Chronic Nausea and Stress

My 17 y.o son has been sufferring from daily nausea since September. He broke his ankle in a soccer game and had to have surgery to have pins/plate inseted. He had post-anesthesia vomitting. Ever since this traumatic event he has experienced daily/chronic nausea. Sometimes he will stop eating mid meal because of it. Worse in the morning-won't/can't eat breakfast, then eats a decent lunch at school , and then most nights eats 1/2 a meal at dinner when he gets full and feels like he is going to throw up. He does not throw up. He is always stressed out about school. He is in honors and AP classes -his choice. He has always been hyperneurosensitive. for example has every tag cut out of every shirt, wears his socks inside out because the seam bugs him, just has a very sensitive nervous system. Can the nerve in your stomach become hypersensitive?
he has not had any diagnostic work up done other than blood work. It's just that so many people have this complaint of chronic nausea-they all go through battery of tests all of which come out negative. There has to be something in common amongst all these people. I'm hoping that oncehe is out of school in 2 weeks and the "stress is removed-school" the nause will minimize. I get so worried about this . He has lost weight and wants to eat but can't due to the nausea.

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Commonest cause of chronic nausea is acidity. Let your son take omeprazole (empty stomach in morning)and antacid gel and see if it helps. Liver and kidney dysfunction is another cause. Hence kidney and liver function tests should be done. Other causes are diabetes and hypothyroidism. Electrolyte imbalance too can cause nausea. IBS, gluten or lactose intolerance, parasites in gut too can be the cause. A stool test should be done for worms, giardiasis etc. Also if nothing is found then food challenge test to detect food intolerance should be done.
It can also be an allergic reaction to the metal of the orthopedic prosthesis. Spinal nerve compression in cervical spine, and orthostatic hypotension could be the other causes. It could also be a vasovagal syncope or a vasovagal attack. The complex group of symptoms is mediated by the vagus nerve. This nerve is irritated by prolonged standing, standing up suddenly, stress, pain, hunger, dehydration, intense emotion etc. A tilt table test, holter monitor, echocardiogram etc are done for confirmed diagnosis. Do discuss this with your son’s doctor.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

[anxioustoo]

Thanks so much for taking the time to reply to my post. I would like to add that he has daily normal bowel movements. He does not have abdominal pain. He plays soccer without dizziness. his celiac test was negative, along with other blood work. He has not been to a GI doc yet. That would be my next step, but I feel like his stress level has a lot to do with it. I think putting him thorugh a bunch of GI tests would just add to his stress and most likely be negative. Hypothyroidism-i would think he would be overweight? He is 5"11 and 130lbs....thin....So you say intense emotion can stimulate the vagus nerve and cause nausea? Sorry for the barrage of questions. But I have been spinning my wheels for a while....He drinks more than he eats and he claims cold food are less bothersome to his nausea than hot. But spicey foods have no effect. He also has a history of consuming sushi alot. mostly cooked seafood but at times in the past he has eaten raw fish.   wouldn't he have diarrhea with parasite/giardia? Just thought I'd give you some additional info.. I really appreciate your input. What is your profession?

[anxioustoo]

Thanks so much for taking the time to reply to my post. I would like to add that he has daily normal bowel movements. He does not have abdominal pain. He plays soccer without dizziness. his celiac test was negative, along with other blood work. He has not been to a GI doc yet. That would be my next step, but I feel like his stress level has a lot to do with it. I think putting him thorugh a bunch of GI tests would just add to his stress and most likely be negative. Hypothyroidism-i would think he would be overweight? He is 5"11 and 130lbs....thin....So you say intense emotion can stimulate the vagus nerve and cause nausea? Sorry for the barrage of questions. But I have been spinning my wheels for a while....He drinks more than he eats and he claims cold food are less bothersome to his nausea than hot. But spicey foods have no effect. He also has a history of consuming sushi alot. mostly cooked seafood but at times in the past he has eaten raw fish.   wouldn't he have diarrhea with parasite/giardia? Just thought I'd give you some additional info.. I really appreciate your input. What is your profession?

[Jaquta]

What about hyperthyroidism?  Underweight and anxious.

My three guesses would be: acidity (reflux, etc), an allergy to the plate (seems odd that these symptoms started after surgery) or anxiety.

Whatever the cause I think it needs addressing.  If anxiety, take him to a psychiatrist and have him try psychotherapy.
I don't think allowing this to continue is very acceptable.

Minimum he should be seen by his doctor.