What could these symptoms mean?
September 15, 2016 8:24 AM   Subscribe

Asking for a friend who will see their primary and a specialist - what are some possible explanations for these symptoms? Friend would like to have some questions to ask their primary.

The friend in question has had chronic, low-grade nausea most days over the past month, sometimes overlapping with headache and waves of heat. (Perimenopause is not a possibility.)

This is more likely to happen at work and less likely to happen on the weekend. If the friend is able to eat, this sometimes settles the nausea for an hour or so.

It usually starts mildly in the morning and builds up over the day, but some days are bad from the start.

Friend is substantially overweight, has had their gallbladder removed, has a family history (but no personal history) of migraines, takes high blood pressure medication and an anti-depressant and is somewhat sedentary. Friend tends to eat calorie dense foods at irregular intervals. Friend does not drink caffeinated things.

YANAD, but what would be some starting points to ask about at the doctor's? Historically, friend has not had good follow-up care and there has not been a strong push to diagnose their illnesses, so friend would like to be able to consider as many possible causes as possible so that friend can push the doctor for tests and referrals.
posted by Frowner to Health & Fitness (18 answers total) 2 users marked this as a favorite
I would see the blood pressure or the blood pressure medication might be something to pay attention to. My partner takes blood pressure meds, and if they're off in some way, he gets very nauseated and headachey.
posted by xingcat at 8:28 AM on September 15, 2016 [2 favorites]

Low-grade nausea and waves of heat sounds like what I experience when I'm having a particularly bad day with anxiety or am about to experience an acute panic attack. Generalized Anxiety Disorder might be something to ask about.
posted by lindseyg at 8:50 AM on September 15, 2016 [5 favorites]

Has friend been pooping normally?

Migraines are high on my list.
posted by i_am_a_fiesta at 9:02 AM on September 15, 2016 [1 favorite]

I would definitely pursue the migraine angle - everyone who has them started out with no personal history of them, your friend is no different. And they run in the family so it's a possibility. Please ask your friend if they have made any changes to their workplace, anything and everything from a new heating system, replacing some worn carpeting, or simply changing some light bulbs. The whole happy family of migraines (all migraines are not the same) include those that include nausea and those that are triggered by lights, sounds, heat, and humidity, among other things.

Your "calorie dense" is interesting. I know two people who have had their gallbladders removed and both eat small meals, but frequently. Like maybe 6 meals a day. Something to do with release of bile and fattiness and other things that I don't know much about but eating habits are definitely worth looking into. Plus a huge no no is eating a large meal before bed. So...the whole digestive system is at question - bowel movements especially. Irregular bowels can cause all of those symptoms.

I hesitate to even link to this web md symptom checker if your friend is the sort to freak out over it, but it can be a really great tool to help narrow down the possibilities. For example, here are some medical conditions for those experiencing fatigue, waves of heat, nausea and headaches. Also have them ask about their medications and how they interact with each other, side effects, etc.
posted by the webmistress at 9:05 AM on September 15, 2016 [2 favorites]

I would get these symptoms when I'd been messing with my blood sugars. For example, if I ate candy for breakfast (don't judge - I did this for YEARS without incident!) I would have a spike, and then a HUGE crash that would make me very nauseated, light headed, weak in the knees and hot!

It would also happen after I'd eaten a large brunch. Huge blood sugar spike: followed by crash and awfulness.

I also have low low pulse and blood pressure, so I've switched to candy-breakfast to salty-snack lunch, followed by lots of fluids, and I haven't had a "OMG going to pass out" incident ever since.
posted by Dressed to Kill at 9:08 AM on September 15, 2016

I hesitate to point out the obvious, but this could be as simple as dehydration.

Larger bodies require higher amounts of fluid intake to stay hydrated, and nausea can create a snowball effect of dehydration even without vomiting, because chugging a glass of water is the last thing a nauseated person wants to do.
posted by whoiam at 9:08 AM on September 15, 2016

Another rule out the obvious: pregnancy?
posted by Kriesa at 9:11 AM on September 15, 2016 [7 favorites]

Just as a data point -- I was experiencing very similar symptoms and also had incredibly low iron levels that did not respond to supplements. I was given an iron IV treatment, and those symptoms haven't showed up since. I'm not quite sure how they might be linked, to be honest, but perhaps just a good idea for your friend to get her iron checked. My PCP did a test for my actual iron level as well as one to see how well I'm absorbing iron.

