Nausea and Opioids?

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ThunderJeff
ThunderJeff Member Posts: 38
edited February 2018 in Stage IV/Metastatic Breast Cancer ONLY

My mom was admitted to the hospital Friday. Nausea when going from horizontal to vertical is awful. Retching, unable to keep food down and/or no desire to eat. Have managed to get some fluids in her during her stay (which is still ongoing, and she had brain MRI (report went from inconclusive to benign cavernoma and no lesions); doc mentioned they still want do a spinal tap to assess meningeal changes.

I'm all for checking for brain metastasis to rule it out as an underlying cause of the nausea, but I have a different theory: the pain meds she's taking (gabapetin up to 2400 mg, hydroxymorphone as needed, ativan,100 mcg fentanyl patch, antidepressant) are the underlying cause of her nausea. Her pain doc mentioned this could be a possibility, and that drug-induced vestibular episodes can result.

Has anyone else had trouble pinning down their nausea source? Seems like we're fighting this instead of the cancer at this point, and time's arrow marches forward in the meantime. We just want to get her feeling better so she can take on the gem carbo regimen in the near future. Right now that isn't an option.

Prayers to all,

Jeff



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  • blainejennifer
    blainejennifer Member Posts: 1,848
    edited January 2018

    Jeff,

    I know the opioids I take cause nausea. In fact, when taking a larger then normal dose, I just throw down a Zofran at the same time. And, be sure to take them with a little bit of bland food, or you will see them again soon.

    The pills I take manage my pain the best, so I've just learned to deal with the nausea. Be warned that the anti-nausea pills can cause constipation, so keep the fiber tablets coming.

    With cancer and pain meds, food can get weird on you. Things that used to taste great don't anymore, and sometimes three bites can feel like too much. If your Mom doesn't have a whole lot of weight to spare, keep her on small, frequent meals of foods she likes. Protein can get problematic. A lot of cancer friends have trouble eating meats as they start to taste "funny". Eggs haven't turned on us yet, and I have one friend who can eat anything as long as it is in sandwich form. If your Mom can tolerate dairy, smoothies are a great way to slip a meal into a fractious stomach.

    You are clearly a loving son. She's a lucky Mom.

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  • ThunderJeff
    ThunderJeff Member Posts: 38
    edited January 2018

    Blainejennifer,

    Thank you for the kind words. I forgot to add that she is on a steady zofran regimen as well, although your point about taking the meds with bland meals is well taken and something that isn't currently happening to my knowledge. I had a long conversation with the pain doc that is part of the larger oncology team a couple of days back, and they may be adding something else to the mix to combat the nausea.

    I feel she went up on her dosages way too quickly. It went from norco to morphine to fentanyl in less than a month, and the fentanyl doses kept climbing almost arbitrarily. I would describe her as having near hallucinations on the 100 mcg patch in addition to this horrible nausea; scary stuff.

    Honestly, I think this community has better collective knowledge sometimes than the docs, so I greatly appreciate the insights.

    It's just devastating to see the frustration in her eyes. No matter how long or short this journey is for her (and I pray it is a long one), she doesn't deserve to waste away like this.

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  • blainejennifer
    blainejennifer Member Posts: 1,848
    edited January 2018

    Jeff,

    That is a rapid increase in pain meds. I am so sorry that her pain was so intractable. Has she ever had radiation to address specific painful sites? I've done that, because being loopy on pain meds is no fun. I'm a larger lady, and were I on her regimen, I would be immobile.

    Given the Zofran and the pain meds, I hate to ask, but is she pooping? Constipation can also cause terrific nausea. Trust me. Also gallbladder issues cause nausea.

    Give your Mom a hug from all of us. I truly hate nausea, and feel it is more incapacitating than simple pain.

    Jennifer



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  • ThunderJeff
    ThunderJeff Member Posts: 38
    edited January 2018

    Hi Jennifer--

    She's done 4/10 rads sessions on her spine (cancer helped cause fracture at C6 vertebra the cause of her pain). Was supposed to be done with session ten tomorrow but the nausea got in the way of her treatments, hence why we admitted her. Pain pill regimen has rendered her immobile for sure. Not sure about bowel movements (not sure if there's much to move at this juncture). Rads have helped with the pain, which is why I think we need to dial back the pain meds.

