[ARCHIVED THREAD] - Weird vomiting problem (Page 1 of 2)
Posted: 12/19/2013 11:26:20 PM EDT
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A friend of mine, a 22-year old woman, has this odd problem involving vomiting. I'm curious if anyone here has any insights into it. I'll preface this with, yes, I know she needs to see a gastroenterologist, but she has no insurance and doesn't earn enough money in her job to go see one. If the hive consensus is it's a serious enough thing, I'll sell a rifle or two to pay for her to see a doc. That said, this is what's going on. If she gets too hot, she'll start puking. When I mean hot, I mean, like if the room is over 73 degrees, she pukes. She keeps her apartment about 67 degrees, or cooler, year round. She's also always warm to the touch, her hands and feet almost never get cold. If she gets an empty stomach for too long, she pukes. She has to eat small little meals throughout the day. If she eats "too much" she pukes. That amount changes. Sometimes she's fine, other times, not. If she drinks more than an ounce of liquid at a time, she pukes. She usually lightly sips whatever she's drinking. If she drinks soda, she can drink more before she pukes. If she drinks anything non-carbonated, she says she can feel it sloshing around, at which point, she pukes. She belches like a lumberjack after drinking soda or while eating. It's difficult for her to get the belch to come up, it can take minutes sometimes, but when she does let it rip, it's quite impressive. She mostly pukes in the morning. And no, she's not pregnant. She has no problem swallowing food or drink. This vomiting problem has been going on for over 2 years. But it's gotten worse the past few months. In all other respects, she's in good health. She's in good shape, she exercises. Blood pressure and blood glucose are perfect. She is on a low dose opiate for her scoliosis, but the pain clinic swears the meds couldn't be causing the vomiting. Sadly, since she can't keep food down, she's losing weight. She's a small person, 5'2" about 105 pounds now, so she doesn't have a lot of weight that can be lost before she looks bad. And no, she doesn't have AIDS. BTW, none of this is small little upchucks, this is the full-body hug-the-toilet style vomiting. And no, she doesn't drink. She's my best friend. I'm hoping someone here can provide a clue as to what is going on. |
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Sounds like a physical stomach defect, possibly due to her pyloric or esophageal sphincters having an issue. Either way, having that much gastric content being forcibly regurgitated leads to a lot of secondary issues like esophageal burns, tooth enamel decay, micro-aspiration, etc.
Probably going to want to do a Barium swallow with a CT scan to get the physical layout. |
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3:1 its a supratentorial problem.
Edited after re reading. If this started after the opiates, consider gastroparesis. Also, first thing a GI will say is try a reflux med. Have her start prilosec for a few months, then go to GI if not improving. Even then it might just be switching to nexium. |
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22 year old on chronic opiates does not have a good future. She needs to get off them. Chronic opiate users go into withdrawal when they start vomiting and it is very difficult to recover from because they can't keep enough down to get an adequate serum level to stop vomiting. Twenty two is way to young to be opiate dependent unless you have a terminal disease I don't care how much pain she is in, the opiates will make her life worse not better in the long run. Does she smoke pot? There has been an unbelievable increase in Cannabis hyperemesis syndrome in Colorado in the last few years all because pot use is so common. None of the users want to believe it, but I now see this every 1-2 weeks when I used to see it 1-2 times per year. All of the patients are smoking pot. Yes, she should see a gi doc and be evaluated. It is possible but unlikely that there is a structural problem, but the vast majority of patient with this history are having symptoms due to pot or anxiety/ psychiatric issues. My go to drug for cyclic vomiting is haldol and it works better than 90% of the time. I know that sounds harsh, but it is true. Patients can choose to believe it or not. Most of them don't, so we see them over and over some 15-20+ times a year. Posted Via AR15.Com Mobile |
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Quoted:
I'll preface this with, yes, I know she needs to see a gastroenterologist, but she has no insurance and doesn't earn enough money in her job to go see one. If the hive consensus is it's a serious enough thing, I'll sell a rifle or two to pay for her to see a doc. That said, this is what's going on. You don't need a consensus to realize that this is a "serious enough thing". That shit is serious. Get her to a doc. |
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Just to add: GD folks like to say "get to the ER now!", but two years of vomiting is not an ER problem. It will cost you a lot of money, you will get Labs done which will be normal(or possibly a low potassium and or albumin which are symptoms, not the cause) a liter of saline, a prescription for zofran or phenergan and instructions to follow up with primary care and GI. Unless she is dehydrated acutely to the point where she actually needs IV fluids, you will waste $1000. The ER is set up to handle acute not chronic problems. |
