Psychosomatic gagging/nausea: Need Help (pretty serious medical problem)

In My Humble Opinion
1

My younger brother (19 years old) has cancer. He’s currently going through chemotherapy and, as you might expect, there are lots of pills to take on an almost daily basis. The problem is that he has an overactive gag reflex and has always hated swallowing pills. Until recently this has mostly been an inconvenience, forcing us to nag him to take all his medication in a timely fashion. Annoying, but manageable.

But now there’s a serious issue. The side effects of one of his chemotherapy drugs include constipation, which we were supposed to manage with stool softeners. Unfortunately, it seems he wasn’t very diligent about this and the constipation has snowballed into a train wreck. Scans show no big blockage, but there is quite a backlog in his gut, if you catch my meaning. This constipation is causing nausea and lack of appetite, and he’s losing weight.

Anyway, now he’s on a massive regimen of laxatives: colace, senna, miralax, and lactulose, all twice a day. Unfortunately, he seems to have developed a sort of gagging PTSD, as the memory of various disgusting elixirs he’s had to choke down during this whole odeal has left him in a state in which the mere mention of these laxatives is often enough to set him into a gagging spell. His solution when we present him with his twice daily assortment of pills/syrups is to spend two hours gagging and dry heaving until he feels well enough to force everything down, then pray he doesn’t barf it right back up.

He’s spending a huge portion of each day miserable, he’s dropping weight that he can’t spare, and it’s making him weak and tired most of the time. These issues won’t be entirely fixed until the constipation resolves itself, but the psychological hurdle he has to clear is a big part of his immediate problem, and of course it also makes it more likely for him to delay and/or skip doses, which endangers his life, ultimately.
Sorry, didn’t mean to dump all that on here, but I need ideas. We’ve suggested sedatives (ativan, e.g.) to calm his anxiety, but he’s adamant that he doesn’t want to be gorked all the time. We’ve joked about hypnotherapists, but at this point I’d consider it. I’m kind of at a loss.

Possible solutions? Personal experiences? Anything, really? Thanks.

2

Moderator Action

Since this is asking for medical advice I am going to move it to IMHO.

Moving thread from General Questions to In My Humble Opinion.

3

Every medication you have mentioned is available as a liquid and/or powder so how does the gag reflex come in to it? He doesn’t have to take pills necessarily.

4

Things in powder or non-time release pill form that can be crushed, can be mixed with stuff like apple sauce. Things in liquid can often be diluted in juice.

I have a bit of a gag reflex that becomes extra sensitive at the dentist. One hydrocodone tablet helps ease the anxiety and seems to take away the gag reflex and makes for a pleasant appointment for everyone. Maybe just a half a xanax crushed in apple sauce, 20 minutes before anything else, or something like that, would help at med taking time, and not be enough to gork him at all.

5

Yeah, not taking stool softener, when directed is a recipe for troubles. You may require suppositories to clear the blockage, for now. Consider a compounding pharmacist. Tell them about his issues, and all his meds and see what they recommend. They ought to be able to reduce everything to liquid form and possibly reduce the number of times he takes his meds throughout the day.

I was giving 17pills a day to someone who had difficulty swallowing and managed to make it work by crushing them and mixing them with jam! Talk to the doctors, nurses, pharmacists, they’ve all dealt with such problems before. There are lots of things to try, but you gotta speak up!

I’m assuming you’ve suggested Gravol to stop the nausea? Does his doctor know about this? If not, why not? If so, what does the prescribing physician have to say?

6

I hope some of the above suggestions will help. I used to take 1/4 of an ativan to help with anxiety. It’s not enough to make one groggy or anything, but really eased my nerves.

I hope the prognosis is good for your brother. His situation sounds just miserable and I hope he feels better soon.

7

The main problem isn’t the pills (colace and senna); those are mostly just very annoying to him. The problem is getting down the miralax and lactulose, the mere thought of which makes him wretch. When mixed together into a cup or two of water they have very little taste IMO, but he’s had such bad experiences with other liquids and syrups he’s been forced to chug during this ordeal that his mind just wants to reject it altogether.

