I am nearly always nauseous. Help.
February 14, 2020 2:53 PM   Subscribe

I know YANMD, but would like advice anyway for how to deal with this.

I have always had a very sensitive stomach. I get motion sick more than anybody I know, for about a decade I had the symptoms of (and was diagnosed with) cyclical vomiting syndrome, my pregnancies were horrible verging on hyperemesis, etc.

The last year has been terrible for me with lots of life upheaval and severe depression. As part of that, I completely lost my appetite and often puked out of emotional distress -- in the worst of it, nearly daily. I lost almost 50 pounds, which was more than 30% of my body weight.

Starting in October I started on anti-depressants (Brintellix) which helped with the worst of the depression symptoms. The nausea and puking also resolved, not entirely, but down to like once a week instead of once a day. I am in the care of both a therapist and psychiatrist.

In the past three weeks or so I'm back to not only puking at least once a day, but also feeling nauseous every morning until about 1pm or 2pm. The only reliable way to deal with it is to lay down (not at all compatible with my job and kids) or if I'm lucky and I puke enough then the feeling passes. But often I can't even get myself to puke and just feel miserable and nauseated until the early afternoon.

I am going to talk to my doctor about this. But I am travelling overseas for another two weeks for a work trip which means I can't see them until I get back.

The thought of trying to power through like this, while trying to perform well at work, has me close to tears. I'm doing better depression-wise than I was a few months ago but everything is still a struggle and I just do not know what to do with having to deal with this nausea on top of it. I don't know if it's a side effect of the medication -- it's possible, but I've been on it for months without side effects and I have the nausea both before and after I've taken the pill. In any case, I can't discontinue it without doctor supervision and since I was suicidal before I got onto the antidepressants I'm scared to. I have to give some talks while I'm overseas and my productivity at work was terrible all last year so I feel like I'm kind of on thin ice as it is and I can't have any more incidents where I bow out "for health reasons."

I also am really scared of losing more weight. It's reached the point of being quite unhealthy. I get unsolicited comments from friends who haven't seen me in a while and are aghast at how much weight I've dropped. I see myself in the mirror and I'm aghast. But I really can't keep much down. Even smoothies and milkshakes, which used to be one thing I could reliably handle, are not always good.

I don't know exactly what I'm asking. I guess: how do I get through the next two weeks, or more, if as seems likely the doctor isn't much help? And does anybody have ideas for what is going on here? Like I said my mental health was already kind of tenuous and trying to persevere through this on top of anything else feels like one straw too many on this camel's back.
posted by forza to Health & Fitness (16 answers total) 2 users marked this as a favorite
Response by poster: Just to add: I am 100% absolutely confident that I'm not pregnant. There is no possibility of that.
posted by forza at 2:54 PM on February 14, 2020

I know this is probably not a satisfying answer, but give how underweight you are and that you’re not keeping food down, might this rise to a level of health emergency that justifies postponing the work trip for a couple days to see a doctor?

You say you’re in the care of a therapist and psychiatrist, but do you have an internist you see regularly whom you’ve consulted on this problem in the past? Could you book an appointment to discuss the issue over the phone before or during the trip?
posted by sallybrown at 3:20 PM on February 14, 2020 [1 favorite]

Are you taking vitamins with iron in them? They make me nauseous for a few hours after I take them. Given your timing and the fact that many people take vitamins in the morning, it made me wonder.
posted by lollusc at 3:22 PM on February 14, 2020

Best answer: That sounds really awful. I may have missed it in your question, but are you on or have you been on medication for your nausea, prescription or OTC? Even though you can't see your doctor, can you message them to ask if there's an OTC medication or something that you can take for the time being that doesn't conflict with any of your other medications? At least as a stop-gap for the next two weeks? I have no doubt that you have tried many remedies over the years but I'm just throwing that suggestion out there. Message your doctor. Even if it doesn't relieve the nausea, maybe there is something that can reduce it to a less awful level.
posted by acidnova at 3:22 PM on February 14, 2020 [1 favorite]

