care team can help you find a treatment that makes you feel better.
Ideas for managing nausea and vomiting:
- Eat six to eight small meals a day instead of three large meals. Keeping some food in your stomach throughout the day can help you to feel better. Remain upright for an hour after eating.
- Sip on beverages that provide calories—such as fruit juices, sport drinks, or flat sugar-sweetened soda throughout the day. Drinking small amounts continually will help you get enough calories, nutrients, and fluids.
- Drink clear liquids as often as possible after vomiting to prevent dehydration and keep your mouth clean.
- Avoid foods that are very sweet, fatty, greasy, or spicy. Try eating cool, light foods.
- Eat dry foods (such as crackers, toast, dry cereal, or bread sticks) when you wake up and every few hours during the day when you are taking medications or when you feel nauseated.
- Avoid strong odors, which can cause nausea. Eat cool foods or room-temperature foods instead of hot foods. (Food odors are stronger when foods are hot.) Eat in a well-ventilated room that does not smell of strong food or cooking odors.
I don’t have any appetite. What can I do about this, I’m afraid I’ll lose weight and be tired ?
Loss of appetite (the desire to eat) is a common side effect and can be caused by use of certain medications, cancer and cancer treatments such as chemotherapy and radiation, constipation, fever, fatigue, nausea, or sadness, depression, grief, or anxiety.
It is important to try to overcome a poor appetite since not eating can lead to weight loss, weakness, and fatigue. Eating is part of your care routine, just as taking medications and having your treatments are a part. It is necessary to eat and drink fluids even when you don’t feel like it.
Review the medications you take with your doctor. For example, some medications for constipation, nausea, or pain can cause poor appetite. It might be possible to improve your appetite by changing the type of medication you take, the dose, or the medication schedule. Ask your doctor if a medication to increase your appetite could be right for you.
Eat small amounts throughout the day instead of eating big meals. Try half a sandwich, a bowl of yogurt, cereal and milk, custard, or a granola bar. Try using small dishes to help you feel like you have “just a little” to eat. Having a little food in your stomach all day long can help eliminate or reduce nausea. Make every bite count by choosing higher calorie foods.
Eat on a schedule, instead of when you feel hungry. For example, eat a small meal or snack every 2 or 3 hours or take a few bites every 30 to 60 minutes. Use the clock, TV shows, or commercial breaks to remind you to take a sip, eat a bite, or have a snack.
Eat foods that are easy to prepare to eliminate fatigue. Keep your pantry and freezer well stocked with foods that make quick and easy meals and snacks, such as single-serving entrées and ready-to-eat packaged foods. Keep a list of favorite recipes and meals on hand for friends and family members who help with cooking or shopping.
Choose drinks that are nourishing, high in calories, and high in protein. Do not fill up on low-calorie beverages like diet soda or coffee. Water, milk, broth, a smoothie, 100% fruit juices, sports drinks, or liquid nutrition drinks can be helpful.
Move around when possible. Walking and other gentle forms of exercise help encourage a better appetite. Make your surroundings cheerful. The distraction of a pretty table, flowers, or soft music may help you eat better.
How can I deal with constipation, and avoid having it recur ?
Constipation occurs when you cannot move your bowels, when you have bowel movements less often than normal, or when you have to push harder than usual to move your bowels. Constipation can be painful or uncomfortable. You may have infrequent stool (less than 3 times/week), have hard stool, or have a sense of incomplete elimination.
It is a common side effect of some types of cancer, cancer treatments such as chemotherapy, and changes in eating habits due to nausea. Constipation may also be caused by being less active than is normal for you, eating or drinking less than your usual amounts, taking certain medications, such as medications for nausea or pain, taking calcium or iron supplements, or prolonged bed rest.
The following ideas may help you keep your bowel movements regular and easy to pass.
Eat your meals at about the same time each day. Following a regular pattern of eating and drinking can be helpful. Use the bathroom at the same time each day as much as possible, and allow yourself enough time in the bathroom to have a bowel movement. Try not to rush yourself.
At breakfast, drink a hot beverage or eat hot cereal to stimulate a bowel movement. Prune juice or lemonade warmed to the temperature of hot tea may be helpful.
Try to drink at least 48 to 64 fluid ounces (6 to 8 eight ounce cups) of liquid each day. Track your intake on a piece of paper and record each time you drink. Getting enough fluid is especially important if you add more fiber to your diet or if you take medicines that can cause constipation. For variety, drink water, prune juice, warm fruit or vegetable juices, decaffeinated teas, or hot water with added lemon juice and honey. Fluids also include foods that are liquid at room temperature, like frozen ice pops, gelatin, or ice cream.
Consider slowly increasing the amount of fiber you consume each day. Increase the amount of fiber you eat by no more than 5 grams each day, and do not consume more than 25-35 grams of fiber per day. Increased fiber can help move food through your digestive system faster.
To get more fiber read the Nutrition Facts on food labels to find out how many grams of dietary fiber are in one serving of the food you are eating. Comparing similar products can help you choose higher fiber options.
Common foods that are high in fiber include fruit, vegetables, grains and cereals, beans and legumes, and nuts. Do not start a high-fiber diet without first talking to your doctor or Registered Dietitian(RD). Because high-fiber foods can fill you up quickly without providing lots of calories, they might not be the best choices if your appetite is poor. High-fiber foods can also be difficult for some people to chew, swallow, or digest.
Use a preventive routine to manage constipation. Ask your doctor, nurse, or dietitian to help you choose a stool softener and use it correctly, usually once or twice daily. You may find one works better than another, so if necessary try several different brands. Consider the short term use of a laxative, again with advice from your medical team. Have milk of magnesia on hand at home to help with constipation of several days, and ask your team if this is safe for you to use.
If possible, increase the amount of physical activity you do. Physical activity can help you move your bowels more regularly. Check with your doctor before starting any exercise.