I’ll run the idea of mixing things into applesauce or something instead of water by him, though I’m guessing he won’t go for it.

He has oxycodone he can take, and when he’s in particular distress he’d like to be able to, but opiates contribute to constipation, and he wants this to be over.

Being a chemo patient he has fantastic anti-nausea meds, but they don’t seem to help when the nausea is caused by the brain flipping out on itself and not something physical.

His doctors are well aware of the situation: this is their prescribed treatment. I’m not so much looking for advice on how to fix the constipation (that’s what the MDs are for), but rather advice on how he can swallow what amounts to a small amount of sugar water without his psyche going nuts and reversing the flow.

8

I have a strong gag reflex and drinking them with water makes it worse. I found swallowing big pills with my favorite drink coke is the only way to keep it down without barfing it all up. Has he tried drinking it with something other than water?

9

I am sorry to hear about your brother. My sister also had cancer around that age and had the same issue. We crushed up the pills we could and mixed them with apple sauce. She also had constipation and had to have an enema a few times to get things moving. It was such a horrible experience.

She was assigned a psychologist by the Children’s Hospital (where she was treated). Does your brother have the same? They might be able to help with that side of things - not to mention, cancer sucks, and he might need help getting through the emotions.

10

Consider something thicker, with stronger flavour than applesauce. Like jam, or chocolate syrup.

11

Does magnesium citrate or magnesium sulfate soda/solution make him gag? It’s an odd taste, but some people tolerate it. It also causes a rather secretory diarrhea, so he needs to be able to keep up with fluids on it. But it could be a possible answer.

12

One person I know was able to train herself out of the pill gagging problem with Jelly Belly jellybeans. They’re small and pill-like, but her brain categorized them as “candy,” so they were able to be swallowed. After a few trials of swallowing (whole) Jelly Bellies, she was able to do Jelly Belly, pill, Jelly Belly, pill…

Some people find that a straw helps make them not gag so much, because it puts the liquid at the back of the tongue where they don’t taste so well. Others, particularly those with swallowing difficulties that are physical in origin, find straws make it much worse.

If the liquid can be refrigerated, do so. Cold makes bad things taste less.

They sell medical liquid thickeners if a different texture might help. These are often used for people with swallowing difficulties after a stroke; liquids seem like they should be the easiest to get down, but they actually require more coordination between more muscle groups than solids. I know his problem isn’t neurological, but perhaps just having something with a different texture would help.

This is definitely one to run by the pharmacist first for safety, but it may be possible to differently flavor his liquid meds, either at the pharmacy, or with those water flavor drops (Mio is one brand) at home. It may not be so much a strong flavor as a *different *flavor that’s needed.

Failing that, suppositories or enemas may be what’s needed in the short term while this works itself out - but that’s definitely a “check with his doctor” thing first.

13

Any chances you guys could make him smoothies without even telling him the miralax and lactulose are in them? The freezing aspect really helps to cover any taste.

14

Gravol isn’t available in the United States.

How does he eat, or take fluids, if he can’t take his medication? I’ll grant you that lactulose is some nasty stuff. I’ve licked it off my finger, and can’t figure out how people can swallow that gunk by the ounce.

15

Gravol appears to be dimenhydrinate, which is available over the counter in the US as Dramamine and any number of generic forms.

16

I’m hesitant to mention this, but would medical cannabis help some of his symptoms, including the constipation? Experts (sorry for the lack of hot link: I’m still figuring out this tablet. ) I am not a cannabis user, and I realize the prostylitizing attitude towards it a lot of proponents have, but perhaps it might help his set of symptoms? I’m also not a doctor.

I wish you both the best and am praying for his recovery.

17

It’s a brand and has several formulations.

Not a small number of Canadian women who have difficult pregnancies take it, so that’s the main way I knew about it.

18

The non-dimenhydrinate formulations seem to be ginger or ginger + willow bark, which are available in many products.