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Quoted: 22 year old on chronic opiates does not have a good future. She needs to get off them. Chronic opiate users go into withdrawal when they start vomiting and it is very difficult to recover from because they can't keep enough down to get an adequate serum level to stop vomiting. Twenty two is way to young to be opiate dependent unless you have a terminal disease I don't care how much pain she is in, the opiates will make her life worse not better in the long run. Does she smoke pot? There has been an unbelievable increase in Canibis hyperemesis syndrome in Colorado in the last few years all because pot use is so common. None of the users want to believe it, but I now see this every 1-2 weeks when I used to see it 1-2 times per year. All of the patients are smoking pot. Yes, she should see a gi doc and be evaluated. It is possible but unlikely that there is a structural problem, but the vast majority of patient with this history are having symptoms due to pot or anxiety/ psychiatric issues. My go to drug for cyclic vomiting is haldol and it works better than 90% of the time. I know that sounds harsh, but it is true. Patients can choose to believe it or not. Most of them don't, so we see them over and over some 15-20+ times a year. Posted Via AR15.Com Mobile I'll go with this one. I've seen it happen in brother's family. The DENIAL was monumental. The main telltale sign is hot baths/showers sometimes alternating the water between extreme temps on both sides. The patient always says that these bath and showers are the only thing besides being knocked out with an opiate to sleep it off are the only thing that actually help. They can lose up to 40 lbs on attacks that last anywhere from a week to 10 days. During the attacks they become so dehydrated and want to drink or sip water, that just makes them vomit again and again. Constant abdominal pain. All the tests will come back negative, nothing will show on MRIs, basically the GI doctor will tell them that pot is a trigger, and sure enough when we sent her overseas where she couldn't find any, the problem vanished. Had nothing to do with diet either, it was the pot. She wasn't always smoking the good stuff either. The reason they need to get to the ER asap is because the only way to rehydrate is to quit the showers and baths and get an IV. Two full bags of IV solution will rehydrate them and at least get them comfortable for sleep. There are some good anti nausea drugs that make them sleepy too. It's a start. Anything to get them to be able to sleep it off is a good thing. Hot baths and showers dehydrate even further, but it's heaven for someone going through an episode. When it first happened in my family, there was no name for it. Then it was called CVS http://en.wikipedia.org/wiki/Cyclic_vomiting_syndrome |
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I'm always amused by these patients--they can afford chronic narcotics & pain management doctors, but don't have a "regular doctor" because it's too expensive. 
Pain management is not a primary care specialty. +1 I've known people who spent half their paycheck on pot and booze, but claimed they couldn't afford to see a doctor. And don't even get me started on people who lease luxury cars to impress their friends and then say they need "free" medical care.
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I don't think that ripping on her is right, and I had no intention of doing that. What I am saying is that if you really care about someone, you tell them the truth even if they don't want to hear it. Being on chronic narcotics at age 22 for scoliosis is not in her best interests. I have seen many crazy things that other doctors do, and this fits in that category. I jumped to pot because it is the most common reason I see for symptoms like hers. I could be completely wrong, and she may not smoke it at all, but if she does, then telling her that her symptoms are likely related to this is what is best for her. As I said above, if she smokes pot this is far and away the most likely cause. If not, then she should see a primary MD and a gastroenterologist for evaluation although the yield for an identifiable problem is low. ETA gallbladder pathology is in the differential but it is unlikely that a person would have chronic symptoms for two years without getting cholecystitis and end up in an ER pretty sick. Again, if she is not smoking pot, this is something a primary doc would evaluate for with an ultrasound, along with chronic pancreatitis, gastroparesis, and other things ( gastric outlet obstruction, zenkers diverticulum, bezoar, etc). |
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There has been an unbelievable increase in Cannabis hyperemesis syndrome in Colorado in the last few years That's probably because they aren't used to the munchies that happen when you smoke weed. Get stoned and eat two packs of Oreos, a bag of Chips Ahoy, a half-gallon of ice cream, then chase that with shots of tequila and the result is inevitable. Hyper-emesis syndrome. Yeah. 
