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    Suggest treatment for nausea while on treatment for mesothelioma

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Posted on Fri, 3 Jun 2016 in Lung and Chest disorders
Question: My husband has many problems related to his recurrence of mesothelioma. He has just been in hospital, and has been treated for a cellulitis infection in the scar from initial EPP surgery, fluid overload, and Heart flutter. He is currently on a clinical trial for an immunotherapy drug called Keytruda, but has only had one treatment so far, another due next Wednesday. His main, ongoing problem is nausea. We are disappointed that even after treatment in hospital for these other conditions, the nausea remains. He has tried all regular anti nausea drugs......Motillium has helped successfully in the past, but not any more. I wonder if his nausea could be caused by a stomach bile problem, as he rarely vomits food, it is always more a clear light greenish yellow vomit. Often it is more dry retching, and he can control keeping the vomit down, but it is still horrible, for himself, and others. Often the vomit is before a meal, even though he has had the Motillium, and once he has got over the vomit or dry retching, he can then eat a little food. What do you think this problem could be? and is there a medication you coulkd suggest? He snacks on dry biscuits between meal, trying to keep something in his stomach at all times, but we don't know what else to do. He is living on borrowed time, and we want the time to be happy, not spoiled by constant nausea.
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Which drugs he had taken for nausea?

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Motilum is having domperidone.
There are other drugs available for nausea in cancer patients.
Drugs like ondensetron, granisetron, palonosetron, olanzapine, aprepitant, steroids etc
So please let me know which drugs he already taken for nausea problem.
I will be happy to help you further.
Wishing good health to your husband.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 13 minutes later
He has tried ondansetron, ( Zofran )metoclopramide ( Pramin, Maxalon ), prochlorperazine ( Stemzine, Stemitil ), and Domperidone ( Motillium. None of these help. He can't have steroids while he is on the clinical trial. And the GP is reluctant to try any other drugs which will have a sedative effect.

I want to know if there is something that would reduce the stomach acid / bile from building up, as I wonder if this is what is making him sick.

He is not on chemotherapy at the moment, and the Keytruda clinical trial is unlikely to cause nausea.

At the moment his tumour regrowth is very small, and should not be causing nausea. So we are trying to determine the cause of the nausea, and find something to help.
doctor
Answered by Dr. Kaushal Bhavsar 6 minutes later
Brief Answer:
Has he ever undergone upper GI scopy?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, he should definitely take olanzapine.
It is having promising role in nausea.
For stomach acid issue, he should take antacids like pantoprazole or rabeprazole.
Please let me know
1. Is he taking any antacid drug?
2. To determine cause for nausea, upper GI (gastrointestinal) scopy is must. Has he ever undergone this?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 31 minutes later
Thank you for your quick answer.

I looked up olanzapine,......it is used for schizophrenia and other mental illness, so presumably is a strong psycotic drug......so I assume it could have weird side effects in a mentally well person .......don't like the sound of it....can you tell me more about it?

He is already on pantoprozole, 40mg tablet every morning. This is to counteract any possible damage to his stomach caused by Cisplatin chemotherapy he has had in the past. I am now wondering if the nausea could relate back to that......he hasn't had any chemotherapy since December 2105.

What sort of problems would a gastroscopy show?

Kind regards

XXXX

doctor
Answered by Dr. Kaushal Bhavsar 55 minutes later
Brief Answer:
Olanzapine is useful I'm resistant cases of nausea.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you are right. Olanzapine is used mainly for schizophrenia. But it is excellent drug to reduce resistant nausea.
It is not having great sedative effect. So don't worry about sedation.
Initially you want peaceful time for him. And in medical terms, this means lesser symptoms and more comfort. So in my opinion, he should definitely start olanzapine. No harm in mild sedation. In fact it is good for him for mental peace at this point of life.
Regarding upper GI scopy, it will tell you if any lesion present in upper airways, esophagus, stomach and duodenum.
Lesions like mass or ulcers or polyps can cause nausea.
We can identify them is present.
Please let me know
1. Have you tried other home remedies for nausea?
2. How is he vomit? I mean is it projectile in nature?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 16 minutes later
Thank you for your kind and thoughtful reply.

