Seeking Help for Chronic Vomiting
A 30-year-old woman weighing 144 pounds is experiencing significant health challenges. She has been diagnosed with gastroesophageal reflux disease (GERD), anxiety, borderline prediabetes, allergies, and asthma. Her current medication regimen includes 40 mg of pantoprazole, 5 mg of Lexapro, and occasional doses of 5 mg hydroxyzine. Since January, she has been dealing with near-daily vomiting, which intensified following her discontinuation of mirtazapine in early December. While on mirtazapine, she endured extreme nausea, and withdrawal from the medication brought about severe effects. Since her first attempt to stop taking mirtazapine in April, she has lost around 40 pounds due to decreased appetite and persistent vomiting. Following a second effort to discontinue mirtazapine in February, she started Lexapro to manage her severe depression, but she initially faced uncomfortable side effects, which have since mostly subsided. Unfortunately, her acid reflux has spiraled out of control. For roughly three months, she experienced morning vomiting (January to mid-March), which has now progressed to post-meal vomiting. Recently, she has found herself awake after just one hour of sleep, experiencing four violent episodes of vomiting in one night. The patient has frequently reached out to her gastroenterologist regarding her condition but cannot secure an appointment until June. She’s concerned about overwhelming him with messages, yet her suffering is becoming unbearable. An endoscopy performed in 2021 revealed inflammation and erosion of her mucosal lining, with tests coming back negative for H. pylori and celiac disease. She recently underwent blood tests evaluating the functioning of her pancreas, liver, and kidneys, alongside an ultrasound covering those areas and the gallbladder; all results were normal. Furthermore, a recent stool sample returned negative for any irregularities. Despite her medical investigations, she continues to feel extremely nauseous after eating, sometimes reaching the point of vomiting. She also experiences foul-smelling diarrhea almost every morning, often containing undigested food. While she occasionally suffers from abdominal pain and bloating, heartburn is a rare occurrence. She feels utterly desperate, as she cannot find relief from her relentless vomiting.
Answers (1)
3/24/2025, 9:50:39 AM
OpenHealth AI
I'm really sorry to hear about your ongoing struggles with chronic vomiting and how much it has affected your quality of life. It seems like you've been through a lot with your health, and it's understandable to feel desperate to find relief. Here’s a summary of the key points and some suggestions to help you manage this situation until your gastroenterologist appointment.
Key Points:
- You have a complex medical history that includes GERD, anxiety, and recent medication changes which may be contributing to your symptoms.
- The nausea and vomiting rooted in the withdrawal from mirtazapine may be exacerbated by your existing conditions and medications.
- The recent onset of foul-smelling diarrhea may signify a digestive issue that needs attention.
Explanation:
Chronic vomiting, particularly after meals, can stem from several factors including the underlying conditions you've mentioned (like GERD) and possibly side effects from your medications. It's important to approach the symptoms with a multi-faceted strategy since they've not improved despite medical interventions.
Next Steps:
-
Modify Eating Habits:
- Eat Smaller Meals: Try to have five or six small meals instead of three large ones. This can ease the burden on your stomach and reduce the chances of vomiting.
- Avoid Trigger Foods: Identify and avoid foods that seem to trigger your nausea or vomiting. Common triggers can include spicy, fatty, or acidic foods.
- Stay Upright Post-Meal: Remain sitting up for at least 30 minutes after eating to help with digestion and minimize reflux.
-
Hydration:
- Drink clear fluids like broth, herbal teas, and electrolyte drinks to stay hydrated, especially if you are losing fluids from vomiting.
-
Monitor and Document Symptoms:
- Keeping a symptom diary can help you track patterns, triggers, and any correlations with food intake or medication. This information can be beneficial in discussions with your gastroenterologist.
-
Anxiety Management:
- Since anxiety can worsen gastrointestinal symptoms, consider practicing relaxation techniques such as deep breathing, meditation, or gentle yoga. These may help alleviate nausea as well.
-
Reach Out for Support:
- If your symptoms worsen or you experience severe dehydration (like reduced urination, dizziness, etc.), it’s important to seek urgent care.
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Communicate with Your Doctor:
- It’s okay to communicate your urgency and ongoing issues to your gastroenterologist through secure messages if allowed. It might even make it easier for them to address your concerns in your upcoming appointment.
While it's frustrating to experience these persistent issues, focusing on these actionable steps could provide some relief and improved management of your symptoms in the meantime. Please take care of yourself, and I hope you find some comfort soon.
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