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Quoted:
I don't think that ripping on her is right, and I had no intention of doing that. What I am saying is that if you really care about someone, you tell them the truth even if they don't want to hear it. Being on chronic narcotics at age 22 for scoliosis is not in her best interests. I have seen many crazy things that other doctors do, and this fits in that category. I jumped to pot because it is the most common reason I see for symptoms like hers. I could be completely wrong, and she may not smoke it at all, but if she does, then telling her that her symptoms are likely related to this is what is best for her. As I said above, if she smokes pot this is far and away the most likely cause. If not, then she should see a primary MD and a gastroenterologist for evaluation although the yield for an identifiable problem is low. ETA gallbladder pathology is in the differential but it is unlikely that a person would have chronic symptoms for two years without getting cholecystitis and end up in an ER pretty sick. Again, if she is not smoking pot, this is something a primary doc would evaluate for with an ultrasound, along with chronic pancreatitis, gastroparesis, and other things. Thank you for your wise posts in this thread. I only clicked-on it because I often have a "weak stomach" and am always curious as to what's going-on with that (have seen a GI doc, been scoped, etc). Turns out that none of this really applies to me (don't smoke pot, and only take opiates a couple courses a year after a bad back episode). But your posts have been very informative and are appreciated. |
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She needs to stop deep throating it if she has such a sensitive gag. Have her work with her tongue and cheeks.
In all seriousness... doctor should have been seen some time ago. If this has been going on for 24 months, then she is behind the eight ball. There isn't nearly enough information here to come up with a cause, but one can imagine a number of very-bad-things that could cause this or that likely will be caused by this. For actual causes, there are just too many to list from the limited information provided, neurological, psychological, medication, cancer, a multitude of GI issues, who knows what else, but plenty of scary ones that can kill you and require medical intervention sooner, not later. Further, if she is unintentionally losing weight now as you indicate, the loss of ability to maintain proper nutrition will eventually dispose her to illness and lead to hospitilization with a tough course, and worsening nutritional state makes it harder for her to recover from whatever the underyling cause is. As far as other issues that stem from this level of nausea/emesis, just look up esophegeal tears and ruptures if you need to provide some motivational reading material for her to go. Start here:http://emedicine.medscape.com/article/775165-overview IANAD. ETA Link is hot. |
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Get her checked out by a competent doctor. That sounds like a serious issue at best and cancer or something at worst.
Btw what is this "cannabis hypermesis" everyone is talking about? I've never known anyone to have that. Is it some kind of allergic reaction that certain people have or what? |
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Quoted: A friend of mine, a 22-year old woman, has this odd problem involving vomiting. I'm curious if anyone here has any insights into it. I'll preface this with, yes, I know she needs to see a gastroenterologist, but she has no insurance and doesn't earn enough money in her job to go see one. If the hive consensus is it's a serious enough thing, I'll sell a rifle or two to pay for her to see a doc. That said, this is what's going on. If she gets too hot, she'll start puking. When I mean hot, I mean, like if the room is over 73 degrees, she pukes. She keeps her apartment about 67 degrees, or cooler, year round. She's also always warm to the touch, her hands and feet almost never get cold. If she gets an empty stomach for too long, she pukes. She has to eat small little meals throughout the day. If she eats "too much" she pukes. That amount changes. Sometimes she's fine, other times, not. If she drinks more than an ounce of liquid at a time, she pukes. She usually lightly sips whatever she's drinking. If she drinks soda, she can drink more before she pukes. If she drinks anything non-carbonated, she says she can feel it sloshing around, at which point, she pukes. She belches like a lumberjack after drinking soda or while eating. It's difficult for her to get the belch to come up, it can take minutes sometimes, but when she does let it rip, it's quite impressive. She mostly pukes in the morning. And no, she's not pregnant. She has no problem swallowing food or drink. This vomiting problem has been going on for over 2 years. But it's gotten worse the past few months. In all other respects, she's in good health. She's in good shape, she exercises. Blood pressure and blood glucose are perfect. She is on a low dose opiate for her scoliosis, but the pain clinic swears the meds couldn't be causing the vomiting. Sadly, since she can't keep food down, she's losing weight. She's a small person, 5'2" about 105 pounds now, so she doesn't have a lot of weight that can be lost before she looks bad. And no, she doesn't have AIDS. BTW, none of this is small little upchucks, this is the full-body hug-the-toilet style vomiting. And no, she doesn't drink. She's my best friend. I'm hoping someone here can provide a clue as to what is going on. She goes to a pain clinic but can't afford a doctor's visit? I'm sorry dude, but this is what we call a clue. Go out to the g-damn healthcare site, get her signed up with some sort of insurance (if she's truly that poor, she can probably get on something fairly cheap with the subsidies), and get her to a real doc. And she needs to be off the opiates. But be very aware that this person has some serious other issues as well, be it just weed smoking, or some painkiller addiction things going on.
