nausea/acid stomach in the morning only

[surfjam]

I have had type 1 diabetes for 35 years. I have an insulin pump and good control (though I am brittle)
Over the last 3 years I experienced increasing
problems with nausea that was diagnosed as gastropariesis. Last year I was hospitalized
4 times when I couldn't stop vomiting for 1-2 days, got dehydrated and DKA. In November, I had a heart
attack, angioplasty (4 stents) and it appeared that the nausea was really coronary artery disease.
I was not aware of the chest pressure I was feeling because it happened gradually - it went away after angioplasty.

I stopped taking Reglan, ate whatever I wanted and believed my stomach was okay. I am takin Plavixx, aspirin,
and a number of other medications. I have experienced anxiety since my heart attack.

In February, I experienced the unstoppable nausea again and was hospitalized and vomiting for 4 days. They wanted to do
endoscopy but I was so weak and my stomach so raw I couldn't bear the idea.
I changed my diet, added 40 mg protonix and try to take nightime medications with more food and wait 1-2 hours
before going to bed. For 10 weeks since being hospitalized (Feb)
I have been mostly okay, though I had trouble eating in the morning and a few occasions when I had 9am appointments ,
I threw up a small amount of acid and then was fine the whole day.

Two weeks ago I had PMS/nausea and almost every morning since, I wake up, feel fine, hang out with my dogs and as soon as I try to get my day started (especially if any appt is involved)
I vomit, experience acid stomach, hot/cold sensations. Compazine helps, I sleep for a few hours, then I am fine the rest of the day, am able to eat, and even exercise.

I am trying to get back to my life after the heart attack and being sick again has been demoralizing.
Thank you for your help.
KL

[Kevin Pho, MD]

I think an upper endoscopy is warranted at this time.  It is the most comprehensive test we have to look at the upper digestive tract, and rule out a mass, stricture or obstruction.  GERD and ulcers can also be evaluated for.

If the symptoms continue, imaging can be done with an ultrasound to exclude liver and gallbladder disease.

More specialized tests like a gastric emptying scan can be considered as well if the tests remain non-revealing.

These options can be discussed with a GI physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[surfjam]

I plan to follow your advice.

One followup question I have is :
if there is some physical problem that could be seen via endoscope,
wouldn't I experience problems all the time ? (Not just in the morning for example).

thanks again,
KL