Can Anybody Help Me, Please?

[Komet Alan]

Eight years ago, I had my first incident of vomiting green bile coupled with extreme pain in my upper left quadrant.  They initially thought it was pancreatitus (pancreatitis), but all the bloodwork came up good.  Then they thought I had a gallbladder problem, but I never had any gallstones.  Several months later my brother passed away, and two days after that, the doctor in Las Vegas removed my gallbladder.  I had about five more incidents of vomiting the green bile and I have had every possible test done to no avail:  no Doctor can diagnose me.  Over these past eight years, sometimes I would have a few incidents a year, sometimes none at all.  But this year I've lost count of how many incidents I've had.  I even know what to tell the doctors in the emergency room how to treat me:  4 miligrams of zofran, 2 miligrams of dilaudid.  This combination stops the vomiting immediately and then the pain goes away.  Still, no diagnosis.  One gastroenterologist read my medical history and assumed I had IBS, but I've never had a problem in that area.  Something is seriously wrong with me, I have to admit it now.  A friend of mine told me about a book called "Patient Heal Thyself" and I bought it.  Then on September 10 of this year, I had a really bad incident and I knew they were going to admit me to the hospital so I brought the book with me.  I was so frustrated with all the doctors and scared that I was actually going to die that time.  The pain is indescribable and the bile is horrible.  So I read the book and it was amazing to me that a man could, and did, cure himself from Crohn's disease.  In a nutshell, he did it through a homeostatic soil organism (I call it the dirt pill) and some digestive enzymes.  So I went from the hospital to the health food store and bought these supplements.  From that day on, there were no more incidents which was great because I was averaging about 1 hospital visit per week by September.  But here's the worst part of my plight:  On October 30, I went on a cruise with my mom.  I've been waiting to go on this particular ship for years so I could ice skate, and I ended up in the hospital of the ship every single day of the cruise.  I even threw up blood for the first time and that's not good when you're in the middle of the Atlantic ocean.  The scary part is is that I don't know what triggers it, but I'm terrified to eat.  I've never gotten sea sick on those big boats so I don't think it's that.  When I got home, my little arms looked like I was a heroin addict from all the IV's I had.
Is there anybody out there that can help me?  Does anyone even care?  I haven't had any more incidents since I've been home from the cruise, and I still take the dirt pills and enzymes.  But I could start vomiting at any time, and it's hard on me physically and psychologically.  I'm a 38 year old woman and I'm in good physical shape, and I want to be cured, or at least diagnosed.  I'm running out of energy from this so please help save me, please.

[Kevin Pho, MD]

Chronic vomiting can be a difficult symptom to treat.  

More obvious causes can include any type of upper GI disorder.  An ulcer, esophageal dysmotility or stricture, or gastroparesis can be considered.  

Tests to evaluate this would include an upper GI series or upper endoscopy, gastric emptying scan, or 24-hr pH study with esophageal motility studies.  

A CT scan can evaluate for pancreatitis.  

If the GI tests continue to be negative, you can consider neurological causes - starting evaluation with an MRI of the brain.

These options can be discussed 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.
kevinmd_

[sdp4314]

I have no answers for you, but feel like I need to respond to your plea.  I am so sorry for you pain and discomfort.  It sounds like you've been through hell and back, but has anyone done any laproscopic looks, via esophogus or colon?  Have you been checked for celiac sprue?  A number of things come to mind, but when you vomit bile, that usually means you've exhausted all of your food left in your stomach.  I'm wondering if maybe you have pancreatic issues other than pancreatitis.  What tests have been done?  Please let me know and I'm sure others will chime in and give you some ideas.

Hang in there....

[Felix'sMum]

Hi, I also felt I should respond as you sound so desperate. It sounds to me that, in a nutshell, your problem is excessive vomiting and that is what worries you and spoiled your holiday etc.