Best answer: I think you need to see a neurologist if you haven't already. I would get bouts of this as a kids regularly and it had to be treated as a migraine with a shot at the hospital and fluids or it wouldn't stop. It was explained to me that it was vagus nerve dysfunction. The attacks did eventually turn into more classic migraines as I got older but I still had bouts of vomiting and almost daily nausea. At various times I've taken effective medications, those being migraine medication, a beta-blocker and finally a course of anti-seizure medication for 6 months. The anti-seizure medication worked to break the cycle and I've not vomited or had long periods of nausea one time in the 11 years since except the time I had the stomach flu. Of course, ANY vomiting could set the cycle off again so I was worried it would but so far it hasn't!! The neurologist wanted me to stay on the anti-seizure medication longer term but I declined to as the side effects were problematic and also I thought he was a bit medication happy. I would take it again if the nausea returned tho.

Once the vomiting stops you need to rebuild your stores of vitamins and minerals. I found a course of vitamin shots and supplements enormously helpful with my moods and general health. Not feeling puke-y all the time was pretty great too.
posted by fshgrl at 3:32 PM on February 14, 2020 [9 favorites]

Electrolyte tablets make me feel better when I can't even keep much water down. If I haven't been able to eat for a long time, that itself can prolong nausea, and the electrolytes stop the cycle. Also, I think that low electrolytes might be a nausea trigger for me, but I'm not sure. This is all self-diagnosed, but the tablets really work.

You can get them in sports supply stores or online; there is a brand that comes two to a small paper packet that is handy to carry around. The large capsules aren't so handy.

My ultimate fallback food is watermelon. If you can get that, try it. I think it has mainly sugar, salt, and electrolytes, with just a bit of fiber -- colder is better for me.
posted by amtho at 3:36 PM on February 14, 2020

Best answer: I am loathe to comment on what is a serious medical issue, but for what it is worth when I was vomiting consistently the cause was my anxiety and not my depression.
posted by Tell Me No Lies at 4:39 PM on February 14, 2020 [1 favorite]

Best answer: Do you have access to legal cannabis, or will you on the trip? I don't partake, but I had a coworker with cyclic vomiting syndrome and it was the only thing that worked, if she took it right when she started feeling woozy.
posted by misskaz at 4:59 PM on February 14, 2020 [1 favorite]

Best answer: Agree with Tell Me No Lies, from my personal experience, it sounds like anxiety, and the symptoms are making you more anxious which is putting you into an anxiety loop. Would it be possible to get a prescription for a small amount of Ativan or Klonopin?

Alternately, I also get migraines and with it horrible nausea, so that's something to consider.

Either way, another route is to get some kind of anti-nausea medication. That might be easier to get from a visit to a minute-clinic type place or telemedicine visit. Zofran works pretty well for me when I get migraine nausea. They sell tongue-disolvable tablets (at least in the US) which can be easier to take than swallowing a pill. It can make you constipated but OTC Miralax and/or Colace will help with that.
posted by radioamy at 4:59 PM on February 14, 2020

Best answer: What you are going through right now sounds like my last two months before being diagnosed with pernicious anemia.

I lost 55 lbs. and could not eat solid food at all the last several weeks, but still threw up at least once a day when I tried to brush my teeth. I knew I was dying, but my emotions were so muted it just didn't matter that much.

I was hospitalized with a hematocrit of 10, got a transfusion and felt almost normal within about 10 minutes, though I was still weak.

The symptoms you have are nothing to mess around with; I think you should go to an MD immediately and insist on a blood test. My hematologist told me I should have died, and that he'd had patients with twice my final hematocrit who never got up out of a wheelchair.

