Not eating or Drinking

[DebsA]

My partner of 31 years became ill with stomach pains end Oct 2021 and began to lose weight rapidly. Eventually after several trips to doctors and hospitals we got a ct scan in January 2022  and in eventually early February 2022 we got the awful news that he had Pancreatic cancer into the Liver and there was nothing they could do to  help him. After a biopsy they offered him palliative chemo and said this could possibly extend his 3 months to 6 months. I told them all he was still not eating and drinking very little (he has been given creon and fortisip but this is no use if he is  not eating) and the weight loss is sole destroying to witness every day.

 

He was unable to have his 1st course of chemo and was admitted straight from the unit for hydration an infection and they discovered his type 2 diabetes was out of control. Following the hospital admission he is now on  insulin every day (after nearly dying with blood sugars at KETONE level high enough to kill ) and so  trying to encourage him to eat, when he has no appetite, having to have creon and insulin injection beforehand, is impossible. He has no appetite (full all the time - i know the cancer hormones can cause this) and he now also worries about what he eats and drinks because of the diabetes blood sugar levels, even though I have told him the insulin can control them 

 

He had  his first Chemo  last week and has eaten and drunk nothing since. I have spoken to GP, chemo unit ,anyone who is there or I have a number for but getting nowhere. I am told steroids may help with appetite but they have not given him them due to his diabetes.

 

He is due to have his 2nd chemo session tomorrow. I hope someone will do something  to help us then. 

Can anyone help? Have you had similar experiences I can learn from. Is there something or someone I should be talking to about this.

 

Everyday I see him in pain from the cancer, watch him waste away (he is now under 6 stone) and I have to test him and inject him for the diabetes and its all getting unbearable. Any help/advice appreciated. 

[Jen]

I'm so sorry to hear about what you and your husband are going through.  Is he able to keep food/fluid down?  Nutrition drinks like Fortisip are good as well as drinks like Ensure.  Ensure makes a diabetic drink as well.  But the Ensure Completes have the best protein amount, etc in them (I don't know if they do a diabetic complete)  I don't actually know as much about Fortisip as Ensure ( It is the kind my mother has liked the best).  Adding ice cream to fatten up the drink and turn it into more of a milkshake can help add calories as well (if he can handle dairy at the moment).  Calories in fluid form tend to be easier to get into someone than solid food if people don't feel like eating.  If he can handle solid food then adding butter/protein powder/full fat creams, etc can help with adding calories too.  Smaller frequent meals are best, but if he can tolerate fluids I would try and get 3 or 4 Ensures/Fortisips into him a day than try and make him eat solids if he just can't stomach it.  Even if you can get him to take the nutrition drinks without the Creon will have some nutritional benefit but would be better to have creon prior to each Ensure if he can take it.  If he is nauseated then giving him an antiemetic 30min prior to eating can help as well.

 

Steroids will tend to increase blood sugar levels but definitely discussing with his oncologist if this is an option should occur.  Steroids many times tend to be used for anti nausea purposes during chemotherapy treatment.  Have you been referred to any kind of diabetic service such that a diabetic nurse can be contacted for advice with regards to Insulin management if you have questions with this?

 

Again I know this is a very difficult time and I hope you can get some face to face advice soon.

 

Also if a dietician hasn't been involved then talking to your oncology team about a referral could be helpful as well.

[LisaC]

When Lewis had a poor appetite I would make him milkshakes and add ice cream for extra calories and just titrate his insulin to his blood sugars, eat little and often and what ever he fancied (tuna mayo, cheese and ketchup roll one day!) 

 

If you have not all ready been referred to a hospice I would ask to be by GP or specialist nurses at the hospital, they can help with symptom control, especially if his pain is not well controlled, they were an invaluable source of support for me and Lewis and they helped us in so many ways. 
 

x

[DebsA]

Thank you for your replies. 

 

I am feeling a little more calm today but yesterday I was feeling so hopeless and the kind words help.

 

He had his second chemo today and his oncologist is going to consider steroids next week. It all seems to take so long to get anyone to do anything.I do have the support of a great diabetes nurse  so I am not worried about what it does to his sugars as long as he starts to get some nutrition.

 

He has been given fortisip but cant drink it now as it tastes sour (another side effect of this horrible cancer and the hormones it creates)  and I have tried to get him onto homemade , supped up milk shakes and other forms of high calorific meals, all to no avail I'm afraid. 

 

We have had a telephone appt with a dietician but she has not even seen him and all she can tell us  is he must eat, even if it is small snacks. I already know this. I already know this. 

 

We have not been put in touch with a hospice ... this may have to be my next step if steroids do not help.... and even without them. 

 

Thank you again

 

 

[Skippy]

My brother Nov 2020 was referred to a "home care team" via the Hospital via the Drs Surgery. We received a regular nurse weekly into his home, even during covid. Nurse came to ask how he was every week, how his food intake was going.. She would sit a good half hour chatting to us we were able to discuss any fears and I recall my bro didn't have many poorly symptoms at this time.

He was eating blended foods and custards and pureed fruits.  With Creon x3 b4 every meal. He hadn't even had his last CT scan either, that was not until the late December as it had been due then. It revealed a further spread to Liver and Lungs where this gave him "possibly 6 weeks"  We were provided then with further care team members (3) plus one 24/7 to ring for their attendance.

I'd like to think everyone with this diagnosis obtains the same -  home visits - to actually see the patient with this diagnosis. We also had a list of those specialist nurses M Curie to ring. 

I wonder if Drs need reminding you need a weekly care team set up? 

[Lornacath]

Hi Debs, my heart goes out to you with the ordeal you and your partner are going through. Watching someone you love suffer is like torture.

My mother is very Ill with P/C stage 4 with Mets now in her liver. She was due to start chemo 2 weeks ago but got rushed into hospital for a life saving prolapse operation that left her with a Stoma just to add to the list of health issues she is having to deal with. Mum is in pain every time she eats and has been told to take Shortech at the 1st sign of any break through pain. This is along with many other tablets including steroids which she has been taking this last week. I have noticed in the last few days her appetite is improving slightly.

The stent mum had fitted back in July 21 helped my mum a lot to begin with and she luckily has not had to deal with diabetes. I’m really not sure whether she is ever going to be well enough to start chemo.

Mum has had a wonderful hospice nurse calling on her and has been a hugh help in sorting out all pain medication and advice on diet.

My thoughts are with you both, I hope chemo is successful and that your partner will soon be able to enjoy some food.