Good luck!
posted by fairlynearlyready at 9:12 AM on September 15, 2016

Do they take vitamins? Iron often causes nausea.
posted by pseudostrabismus at 10:00 AM on September 15, 2016 [1 favorite]

Iron (either deficiency or supplements), anti-depressant side effects and anxiety have all led to nausea for me. Is her thyroid okay?
posted by LoonyLovegood at 10:04 AM on September 15, 2016

Thyroid, though getting doctors to take borderline results as something to treat can be really hard. (However, it can cause nausea, and also temperature management issues, so waves of heat, possibly also waves of feeling way too cold though summer might have been masking that.)

There are also links between hypothyroidism and migraines, fwiw.

(Feel free to MeFiMail for more specific stuff if you'd like.)
posted by modernhypatia at 10:04 AM on September 15, 2016 [3 favorites]

My first thoughts are pregnancy or stress. Headaches and nausea are symptoms of both, and I've definitely had nausea and headaches that only presented at my super stressful job that I hated and dreaded going to every day, and then permanently disappeared when I got a better job.
posted by Sara C. at 10:05 AM on September 15, 2016

Given the information you provided I have to believe that any effort to answer your questions are at best informed guesses if not speculation. Every thing you mentioned has potential implications ( two medications that have known side effects, obesity, possible post cholecystectomy complications which are not unusual, failure to follow up, possible diabetes (TypeII), migraines etc.. It would seem to me that the most important thing is to be clear and thorough in explaining her concerns to her physician or find a physician who she feels is sympathetic to her needs. My hunch (and only a hunch) is that it might be interrelated to some of the predictable complications of gall bladder removal + erratic diet + obesity + anxiety/depression etc. I hope this can be sorted out for her and she finds some relief and a physician who can put this in perspective.
posted by rmhsinc at 10:16 AM on September 15, 2016 [1 favorite]

post cholecystectomy complications

Could be anything, but that's my guess. (Postcholecystectomy syndrome)
posted by cotton dress sock at 11:20 AM on September 15, 2016 [1 favorite]

So my waves of nausea, vertigo, migraines, and overheating likely seem like I needed glasses. Sounds nuts. But I probably needed them for a long time and didn't know. Now I've had glasses for a month and the symptoms are way reduced. If you would have told me I needed glasses I would have laughed. And like her, things got worse over the day. So even if she currently has them - check her vision. You can print out eye tests online to start.

Now if that's out of the way and done then it's something else. Again I mentioned it because I literally was sick for at least a year and debilitated in addition to my chronic illness because I needed glasses.

Anyway besides that it could be a food intolerance, a medication, migraines, dehydration, blood sugar, and blood circulation issues. For example I have POTS so I get headaches and I get nausea because I have stomach issues and bad blood flow.
posted by Crystalinne at 3:09 PM on September 15, 2016

Similar symptoms resulted in an endoscopy and a diagnosis of h. pylori for me, followed by an absolutely brutal course of antibiotics. Not necessarily the case for her, but it's definitely something that she can be tested for at least.
posted by lydhre at 6:52 AM on September 16, 2016

At a minimum, friend probably needs to start eating a high-protein breakfast every day. Those juices with 30g of added protein by Naked, Odwalla, etc. are great to drink first thing in the morning.

In addition to what everyone else has suggested, what is friend's posture like at work? Sitting the wrong way can fuck with your stomach.
posted by Jacqueline at 9:19 PM on September 17, 2016

My first thought was it sounds like hyperthyroid. The fact that this person is overweight makes me then wonder if they were hypOthyroid and perhaps are taking too much thyroid replacement hormone, and have tipped over into hypERthyroid territory. The heat waves and nausea both suggest that. But you did give a medical history for them and didn't mention any thyroid issues...
posted by mysterious_stranger at 6:11 AM on November 6, 2016

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