My only ongoing treatment is megadoses of B12 for a week every 3 weeks: 10,000 mcg a day, which is ~4000x the RDA. I'd suggest taking such a dose as a precautionary measure, but I really want you to see a doctor before you go on your trip.
posted by jamjam at 5:01 PM on February 14, 2020 [4 favorites]

I think you need something like Zofran to help you get through the trip. Is there any way you can see a local doctor and get something similar? I HATE being nauseous and throwing up (so you have my profound sympathy for dealing with this!), and a dissolvable Zofran has taken me from miserable to pretty much fine within ten minutes with no discernible side effects when I’ve been sick with the stomach flu and nauseated from other medications. Then definitely see your doctor when you go home. You may need to have an upper endoscopy to see what’s going on, plus lots of bloodwork including nutritional levels. Good luck!
posted by bananacabana at 7:18 PM on February 14, 2020

This sounds so difficult! I agree with you, and those above, that this sounds like a serious medical thing that needs more care than just momentary remedies.

But in the meantime, here are my momentary remedies for nausea based on years of motion sickness and pregnancy experience:

- Don't try to multi-task in moving vehicles. Sit facing forward, and look forward out the window, ideally in front of you but beside you is ok too. But don't crank your head sideways, just angle it slightly.

Do NOT sit backwards or sideways, or scroll your phone, read, watch a screen, or look at something in your lap.

You need your head level and your eyes on the world moving outside the vehicle- especially if the vehicle is reversing or turning!! That way your eyes can collect info about the movement that will align with the info your inner ears are getting. That way your brain will stop getting conflicting signals which make it think you ate a poison mushroom, which is why it's trying to make you vomit it away.

- Drink cold water or, even better, icy cold Coke, when you feel nausea.

- Eat tangy fruit popsicles. Mango or strawberry juicy ones were best for me.

- Eat cold green apples, sliced thin.

- Carry isopropyl alcohol swabs (sold individually wrapped at the drug store for injection prep) and sniff them when you're nauseous.
posted by nouvelle-personne at 8:14 PM on February 14, 2020

Like misskaz, I know someone who suffered similarly (including severe hyperemesis during pregnancy), and medicinal marijuana is the only thing that works for her.
posted by Paper rabies at 2:20 AM on February 15, 2020

Response by poster: Thanks for all of these answers! They are really helpful. I marked as "best answer" the ones that gave me some ideas I hadn't had already, and that drive home the fact that this may be a much more serious medical issue than I've been treating it as. I've just been assuming it's something I have to soldier through because it's obviously caused by depression, but while there may be a link, there might not. (I did have bloodwork done a few months ago just to cover the obvious bases so I don't think I have pernicious anemia - though definitely if I take a sudden turn I will not be shy about going to the ER).

While I'm overseas I'm going to take a bunch of these suggestions for coping -- already emailed my psychiatrist to find out what OTC meds I can take alongside the existing ones (or cannabis, I'll be in CA which I think is a legal state). And when I get back I'll get a referral for a neurologist because this does sound a lot like vagus nerve dysfunction, and maybe also a gastroenterologist too. And talk to my psychiatrist about the possibility that this is anxiety-related.

Yay. It's a daunting list of stuff to do but way less daunting than just feeling hopeless and stuck, and I feel like maybe I'll get through the next few weeks as well. So thank you everyone!
posted by forza at 12:26 PM on February 15, 2020 [3 favorites]

Vomiting can be lots of things. But I find doctors don't always think to ask about *food*, which seems a bit silly when you think about it. Have you been tested for celiac disease? What about other food allergies or an elimination diet?
posted by cnidaria at 7:18 PM on February 15, 2020 [1 favorite]

Response by poster: Update: Nausea has gone down again recently, which strongly supports the "emotional distress" theory that I was originally operating under. I'm probably still going to go to a doctor I think (because it could always be multiple things, i.e., a physical underlying cause that is greatly exacerbated by stress) but the urgency I feel about it has decreased markedly. I'm not losing weight anymore and that's good.

Thanks everyone for helping me through a rough patch!
posted by forza at 2:10 PM on March 1, 2020

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