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Medical Forum / Diseases and Disorders / Cancer / December 2003

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Thirst, or the Lack Thereof

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Tracy - 24 Dec 2003 03:41 GMT
My dad (75 years old) was recently diagnosed with large cell lung
cancer.  He's doing radiation and platinum chemo and is doing pretty
well with it.  No nausea, doing pretty good.  He has little appetite
but my big concern is that he will not drink fluids.  They give him
IVs three times a week before radiation treatments to counter
dehydration, but I don't understand why he doesn't feel thirsty.  I
would expect that from someone who is nearing death, but he is not
(not yet, he might be if we can't do something about this).  He's a
little on the senile side but it's not that he forgets to drink.  He
knows he needs to drink water but he just doesn't care to.  I give him
a glass of water and he'll hold it for hours but not take a drink.  

I can't blame chemo because he was like this before he was diagnosed.
It was the first thing they treated him for when he got sick.  I'm
starting to wonder about Melville's Bartleby - maybe he "preferred not
to" because he had cancer.

Anyone have any tips and whetting someone's thirst?  Is there a way to
make a person feel thirst or make them want to drink fluids?  He likes
beer but I don't think that would be helpful to him just now.

Thanks in advance,

Tracy
J - 24 Dec 2003 09:07 GMT
> My dad (75 years old) was recently diagnosed with large cell lung
> cancer.  He's doing radiation and platinum chemo and is doing pretty
[quoted text clipped - 16 lines]
> make a person feel thirst or make them want to drink fluids?  He likes
> beer but I don't think that would be helpful to him just now.

Hi Tracy,
Eating "salty" can increase thirst. (but can cause other problems)
I've read where swallowing problems can occur with lung cancer. (in case
you want to test that theory with a beer).

If it was my Dad, I'd give him the beer to see if it would perk him up, to
see if he would start drinking water, or just because...
but then if it was my Dad and that age & diagnosis, I'm positive he would
not have chosen chemo...
Hugs
J
Tracy - 28 Dec 2003 00:07 GMT
<snip>

>If it was my Dad, I'd give him the beer to see if it would perk him up, to
>see if he would start drinking water, or just because...
>but then if it was my Dad and that age & diagnosis, I'm positive he would
>not have chosen chemo...

He knows he's incurable and he never considered not pursuing
treatment.  It's not kick a.s chemo, it's just radiation booster.  I
think he's hoping the treatment buys him some time.  Radiation and
chemo can be very effective at relieving the symptoms.  If it can
shrink the tumors enough to give him relief from the terrible cough
and make it a little easier to breathe, it could be a fair trade.

It might all be moot since the doc skipped chemo this week because my
dad's not well enough to take it, mostly due to the dehydration.

Hugs back,

Tracy
J - 28 Dec 2003 00:26 GMT
> He knows he's incurable and he never considered not pursuing
> treatment.  It's not kick a.s chemo, it's just radiation booster.  I
[quoted text clipped - 5 lines]
> It might all be moot since the doc skipped chemo this week because my
> dad's not well enough to take it, mostly due to the dehydration.

Hi Tracy,
well, other than chemo combinations, I thought platinum-based had the best
chance of shrinking and the most potential for toxicity (but I could be
wrong).  An example of one is here
<http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPro/Cisplatin.htm>

Another past poster used Iressa for a while and her lung tumour shrank.
Unfortunately, at check up time, a new tumour had appeared in her kidney
(August) and I believe she started Taxol, a stronger chemo. It was so toxic,
she's not been back on newsgroup since and she's stopped the chemo..
She did buy time and the first 8 months wasn't so bad for quality of life.
However, she is much younger than your father and was IIRC fairly physically
fit at the time of diagnosis.

There's costs to treatments (not just in $$)...quality of life.
As you say, it might be moot, but I do hope your father's doctors have run
something like this by him and yourselves.
<http://groups.google.com/groups?hl=en&lr=&ie=UTF-8&selm=KyW97.994%243x.3689%40ne
ws.bc.tac.net
>

(Steph's questions to ask).

So in your father's case his aim is to shrink the tumour so he can breathe a
little better.
Perhaps there's other means of doing so, in the meantime,
hope so.
Hugs
J
Tracy - 28 Dec 2003 04:16 GMT
Hi J.

You wrote:

>Hi Tracy,
>well, other than chemo combinations, I thought platinum-based had the best
>chance of shrinking and the most potential for toxicity (but I could be
>wrong).  An example of one is here
><http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPro/Cisplatin.htm>

Cisplatin is a bugger for nausea, at least my brother found it so.

