Exploring nausea
December 5, 2021 1:10 PM   Subscribe

A young male teen in our home has experienced nausea for 6+ consecutive days. We have scheduled a Dr’s appointment for next week (earliest we could get an in person appointment). The duration of this illness seems long to us and unusual for them, and we are working to create a list of possible questions to ask at the Dr. appointment. I am not seeking medical advice. However, can you help to brainstorm questions to ask?

Details as follows
-Covid test was negative
-The first three nights, teen vomited in between midnight and 4 am, but at no other times during the day. They haven’t vomited in about 3 days. No diarrhea
-We have worked to keep their hydration up.
-Their food intake is low, and they have an aversion to eating most foods they typically enjoy, and are subsisting on bland and starchy foods
-They say that they ‘feel better’, but are exhausted and look it, and again, are avoiding a lot of foods they usually enjoy while also saying that the nausea is particularly present after they eat anything
- They are sleeping a bit more than normal and have low energy
-They have been resting a home for the duration of this illness, not doing anything that would exert themselves

Other factors
-They have been quite anxious at school lately and particularly the day before they became ill
-No one in their social circle or school or anyone we know of has had a stomach bug/flu etc
-They have a parent with Crohns
-They have made comments about their weight and self image and have shifted their eating in general this school year, eating less than they did last year (granted they also appear to be growing at a slower rate than last year)

Thanks in advance for your suggestions. I may be over thinking this, I'm just worried about them.
posted by walkinginsunshine to Health & Fitness (17 answers total) 2 users marked this as a favorite
Every time I go to a doctor, or consult a doctor regarding my child, I ask, "considering what I have described to you, are there symptoms I should watch for that you would consider particularly alarming, that require immediate medical attention?"

You want to come away from every sick visit with a list of "go to ER ASAP" items.

For a minor with nausea issues, that might be something like inability to keep down fluids.

You could also see if the doctors office has a nurse hotline, so you can ask this question.
posted by champers at 1:16 PM on December 5, 2021 [8 favorites]

I'm a social worker in the medical/psychiatric field so I immediately jump to wondering about mental health. Given the symptoms and history you report: anxiety, nausea, maybe some self-esteem issues or issues around food, it may help to ask them if they think it'd be helpful to talk to a therapist -- if even just for a few sessions -- to see if there's something there.

That doesn't mean they're "crazy" or even necessarily meet Official Criteria for depression or anxiety disorder or whatever. But hey, adolescence is rough at the best of times. And this is hardly the best of times. Maybe taking some time to talk to someone outside the family and peer group to explore what's going on would help.

This is not to say that you should blow off the idea of any physical medical issues that may be happening. But keep mental health in mind as well.
posted by tivalasvegas at 1:43 PM on December 5, 2021 [3 favorites]

This sounds like a standard stomach bug to me, which is to say, they can be exhausting and cause ongoing digestive issues. Many people don't point it out if they have diarrhea for a few days so you may not know about a bug/poisoning, or your child may have just eaten something no one else did (a sandwich left out too late, or what have you). I would say that anxiety is also a possible issue; it can definitely manifest in vomiting (ask me how I know!).

It's great that you're so supportive. However, I want to point out that realistically, teenagers can really benefit from a solid amount of time alone with their medical caregivers. This is particularly the case when you're dealing with anything that may be related to mental or sexual health.
posted by Rock 'em Sock 'em at 1:46 PM on December 5, 2021 [7 favorites]

Also -- and I'm not saying this is the case -- sometimes teenagers get caught up in lies, like for example, if they were really stressed and maybe lied about having vomited (for example) or lied about something else. If you give them time alone with caregivers, that can give them an "out" to tell the truth without worrying about the consequences with Parents.
posted by Rock 'em Sock 'em at 1:48 PM on December 5, 2021 [3 favorites]

Response by poster: Thanks for the responses this far, keep them coming! One point of clarity, my plan is to go in with them at the start of the appointment to help confirm details, timelines, what we’ve seen etc, then to leave kiddo alone with the Dr.
posted by walkinginsunshine at 1:52 PM on December 5, 2021 [4 favorites]

You don't need to ask questions in the doctor's appointment, it's the doctor's job to ask questions. Let your family member go in and describe their symptoms while you wait outside (which you may have to do for social distancing reasons anyway). The doctor is a professional and will be able to help. The only thing you should ask your teen is whether they'd rather see a doctor of the same gender or not and then arrange that for them if necessary.

You sound as though you're pretty anxious about this which might be making your family member anxious too, especially if they're already stressed out by school, so it would be good for you to try not to worry unduly about what sounds like a pretty normal progression for a stomach bug or virus (I can remember a few gastric illnesses I had as a young person that knocked me out for a week or so just like this -- it sometimes takes time to heal and get back to eating normally).

On preview: your plan sounds fine! It sounds like you're already doing all of the right things. I recommend mint or ginger tea for an unhappy tummy if you don't have any already.
posted by fight or flight at 1:56 PM on December 5, 2021

Take a moment to read up on Cannabinoid Hyperemesis Syndrome. Easy to rule out if it’s not that, but still an emerging thing so some docs aren’t familiar.
posted by sixswitch at 4:15 PM on December 5, 2021 [13 favorites]

I was coming to say what sixwitch said. With pot being so much more potent now a days, Cannabinoid Hyperemesis Syndrome is becoming more prevalent. I have a family member who suffers from it but continues to use. The one tell tale sign of this is that the only relief the person gets is when taking a very hot shower.
posted by momochan at 4:21 PM on December 5, 2021 [4 favorites]

