How long does nausea and lack of appetite last after transplant?

How long does nausea and inability to eat last after transplant? How can nausea be managed?

As part of stem cell transplant, we use a high dose chemotherapy called melphalan. And remember, melphalan is the kind of magic of a transplant that's designed to kill the myeloma cells that we're trying to.

But one of the most common complications or side effects of transplant is that the melphalan can really affect the GI tract the most.

We know that that means that this is where patients are most symptomatic during their transplant, because of the effects of the chemotherapy on the GI tract. So that can manifest itself. I always tell patients from kind of tip to toe, if you will.

Your GI tract is kind of includes your mouth, the esophagus, which is kind of the food tube.

This connects your mouth to your stomach and then all throughout your intestines. And any part of that can really be affected.

Now, plenty of people know that during melphalan administration we have patients keep you know, ice in their mouth in order to help, restrict the blood flow to the mouth to see if we can decrease what's called mucositis in the mouth.

So by making your mouth nice and cold, we can restrict blood flow where the blood has the chemotherapy in it so it doesn't go near your mouth. We don't need the chemotherapy near your mouth. But obviously it's harder to put your whole body on ice to prevent that from happening. And so the GI side effects of transplant can really include, mucositis, which is inflammation of any of the part of the GI tract that can manifest itself, like nausea.

Heartburn is very common and diarrhea.

So what are some of the GI side effects with, with autologous stem cell transplantation. So for one there are a lot of different things that the drug melphalan can cause on the GI system. It's everything from nausea and vomiting to diarrhea to other things that one may not expect such as mouth sores, all of which can make someone particularly miserable during the time of transplant. But all of which have different remedies to try to help them. So, for one, if there's something that is potentially reversible, that's something that we advocate for a patient. So for instance, if they are really limited by pain from mucositis, there are a lot of great options for pain control or opioids being the mainstay.

This is rarely kind of a painful process we'll say, in the sense that we hope that people are not having pain during their transplant, but it can be sometimes uncomfortable because of things like heartburn as examples. This is usually most common during about the one week time period where your stem cells are finding their way to your bone marrow.

They're planting themselves. They're going to grow back into being your new immune system. But the job of your immune system usually is to heal injuries, right? Heal any damage that’s been done. And after the chemotherapy has kind of been put into your body and is doing what we want it to, kind of those innocent bystanders, I say, is what really can be affected.

And until the immune system cells are able to grow back, those are the stem cells we put back in. Then it takes a little bit of time for that healing process to happen. So I usually say it's about seven days during your transplant where nausea diarrhea is common. Once those stem cells grow back. However, though I always say they kind of grow back and they get back to work and start healing everything.

And most of the time that patients are ready to go home after their transplant or are feeling better after their transplant is when those stem cells have grown back and they've started that healing process. And so, you know, where I work, we hope that people, when they are ready to continue their recovery outside of the hospital, their nausea has calmed down, where we use, a variety of different anti-nausea medicines to manage that.

IV if needed, if it's getting hard to even swallow some nausea pills.

But by the time you get home from your transplant process, your nausea hopefully is under better control. You have pills kind of in your back pocket should you need something. Your diarrhea has settled down. And the heartburn has gone away. And, so by the time I'd say the week, a week during that transplant process is the hardest point.

But by the time that your stem cells are grown back, hopefully many of those symptoms have resolved.

For issues of really primarily related to nausea itself, we have a lot of great antiemetics ondansetron, Prochlorperazine and nausea is one of those things somewhat similar to pain, where I advocate that patients do the best, that they try to stay ahead of it rather than try to catch up. So taking scheduled antiemetics roughly three times a day, something before meals roughly 45 minutes before really helps keep that at bay.

In general, what we see is during transplants, the onset of nausea starts to kick in around day four day five, and it can really linger up to about 2 to 4 weeks. It's really not a cutoff of when someone no longer feels nauseated. It's sort of a gradual process. And during that time, people's appetite significantly changes things that they tolerate, things that they don't tolerate.

And we usually say to patients, trust your gut. You know, you know what you're going to be able to eat. And you know what you will not be able to eat. So perhaps having a steak with the pasta arrabbiata is not the right time. But simple things like bread, rice, bananas those are usually things that are very well tolerated and small quantities make a big difference.

And over time, the your body will recover from this and you will overall feel great at the end of it.

So we have great medications for that. Oftentimes we just ask them to take some compazine or Zofran or sometimes something called ativan which they anticipate anxiety when, they look at food. So that can calm them down and we can just schedule that around the clock in patients who are having a lot of trouble.

IV fluids help.

Sometimes low dose steroids can also be very helpful in calming those, issues.

So most patients we can get through the transplant procedure with, without them feeling too bad.

Sometimes the diarrhea can be a little bit. Sometimes it can be a little bit more than a little. And we do use anti diarrhea medicines, medicines like Imodium as examples. One of the most important things about immune system right, is we have to make sure that there isn't an infection that's causing some of that diarrhea, although it's most likely to be a side effect of the chemotherapy.

Yes, we do use anti diarrhea medicines to help kind of calm things down.

For diarrhea. That's also a very common side effect with melphalan. one phrase that I've heard before is called melphalan misery. And it's it's true. So for one, for people who do have diarrhea in the midst of transplant, we like to make sure that there's not an infection. So Clostridium difficile infection is something that's very prevalent.

Particularly when counts get low that we need to rule out. There are other infections that can also cause diarrhea. Once those have been ruled out, though, then it's usually quite safe to take simple antidiarrheals such as loperamide, and these tend to be quite effective. And over a few days, typically the diarrhea subsides and people start to feel quite well.

For more information on managing GI side effects, visit Health Trees Side effects solution tool.

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