How do you deal with low appetite?

Nausea and vomiting as well s no appetite is normal. My wife has same issues. Water is critical after chemo as it flushes the chemicals through the kidneys and out through urine, Try to drink as much as you can. Food is needed to keep body weight up. try small meals 8 x per day every 2 hours. Avoid large meals. This works for my wife.

Talk to your doctor to prescribe better pre-meds. Nausea can be addressed with the pre-meds and also a prescriptive drug.

I’m just the opposite. I look at food and don’t want it. But if I force myself to eat it’s good. I lean towards things with “bright taste” like sipping on cold orange juice, yogurt, etc. I also work hard on protein even resorting to protein waffles and pancakes on those days where I need the “BRAT” diet.

Always check with your nutritionist before trying something not previously discussed.
At times, my wife didn’t like anything. Protein drinks, texture of foods, anything. Our nutritionist said anything to get her calories and keep her weight up. Baskin Robbin’s Medium Chocolate extra thick milkshake has about 1500 calories. We did a bunch of those for awhile.
Other phases were: the gravy phase, fresh crab phase.
Also she only drank liquids with a straw.
My brother brought us home made soups which she loved. He always said try it. If you don’t like it throw it out.
Keep trying things. Hang in there!

Which chemo drugs are you on? Hydration usually helps, if nothing else to help protect your kidneys by flushing the chemo out after it's done its job. I got 500 mL to 1000mL of saline at the end of each infusion to help with that. When I switched to a 5FU+Onivyde regimen that required the 46-hour take-home pump, I would get another 500 mL saline infusion when I went in to have the pump disconnected. After my last cycle, when I was getting the pump disconnected, they also mixed another anti-nausea drug (Kitryl / granisetron) in with the saline, and that helped keep my stomach under better control for another day or two.

Appetite and nausea are related problems; i.e., when you feel nauseous, you generally have no appetite. And chemo-induced fatigue doesn't help. But it does help if you can be more analytical about the nausea. In my case, it often felt more like heartburn -- a burning volcano of vomit about to erupt from my esophagus rather than from my stomach.

One thing to remember is that traditional cytotoxic chemo drugs kill fast-growing cells indiscriminately, and the lining of your stomach and digestive tract are innocent bystanders that suffer collateral damage from treatment.

Sucralfate (Carafete) is a syrupy liquid medicine that can be taken about an hour before meals. It reacts with stomach acids to create a protective lining / barrier that prevents food eaten later from causing more irritation. (Please forgive my layman's vague description). It helped me quite bit.

My local ER nurse (my son) also recommended what they call a "GI cocktail" -- a mix of Maalox with Lidocaine Viscous. This was a huge help for me. The Maalox liquid antacid coats your esophagus a little bit as it goes down, and then seems to do a better job than powdery tablets like Tums or Rolaids at neutralizing stomach acid.

[*] Note: I think you're NOT supposed to take antacids shortly before/after Sucralfate, because Sucralfate depends on high acidity to drive the reaction that creates its protective barrier, iirc.

Viscous Lidocaine requires a prescription. It works by numbing the tissue it comes in contact with. It's a really thick (viscous) liquid that coats your esophagus as it goes down, so it really helped me with the heartburn feeling. For me, it worked better to take last and separately from the Maalox, so it would coat the esophagus for as long as possible without getting washed down and diluted by anything else.

As far as appetite itself goes, try to be observant of what appetite suppressants and stimulants might be part of your diet. I was a coffee addict, and caffeine definitely helped relieve some of my chemo-induced fatigue, but it's also an appetite suppressant. Not to mention that coffee and the heavy creamer I added were not good for the stomach pH balance in general. Various prescription appetite stimulants are available (e.g., Remeron/mirtazipine and Megace/megestrol) but can have some undesirable side effects, especially with longer-term use. There's always medical marijuana, if legal in your state. Your mileage with it may vary. If not legal in your state, you can get pure, FDA-approved THC (Marinol/dronabinol) in capsule form by prescription in all 50 states. I'm not sure if the pure THC does as much for appetite though as it's supposed to do for pain relief. (Sometimes generalized pain, or specifically GI pain, can worsen nausea and appetite, so it may help by that indirect, secondary mechanism of action.) The other "active" (but not psychoactive) ingredient in marijuana, CBD, is said to be helpful with GI issues and relaxation, and can be obtained w/o prescription. Again, your mileage may vary with these, as doses and concentrations are not well established or regulated.

I hope something in here helps, and wish you the best!

I am so thrilled at all the suggestions given. I have so many options to try. I have some appetite back now, but quite diminished. The shakes they made me in the hospital went down well and I can see where using a straw helps. We have protein powder at home so with Ice Cream and some other stuff should be able to supplement there. I love fresh fruit and most veggies and I could eat a decent amount of them, but I know I need some protein to keep up the weight.

New to me is a bit of a feeling of heartburn/reflux today as I feel full. Drinking as much water as I can in hopes of moving what I ate on through.

I started back at work today(band and Shop teacher) and it helps with purpose but I can feel the fatigue so will have to figure out what I can do with the chemo. I work in an incredible small school. The superintendent and principal figured a way to move another teacher over to help in my shop classes and found someone who can take my band classes. I am grateful for so much today.

Thank you, all, for your constructive advice!! I have to sit down and get all the suggestions on one piece of paper.

brad

Wife wife takes Mirtazapine and it definitely increases her appetite. Talk to our oncologist about this.