Gallbladder HIDA Scan teenaged daughter -- 33%

[stclairt]

My 16 yr old daughter has been having vomiting issues for 9 mo's. It seems to come & go or appear in cycles, seeming to rear its ugly head after a virus. She eats and most meals come back up within 15 mins to an hour -- sometimes longer but that is rare. She doesn't eat a lot at one time, right now she's a snacker. Along with this she has crazy insomnia.

After blood work, stool test, upper and lower GI xrays (with barrium), EGD scope, sigma-scope/colon, CT on her belly ... all ok. She ended up on a NG feeding tube in June when the vomiting got especially bad and she lost 12 lbs. (she's a thin fit teenager already).

Her GI dr doesn't think its gallbladder related -- he wants to say its IBS -- I am at a loss. What do you think on this? If you have time read the entire email from top to bottom ... see what you think? I am going crazy.

The HIDA was 33%, essentially low normal.  The IBS is a family of conditions;
she has what is called non-ulcer dyspepsia and tachygastria.  The weight loss
she experienced delays stomach emptying as a secondary effect; thus the
nausea/vomiting.  The stomach is less able to handle larger meals.

We've tried prokinetic agents with her; erythromycin and reglan, which both help
this, but my understanding is that she didn't tolerate them.  Is this correct?

I do not think this is food allergy; as the symptoms would be different.

We scoped her in June and at that time she had very minimal gastritis, which is
usually healed with medicines and time, but if she is persisting in nausea and
vomiting this may still be contributing to delaying her stomach emptying.  
Weight loss always makes this worse; thus NG feedings can turn the ship around
if needed.  

Be sure to give the amitryptiline (Elavil) at bedtime.  I also want to add a
nighttime medicine that we use for sensory problems and IBS called
cyproheptadine.  This is a tablet at bedtime (an hour before bed) that will help
her sleep, help her sensory issues, and hopefully stop the nausea cycle.

If this persists after one week on this new medicine; then another endoscopy is
warranted.  In the meantime I also want to reorder a fecal test to look for any
persistent luminal gut inflammation.  Go to any Carilon lab and this will be
waiting for you.  The cyproheptadine will be at your pharmacy this AM.

Michael H. Hart, M.S., M.D., FAAP, AGAF
Professor & Director, Division of Pediatric Gastroenterology & Nutrition
Virginia Tech-Carilion School of Medicine
102 Highland Avenue, Suite 305
Roanoke, Virginia   24013
Phone:  [phone]
FAX:  [phone]
email:  ***@****


>>>  11/3/2009 8:36 PM >>>

What is the % on the HIDA scan? Just curious.

I guess where I struggle is Kayleigh has no bowel symptoms at all. Nothing
abnormal. She is still vomiting after eating. If IBS is her condition wouldn't
there be a bowel symptom? From everything I have read it points to having
constipation-diarrhea-bloating -- she has none of that. Since  June/July she has
been pretty OK but not 100%, her energy level struggled, she didn't got back to
working out 5x week like before but she did go back to soccer, until the last 3
weeks she quit (soccer). She got that stomach virus from the best we can tell
and she didn't rebound, she said she felt just like she did in April/May/June.
Now for about 10 days to 2 weeks she was vomiting 10 times a day or more, that
has tapered off and she isn't vomiting everything but it is still frequent and
the insomnia is relentless. As her mother I am left to guess this condition --
is it IBS, is it something else? Is her condition have insomnia as a side effect
or is insomnia a key component of her illness -- the vomiting has been partnered
with the inability to sleep. If she falls asleep she doesn't stay asleep which I
know part of the reason for her feeling so badly ... it is a terrible cycle.
With the lack of sleep and the vomiting she wasn't able to manage school -- we
are going to do home bound until January but she wants to get back to school but
we need to get her on a healthy cycle first. I just stress over this all day and
all night ... is it something else? Something that comes in cycles?

On a side note, Kayleigh's little brother (he's 11) is doing some of the same
things as she does. He gets sick after eating too, about the same time frame as
she does, within 1 hour. At first it was things like chicken nuggets at McD's.
Not something good for him anyway's so of course we took that out of his diet
... then as time went on he would get sick off of any fast food meal or chicken
tenders from a steak place ... then it was pasta (plain with parmesan cheese)
from home ... it has been his morning cereal ... pizza, bread sticks. It seems
to be more fatty things but like I said it can be his Honeycombs too. We ask
ourselves, are these related? Is it a toxin they are exposed to? A food
allergy/intolerance? It seems so odd. Her pediatrician, Dr. Russell Delaney saw
him a week or so ago (he also has that same stomach virus and wasn't getting
better so I made an appt for him) .. he did blood  tests and we are waiting on
results. So ... I am left to ask is there anything genetic? Or something they
are exposed to or it is a very odd coincidence. We are really praying for a
resolve. This is not normal for our once healthy family. Thanks for listening,
Dr. Hart. I just feel overwhelmed.

Tammy St. Clair


-----Original Message-----
From: Michael Hart
To: ***@****
Sent: Tue, Nov 3, 2009 4:52 pm
Subject: Re: HIDA Scan for Kayleigh



that is good.  Where it comes to IBS it is often difficult to recognize that we
an have pain without inflammation.  It is important to know that it isn't an
illness", rather it is a "condition", similar to having sensitive skin and
etting sunburned if you stay out in the sun too long.  There isn't an "illness"
ith your skin, but it sure does hurt when it gets burned.
We have lots of medicines that affect pain perception, but naturally they all
ave side effects.  I have this condition myself and use diet and peppermint and
epcid complete and other techniques to help "manage" the symptoms.  They never
isappear, anymore than next year I'll start being able to get a tan and not get
unburned.  It has to do with genetics and the way sensory nerves are
rogrammed.
Depression and anxiety can often be exacerbating factors, even without any
sychiatric problems.  
Michael H. Hart, M.S., M.D., FAAP, AGAF
rofessor & Director, Division of Pediatric Gastroenterology & Nutrition
irginia Tech-Carilion School of Medicine
02 Highland Avenue, Suite 305
oanoke, Virginia   24013
hone:  540-985-9832
AX:  540-224-4421
mail:  ***@****

>>  11/3/2009 4:36 PM >>>
Goodness, I know it sounds terrible but I was really hoping this would be the
nswer we were looking for. We are really struggling with this 'illness'. She
idn't have much to say about the test, she fell asleep during it for the most
art.


----Original Message-----
rom: Michael Hart
o: ***@****
ent: Tue, Nov 3, 2009 4:32 pm
ubject: HIDA Scan for Kayleigh

Her HIDA scan looked good, no evidence of acute gallbladder dysfunction or
disease.
How did the test go for her?
ichael H. Hart, M.S., M.D., FAAP, AGAF
ofessor & Director, Division of Pediatric Gastroenterology & Nutrition
rginia Tech-Carilion School of Medicine
2 Highland Avenue, Suite 305
anoke, Virginia   24013
one:  540-985-9832
X:  540-224-4421
ail:  ***@****

[stclairt]

Thanks for the info. My son is being tested currently -- I need to follow up on the results. As for my daughter they did test for celiac via EGD but I don't know if they did the genetic test? I need to ask about that ....

Thank you!!

[CalGal]

Have you considered the possibility of celiac disease? It can present in a number or different forms and is a great 'mimic' of different GI issues. It is often times not found during either blood tests or an EGD. You can easily check her genetic predisposition through allele testing, and you may want to consider checking your son, also. Genetic tests can be ordered by individuals via enterolab.com or through Prometheus Labs. Enterolab can also do fecal antibody testing for gliadin - the basic 'unit' of gluten.