Six+ days is a long time to be dehydrated. If your teen can't keep any fluids down - plain water actually can cause nausea, try fluids that are either sweet or salty. Would they tolerate chicken soup or broth? Popsicles? All qualify as liquid and may be easier to tolerate. If their eyes look "sunken" or "flat" I think they may need IV fluids, especially if they are not urinating urine that is light yellow or very light yellow. Deep yellow or brownish urine, indicating urine concentration, would indicate significant dehydration and should also be considered. This may be a situation where waiting for an office appointment is not the best option, but you and your teen are in the best position to judge.
On edit, this goes twice if there has been diarrhea, another notorious cause of dehydration.
posted by citygirl at 4:22 PM on December 5, 2021

This is about the age where we discovered Kid Gyre was lactose intolerant, after a long happy life of regular milk/ice cream/yogurt to kid's dismay. Kid's presented as nausea and stomach pain.
posted by Gyre,Gimble,Wabe, Esq. at 4:34 PM on December 5, 2021 [5 favorites]

So I had a spell of this as a teen; I think it was likely an undiagnosed allergy or food poisoning. But it happened like 4-5 times and I got hospitalized once for dehydration. Definitely not weed related. I eventually grew out of it but it was never truly diagnosed.

If your kid is not keeping many fluids down you might consider the ER or asking for an earlier appointment, you don't want to fuck w dehydration.
posted by emjaybee at 5:17 PM on December 5, 2021 [1 favorite]

This actually sounds like food poisoning, possibly from bad dairy or salmonella or something. My husband had the same symptom pattern after eating some cheese that had gone off. It took over a week for him to recover, though the vomiting was only for the first couple days. He could barely get out of bed for a while, he was so exhausted. I had a similar experience after eating jalapenos that had salmonella (the recall happened literally the next day, I was pissed).

If stress / anxiety related, check out 'dorsal vagal shutdown'. I am only just learning about polyvagal theory, partly bc said husband is often nauseated and has frequent stomach pain but all his tests come back normal so we are trying to look at this from other angles.

Hope the kiddo feels better soon!
posted by ananci at 6:22 PM on December 5, 2021 [1 favorite]

Not an answer to your question, but an aid for nausea that not a lot of people seem to know about is sniffing rubbing alcohol. You can tear open a little swab but leave it in the packaging and huff as needed.

I have a mystery chronic illness, and I'm a big proponent of preparing questions to bring to medical appointments, but I wouldn't feel a need to be super prepared in this case. This is the sort of illness that primary care providers are very good at diagnosing. They will be naturally motivated to be thorough and careful because dehydration can be dangerous, and teens don't typically experience random bodily weirdness like older people. If it happens more than once, that's when I would start researching. Hang in there!

(I would confirm with teen that they are pooping normally, though.)
posted by Comet Bug at 10:53 PM on December 5, 2021 [4 favorites]

Keeping a (food, etc.) diary will be helpful for diagnosis. I'm a toxicologist/epidemiologist, and I developed Crohn's disease when I was ~11 years old. Initial signs and symptoms were so general that they weren't too much help as diagnostic criteria/ What became clear quickly enough was that my nausea would peak and crest in time with certain stimuli: peak within half an hour of eating, peak incredibly strongly when I would eat fatty or oily foods, crest would be significantly lower if I'd fasted, etc. This diary can and should also include anything else you may think is significant (examples: time and dose of any medications, prescription or OTC; body temperature measurement and time of measurement, a few different times each day if you can manage it; subjective entries written by teen about how they feel when they feel particularly unwell or notably well; how much sleep they're getting; etc.). It really is just giving your physician a lot more information that can inform a diagnosis--in a way, it's sort of giving them the information they can use to determine what questions to ask.

Hang in there.
posted by late afternoon dreaming hotel at 1:10 AM on December 6, 2021 [2 favorites]

There are so many things this could be, but I would definitely focus on physical causes before blaming it on mental health - vomiting, nausea, lack of appetite are all pretty standard signs of foodborne illness, and nobody else needs to have been exposed/sick for it to be food poisoning. There are other pathogens that are not specifically food poisoning that can cause such symptoms as well - including some types of tick-borne illnesses, parasites from contaminated fresh water, etc. The fact that the teen "feels better" may also mean they're on the mend, even if they're not totally better.

So questions I would focus on:
-Does this seem to indicate an isolated infection that time will mend, or is there reason to look further into the possibility of allergies/chrohn's etc. at this time?
-Are there any recommended test?
-Are there any signs or symptoms to watch for that would indicate a) teen is not improving and needs to be seen again or b) emergency care is indicated?
posted by DoubleLune at 6:26 AM on December 6, 2021 [1 favorite]

I wish I had answers but I don't.

I just wanted to say that one of my sons started having an upset stomach, with vomiting, on Sunday nights. He'd feel awful, look awful, and would stay home on Mondays, usually feeling a bit better by Tuesday.

Anyway, it turns out that he was being bullied on the school bus by the neighborhood bully, and the stress was causing his stomach issues. I wish he'd just told us - when we finally learned the bullying was going on, we immediately addressed it (the other child..well, it wasn't the first time, and he ended up being banned from the bus for his behavior).

Stomach issues faded away.

I'm hoping your kiddo gets answers rapidly, and feels better very soon.

Also, and I just though this, their room isn't closest to the furnace, is it? Carbon monoxide came to mind, I don't know why. What if there's a slight leak, and they are sensitive to it?
posted by annieb at 6:23 PM on December 6, 2021 [2 favorites]

Have they had a haircut recently? There's lots of other, probably more realistic suggestions here, but I had oddball nausea issues for a couple of days as a teen. The culprit was a hair from a recent trim that had worked it's way into my ear and gotten stuck like an arrow in my eardrum. As I moved around, it would bounce.

I think they'll check the ears by default for nausea complaints, but maybe worth reminding the doctor about.
posted by jellywerker at 3:57 AM on December 7, 2021 [1 favorite]

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