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Persistant Nausea and eating(YANMD)
April 14, 2014 4:40 PM   Subscribe

I'm going on two months of frequent nausea. Sometimes I throw up, most times I don't. Otherwise I generally feel fine (no fatigue, headaches, other pain aside from my possible endometriosis, sniffles, fever or anything else). I've been to my GP.

I am being prescribed Zofram (it helps!!) I have pain when my gall bladder is pressed, but the blood tests came back normal, and he said he could do an ultrasound but I asked him if he thought it was necessary at this time, and he said no. If it continues we will revisit. The nausea doesn't seem linked to any particular food (I've thrown up in the morning after having water, sometimes after salads, sometimes after fried food.) I haven't started or stopped any medication in the last two months.

I have a history of anorexia. I've been in recovery for almost 6 years. I have a therapist, and a group therapist. I also have a psychiatrist, but its a very new relationship and she doesn't know me well. I do have PTSD. There is some talk about it being stress related which is possible,and I'm diligently attending my appointments and working on that angle as well but I'd like to rule out just in case it isn't.

Honestly, I'm pretty conflicted about this whole nausea thing. If I force myself to eat when nauseous, I will throw up. I know I need to lose weight (I'm pretty over weight and could safely lose 30 pounds and be in my normal weight range and not the low end of it. I've lost 10 lbs in the last two months. But I'm losing because I'm avoiding empting out my stomach uncontrollably not because I purposefully set out to diet. I had been avoiding losing weight due to the amount of mental energy and dealing with a nutritionist and keeping myself from going into weightloss obsessiveness territory.

As I'm thinking about it all the time anyway, I'm planning to make an appointment with a nutritionist. In the meantime, I'm asking this askme to try and figure out strategies to keep me normalish eating. I also will take suggestions for possible medical things to explore with my GP or bring up.
posted by AlexiaSky to Health & Fitness (24 answers total) 1 user marked this as a favorite
 
I would ask to see a specialist. If a GP dismissed my "vomit when eating" problem, I would ask for a second opinion.
posted by xingcat at 4:48 PM on April 14 [2 favorites]


You hurt over your gallbladder and the nausea and vomiting have been going on for two months. I think you should take him up on that ultrasound offer now and keep going after this until you have more data.

Yes, it could be related to the fact that you had a prior eating disorder and that you have psychiatric issues, but don't assume that it IS related to that and let that distract you until you have had a full workup. Right now you've only had a basic initial check. You need a lot more information before the conclusion could be made that this is just stress. If the ultrasound is negative consider asking for a referral to a gastroenterologist.
posted by treehorn+bunny at 4:52 PM on April 14 [5 favorites]


I should add that on reading your question again, it seems like you might be saying that you feel you're putting off having the issues addressed because you're losing weight and you need to lose weight and won't be able to do it otherwise.

That seems even more reason to be aggressive about getting answers on this, because it might be bringing back some unhealthy thought patterns about eating and weight loss that could interfere with your recovery.
posted by treehorn+bunny at 4:58 PM on April 14 [9 favorites]


Are you taking multivitamins or other supplements? Vitamins can make people nauseous very quickly, often to the point of vomiting.

I assume you include those under the heading of "no medications stopped/started" so I'm sorry if this is redundant/obvious. But I was so alarmed at how ill I got taking after taking vitamins on a not-that-empty stomach, I have to mention it.
posted by juliplease at 4:58 PM on April 14


Get a second opinion and don't screw around with the internet. Seriously. I had these exact symptoms and it ended up being chronically low potassium which almost put me into renal failure. I'm not trying to scare you, but your body is telling you something is wrong. If your doctor disagrees, get the opinion of a different doctor.

In the meantime: soup, Popsicles and eat ANYTHING that sounds good. I lived off of popcorn, chips and ginger ale for about 3 months. It's just temporary.
posted by floweredfish at 5:09 PM on April 14


No vitamins.

Treehorn+bunny: I agree.

I did to forget to mention that I am trying some antacid tablets for two weeks in the meantime and if symptoms persist I'll be seeing my gp again and can re bring up the ultrasound. I do not feel ignored by him at all.