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  • blainejennifer
    blainejennifer Member Posts: 1,848
    edited January 2018

    Jeff,

    If they are radiating her from the front for the spine, you could could have your nausea answer: radiation enteritis. When I was radiated for my lower back, I got it bad. I'd barf just walking around.

    Could that be a contributing factor?

    Jennfier

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  • bigbhome
    bigbhome Member Posts: 840
    edited January 2018

    Jeff, I had the same issue with my first round of tumor reducing rads. Could not stop vomiting, even when there was absolutely nothing more to vomit. Just painful retching. Any type of movement, even just turning my head too quickly, would start up again. I was given fluids, several times, and also compezine(sp?) . it lasted for a couple of weeks, them had nausea alone for a couple of weeks. It is rough, but the end result was a 70-80% reduction of tumors.

    Honestly, I have an incredibly sensitive stomach. The combination of pain killers that your mother is taking would have me as horribly sick as she is. Jennifer is right about taking with food! So important! Also, maybe try drugs with no codeine and maybe switch to a liquid. When I had my back surgery, I found Roxicet(sp?) to be much easier to tolerate.

    Hugs and prayers,

    Claudia

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  • ThunderJeff
    ThunderJeff Member Posts: 38
    edited February 2018

    So an update on the nausea saga--

    My mom ended up staying at the hospital thru last Wednesday. She improved significantly since being admitted, which in my view confirmed my "too many meds including opioid meds is causing nausea" theory. It was a bit of revolving door on her second to last day. Palliative team visited and two different members of radiation oncology group came in--a resident and his attending. These visits startled my mom a bit. There was a focus on an unknown "signal" shown in the meninges of the brain scan and talk of brain radiation from the radiation oncologists (which is the first we had heard of that, as the head oncologist and his PA had previously told us that said "signal"/changes in the right meninges were most likely due to her previously dx'd mets to the right side of her skull). A member of the palliative team mentioned leptomeningeal carcinoma has not been ruled out. Radiation attending mentioned a "60 percent chance" the signal is mets to the CNS. But, after examining my mom, he seemed shocked that her pain meds were at such high dosages and thinks someone may have jumped the gun on ordering the brain scan, as she has no other neurological symptoms. So no brain radiation. Palliative team tweaked her nausea regimen which has helped.

    So now the plan is to finish her spinal radiation (only three sessions left!) followed by starting gemcarbo, and, for good measure, a brain scan in a month to rule out LM. A spine scan and spinal tap were discussed, but radiation onc attending didn't feel they would give positive results (which makes me think his 60 percent prediction = he has have no idea. As an aside, I checked out his bio, and I think there may be some confirmation bias at play, as his research specializes in brain rads and case studies/clinical trials involving the same).

    I went back and looked at her radiology report on the meninges, and it's about as CYA as possible: "there is a possibility that the signal could be indicative of metastatic disease ... or [insert twenty other non-cancerous reasons]." Holy hedging Batman.

    I'm glad she's feeling better, but the level of punting and the disconnect between the head oncologist and the radiation guys was palpable. We are frustrated to say the least, and praying the CNS is not involved in any way.

    Hugs to all,

    ThunderJeff


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  • pajim
    pajim Member Posts: 2,785
    edited February 2018

    ThunderJeff, I'm glad your Mom is feeling better.

    I have two thoughts about your recent experience. One is to let you know that radiologists ALWAYS hedge when they write their reports. They don't want to be accused of missing something later. It's CYA for malpractice suits. Usually the onc will also look at the scans themselves and make some recommendations.

    Second is that it feels like you don't have one doctor your trust who is "in charge". You seem to have a whole bunch of doctors giving you opinions and your Mom is having to decide. Or they aren't talking to one another before talking to you. Maybe you prefer it that way but it doesn't sound like it.

    I like listening to all my doctors, but there was a time where I had four. Surgeon, MO, GI guy, RO. One was saying Do A. Another was saying Do not-A. So I finally went in to my MO and asked who was in charge? If I got conflicting information, who was the final arbiter? Besides me, of course. And he said he was. So now everything goes through him. I trust him and his clinical and scientific judgement so that works for me. May or may not work for you. And its possible that it's not your Mom's MO. Maybe it's one of the palliative care docs.

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