Help with nausea and vomiting relief post-esophagectomy

My husband is now 10-½ months post-op; his surgery was on June 7, 2023 (esophagectomy, removing the lower portion of the esophagus and approximately 25% of the stomach, pyloroplasty and insertion of a j-tube).

After all this time, he still continues with daily nausea and frequent vomiting, which seems to be brought on by eating, drinking, on taking formula. We have tried four different formulas hoping to find one that he tolerates—first it was Osmolite, then KateFarms, then Nutren (based on suggestions from people on the Mayo Clinic forum), and finally Abbott’s Vital Peptides 1.5 Vanilla (suggested by a hospital nutritionist as being very digestible)—but he has not been able to tolerate any of them. He can sometimes make it through a single carton before becoming nauseous but once he does become nauseous, it’s impossible for him to continue with the formula. I have slowed the delivery rate down as far as 55-mL/hour but that doesn’t seem to make any difference as to whether he is able to tolerate the formula. The Vital Peptides can be consumed orally as well as enterally—and its taste is similar to the high-calorie Boost. He takes in very little orally but deals pretty well with Boost, yogurt, etc., in fact better than the formula. His inability to consume sufficient calories over the course of the day has resulted in severe weight loss. He is down to 138 lbs. from about 218 at his finest! Medications (Ondansetron, Prochlorperazine) don’t relieve the nausea. He tried Dronabinol but passed out. It should be noted that the “nausea” that my husband feels is not coming from his stomach, but rather the abdominal area. And, he burps a lot, suggesting to me that he has too much air in his system—maybe he keeps his mouth open while sleeping—or could it be something else? I have no idea but I’m very careful not to get any air in when flushing his tube.

Speaking to the tube, hubby’s j-tube continues to be problematic—it seems to succumb to pressure and wants to come out. When I say pressure, I mean when he occasionally has to strain with a bowel movement, or has a forceful vomit. In fact, I believe that something, perhaps the straining, has caused the tube to move and enlarge the opening in the intestine because lately there has been a great deal of leakage around the outside of the tube (the leakage consists primarily of bile), about the same as when the tube has been replaced. It causes the skin around the outside opening to get very red and burn, and the tissue at the opening itself is very granulated. We keep the area clean with Hibiclens and coat it with Maximum-strength Desitin, which usually clears it up quickly but today it was extremely red and painful.

It’s heartbreaking to watch him going through this. He feels horrible. He is weak and fatigued, and both his white and red blood cells as well as his hemoglobin are low—I’m sure this is because he isn’t consuming enough. Blood work comes back with a notation of possible nutritional anemia. He is also suffering from ongoing shortness of breath—again, likely due to lack of nourishment. He has seen both an acupuncturist and a hypnotherapist, unfortunately neither with much help resolving the issue. Surely there must be some relief for him—he can’t be the only one to have suffered this way after an esophagectomy. In June, at the time of surgery, he was told that he’d be eating normally by September—that was three-months and now it is almost one year. I really believe that if we can get a handle on the nausea, everything else will start to fall into place. Please offer us some suggestions.