As sdp has said, bringing up bile usually only happens when there is no food in your stomach. The vomiting mechanism simply empties the stomach contents and if there is nothing in there, then only digestive juices will come up. Do you eat small meals regularly. that would be my first suggestion. Obviously there are Forum doctors here who can suggest possible tests you might want to ask your doctor to do and one of them will probably respond to your thread in dues course, but the rest of us are just other patients so we can not help save you, as you ask. We can only tell you what we think and whether we have experience of anything similar.

If I were you, I would go and see another doctor if you can and explain quietly and calmly that you feel you are vomiting excessively and that much of what you are throwing up is green bile. In my (admittedly not enormous) experience, excessive vomiting usually has its origins in a psychological problem like stress or anxiety. Have you any reason to believe that might be the case?

[lizziecee]

Your heartfelt post struck a cord with me, and I have struggled all day trying to respond optimistically  - some 35 yrs ago I was struggling with GI problems and after a whole year, and in 5 different hospitals, was dx with Crohn's - I didn't present "normally" - no pain, then!, but went down to 98 lbs. There was no colonoscopy in those days and I had to undergo 3 weeks in hospital with various tests. Eventually a laparotomy with biopsies of my small intestine showed I had Crohn's. It is much easier to dx today through colonoscopy and biopsies.

There is a relatively new test, non-invasive, that I have periodically. I don't know if this is available in the USA, as a physician in England developed it Whenever I get a flare of my Crohn's disease my gastro has me do this test - it costs all of $4.00 This can conclusively show if a patient has IBS or IBD and if inflammation is present, although it can't show where in the gastro-intestinal tract it is.  As it is not invasive, this is a first step along the road to a definitiv dx.
Colonoscopy, with biopsies, is the only way they can rule out IBD as opposed to IBS.  

The other avenue I would pursue is pancreatitis - I live in England but met a young female living in San Fransisco on the Crohn's & colitis website some 4 years ago, who had dreadful problems with vomiting, diarrhoea and weight loss. She was dx with Crohn's, but then went on to get, at 37 yrs old, a cancerous tumour in her pancreas. The source of the tumour has never been found, despite many tests and surgeries. She now has
an IV for hydration and seems to be in hospital every other week and most of the time with parenteral iv pumping in liquid food.

I would suggest you pursue your problems with your gastros. Perhaps you could contact the CCFA and see if they have accredited physicians in your area that can help.

Take care - pursue it - and good luck
Liz.

[lizziecee]

Hi - I have struggled all day today wondering how to respond to your heartfelt plea. Lots of us care, even if it can only be in cyberspace.

All I can think of to help you is a relatively new test we have in England to differentiate between IBD and IBS. It is a faecal calprotectin test - non invasive, you just need to provide a stool sample. Here, in the UK, it costs all of $4.00
I have had Crohn's for some 37 yrs now, and never "presented" normally - had no pain in those days. I was in 5 different hospitals before it was finally dx. I then weighed some 80 lbs, no matter what I ate. There was no colonoscopy in those days, but I got lucky with a great gastro in London who could do some sophisticated tests, like B12 absorption etc. I need monthly B12 injections, which is not a problem.

I am now on methotrexate (a cytotoxic drug) that I inject once a week, along with a daily dose of Cipro to counter the bad overgrowth of bacteria in my gut.  I got breast cancer 4 yrs ago, and happy to say that after 2 surgeries, chemo and rx I am doing well. My doctors some 37 yrs ago, said I wouldn't live 5 years! Just goes to show how you can beat the odds.

Keep pursuing an answer - anything I can do to help, please email me: ***@****

Take care, Liz.

[lizziecee]

Apologies - my computer crashed and I wasn't sure my post was sent.

[_Mal_]

Hi,

Not sure if your doctor has mentioned Bile Reflux disease.  I believe this can cause one to vomit bile as well as other problems.  A quick search on the web should be able to bring up more information about it.  

I hope you can find a proper diagnosis soon.  I think sometimes the worst part is simply not knowing what's wrong.