I will ask the local GP about Olanzapine and a gastroscopy when we see him on Friday.

His vomit starts with a feeling of nausea, and once it gets to that stage nothing, no drug, will fix it. He always has Domperidone 30 mins to an hour before meals, and this used to prevent the nausea, but it doesn't make any difference now. He gets to the stage where he dry retches, and can quite often force himself not to vomit, and then the nausea will go away. Other times he does vomit, and it is quite forceful, but he doesn't generally bring up a meal, just a bit of greenish yellow liquid. Then he feels a bit better, and can have a little bit to eat.

I am interested in any home remedies to try if you know of anything that could help. He has tried nibbling ginger, but that doesn't help.
The funny thing about this nausea and vomiting, is that it is not every day, but about every second day. We can tell early if it is going to be a good day, or a bad day, Yesterday he was sick before every meal, today, it is lunch time, and he is eating a meat pie! Not that he eats much, even on a good day.

I do appreciate your answers thankyou!
doctor
Answered by Dr. Kaushal Bhavsar 58 minutes later
Brief Answer:
You can try these techniques.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I am about to say ginger use as home remedy.
But since it is not helpful in his case, you can try following things as home remedies.
1. Avoid deodorants and strong scents.
2. Dietary modifications such as eating several small meals throughout the day, eating high-protein, high-calorie food, drinking lots of clear liquids
3. Avoid spicy, fatty, fried, or acidic foods from the diet.
4. Encourage him to participate in alternative practices such as self-hypnosis, relaxation, acupressure, imagery therapy, distraction, music therapy etc. For this you will need psychiatrist's help.
I am sure you must have tried many of these things. But incase something is left then you can try.
I just want to clear one thing
1. Is it nausea only?
2. Or is it associated with hiccups also?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 33 minutes later
Hello again,

He doesn't have hiccups, just the nausea followed by dry retching and vomiting. What is the significance of this?

He likes spicy food, so I haven't restricted that, but will do so, and see if that helps. However, he had very bland food in hospital, and still felt sick.

I am still interested in ginger. He has had glace ginger to snack on, but that is all. Do you know of other ways we could use ginger to prevent the nausea?

Many thanks again
doctor
Answered by Dr. Kaushal Bhavsar 23 minutes later
Brief Answer:
Ginger paste is also available if he likes.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Other forms of ginger include ginger paste, dry ginger etc.
He can take ginger paste with bread. He can keep dry ginger in the mouth and slowly swallow it's juice.
You can try all these only if he likes ginger taste. Otherwise it will give him more nausea.
I was asking about hiccups because sometimes, mesothelioma can involve diaphragm and phrenic nerve. And this can cause hiccups. And in some patients, due to hiccups they feel nausea.
I am pulmonologist practicing in XXXXXXX
Here we are able to see many patients of mesothelioma.
I wonder when I get patient from outside XXXXXXX
May I ask about his mesothelioma details if you don't mind?
I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 12 minutes later
I am happy to tell you all about his mesothelioma.

Are you able to read back on previous questions from this site? I have asked questions a few times since he has had a recurrence.

