Persistent Nausea

[LarryG62]

I hope that there is someone on this forum has had some experience with or treated someone with the same symptoms my wife has.  I'm really frustrated trying to get her some help.  Her local doctor has thrown in the towel,,,,he hasn't a clue.
See the symptoms she has been experiencing since mid February, with the exception of a four or five week period in May-June when they just disappeared..  Any help will be greatly appreciated. Thank you.

My wife, age 70,  awakens in the morning and experiences nausea when she gets out of bed. She has had all kinds of tests of potential causes of these symptoms in her abdominal area(Endoscopy, HIDA scan, CAT scan, Inner ear test, etc) and all are normal.  HIDA scan was inconclusive because the injection could not excite the gall bladder. Blood tests are normal. She has been experiencing it for several weeks. No fever and rarely has to vomit.
She has no appetite,but will eat and drink. Some relief comes after she eats a little food and drinks some liquids, but whenever she gets active again, the nausea returns.
Medicines for nausea like Meclazine, Dimenhydrinate, Dramamine, and Zofran appear to have little/no effect on the nausea.  
She takes Toprol and  Avapro for blood pressure, and razadyne and Namenda for memory problems. None were new when she first ecame sick in February.
Has anyone had similar experience or has any doctor treated similar conditions?

[Kevin Pho, MD]

Many of the major GI disorders would have been evaluated with the tests you have mentioned.  

I agree with the recommendation of a gastric emptying scan.  Other specialized tests would be a 24-hr pH study (to exclude GERD) and a esophageal motility test to look for dysmotility.

If the GI route is non-revealing, looking for neurological conditions can be considered - as they can lead to chronic nausea as well.  A brain MRI or CT scan would be a reasonable place to start.  

Another GI opinion at a major academic medical center, or a neurological consult be considered.

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.
www.kevinmd.com

[maxwell66]

Google gastroparesis, which is diagnosed with a gastric motility test/gastric emptying test.

You will find plenty of info on it on the net.

[LarryG62]

Thanks for your note.  I checked it out, but don't think it's the problem.  She has no pain, normal bm, normal blood sugar when tested, and the endoscopy showed nothing but a bit of gastritis.

[mikcin]

It is strange that they just over looked the hydascan.  I think they should take a closer look into the gallbladder.  Possibly an ERCP to check for blockage of her common bile ducts.  

[John2155]

After your comments of it not fitting gastroparesis I agree with the Dr and Maxwell66 that a nuclear gastric emptying scan is in order. It can fool one. My wife went years with people saying she did not need one and when she did - it suddenly was all obvious!

Also check out www.digestivedistress.com and then open Home Page.

[John2155]

I should have said in the above. She also finally had an esophageal motility study done (gastric motility from Maxwell66 above) and was found to have Achalasia. Had balloon dilatation of the esophagus. It worked but concentrated the problem lower as seen above! Worth a try.

[John2155]

And on reading Mikcin comments. One surgeon also said her Gall Bladder was OK and another one took it out last New Years Eve in ER after we got an ambulance - it was totally rotten! Keep pushing!

[mikcin]

I also think that if you get nowhere with your current doctor seek out a second opinion with a very experienced GI.  Just make a list of questions before you go to see either your existing or new doc.  Because I found out if you don't ask you will never know.  Just don't give up.  I found that as long as you don't push for answers they all seem to be too busy to worry about you.  If it comes down to it demand something be done or refer me to someone else that can help!!

[dessy56]

I also have that promlem i am 34 yrs old but all the tests i have had done including the ones your wife has had  drs said it was gallstones so i had my gallbladder taken out still does me no good im still having nausea and know since i had my gallbladder removed diaherra but I feel a little better dont have to take as many nausea pills praying for you and your wifehope you find the answers your looking for

[Over_Dairy]

I'm with Mikcin -- they need to repeat the HIDA/CCK and stimulate her GB with morphine.  I went 4 hours before they added the Morphine and it still took another hour to get it to light up so they could do the CCK.  (It'd be great to know why it has to light up first or they won't do the CCK but I can't find that answer in the literature.)

Anyway, my money's on her GB or a maybe a duct stricture... As it stands, they HIDA result is inconclusive and should be further investigated.