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Gastroenterology (Expert Forum)
5 Years of Nausea/Vomiting
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
5 Years of Nausea/Vomiting
by Cabrill, Jun 15, 2004 12:00AM
1999: I lost my job and my stomach had a breakdown. I couldn’t open my mouth without vomiting or going into dry heaves. As soon as I inhaled cold air I immediately started vomiting. It lasted for about 3 minutes, and usually consisted of yellow bile. I went to a walk-in clinic and spoke with a doctor who diagnosed it as stress and gave me a simple med. I took it and avoided food for the rest of the day. The next morning I once again got up, feeling sick and as soon as I opened the door and felt the cold air on my throat I started heaving bile, again.
I tried drinking nothing but water, and eating nothing but soup but found I could not keep these simple things down. Within seconds of swallowing I would start gagging and soon regurgitate the food. I tried only water, but couldn’t consistently keep that down, either. I was stuck in bed for almost 2 months in which I lost 80lbs. It wasn’t until I managed to secure a new job that things started getting better. I started seeing a physician. He diagnosed that stress caused the problem, but my weight perpetuated it, and I was placed on a protein diet, supplemented with Belladonna. I had no more luck holding down these foods than any others. My mother had her gallbladder removed, so he scheduled a gallbladder radionuclide scan, but there was a shortage of the chemical used to irritate the gallbladder, and after injecting the tracer I was given a full cup of Half-and-Half cream, which I kept down for 2 min. The results were that my gall bladder was only operating at 60% efficiency and they’d like to remove it. But I did not trust the results due to the substitution of Half-and-Half, and the short duration I kept it down.
The vomiting was so violent and common that I had continual red circles around my eyes from burst blood vessels, there was fresh blood in my vomit, and I would spit up blood for approx. 5 minutes afterwards. I then turned to a GI doctor. Upper GI Ultra-sound: normal. Then upper entroscopy. After the operation I was told I hadgagged on the scope the entire time and they had to give me a double dose just to keep me unconscious. He didn’t see any abnormalities except heavy esophageal damage attributed to GERD, although I had suffered no heart-burn, the final diagnosis was GERD and I was placed on Protonix.
I’ve been taking Protonix since, but it seems to have no effect on my nausea. Instead, I eat very small meals, avoid drinking/eating at the same time, and do not travel within 2 hours after a meal. Also, I avoid swallowing after eating as it usually triggers the gagging. Instead, I spit any saliva into tissues for 20-30 minutes after eating. These greatly alleviate the nausea/vomiting I experience. I always get nauseous after eating, but I only vomit maybe 1 out of every 30 meals now.
I really just want a final solution or diagnosis. Do you advise I look into my gallbladder again, different GERD medication, stress medication, or something else?
I tried drinking nothing but water, and eating nothing but soup but found I could not keep these simple things down. Within seconds of swallowing I would start gagging and soon regurgitate the food. I tried only water, but couldn’t consistently keep that down, either. I was stuck in bed for almost 2 months in which I lost 80lbs. It wasn’t until I managed to secure a new job that things started getting better. I started seeing a physician. He diagnosed that stress caused the problem, but my weight perpetuated it, and I was placed on a protein diet, supplemented with Belladonna. I had no more luck holding down these foods than any others. My mother had her gallbladder removed, so he scheduled a gallbladder radionuclide scan, but there was a shortage of the chemical used to irritate the gallbladder, and after injecting the tracer I was given a full cup of Half-and-Half cream, which I kept down for 2 min. The results were that my gall bladder was only operating at 60% efficiency and they’d like to remove it. But I did not trust the results due to the substitution of Half-and-Half, and the short duration I kept it down.
The vomiting was so violent and common that I had continual red circles around my eyes from burst blood vessels, there was fresh blood in my vomit, and I would spit up blood for approx. 5 minutes afterwards. I then turned to a GI doctor. Upper GI Ultra-sound: normal. Then upper entroscopy. After the operation I was told I hadgagged on the scope the entire time and they had to give me a double dose just to keep me unconscious. He didn’t see any abnormalities except heavy esophageal damage attributed to GERD, although I had suffered no heart-burn, the final diagnosis was GERD and I was placed on Protonix.
I’ve been taking Protonix since, but it seems to have no effect on my nausea. Instead, I eat very small meals, avoid drinking/eating at the same time, and do not travel within 2 hours after a meal. Also, I avoid swallowing after eating as it usually triggers the gagging. Instead, I spit any saliva into tissues for 20-30 minutes after eating. These greatly alleviate the nausea/vomiting I experience. I always get nauseous after eating, but I only vomit maybe 1 out of every 30 meals now.
I really just want a final solution or diagnosis. Do you advise I look into my gallbladder again, different GERD medication, stress medication, or something else?
Doctor's Answer
by Kevin Pho, MD, Jun 17, 2004 12:00AM
, Jun 17, 2004 12:00AM
I would suggest a HIDA scan with CCK stimulation to quantify the function of the gallbladder. If decreased, removing the gallbladder may improve the symptoms.
Other tests to consider would be a 24-hr pH study or gastric emptying scan. The first study would be a definitive study for GERD. If you continue to have increased acid secretions despite Protonix, then surgical therapy may be considered. The second test would evaluate for delayed gastric emptying - which can result in the nausea.
You may want to discuss these tests with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Other tests to consider would be a 24-hr pH study or gastric emptying scan. The first study would be a definitive study for GERD. If you continue to have increased acid secretions despite Protonix, then surgical therapy may be considered. The second test would evaluate for delayed gastric emptying - which can result in the nausea.
You may want to discuss these tests with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Finally, I saw a different doctor. He ran the HIDA scan again. This time they used the second injection to make the gall bladder contract. When it did, I had awful symptoms...nausea, pain in the right ribs etc. My function was rated at 24%.
I had my gall bladder removed four days ago. Although I am still sore, I am feeling so much better already. They also found several small stones. If your doctor thinks it may help you to have it removed it is worth a try. The surgery is not bad at all. I am glad I went through with it. Good luck.
Did you get the cholesectomy with laparoscopic procedure ? How was your post op pain (1-10 scale)? How much did the pain reliever help ?