<snip>

>There's costs to treatments (not just in $$)...quality of life.
>As you say, it might be moot, but I do hope your father's doctors have run
>something like this by him and yourselves.
><http://groups.google.com/groups?hl=en&lr=&ie=UTF-8&selm=KyW97.994%243x.3689%40ne
ws.bc.tac.net
>
>
>(Steph's questions to ask).

They are good questions.  The thing is, being neither the doctor nor
the patient, I don't get a vote.  I don't even feel in a position to
advise.  Right now my dad wants to live as long as he can.  Dementia
or not, that's his call even if it appears contrary to common sense.
Even if it appears contrary to some of his actions, like refusing to
drink fluids and still smoking.  

I really don't know about the various chemos.  I know that there
hasn't been much new in the world of chemo in the last 20 odd years,
that chemo is very rarely a cure and that the triple-shot cocktail
they had my brother on was very bad.  Beyond that, I have to trust the
doctor to decide what treatment promises the most benefit with the
least discomfort, and to back off when treatment will definitely do
more harm than good.  So far he seems to be proceeding gently and
showing wisdom in restraint.

Hugs,

Tracy
J - 28 Dec 2003 09:15 GMT
Tracy,

It's so foreign to me to not want to drink water and when you mentioned your brother, I just clued
in, you're the same Tracy who mentioned you lost your brother to cancer a year ago (in another
thread). This must be an incredibly painful time for you all.  I am so very sorry.

I know when my cousin in UK died, his father (my uncle) took a big nosedive (and died shortly after)
and she (my aunt) was never the same, a hollow shell for the rest of her life (many years).  Almost
sounds like your father's given up, so makes even less sense then that he's going for chemo, as if
he's just "going along with the program"...whatever someone authoritative suggests (without any real
thought to it).  I don't know if I'd trust an oncologist (other than Steph), they do what they do
(ie suggest chemo), the patient hears "cancer" and expects chemo, so it's up to someone else to say
"you have another choice..no chemo". I'd certainly "vote" and make sure it's understood that that is
a choice (if it was a family member I had access to).

A neighbour friend and I talk about these things frequently. His brother-in-law, who's in his early
80's has esophageal cancer. Before they could do surgery for that and chemo, he was found to have a
heart defect. So they opened him up for that surgery, then recovery, by then the cancer had spread
and had to have even more extensive esophagus surgery and he can't eat nor drink and now they're
going to be asking for chemo.  Neighbour friend just keeps shaking his head ... there's been no
quality of life in that family at all for over a year now, yet he feels he can't say anything
because it's his sister's husband, so not quite family the same as a brother or a husband or
father.  Probably a non-starter anyway, because at last word things were looking grim. My point
(gasp...getting long) is that so much quality of life was lost. Neighbour said "it'll always be a
relief to the family when he dies", they've all had such a rough time the past year.  Sad, isn't it?
When they could perhaps have been doing so much else in the interim.

Other than that, here's what I found.
http://health.yahoo.com/health/encyclopedia/000982/0.html
Dehydration can also occur from inadequate intake as in:
nausea
refusing to drink because of mouth sores (stomatitis) or a sore throat (pharyngitis)
acute illness with loss of appetite

(here's one I'll add, and I'm no medic, dehyration in of itself can maybe be an acute illness..
and/so is he getting IV fluids?)
Another one, something worse gone wrong in his brain.  (the reason I'm thinking that is because of
Lowkey's "nausea without vomiting"..it was a stumper and I still feel awful that I didn't clue in
that something was very wrong there.

So if no one has checked his mouth or throat, something to look into? And did you read the thread
about "incessant coughing"..some other ideas there as to possible causes and solutions. (in case
someone's just assuming it's smoker's cough which it could be).

Gee, I think I've babbled enough. No need to reply, if you're tired of explaining :-)
Hugs
J
Mike Radcliffe - 30 Dec 2003 01:24 GMT
> He knows he's incurable and he never considered not pursuing
> treatment.  It's not kick a.s chemo, it's just radiation booster.  I
[quoted text clipped - 9 lines]
>
> Tracy

At least he has discussed his options and made his own decision. Too many
people go into treatment not knowing what outcomes are likely.
MIKE
Socks the Whitehouse Cat - 24 Dec 2003 10:18 GMT
Giving up the right to remain silent, Tracy <tracy60
@spamless.newsguy.com> said in news:102iuvob9d4952926kr79f2cueqjlhllu8@
4ax.com:

> My dad (75 years old) was recently diagnosed with large cell lung
> cancer.  He's doing radiation and platinum chemo and is doing pretty
> well with it.  No nausea, doing pretty good.  He has little appetite
> but my big concern is that he will not drink fluids.  