He was diagnosed just over 2 years ago, after experiencing shortness of breath. An Xray showed he was carrying a lot of fluid, and he had 5 litres drained off. He then had a pleurodisis operation in Melbourne, and was given a few months to live. We found out about a surgeon in Sydney, XXXXXXX Yan, and visited him. On the basis of a PET scan he agreed to proceed with EPP trimodal therapy. So he had 3 rounds of chemo, then the operation, followed by ray treatment. They nearly aborted the operation after they had started, as the cancer was far more advanced than they thought. However, we are very thankful that XXXXXXX proceeded with the operation, he took his chest lining, left lung, I whole rib, parts of other ribs, his pericardium, and diaphragm.....and repaired him with Gortex. He gradually got over the whole treatment , and actually the ray treatment was the hardest part
to continue......however in September 2015, just over a year since the operation, he had a recurrence. Just 3 very small sites, but as they were in 3 different areas they said further surgery was not an option, and the only thing was chemo. We heard about Avastin, but it is not available free in Australia for mesothelioma. However, we decided to buy it, even though it was very expensive, to give him the best chance. So he had 3 rounds of pemextred, cisplatin and Avastin, and scan showed stable disease. He had bad reactions to the cisplatin, so for the next 3 rounds thy chose to use carboplatin, pemextred and avastin. He didn't cope with chemo this time though, needing blood transfusions, and terribly nauseous and weak. After the 5th chemo he was really sick, had acute kidney failure, pneumonia, collapsed lung, and was in hospital for 3 weeks.
About this time I started asking questions on this site, as I didn't feel the doctors were telling me much. He couldn't have any more chemo after this, and the tumours were growing, but we were very fortunate to accepted into a clinical trial for Keytruda...pembrolixumap. He is under Dr XXXXXXX Kao in Sydney, and he is looking after us very well, but the problem is that we are so far away. We live in Wangaratta, so we drive to Albury, then fly to Sydney, for every appointment! And XXXXXXX has had problems recently, and been in hospital, with a cellulitis infection in his 18 month old operation wound, fluid overload, heart flutter ( returned to sinus rhythm after a TOE and DCR procedure ).

Please feel free to ask if you want to know any more.!
doctor
Answered by Dr. Kaushal Bhavsar 17 minutes later
Brief Answer:
What about his recent reports?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Thanks for the detailed history. I am impressed, seriously. Hats off to you.
Coming back to the query, you guys have done all the correct things. No question about it.
Please let me know
1. Have you checked for hemoglobin kidney functions, chest x ray after September 2015?
2. What are his recent reports like hemoglobin and creatinine and chest x ray?
I am asking this because medical conditions like anemia, high creatinine, urea can also cause nausea.
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 46 minutes later
Everybody is impressed by what my husband has gone through! So it does seem such a shame to finish up with ordinary nasties like nausea!

He has had lots of blood tests etc of recent times. His kidney function went from acute failure, and back to normal. His hemoglobin is also normal , and last chest Xray, after pneumonia, was normal. He still has a slight collapse of the right lung, but that doesn't seem to be a concern. He had a broncoscopy done at that time....it was normal, and all samples taken at that time returned normal.

His blood tests on 18th March 2016 show Creatinine at 80umo/l, which had been at 268 when he was sick. Urea 3.9 mmol/L, had been 10.4 mmol/L
He had blood tests done on 1/3/16 but we have not seen the results yet. I will ask the GP about it on Friday.

He does have a high reading in one of the liver function levels. His ALP was 208 U/L, and GGT 206 U/L on 18/3/16, and has been high for many months. The doctor used to worry about these high readings until the radiation oncologist said it was probably due to radiation treatment just touching the liver.

However, you have just got me thinking whether this would contribute to the nausea problem? And could anything be done if this was the problem?
doctor
Answered by Dr. Kaushal Bhavsar 12 minutes later
Brief Answer:
Yes, this can lead to nausea.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, it's very shameful, indeed.
But sometimes, irrespective of how medic science progresses, we still remain helpless in some conditions.
Liver pathology can cause nausea.
So his high liver enzymes can be the cause for this.
Please get fresh results as soon as possible.
Please let me know
1. Is he having any pain in right upper abdomen?
2. Have you ever checked for bilirubin level?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 7 minutes later
Bilirubin total was 7 umol/L on 18/3/16.

He has had PET scans, the most recent in February this year, and his liver and spleen are normal. So they think the high readings are a result of the radiation treatment. However, from what you suggest, do you think this may be the cause of the nausea ?

