Hi, BJ,

It's wonderful that you're such a concerned sibling!  (Makes me wish I
weren't an only child <grin>.)  See below for a few thoughts on your
questions, which I'm sorry to say may get a little lengthy.  I'm sorry;
 I just don't have a gift for concision!

How big a problem has it been?  Is she able to keep things down after
chemo, or does she have a period of vomiting after chemo?  (Most women
don't seem to have the vomiting with today's anti-nausea drugs, but --
lucky me -- I did.)

For this reply, I'll assume she's just having the nausea, without
vomiting.

When I have nausea because of something like stomach flu, I've found it
most effective to hold off eating until my stomach settled.  The chemo
nausea was exactly the opposite -- I learned was that I needed to eat
and drink as soon after chemo as I could make myself do so (in my case,
as soon as I could keep things down).

(Note to anyone reading this who's about to go on AC:  I was *much*
*sicker* than most people are on AC; you probably will not have problems
with vomiting!)

So, I would start eating tiny amounts of the easiest-to-tolerate foods &
drinks.  Exactly what this is differs for everyone (so you have to
experiment a little).  What worked for me was to start with tiny sips
every few minutes of room temperature gingerale, maybe a teaspoon or two
every 10 minutes.  If that was OK, I'd progress to (in roughly this
order) lukewarm water, warm milk, small pieces of banana, saltine
crackers, a little oatmeal, mashed potatoes.  At first, I would eat just
a few bites every half hour to hour.

After the first couple of days, I could usually handle a reasonable
range of bland normal foods.  It still helped to eat small amounts, but
very frequently.  When I left home, I would carry plastic bags of
saltines & hard candy in my purse so I could have a small snack about
every hour, maybe just 1 cracker or piece of candy.

Also, after my first round of AC, I learned that there is something
called "anticipatory nausea" . . . if your initial round(s) of chemo
made you nauseated, you can start to feel nauseated again even before
the chemo.  It happened to me, somewhat, and I'm not usually very
suggestible.  I read a research study that said people were helped by
two things:  (1) deep breathing relaxation exercises, and (2) during
chemo, concentrating on visualizing the chemo attacking cancer cells and
killing them.  Silly as it sounds, I tried these things on the 2nd round
of chemo, and had fewer problems with anticipatory nausea thereafter.

Another personal strategy during chemo (not just for nausea, but I think
it helped with that psychologically, too) was to rent lots of comedy
movies on video and watch them, when I was feeling too sick to do much.
 It distracted me & helped keep my spirits up.

It also helped when friends made special efforts to make me nutritious
but mild foods to eat during early days of each chemo cycle.  One friend
made me a nice rich mashed-potato casserole, and an interesting ethnic
cream-of-wheat dessert with a grape-flavored sauce.

It's important to eat, especially protein as I understand it, to regain
strength and build back blood cells during the chemo cycle.  In that
way, eating will help fight the fatigue.  I was told not to eat raw,
unpeeled vegetables & fruit, however (because of the possibility of
bacterial residue).

For the fatigue, too, exercise truly does help, even though it's hard to
find the energy to do it.  Just a walk around the block, or something
like that, can be a start.

Yes, she should drink quite a lot, especially in the first couple of
days after chemo.  At least the regular "8 glasses a day" thing, or more
if possible.  Some experimentation with beverages may help identify what
sets in her stomach the best.  I found beverages at body temperature
more tolerable than cold ones, but others say cold is best for them.

If your sister can't keep water down (I couldn't, on my first couple AC
cycles, for up to 24 hours), she should talk to her doctor.  They ended
up giving me extra IV fluids with the AC, then having me come in the
next day for more IV fluids, which *really* helped.  It reduced not only
the initial nausea, but because it reduced the vomiting & helped me eat
sooner, it helped reduce fatigue, too.

I feel for your sister -- I have some idea what she's going through.
It's no darn fun.  Sometimes, I felt down and like I would never feel
strong or good again.  One thing that helped my spirits was hearing
about dragon boat racing teams for breast cancer survivors -- basically,
22 women paddling a giant canoe.  Since they could do that, I knew there
could be strength & health on the other side of BC treatment.

And there is, though I've found that in some ways, I've had to really
work to regain my strength.  Now about 4 and a half years after
treatment for locally advanced breast cancer (5 tumors in one breast,
largest 3.1 cm, 1 tumor in the other), I'm doing great.  I've found &
joined a rowing team for breast cancer survivors, and am probably
stronger than I've been in 20 years or more.

Keep up the good work in supporting your sister so sympathetically --
she may be too wrung out to let you know how much she appreciates it,
but I sure do know that support meant a lot to me.  It will be hard for
her to get through this, but many of us do so, and she will, too.  I
send her my best, & you, too.

Take care,

Ann T.
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What did her doctor give her to prevent nausea, a change in medications can
make a difference, Give her a hug this isn't easy, Alex