I'm also looking for tips on managing my eating (for example multiple small snacks) to keep my intake regular, which may not have been clear in the question.
posted by AlexiaSky at 5:17 PM on April 14


Go to a doctor. If you haven't had a stool sample, I suggest having one done because I had similar symptoms and it turns out I had a parasite.
posted by kinetic at 5:28 PM on April 14


When I was experiencing frequent unexplained nausea it turned out that it was how my body manifested acid reflux. Maybe consider trying out an over the counter acid med like Pepcid AC.
posted by brilliantine at 5:36 PM on April 14 [3 favorites]


ask also for a gastric emptying study - nausea and vomiting are closely tied to gastroparesis.
posted by shrimpsmalls at 5:45 PM on April 14 [2 favorites]


If that pain in the gallbladder area isn't just something that happens once in awhile but pretty reliable, I definitely think you need to need to take them up on the ultrasound. My ex also put off taking her gallbladder attacks seriously for a long time because they were resulting in desirable weight loss and, well, it only got way worse from there, you know? From looking at people I've seen go through this, weight lost during gallbladder attacks seems to pretty universally come back afterwards. And, more broadly, you have to learn to eat healthy, in the long run, not just how to stop eating periodically.

Outside of the gallbladder possibility: I have occasional problems with anxiety-related nausea that goes away when my anxiety's in check, so it's a good idea to keep some kind of journal to inventory how you're feeling aside from the nausea when it kicks in. If it is more anxiety-based, start small--if I start with a few saltines, I can work up to proper food later. But it's really rare for me for that to rise to the level of actual vomiting unless I'm so freaked out that there's no question what the problem is, so that's what tends to make me think there's another cause.
posted by Sequence at 5:50 PM on April 14 [1 favorite]


Pregnancy has been ruled out, right?
posted by the young rope-rider at 6:12 PM on April 14 [2 favorites]


I had this issue sans vomiting, and lost 56 pounds and became very unhealthy. I had a colonoscopy, ultrasound, gastric emptying study and endoscopy. Results were all normal except hiatal hernia and stomach inflammation (gastritis). But my pain was directly in middle of my stomach below my chest. I took nexium, phenergan and stayed away from most foods and beverages. I also contribute a lot of my issue with severe anxiety and phobia of getting sick.

Gallbladder pain, I imagine, could indicate a gallbladder issue. Ultrasound/scan should be your next step. You're symptoms don't sound like fun, and if I were you, I'd want to find out whats wrong and fix it.
posted by KogeLiz at 6:41 PM on April 14


Yes, do rule out pregnancy! Also, hormone fluctuations can cause nausea so, if you are using birth control, that might be the culprit.

You didn't mention your age but, it bears mentioning, during my most fertile years, without using birth control, I did have hormonal spikes that triggered nausea. When you are very thin, you don't ovulate as easily. The extra weight could be triggering a lot of make up ovulation, causing the nausea. That is what happened to me. I did not have an eating disorder but I was very underweight for many years. As soon as I was a healthy weight, my hormones went a little crazy.
posted by myselfasme at 6:45 PM on April 14


Nausea is one of the symptoms of my (confirmed by laparoscopy) endometriosis. So it could well be that.
posted by fiercecupcake at 7:02 PM on April 14


Nope not pregnant and I'm on birth control.
posted by AlexiaSky at 7:20 PM on April 14


HA!

That's EXACTLY how it was with me before I was finally diagnosed with endo and had laser surgery... and then I got the bottom of your question and it says you possibly have endo.

Case Closed.
posted by jbenben at 7:31 PM on April 14 [1 favorite]


An ultrasound was how I was diagnosed with endo, FWIW.
posted by jbenben at 7:32 PM on April 14


Definitely pursue more testing beyond the GP if necessary, and consider that if it is reflux / stomach acid, the tablets may not help so much being a reactive approach to a sort of delayed-reaction manifestation (nausea from GI inflammation) rather than a treatment for immediate symptoms like "acid burps" or obvious acid in the esophagus.

Not medical advice, but as FYI, the big gun treatments for that sort of reflux damage (often there's some inflamed or damaged region that needs a "break" to heal) typically involve proton pump inhibitors like Prilosec, Prevacid, Nexxium, etc, which are not typically recommended for more than 14 days (despite their acceptance in the marketplace as daily drugs) , but work well as a temporary regimen to massively drop acid production over a constant period of time and allow for healing and possible combined treatment of ulcers with antibiotics. Less potent acid blockers like Pepcid and Zantac block the H2 receptor and are less heavy-weight but sometimes Pepcid (Famotidine) on its own is a good test because it lasts around 24 hours, kicks in around an hour, and can sort of relieve general nausea on its own sometimes.

