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PERSONAL HEALTH: Nausea? There's No Need to Suffer in Silence

Although there are now safe and effective ways to prevent and to treat predictable cases, like those involving pregnant women and cancer patients, many people who could benefit fail to receive adequate treatment, if any treatment at all.

Common in Pregnancy
In the 1960`s, a friend of mine spent her two pregnancies nauseated and vomiting. By the time her sons were born, she looked like a poorly nourished scarecrow. Fortunately, both babies, true to their role as parasites, were hale and hearty at birth. Another friend soon to give birth to twins was so sick during her first trimester that she hardly left the house, and she lost weight instead of gaining it.

October 24, 2006

PERSONAL HEALTH; Nausea? There`s No Need to Suffer in Silence

By Jane E. Brody

Anyone who has ever been nauseated knows what an awful feeling it is. Yet for millions of Americans, nausea and its frequent aftermath, vomiting, are facts of life that occur periodically over many months.

Infants of those severely afflicted through their pregnancies -- the condition is known medically as hyperemesis gravidarum -- typically have lower than normal birth weights for their gestational age. Up to 2 percent of pregnant women experience such severe and protracted vomiting that hospitalization is necessary to keep them from becoming dangerously dehydrated and to keep their weight up.

Nausea and vomiting affects 70 to 85 percent of pregnant women for varying lengths of time. Half of pregnant women have both nausea and vomiting, a quarter have nausea only and the remaining quarter are spared. For many women, nausea and vomiting is their first indication that they are pregnant. Typically, the distress dissipates after about 12 weeks, and women who experience it are often reassured by friends and relatives that it is an indication of a healthy pregnancy. Indeed, there is a lower rate of miscarriage among women with nausea and vomiting of any severity; even hyperemesis gravidarum most often results in a good outcome.

Alas, for large numbers of pregnant women, so-called morning sickness, although it can occur at any and all hours of the day, is often minimized by their physicians and thus undertreated, according to a report in 2004 from the American College of Obstetricians and Gynecologists.

In a clinical guidance bulletin for obstetrician-gynecologists, the college wrote that an investigator found that among women who called a help line for those with nausea and vomiting during pregnancy and who subsequently terminated pregnancy because of these afflictions, fewer than 50 percent were offered anti-emetic therapy.

``Of those offered treatment, 90 percent were offered regimens that were not likely to be effective,`` the bulletin says. ``Furthermore, some women do not seek treatment because of concerns about safety.``

It is true that most women today are terrified of taking any medication during pregnancy. Some may remember the voluntary withdrawal of the drug Bendectin by Merrell Dow after a barrage of lawsuits amid claims that it caused birth defects. At the time, Bendectin (doxylamine) was being used by about a quarter of pregnant women to relieve nausea and vomiting.

Since then multiple studies have exonerated the drug and found it to be safe and effective. In the hierarchy of remedies for nausea and vomiting due to pregnancy, the practice bulletin ranks a combination of doxylamine and vitamin B6 among ``first-line therapies.`` The drug combination can be legally prescribed and prepared by compounding pharmacies upon request.

Other drugs deemed safe and effective include phenothiazines and trimethobenzamide.

Before going the drug route, however, there are lifestyle and diet options that are effective for many women, according to the March of Dimes. Most important:

Eat frequent small meals, five or six a day. Hence the classic advice to keep crackers at the bedside and to consume several before getting up in the morning.

Get up slowly in the morning, sitting on the bed for a few minutes before standing up.

Eat snacks high in protein, like nuts and peanut butter.

Drink fluids often during the day, including broth, cola and a sports drink like Gatorade.

Get plenty of fresh air.

Avoid smells that you find unpleasant and foods that are hard to digest, like fatty foods.

Avoid drinking citrus juice, milk, coffee and tea with meals.

Capsules of powdered ginger have been found in a few studies to reduce episodes of nausea and vomiting in pregnant women.

Effect of Cancer Therapy

Several of the most effective drugs used to treat cancer, as well as radiation therapy involving the digestive tract, cause nausea and vomiting for up to 75 percent of people treated, and it is the side effect most feared by cancer patients.

If untreated, nausea and vomiting caused by cancer therapy can result in dehydration, fatigue, difficulty concentrating, slow healing of wounds and loss of appetite, according to a bulletin produced by the American Cancer Society and National Comprehensive Cancer Network.

Many cancer patients insist that marijuana is the best remedy for this problem. But the United States Supreme Court has refused efforts to legalize marijuana as a medical treatment.

Even without marijuana, however, most patients do not have to suffer. There are now quite a few legal remedies that can treat and even prevent nausea and vomiting. Most often, the anti-nausea remedy is started before the chemotherapy is administered.

The treatments selected are determined by how likely the therapy is to cause nausea and vomiting. For example, for chemotherapy low on the nausea scale, Compazine may be used.

Using Drugs in Combination

For therapies more likely to cause nausea and vomiting, two anti-nausea drugs may be used in combination. One such remedy recently approved by the Food and Drug Administration is Emend, by Merck. Taking one capsule a day for three days starting before chemotherapy can help prevent nausea and vomiting. Emend may be combined with another drug when chemotherapy, for example high-dosage cisplatin, is highly likely to cause nausea and vomiting.

Other helpful measures include acupuncture, biofeedback and relaxation techniques.

The cancer bulletin recommends the following: eat frequent small meals; eat at least an hour before your treatment; avoid fried and fatty foods; restrict fluids with meals; eat foods cold or at room temperature; have someone else prepare meals if you feel nauseated; limit exposure to sounds, sights and smells that cause nausea; avoid favorite foods when nauseated; wear loose-fitting clothes; and freshen the air with a fan or open window. Make sure, too, to let your health care team know if the remedies you try do not control your nausea.

Free copies of the bulletin, Nausea and Vomiting Treatment Guidelines for Patients With Cancer, can be ordered through the Web sites www.nccn.org and www.cancer.org, or by calling 1-888-909-NCCN or 1-800-ACS-2345.

Copyright © 2006 by The New York Times Co. Reprinted with permission.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center
    Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan-Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital