psychogenic vomitting vs. undiagnosed GI problems

My daughter has been ill for one year.  She was diagnosed with a resistant ear infection last March.  After one month of antibiotics and pain meds at home she was hospitalized and placed on IV antibiotics and pain meds.  3 days into the hospitalization she began vomitting and a few days later began vomitting blood.  The diagnosis was drug induced ulcers.  For the entire last year her ulcers have periodically acted up, accompanied by gastritis and esphogitis.  She has bouts of nausea and vomitting and extreme loss of appetite.  She has had a cholecystectomy and stent placement, several upper endoscopies, barium studies, nuclear medicine scans, CTs and MRIs.  Her medical doctors feel her symptoms are out of proportion with their findings.  She also had the misfortune of being  committed to the local psychiatric hospital twice becasue her doctors did not no what else to do.  Most recently she began vomitting about a month ago.  It came on slowly at first only after certain foods and eventually progressed to the point that she could not keep crackers and water down.  This bout came on after a seemingly benign period of resuming normal school activities and more normal teen eating behaviors.  She has spent the last two weeks in the hospital as her doctors scratch their heads.  She is under the care of a psychiatrist and therapist who can not categorize her into any psychiatric syndrome and are encouraging the medical doctors to look again.  The medical doctors (GI doctors and primary physicians) are frustrated and don't know where else to look.  Some of the diagnoses that have been tossed around are bi-polar disorder, post traumatic stress (secondary to the illness), eating disorder, depression, anxiety, gender identity crisis, somatization, Munch-Hausen's, and borderline personality disorder.  During one of her comittments the doctors ruled out anorexia and bulemia.  The shrinks and her therapist do not think she fits into any of these categories, and started talking about shadow syndromes and want the doctors to look again.  The medical doctors say it is psychosomatic and she will not get better until she wants to.  So to make everything worse the doctors can't agree on how to treat her.  This most recent illness came after her psychiatrist took her off Prozac and placed her on Remeron.  Once he upped the dose she had aggressive, angry, depressive behavioral problems and began vomitting and the decision was made to quickly wean her off.  So here we are after 2 weeks of hospitalization, she is on NJ feedings again, continues to vomit and no one can make a decision.  Have you ever heard of a case even similar to this?  Where else could we go?

[HFHS MD - RG]

It is hard to further comment when you have had different doctors giving you different opinions on what is going on with your daughter. On what you have written above that your daughter has had all the test to find out what is going on with her.
Aside from medications, has your daughter been in therapy before to rule out any underlying issues that medications are unable to cure?

You may want to consult a different psychiatrist for a second unbiased opinion.

[cassandra]

Ask the doctors to check for gastroparesis, which is delayed emptying of the stomach. It will cause the exact symptoms you describe. The test for diagnosis is a gastric emptying study. For this test they put something into a food that shows up on x-ray, usually they use eggs or oatmeal, she eats, then they follow it on x-ray. I went through this exact same thing with anorexia, went to psychiatrists. She is clearly suffering, (you too) and it's really unfortunate the doctors can't see that. Insist on the test, when she's having symptoms. Gastroparesis can be intermittent, don't give up even if you have to step on some toes! In the meantime it might be of help to do research on the internet about gastroparesis, to use as ammunition to bring to the next doctor's visit. Please post back here to update on how she's doing, and if you need anymore help! Good luck and God bless.

[vb]

I sympathize with your daughters problems. I ahve had a similar problem for over a year. I do suffer from depression and anxiety but the doctors have concluded that the problem I have is physical. I have been through all of the tests also. I was found to have delayed gastric emptying. You should ask your doctor. Also I have just been put on a gluten free diet. I don't know if it is working yet but perhaps you should ask your doctor about that too. You have to avoid wheat but if it works it beats having alot of tests and medication. Good luck and hang in there.

[Adel]

Thank you for the comments.  My daughter did have a gastric emjptying scan this summer that was very low, borderline normal. At that time it was suggested by a physician to repeat the study with a 2 phase approach, liquids followed by solid intake.  The was a professional disagreement and the test was not repeated. Her most recent symptoms of constant vomitting are relatively new.  Once again her doctors are scratching their heads.   We have had second psychiatric opinions.  She was committed twice for not being able to eat, and other "issues".  So all together there have been 3 therapists and 4 different psychiatrists that have worked with her at some point, and none of them seem to be able to get a clear picture of what is happening.  Her recent psychiatrist will not medicate her because he does not even know what to put her on.  They all say she does not fit any clear pattern of psychological disease. Any other ideas?

[cassandra]

Hi Adel,
I read your post in the gastroenterology forum, I can't believe all that she's been through. It's awful that she couldn't complete the gastric emptying study because she got sick. What if they gave her antinausea meds like IV Zofran, IV Compazine, or IV Inapsine before the test? The only thing is, with Zofran I have read it increases motility which may alter the test. Others meds may not. As far as the professional disagreement, if there was any abnormal result on the first test it should be repeated. This illness (especially in the early stages) is so intermittent, and diagnosis can be delayed many years because of normal test results. Then the doctors think they ruled it out! The first doctor is right wanting to do another test with solid and liquid phases. If that doctor orders it, then it has to be done even if another doctor disagrees with him. I would really push for it. The worst thing that could possibly happen with your daughter is to continue with psychiatrists- unless all medical avenues have been exhausted. Her mental health can wait even if there is something wrong, her physical health needs immediate attention. If you read posts from people in the GI forum, almost everyone with gastroparesis went the "mental route" and it's devastating. She may become really depressed and lose hope just from them telling her it's in her head when she's suffering. She will find hope and peace in knowing what this "thing" is making her suffer. If she can't handle NG tube feedings the doctors need to do something soon, she may need TPN. Has she tried Reglan, Propulcid, or other drugs to increase motility? They even have gastric pacemakers now, there is hope if this is what she has. I will keep her in my prayers. If you need any more help, I will keep checking back here. Take care.

[Myrna Gregory]

My daughter has been having a vomitting problem severely since February.  Hers progressed in thesame way, started slow and began to get worse.  She did have severe stomach inflamation (inflammation) and that has begun to heal, but vomitting still. Also, has delayed emptying.  Done counceling, councelor feels there is no eating disorder.  My daughter wants this to stop, she pray daily for healing.  If you find anything, we would love to know.

[Myrna Gregory]

My daughter has been having the vomitting problem for 4 months.  Doctors are also scratching there heads.  they have suggested reflux, motitlity problem.  But, nothing is helping. I would also love to have some answers.

[Myrna Gregory]

My daughter has been having the vomitting problem for 4 months.  Doctors are also scratching there heads.  they have suggested reflux, motitlity problem.  But, nothing is helping. I would also love to have some answers.