Chronic nausea

I was diagnosed with GERD two years ago.  My main symptom was nausea with the burning and pain.  I had the nissen in Dec 09 which failed, had a redo in May 2010.  I had all of the usual tests (EGD, manometry, bravo, barium swallow.  Also had CT and MRI) except the gastric emptying test.  I'm still having horrible nausea even after two nissens.  I've had an EGD and barium swallow since my last nissen and they came up normal with wrap still intact.  I've tried zofran, phenegran, reglan, OTC antinausea and nothing helps.  I have not vomited from it but have come very close.  There are times when these episodes last hours where it is almost unbearable.  I have been confined to the house just in case I do have an episode.  I am nauseous all day long no matter if I eat or not, what I eat or drink doesn't matter either.  My GI and my gastric surgeon are both at a loss and have basically given up.  I've had numerous bloodwork done, gall bladder ultrasound and HIDA scan which were normal.  This is starting to be debilitating.  Is there something else this can be?  Any tests I can suggest to my dr?  

[FurballsMom]

I can't speak from experience about the nissen fundoplication surgery.  However, I have had GERD for many years.  I also have IBS-C.  I would recommend investigating food sensitivities.  I do better avoiding problem foods.  Not just the foods the GI tells you to avoid either.  You may have food sensitivities you are unaware of that is aggravating your digestive tract.  I'm doing everything I can to avoid this surgery myself.

Do you also by any chance suffer from migraine disorder?  The reason I ask is that I actually noticed a huge reduction in migraines when I followed the elimination diet/food challenge.  Migraines also play a role in nausea and they are affected by these food sensitivities as well as the GERD and IBS do.

A naturopath can guide you through the elimination diet/food challenge and help you determine if indeed food sensitivities are playing a role in all this nausea.  My guess is that food sensitivities are involved with some of this.

I strongly suggest avoiding foods with preservatives and sulfites.  I get sick on these.  Two other people I know who have had the nissen fundoplication surgery are themselves also affected by food sensitivities and even some true allergies.  It also sounds backwards to suggest avoiding gingerroot tea if you're avoiding natural sulfites, too.  Ginger proved to be a food sensitivity for me.  Like the alum family, ginger is high in natural sulfites.  So, when I was trying to fight the nausea with it, I was actually making things worse for myself.  I would have more burning and more nausea and more nerve and muscle pains.  It wasn't until a friend of mine pointed me in the direction of food sensitivities that I was able to figure some of this stuff out.  You might be surprised that if you still have some burning, even with the wrap, that Benadryl will likely help.  The reason actually goes against what conventional doctors follow, but if you find this is the case, that is a strong indication that a lot of your problem is indeed from food sensitivities.  I would even try it with the nausea.  Do this with the caution you were taught to protect your wrap.  

One more thing about the Benadryl:  The OTC dosage is 25mg and the rx dosage is 50mg.  As long as you're not taking any medications that Benadryl would create a problem with, start with the OTC dosage and wait an hour.  If you don't see any improvement, you can take one more OTC dosage.  After that DO NOT take any more for the next several hours to 24 hours.  Minimum on the rx dosage is 8-16 hours.  I noticed improvement myself between following the elimination diet and only ONE prescription dosage.  I already have other allergies, which is how I know the rx dosage.  Do NOT exceed one rx dosage in 24 hours if you aren't prescribed this amount from your doctor.  Once, though, won't cause any harm and you'll soon figure out if it helps at all.

Here's the thing:  I didn't realize that I had all these sensitivities myself and it didn't seem to matter what I ate or not either.  However, when I went through the food elimination diet, I had a reduction in my digestive issues, and I have issues with the whole GI tract due to having Fibromyalgia.  The two people I know also have this issue.  You may not yourself, however, both of these other two individuals do have food sensitivities and avoiding things they're sensitive to helps considerably.  So, I really do believe that it's worth looking into food sensitivities and allergies.  An allergist won't necessarily find food sensitivities, which are like hidden food allergies.  However, an allergist can help you discover what they refer to as true food allergies.  It's kind of touchy with conventional medicine, because they don't have tests for food sensitivities, and they don't believe in the blood tests used in certain fields of natural medicine that test food sensitivities.  But, even though they themselves don't know how to guide you through a food elimination diet/food challenge, they do see value in this approach.  They don't get alarmed because you would still have a balanced nutritionally sound diet with this elimination diet.  You still eat foods from all the food groups.  You just avoid the more common allergens to help you decide which foods are causing your problems.