As for eating with constant nausea, I'd say avoid most dairy except yogurt, the more natural / heavily cultured and less added sugar, the better. Grains may or may not be contributing o your nausea. They might fill you up in a way that is helpful, or they may tear you up inside without you realizing it. It's hard to tell sometimes but usually on balance they help me with immediate nausea unless stomach acid is involved.

Eat the kind of foods you would eat for end-to-end GI troubles, but avoid acidic fruits like bananas and citrus and don't mix fruits with your other foods, eat them at least 15 minutes before more substantial stuff. Fruit leather and apple sauce can be good. Green tea and/or ginger tea can soothe nausea, as can strong licorice candy or tea made from licorice, made from the real deal but if it's concentrated potent licorice like you might find in a tablet form, it needs to be "DGL" (Deglycyrrhizinated licorice).

Don't drink much with your meals / snacks, observe a 15 minute before and after rule. I've heard good things from people about cannabis as a temporary nausea treatment and appetite booster and on the more straight and narrow side, in addition to your Zofran there's something called mirtazapine you can ask your GP about. No recommendations on that one way or another, I just know from recent experience that it's used for stimulating appetite in some folks with wasting / anorexic symptoms and has sort of a general all-around effect in treating nausea and appetite, but is primarily used for mood disorders and is a novel drug sometimes used in this situation.
posted by aydeejones at 7:44 PM on April 14


And more realistically, ask a pharmacist about all drugs including mirtazapine and give them a lot more credibility than your GP. Maybe ask more than one, but they are typically far more well-versed in the pros and cons and interactions of various medications than a GP or in many cases specialists, including many psychs who might have a more rudimentary understanding of how the various drugs interact and can sometimes be more laissez faire about experimenting rather than thinking ahead.
posted by aydeejones at 7:47 PM on April 14 [1 favorite]


Also a relative of mine was on Zofran for really persistent bad nausea and vomiting, and ended up benefiting some what from benzodiazapines like klonopin, which suggested there was some rooting in anxiety. Turns out she was in basically a chronic pain state taking forever to get a hip replacement scheduled, and after going through all of the anticipating and pain of recovery, this very debilitating and persistent sickness which would come every other month or so and last several weeks completely resolved itself for a good two years so far.
posted by aydeejones at 7:49 PM on April 14


Ask your doctor for a referral to a gastroenterologist.
posted by radioamy at 8:11 PM on April 14


As for eating, are there things that are kinder to your stomach?

Ginger is wonderful for nausea. I'd get ginger beer, the real stuff, with sugar, instead of artificial sweeteners or HFCS. It can be strong, so perhaps sip it in 4 oz increments, or cut it with soda water.

I find that yogurt is easy on the tum when I'm feeling whoopsy. I don't normally like it, but I'll eat it if I feel nauseated.

Roasted chicken for protein (stay away from processed stuff) and plain rice are kind to the stomach and are tasty even if you feel unwell. Chicken soup with a matzoh ball is a classic for very good reason. My mother craves Won Ton soup. Go figure.

I also found that very spicy foods helped (endorphin release) so if that's a thing, perhaps a spicy curry or chili (or not, if it sounds gross just to discuss it.) I used to crave a red chili burro from Ponchos when I was sick. I still do.

Smoothies with protein powder may be a good option for you.

Toast. Jello. Applesauce are all things I crave when I feel unwell. Also, grape juice.

For sure, continue to explore these issues with your doctor, but for actually getting some calories into you, try some of these things.
posted by Ruthless Bunny at 8:19 AM on April 15


I posted a similar question a while back. I'm on my phone so I can't link, but it is in my posting history.
posted by kathrynm at 8:32 AM on April 15


Look up some past questions on coping with morning sickness. I know you ruled out pregnancy, but this is exactly what the nausea was like for me and I bet some of the same things would help while you wait for a diagnosis.

The things that helped me the most when I got that about-to-hurl feeling were jolly ranchers and lemonheads . I also ate a lot of bland food like mashed potatoes and chicken.

Good luck!
posted by galvanized unicorn at 11:25 AM on April 15


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