A Beginner’s Guide to Dealing with Chemotherapy-Induced Nausea

The reason I started this blog site was to not only document my story of living with multiple myeloma, but also hopefully create a set of resources for others who become diagnosed with multiple myeloma – letting them know they’re not alone, that others are experiencing the same (or at least similar) situations, and hopefully providing some insights into how to approach and deal with all that might be forthcoming (or even informing them of stuff they don’t know might be forthcoming). To that end, today, I want to talk about chemotherapy and a very common side effect, nausea.

During my six months of induction treatment after being diagnosed with multiple myeloma, I was on the relatively standard RVD protocol – Revlimid (one 25 mg capsule daily, three weeks on, one week off), Velcade (a weekly injection into my abdomen), and Dexamethasone (40 mg of pills, once a week). Dexamethasone is a steroid, and, to my understanding, Revlimid and Velcade are immunotherapy medications and not chemotherapy. That might be splitting hairs, I don’t know – the Revlimid shows up in packages labelled “Chemotherapy,” but I’m far from a scientist.

So, what’s the difference between immunotherapy and chemotherapy? Well, the best as I understand it, immunotherapy treats the patient by acting on his or her immune system, while chemotherapy acts on cancer cells and tumors. 

I’ll let scientists talk about whether Revlimid and Velcade are immunotherapies or chemotherapies. What I will state is that for me, going through my induction therapy was a piece of cake related to what other cancer patients go through in their chemotherapy treatments. 

For my Velcade injection, I would go to the infusion center, the same place as everyone getting their chemotherapy treatments. My treatment was a single injection. Sure, it was a “slow push” of the medicine, but still only about eight seconds in duration. That’s it, and that’s nothing. 

Most of the patients in the center were there for the long haul. A great many of them were reclined back in recliners with blankets over them, napping. Why? Because their treatments were two, four, eight or even 30-hours long. 

I once got into and out of the center in 29 total minutes – checked in, waited to be called back, weighed, vital signs taken, a CBC blood draw performed and analyzed, and my injection received. And, while nausea is a possible side effect, it never affected me. Revlimid gave me skin rashes on a few occasions, and Velcade would discolor my skin at the injection site, but that was it. Seeing what others went through, I made sure to keep my mouth shut about any of my “hardships” because, in comparison, there were none. 

My stem cell treatment at Stanford began my first real exposure to chemotherapy (as I’m writing this, I’ma couple of weeks in on the two-month long process of a stem cell transplant, which requires three total days of chemotherapy). The start of the “mobilization” phase of treatment is designed to not only attack multiple myeloma cells but also entice stem cells to leave the relative comfort of bone marrow and populate themselves in large numbers in the blood stream, allowing for them to be collected and transplanted back at the end of the process. It started with a big dose of Cytoxan (cyclophosphamide), a proper chemotherapy drug. It’s based on that experience that I’m writing this quick and dirty guide to dealing with perhaps the most immediate side effect of chemotherapy, and that is nausea. 

1 – Just because you don’t feel nauseous doesn’t mean you won’t get nauseous

The start of chemotherapy isn’t really the start of chemotherapy, rather it’s the start of a strong dose of a couple of anti-nausea medications that takes some time – an hour or two. So, the start of chemotherapy is really a breeze.

You’ll know when the chemotherapy starts by the dress of the nurse. All through the early hours, the nurse is gloved, etc. But, when the chemotherapy solution arrives from the pharmacy, it’s a whole new process, with the nurse donning a complete personal protective system – a long sleeved gown over scrubs, gloves of course, and a face shield in case of any accidental splashing or spilling. Yes, the nurse doesn’t want to get Cytoxan on his/her clothes, skin or eyes. Yet, at the same time, it’s getting pumped directly into the bloodstream of the patient.

Yeah, it’s a bit discomforting.

Just a couple of paragraphs above, I wrote “… the most immediate side effect of chemotherapy, and that is nausea.” A longer-term side effect is secondary cancers developing later. Chemotherapy drugs are poison, designed to kill/damage cells. Hopefully, it’s the cancer cells, but collateral damage most certainly occurs in healthy, regular cells in the body. My doctor has advised that all my organs will be “injured,” but that as they’re healthy, they will recover quickly. For me, personally, I’m not worried too much about possible secondary cancers. I’ll worry about that if it ever happens. My first priority right now is to effectively deal with my primary cancer, multiple myeloma.

Anyway, just know that you’ll initially feel pretty good. You will have received a base of anti-nausea medication before you get your chemotherapy, and it will take a while for the chemotherapy to have an impact on your systems. But, it will come.

2 – Get started combatting nausea early and often

There’s no such thing as being fashionably late to the fighting nausea party. It’s sort of like voting in Chicago back in the old days – vote early, vote often. 

