Re: chronic nausea

Posted By HFHSM.D.-jg on October 31, 1998 at 12:02:11:

In Reply to: chronic nausea posted by Lisa on October 24, 1998 at 17:21:11:






I've had chronic nausea and vomiting for the last several months. It's been controlled by Ativan until they figure it out. I'm allergic to Compazine and no one wants to try Phengran or Raglan on me. The first specialists my primary physician referred me to were digestive. That that group I had an endioscopy with biopsy, an abdominal ultrasound, a Hyda Scan, an MRI of my head and a delayed gastric emptying test. Lots of blood work with both doctor's offices. Blood chems, CBCs, etc. The only thing they came up with at the digestive specialist was some delayed gastric emptying. Propulsid was tried, gave me a severe headache and did not relieve the nausea at all. Then I went to an inner ear/balance specialist. All kinds of tests run. All we came up with is that I have abnormally good hearing in my left hear. That doctor also examined the pictures of my MRI. The nausea began to follow a pattern with my menstrual cycle come mid-summer in that I would have a 48 hour window of total relief from symptoms, without meds, either just before or right after my period started. Hormonal blood draws began with my gynecologist, who I'm next schedule to see Nov. 5th. In the midst of this I was tested for HIV and Hepatitis C (I wasn't presenting with any typical symptoms for those, but they were running out of things to do with my blood), both negative. I saw an endocrinologist who seemed to be able to only treat 3 things; 1) diabetes; 2) thyroids problems; and 3) depression. I felt he was a little inept. Back to my primary physician, she says let's see what the gynecologist has to say on the 5th. In the meantime this has effected my job so that I only work part-time. It has effected my entire life. I have had some weight loss occasionally when bouts have been bad (between 5-6 pounds, but I'm only 5' tall, so it can make a diff), but it comes back when I can eat normally.
I feel there's a hormonal connection. Anybody with a medical degree got any idea?

Dear Lisa:
As you have learned nausea and vomiting can be due to a number of different causes. Delayed gastric emptying my be the cause of your problem.  Gastroparesis can be primary (i.e. no specific associated disease identified) or secondary (e.g. due to hypothyroidism, diabetes meelitus, visceral nueropathy).  There are however, other possibilities that need to be ruled out. Adrenal insufficiency, medications especially birth control pills/estrogen/progesterone, endometriosis, pelvic inflammatory diseases, and other gynecological diseases related to uterus and fallopian tube must be excluded.  Small intestine diseases such as celiac sprue and Crohn's disease must also be considered. If the all the organic causes are excluded, then psychosocial causes such as depression have to be considered.
In addition to your scheduled gynecological evaluation, you may need further GI work up including small bowel biopsy and small intestine barium X-ray.
For the treatment of delayed gastric emptying (gastroparesis), promotility agents are used.  Commonly used medications include Reglan or Propulsid. Reglan can be associtaed with central nervous system side effects such as tics or involuntary movements of the extremities. Cisapride has been associated with a cardiac arrthymia in patients who are taking other medications concurrently.. Anti-emetics such as Phenergan, Ativan and Zofran may control the nausea but do not treat the cause of your nausea. They might be used for a short term but should be avoided for long term use.  
This informationis presented for educational purposes only.  Always ask specific questions to your personal physician.
HFHSM.D.-jg
*keywords: nausea, vomiting
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