By the way, I'm familiar with the gall bladder ultrasound testing normal in spite of having symptoms.  In my own case that part of the abdomen's symptoms is likely involved with the IBS and I was even told that it's possible that the gall bladder gets spasms and that's what causes that cramping.  So, it's either that part of the colon and/or it's the gall bladder spasming out because it's sensitive.  So, none of the tests showed anything wrong for me either.

Anyway, I strongly suggest looking into food sensitivity and food allergy issues.  This includes what you drink, too.

[micheller832]

Thank you for the reply.  I've never had a problem with food allergies or sensitivities before.  How do you go about finding out what could cause the sensitivity?  I know how to find out the main allergies but what about things like sulfites and stuff like that?  I get nauseated when I don't eat but not as bad as when I do eat.  I could have one oyster cracker and feel awful, just a very small amount of anything really.  I know stress plays a role in it also but I can't really avoid that with work, school, and three kids.  :)  

[FurballsMom]

If you can see a naturopath (some will work with you on a sliding fee schedule) or even a nutritionis, you can get proper guidance for the elimination diet/food challenge.  There are about 16 main things that one would remove from the diet for a period of time.  I was bad off, too, so the naturopath had me do this longer than the minimum of two weeks before attempting any of the food challenges.  You would actually follow the same principles for anything else you suspect of giving you problems.  Those oyster crackers are a wheat flour item.  They also have food preservatives.  They also have table salt, which has sodium chloride added to it.  For the elimination diet, you would stick to a whole foods approach to keep things simple and avoid eating or drinking things you didn't know that you were eating or drinking.  You would also keep the number of ingredients in any of the foods you're eating to a minimum.  

No condiments, because they have a complicated list of ingredients.  It's not as simple and straight forward as it sounds.  White vinegar is bad stuff, because it is made from wheat.  White wine vinegar is bad because it has natural sulfites from the wine being used and the grapes themselves have natural sulfites.  Simplify things and make things yourself, because that way you know what you are consuming.  Avoid all condiments, because they all have at least one major ingredient that will only serve to make you feel ill.  Anything that only uses the generic word "vinegar" is talking about plain old white vinegar which is a gluten product as it is made from wheat and/or barley.  The only thing white vinegar is any good for is as a natural cleaning product.  Don't bother with balsamic vinegar either.  It's tasty, but it still isn't a good thing if you're having digestive issues.

The ONLY vinegar that is even healthy for people is apple cider vinegar that is UNfiltered and still has the "mother" in it.  The most famous brand is Bragg's.  If you live near a Trader Joe's store, they have one with their own label that is good.  Knowing how Trader Joe's operates, it's probably the Bragg's vinegar with the Trader Joe's label.  Filtered apple cider vinegar has had the beneficial and nutritional enzymes and such removed.  It has to be unfiltered.  You will never notice the difference in the taste.  If you are able to tolerate it, apple cider vinegar is used by some people to help with digestive issues.  Some put a teaspoon or a Tablespoon in water to dilute it and drink that to help with problems like GERD or even IBS.  It might even help with the nausea to drink this kind of thing--SLOWLY.

I read someone else's post that intrigued me to do a bit of research for myself about Tyramine Intolerance connected to migraine issues.  It is worth your checking out this website, even if migraines aren't a major issue for you.  I found it to be a pretty good website.  It has a few inaccuracies, but it is actually overall very accurate.  It lists carrots and cherries as hypoallergenic.  Not so.  I'm not the only one with sensitivities to these things that I know about either.  Don't forget to research cross reactions.  Carrots have a lot of plant cousins.  Carrots are related to a medicinal weed called mugwort.  (Produce cousins are:  parsnips, parsley, cilantro, dill, fennel and celery)  If any one of these items is a problem, be mindful of the others.  I can't even touch celery, fennel or dill weed.  As far as cherries:  All fruits with stones or pits, including avocados, are problems for people with latex allergies.  Bananas aren't a stone fruit, but they do have a similar biochemical that is also a problem for people with latex allergy.  They also cause constipation to be a lot worse for some people, too.  Increased constipation will cause increased nausea.

The sulphur or sulfite foods list is missing grapes, ginger and eggs.

Other than that, I didn't see any problems with overall accuracy of this site:  http://www.whfoods.com/genpage.php?tname=faq&dbid=30#age

Anyway, what I said about the naturopath is right on for finding the lesser food issues.  You might be surprised to find that you do have some food issues that you aren't even aware of.  The elimination diet is actually the first thing naturopaths do with their patients, regardless of the main reason for why the patient came in to see the naturopath in the first place.  And, the naturopath will tell you the same thing I did about the whole foods approach.  Steer clear of ALL processed foods.  White vinegar is only good for natural cleaning.  That's the only reason I ever buy it.