(snip)

> Anyone have any tips and whetting someone's thirst?  Is there a way to
> make a person feel thirst or make them want to drink fluids?  He likes
> beer but I don't think that would be helpful to him just now.

I've been in something of the same boat.  I dropped 10 lbs one week
because I wasn't getting enough fluids.  At the same time, for the same
reason, my appetite was suppressed and my energy levels were suppressed.

The beer is a great idea for spurring appetite, except within a day or
two either side of the actual chemo treatments.  The rule I used and my
doctor signed off on was no alcohol +/- 48 hrs from chemo.  

My original cancer center's nutrition guidelines said to drink a glass of
beer or wine before every meal to spur appetite, and to eat more, smaller
meals. At one point I was kidding them that I was having a glass of beer
and a small meal (eg - beer nuts if nothing else) every hour on the hour.  
That was the first doctor ever to tell me to drink more, not less. :-)

However, beer is a diruetic.  It won't help dehydration.  According to
one pharmacy discussion list, "Alcohol inhibits the release of
antidiuretichormone from the brain, this hormone causes the kidneys to
reabsorb water. Consequently, alcohol causes increased urine flow and
dehydration."  When my radiation oncologist caught my dehydration
problem, he recommended fruit juice rather than beer.

One other interesting item, though your dad is not experiencing nausea,
for whatever weird reason ice tea increased my nausea levels
significantly.  I had tried to counter the dehydration problem by
alternating between beer and iced tea, and that was a definite failure.

Google on beer and dehydration for some interesting discussions, mostly
aimed at runners but still relevant.  

Signature

Carpe Daemon -- Seize the background process!

J - 24 Dec 2003 10:24 GMT
> (snip)
> My original cancer center's nutrition guidelines said to drink a glass of
> beer or wine before every meal to spur appetite, and to eat more, smaller
> meals. At one point I was kidding them that I was having a glass of beer
> and a small meal (eg - beer nuts if nothing else) every hour on the hour.
> That was the first doctor ever to tell me to drink more, not less. :-)

ROTFL

> However, beer is a diruetic.  It won't help dehydration.  According to
> one pharmacy discussion list, "Alcohol inhibits the release of
> antidiuretichormone from the brain, this hormone causes the kidneys to
> reabsorb water. Consequently, alcohol causes increased urine flow

I'll say !...remembering roadside stops...and dry mouth in the morning.

> and
> dehydration."  When my radiation oncologist caught my dehydration
> problem, he recommended fruit juice rather than beer.

No problems with (some) fruit juices and chemo? (or other meds)
http://www.dartmouth.edu/dms/news/publications/dartmed/fall00/html/bench_to_beds
ide.shtml


http://www.hc-sc.gc.ca/english/iyh/food/grapefruit.html

J..thirsty for beer ;-)
Socks the Whitehouse Cat - 24 Dec 2003 16:25 GMT
(snip)

>> and
>> dehydration."  When my radiation oncologist caught my dehydration
[quoted text clipped - 7 lines]
>
> J..thirsty for beer ;-)

At the time I wasn't on chemo, just radiation and zometa.  I was warned off
vitamin C at some point during chemo, but I don't remember why.

Signature

Carpe Daemon -- Seize the background process!

J - 24 Dec 2003 18:40 GMT
> (snip)
>
[quoted text clipped - 12 lines]
> At the time I wasn't on chemo, just radiation and zometa.  I was warned off
> vitamin C at some point during chemo, but I don't remember why.

I think it's mentioned here
http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/VitaminCAscorbicAcid.htm
but my heart's not in searching, because I ran into one of your posts and got
lost on theonion.com <g>

J
Mike Radcliffe - 27 Dec 2003 05:47 GMT
> My dad (75 years old) was recently diagnosed with large cell lung
> cancer.  He's doing radiation and platinum chemo and is doing pretty
[quoted text clipped - 20 lines]
>
> Tracy

Did he want the treatment he is getting? Has he changed his mind about it ?
Is his cancer more advanced than they thought it was?
If he wasn't a 'drinker' before then the treatment he is having will
certainly make the problem worse.
I would be a little circumspect about the wisdom of actively treating
someone who is 75 and showing signs of
dementia, given the poor results with NSCLC.
MIKE
 
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