OpenHealth Q&A

Long-Standing Nausea Issues Over the Years

**Patient Profile:** 26-year-old female from Germany, originally from Poland, standing 149 cm tall and weighing 50 kg, identified as white. **Medical History:** The patient has been diagnosed with autism spectrum disorder, anxiety, and depression. Notably, she has undergone gallbladder removal surgery. Since childhood, she has experienced gastrointestinal issues such as stomach aches and consistent nausea, which led to a limited appetite. At the age of 10, she was assessed by a pediatric endocrinologist due to her stature and, prior to turning 11, spent time in the hospital to exclude any genetic conditions, all tests returning negative. Over the years, episodes of nausea have recurred intermittently. For relief, her pediatric psychiatrist prescribed alprazolam to be taken as needed, along with escitalopram, hydroxyzine, and propranolol to manage her anxiety and depressive symptoms. The first significant episode of extended nausea occurred around her 20th birthday. While on a break from her college studies, she began experiencing severe vomiting and persistent nausea, rendering her unable to eat for several days. Despite her doctor prescribing omeprazole, she found no relief and eventually sought help at a hospital. However, after basic tests, she received no further assistance and faced dismissive comments from staff regarding her condition, prompting her to leave. The episode eventually subsided, although she continued to experience brief instances of nausea, managed with her prescribed medications. During this period, she transitioned to sertraline for depression, discontinuing hydroxyzine and propranolol, which resulted in a perceived improvement in her condition, including the cessation of panic attacks. Upon relocating to Germany, she maintained her sertraline treatment and began taking the birth control pill in September/October 2023. By December, she noticed a resurgence of her nausea, leading to a diminished appetite. After enduring this distress for some months, she visited a doctor in February who prescribed Pantoprazole, suggesting a possible H. Pylori infection, and referred her for an endoscopy scheduled for May. As time passed and her condition did not improve, she requested a colonoscopy sooner, which her doctor arranged within two days. Despite undergoing further tests, including blood work and ultrasounds while at the hospital, her symptoms remained unresolved. Amid escalating frustration from her boyfriend and the urgency of her condition, they sought emergency care where a more thorough examination revealed significant sludge in her gallbladder. After being administered antibiotics and antiemetics, the medical team recommended gallbladder removal, although they deemed it not immediately urgent. Additional diagnostic procedures followed, yet she managed only limited nutrition during her hospital stay with the aid of IV antiemetics. Her surgery in April went smoothly, leading to a decrease in nausea episodes, which she could sometimes alleviate with over-the-counter anti-nausea medication. However, by December, the nausea returned, initially sporadic but increasing in severity by March. Complications arose when she faced an ear infection and another round of vomiting, leading her to consult a physician who prescribed metoclopramide and ear drop antibiotics with little relief. After experiencing discomfort in the gallbladder region, she returned to the hospital where examinations yielded only minor issues, such as constipation attributed to reduced food intake. The doctors provided interventions to relieve constipation, which led to temporary improvement, yet she remained predominantly nauseous and was hospitalized for several days without significant resolution of her symptoms. Although she received Pantoprazole again, attempts to return to work after treatment were thwarted by repeated vomiting episodes. She returned to her physician who prescribed Ondansetron for nausea management and scheduled a follow-up appointment in three weeks. The doctor indicated that if her condition did not improve, hospitalization might be necessary again. Despite taking Ondansetron hours ago, her nausea remains persistent. The patient is left feeling desperate for answers and is grateful for any insights received.

Answers (1)

3/31/2025, 3:40:52 PM

OpenHealth AI

I understand that you have been dealing with long-standing nausea and gastrointestinal issues, which have significantly impacted your life and well-being. It’s important to address both your physical and emotional health needs through a structured approach.

Key Points

1. Recurrent Nausea and Gastrointestinal Issues: Your ongoing nausea, alongside your medication regimen and previous gallbladder surgery, is complex and needs consideration of multiple factors.
2. Ongoing Assessment and Management: Your symptoms have persisted despite various treatments, highlighting the need for continuous evaluation and tailored management strategies.

Explanation

Chronic nausea can result from various factors, including medication side effects, gastrointestinal disorders, or emotional stress due to anxiety and depression. Given your history of gallbladder issues and the surgery you've undergone, it's critical to monitor how these factors interact with your ongoing symptoms.

The medications you're taking, including sertraline and ondansetron, can also contribute to side effects like nausea, and it's worth considering their management alongside lifestyle adjustments.

Next Steps

1. Keep a Symptom Journal: Track your nausea episodes, food intake, medication timing, and any associated symptoms (like bloating or pain). This can help identify patterns or triggers that can be discussed with your physician.

2. Dietary Adjustments:

   • Small, Frequent Meals: Try eating smaller portions throughout the day instead of larger meals, which can help reduce nausea.
   • Hydration: Stay well-hydrated but avoid drinking large amounts all at once; sip water or herbal teas.
   • Ginger and Peppermint: Consider using ginger (in tea or candy form) or peppermint; they are often helpful for nausea management.

3. Medication Review: Discuss with your doctor the possibility of reevaluating your current medications. Sometimes, certain prescriptions can exacerbate gastrointestinal symptoms.

4. Follow-Up Care: Given your situation, maintaining regular follow-up appointments with your healthcare provider is crucial. If symptoms worsen or do not improve with your current treatment, advocate for additional tests or a referral to a gastroenterologist who specializes in functional GI disorders.

5. Emotional Support: Consider connecting with a mental health professional who understands the psychological aspects of chronic illness. Therapy may help in managing anxiety and depression, which can impact your gastrointestinal symptoms.

6. Mindful Relaxation Techniques: Incorporate mindfulness, deep-breathing exercises, or gentle yoga to help manage anxiety, which can in turn support your gastrointestinal health.

Final Thoughts

I can imagine how difficult and frustrating this experience has been for you. You're not alone in this; there’s hope for finding a combination of treatments and strategies that work best for your unique situation. Remember to take it one step at a time, and don’t hesitate to reach out for further support or clarification on any matter. Let me know how else I can assist you!