Is there any treatment that would help if this is the case? He drinks a little alcohol now and then, but not much.
doctor
Answered by Dr. Kaushal Bhavsar 15 minutes later
Brief Answer:
It will be harsh but better to avoid alcohol.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
It will be harsh but it's better to avoid alcohol.
Start liver supplements like Liv 52 syrup.
Please let me know
1. Is he taking any liver supportive drug?
Please reply me answer to above asked question, so that I can guide you better. I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 12 minutes later
Hello again.....he isn't taking anything for his liver. Nobody has suggested it before......What is Liv52 syrup? I could enquire about liver support......we sometimes go to a local naturopath, and I could ask the GP. Are you worried about the Bilrubin levels?

Thankyou for your thought and care.
doctor
Answered by Dr. Kaushal Bhavsar 32 minutes later
Brief Answer:
It is having natural ingredients.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Actually, Liv 52 is having natural ingredients. It is basically aayurvedic product.
All herbal ingredients.
It is for liver protection.
No other side effects. I am not sure whether you will get it in Australia.
In XXXXXXX this is very popular.
No, I am not worried about bilirubin levels.
Have you ever heard of ayurveda? Aayurvedic medicine?
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 35 minutes later
I have googled Liv 52, and I can buy it online. I will give it a try, at your recommendation. How much should I buy to try it? What is the dosage?

What is the action of Liv52 ?

What about diet with high liver enzymes? are there any foods he should avoid?

I have heard of Aayurvedic medicine, but I don't know anything about it. Can you tell me something about it?

I really appreciate your helpfulness with this problem!
doctor
Answered by Dr. Kaushal Bhavsar 23 minutes later
Brief Answer:
Here are your answers.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Here are the answers you want to know.

Answer to your 1st question.

You should buy 3 bottles total 600ml.

Answer to your 2nd question.

I want to know his weight first. So please let me know his weight.

Answer to your 3rd question.

The natural ingredients in Liv.52 have potent hepatoprotective properties against chemically-induced hepatotoxicity (radiation unjury). It restores the functional efficiency of the liver by protecting the hepatic parenchyma and promoting hepatocellular regeneration. It is also having antiperoxidative activity which prevents the loss of functional integrity of the cell membrane. It facilitates the rapid elimination of acetaldehyde and ensures protection from alcohol-induced hepatic damage. It also stimulates appetite.

Answer to your 4th question.

Diet with high liver enzymes is also good. You can give him. No harm in it.

Answer to your 5th question.

He should avoid fatty, oily, high cholesterol food. Avoid spicy food also. Avoid stale food. Always give freshly prepared food. Avoid outside food. Give him home made food.

Answer to your 6th question.

Aryurveda is an ancient medicine discovered and studied in XXXXXXX It is now gaining it's popularity in western world also. It deals with herbal compounds,mineral and metal substances.

Please let me know his weight, so that I can guide you about dose.
I will be happy to help you further. Wishing good health to your husband. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 3 minutes later
He weighs 70kg.....
doctor
Answered by Dr. Kaushal Bhavsar 2 minutes later
Brief Answer:
OK. I am extremely sorry, I forgot to ask you one more important thing.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I am sorry. I forgot to ask you one important thing about Liv 52.
Will you be able to get Liv 52 or Liv 52 DS?
Please see for this thing when you order online because dosing will very.
So please let me know which one will you get online? Is it Liv 52? Or Liv 52 DS?
Sorry again.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 2 minutes later
They are both available on line....
doctor
Answered by Dr. Kaushal Bhavsar 5 minutes later
Brief Answer:
OK. Then order Liv 52 DS.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
It's great. Better to order Liv 52 DS.
Recommended dose is 5-6 ml thrice daily on empty stomach.
Total 15-18 ml in a day.
Do let me know after 10-15 days how is he feeling.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your husband. You are taking excellent care of your husband. He is blessed by having you by his side. Hats off lady. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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