From where I sit, it’s better to be not nauseous than nauseous, and once one’s nauseous, it’s a lot more difficult to get rid of nausea than to hopefully prevent it in the first place.

It’s a lot like pain management. When I was going through a back injury fifteen years ago or so, I didn’t want to take any pain medication until I needed it – you know, when I was really in pain. It wasn’t that I was wanting to be a tough guy, although I probably was a bit. Rather, I didn’t think you needed to take pain medication until you were in pain.

Then, I got in pain. On a zero to 10 scale of pain, with a 10 being the worst possible, taking pain medication at six or whatever is probably not good enough. Taking at eight is pretty much worthless. It’s way, way easier to prevent it escalating to an unbearable level than to reduce it from an unbearable level. A nurse, and my wife Lori, both taught me that back then. Well, they tried to. I learned it through experience, the hard way.

Nausea is the same. Best to get on it early than attempt to reduce a nearly unbearable level.

For my initial chemotherapy regimen, I was given anti-nausea medication intravenously at the beginning of the treatment (and throughout the day as well, I believe). Then, I was shipped out with three meds – Zofran (which was one of the drugs given to me throughout the day), Compazine and Ativan. 

The great thing about these medications is that they can be taken together, so you can “stagger” the meds to get the effect you want. So, for example, Zofran can be taken every eight hours. But, say three hours in, if your stomach is feeling a bit iffy, you can take a Compazine (which you can take every six hours). Another a couple more hours, five hours since beginning with Zofran, you can take an Ativan (1-2 tablets every four hours). 

[Pro tip on the Ativan: Place it right under your tongue and have it dissolve, making it super quick into your blood stream.]

In the example above, you’ve taken three different anti-nausea meds in five hours. That’s how you stay ahead of the game! It might not prevent you from becoming nauseous, but it will give you your best shot. 

3 – Have a variety of food available

Ahead of chemotherapy, Lori and I went to the store to plan out my menu for the day of and the days thereafter. However, the mistake I made was I planned it out to precisely. I bought the exact number of meals I thought I would need, and I bought the things I thought I would like – a couple of frozen meals that looked relatively bland, some hard boiled eggs, etc. I had also brought some home-baked “anytime bars” from one of my cancer diet cookbooks and a variety of quick, easy protein-bar type of snacks. 

Here’s the thing: when the time came to eat while I was nauseous, none of it seemed appetizing. None of it.

I mean, I couldn’t even think about a hard boiled egg, much less eat one.

What I discovered is that other than crackers, the idea of anything dry or scratchy on my throat turned me off. All that protein bar stuff, etc. – I wasn’t eating that.

So, I had nothing that really appealed to me and, as a result, I didn’t eat enough. That, of course, led to more nausea, not less.

My advice is to have a lot of variety available to you. You likely won’t know what you want – or even more importantly, what you don’t want – until you’re there, in the moment. Don’t plan too precisely (e.g.; three exact meals for a day). Rather, have a lot of options in small quantities, and food items that can be prepared very quickly. You might like the idea of a roasted chicken, but by the time a chicken is roasted for you, you might now want it. 

Some of the things I found I wanted were vanilla yogurt, canned fruits like pineapple, low calorie ginger ale, Goldfish crackers, and hearty soups, in particular Chunky’s Pub-Style Chicken Pot Pie.

4 – Eat small bites, often

Don’t plan out three big meals a day. They’re too difficult to make, for one. Secondly, you’re probably not going to want them. But, most importantly, it means too long of time between eating.

Get into a habit of almost non-stop snacking throughout the several days after a chemotherapy treatment. You’re probably going to feel better with something in your stomach, so make an effort to nibble on something every 15-30 minutes. It doesn’t have to be a lot – one bite of something is so much better than no bites of everything. 

5 – Drink your fluids

Fluids are important post-chemo, and the good thing is soup is considered a fluid, so a bowl of chicken noodle checks two boxes.

Water might not be the best thing for nausea though. Now, I love water. I drink water all day, every day. But, water does have a bit of a “dead” and/or “metallic” kind of taste (particularly if your taste buds change during chemotherapy). I found a stomach full of water made me feel more nauseous.

Try adding flavored electrolyte solutions to your water, be it a powered mix or a bottled drink like Gatorade, etc. 

6 – Look to add ginger and peppermint

There are a billion people on the plant who think ginger and peppermint both have great digestive properties. It’s been the home remedy for nausea for centuries. 

For a reason.

As I have told some of my friends, chemotherapy doesn’t suck. It’s the hours and days after chemotherapy that sucks. You won’t know until you’re in the moment, but planning to have a bunch of options readily available to you will put you in the best possible position to mitigate the common side effect of nausea. 

Good luck!