Nausea and Vomiting
Sometimes as the tumor grows or swelling increases, certain patients can experience nausea or vomiting that can last for several days or even a couple of weeks (this is not the norm, however)
Over-the-counter medications are often ineffective at stopping nausea, and the same can be true for prescription drugs that used to work fine to control chemo-related nausea (eg, Zofran, Kytril, or Anzemet)---but doctors do tend to have the caregiver use these tools, one after another, in an attempt to find the right drug or combination
Raising the Decadron dose can end this symptom, but only in cases in which swelling is the cause of the nausea
If a decent increase of the Decadron has not brought about improvement of nausea within 4 days, it is possible that the cause is related to fluid buildup in the brain rather than tissue swelling---many doctors will order discontinuation of Decadron after it has become clear it won't bring relief, and for end-stage patients they usually will not express concern about fluid-related causes, since relief often requires surgery
In some cases when the bowels are impacted or when a bowel movement has not occurred after a prolonged period (5 days or more), nausea may reflect the body's attempts to rid itself of the toxins in an alternate way
Hydration becomes even more important when fluids are being lost due to nausea
The Signs
Aware of increasing weakness
"Sick of feeling sick"
Fearful that the nauseous feelings will continue until death comes
Defeated by the illness (emotionally as well as physically wiped out)
May be depressed and may express regret at not having "let this thing take me a long time ago"
Completely turned off of food
Sorry or guilty about "making more work" for the caregiver
What the patient may be feeling
What the caregiver may be feeling
Helpless about finding comfort for the patient
Annoyed when hospice workers and doctors can't come up with an effective solution, since "they're the experts"
Distrustful that members of the medical caregiving team may not care about the situation as they should
Desperate to be able to tell the patient that a solution has been found that should work
Worried that the increasing weakness will make it hard to rebound from this setback
Frustrated if the patient resists efforts to increase strength (through food) or hydration (through liquids)
Physically tired from the extra cleaning duties
Emotionally exhausted from worrying about the patient's comfort and quality of life
Fatigued from lack of sleep if caregiving duties extend into the bedtime hours
Worried that it may become necessary to hospitalize the patient or move him or her to an inpatient facility if the situation continues
Overextended if dealing with young children or other dependents at the same time
Wondering if "this is how it's going to be" through to the end time
Desperate to come up with soothing recipes or some other home-based solution that may work after medications have failed
Anxious to reassure the patient that the caregiving is something he or she is honored to do and that the focus is just on wanting the patient to feel better soon
Resentful and burned out if this symptom has made it impossible to leave the patient at home alone or in others' care
Worried that an odor in the house or the possibility of more vomiting will keep visitors from coming around
Annoyed and defensive when well-meaning relatives and friends offer advice on how to make the nausea stop
Personally turned off of food after performing nausea caregiving duties over a period of several days, as if "unable to get the smell out of my mind"
Angry that prolonged nausea seems like the addition of insult to injury after a difficult enough battle with the tumor
Eager for and a little envious of the peace that most end-stage patients experience
A Decadron increase (check with hospice or the doctor) usually provides an answer within a couple of days. If no change occurs after the dose is raised significantly, brain swelling becomes a less likely cause of nausea. Some people, however, do find quick, effective relief after the Decadron is resumed or raised, providing an almost immediate answer as to the cause. If the doctor has ordered a decent increase in Decadron and there is no change at the 48-hour mark, call in with that update and ask what to do next, rather than wait to see if the third day brings improvement (it may be unlikely at that point).
Gummi bears and ginger ale can bring relief to some patients experiencing nausea---and there are many old wives' recommendations as well---but usually in the end time the causes of nausea are legitimate obstacles that can't be addressed by such traditional measures. In other words, none of these things one would call upon for routine nausea would be expected to shrink a tumor's size, reduce brain swelling, or decrease fluid pressure from around the brain, which are on the current list of suspects. Likewise, the many over-the-counter products to ease stomach upset are unlikely to end the problem, although they might bring about temporary comfort. Caregivers should be aware that these traditional tools may not bring about desired results, so if relief has not been found within a day or two, don't hesitate to push the doctor for more aggressive solutions. Otherwise, it is highly possible that the patient will be put through a string of ineffective options while continuing to feel no different.
If the doctor has been able to determine that the nausea is indeed brain related (rather than just a side "bug" the patient picked up from someone in the house), and if a sizable Decadron increase has not brought about relief, it may be possible that the cause is excess fluid around the brain. Most doctors will choose not to address this possibility in an end-stage patient because the final result is not likely to change; some, however, may view it as more of a comfort issue and may be willing to pursue the fluid possibility. A hospital admission and administration of IV mannitol can sometimes very quickly relieve fluid buildup around the brain without the need to surgically insert a shunt for drainage (as one would do earlier in the course of the disease). The mannital option may be worth probing with the doctor. Mannitol is not given often or lightly, but in the right circumstances it can provide tremendous relief with fast results.
Encourage the consumption of water or a fluid replacement product such as the Pedialyte (fluid/electrolyte) products used in children after prolonged diarrhea/
vomiting. Keep a sports bottle filled at all times and within reach of the patient, and offer it frequently.If the patient had not had a bowel movement in a prolonged period (a week, give or take) before the nausea began, make sure to address this issue with hospice or the doctor. Note that lack of bowel activity after nausea began may be a result of having very little food remain in the system.
Some patients manage to combat cancer nausea with fruit smoothies (see the bottom of the Decreased Eating page for recipes and links).