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I don't have any solutions but that sounds miserable. Kind of like Chrohns of the mouth instead. I hope she figures it out. And yeah see if she can find a clinic that takes cash and maybe works on a sliding scale based on her income or something. Good luck OP. |
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Get her checked out by a competent doctor. That sounds like a serious issue at best and cancer or something at worst. Btw what is this "cannabis hypermesis" everyone is talking about? I've never known anyone to have that. Is it some kind of allergic reaction that certain people have or what? Steady symptoms for 2 years, I assume, would not mean cancer. |
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I got five bucks on a Fentanyl patch. Quoted:
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Define "low dose opiate." Also, when did she start it? That can throw a body off, shut down bowels, ect. I got five bucks on a Fentanyl patch. Opiates are well known to mess some people up. Some people just react extremely badly to them. |
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I don't have any solutions but that sounds miserable. Kind of like Chrohns of the mouth instead. I hope she figures it out. And yeah see if she can find a clinic that takes cash and maybe works on a sliding scale based on her income or something. Good luck OP. Crohns affects the entire GI tract, so you could be right... |
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Gosh, thanks for all the insights, everyone. Just to give a little bit more information to various questions or hypotheses. First I want to point out that since she knows her triggers well, she only gets sick maybe 3 times a week, sometimes not at all in a week. But she has to be vigilant and sometimes it happens anyway. It's been very frustrating for her. She does smoke cannabis. She has anxiety issues as well. Cannabis hyperemesis seems very promising as a cause since she finds relief taking hot or cool baths when she gets nauseous, or to help her recover after she gets sick. She seemed receptive to the idea that it may be the cause once I showed her some info I got online. Though the hyperemesis cases I found online seem far more severe than what she has. The vomiting problem started after the opiates, which she's been on since she was a gymnast in high school about 5 years or so ago. Suffered a few bad falls on her neck and back doing cheerleading routines, too. The scoliosis she developed made things much worse. Under medical supervision, she tried a taper before and it was too aggressive and she wound up in the hospital, at which point they switched her over to another opiate and she's on a verrrry long taper with it now. During that initial withdrawal stage, though, the vomiting problem persisted. Her younger brother has Crohn's disease (but not of the stomach). Her family has a history of GERD. Someone else is paying for her to go to the pain clinic (family member). Her family tried to get her on insurance last year but was denied due to preexisting conditions. And lastly, there is no way she will let me post a picture of her up here now that I've discussed a private matter publicly. |
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That is good that she is willing to quit. I would tell her she needs to commit to quitting 100% for at least 3-6 months to see how she does. It is also good that she wants to get off the opiates as well. I cannot imagine being a slave either to the cannabis or the opiates for the next 50 years of her life, so remind her that although she may not like quitting, the benefits will last the rest of her life. I work with a group of folks who struggle with addiction in my church in addition to seeing them at work and this can completely dominate their lives. The number of lies they tell and people they are willing to use to get their fix is mind boggling. Some find narcotics anonymous helpful, although the ones who I have seen with long term sobriety all have a real relationship with Jesus. This is also the solution to anxiety as well. |