OpenHealth Q&A

Struggling with Persistent Nausea and Weight Loss for Months

**Summary:** For over three months now, I have been grappling with intense nausea, an extremely sensitive gag reflex, significant weight loss (approximately 25 pounds), and ongoing stomach discomfort. * **Investigations:** CT scan indicated colon inflammation; ultrasound revealed fatty liver; both endoscopy and colonoscopy resulted in inconclusive findings for hiatal hernia; gastric emptying test returned normal; thyroid levels showed some variations. * **Medical Opinions:** A gastroenterologist attributes my issues to acid reflux and anxiety, prescribing Voquezna, while a surgeon diagnosed the hiatal hernia as substantial enough to possibly require surgery (awaiting further test results). * **Medications Prescribed:** Zoloft, Bupropion, intermittent use of Zofran (ineffective), Voquezna (no improvement noted), and Mirtazapine (helps with the gagging). * **Current Condition:** I experience daily nausea, frequent gagging episodes, complete loss of appetite, and a prevailing sense of frustration and confusion between conflicting medical advice. **Chronology of Symptoms:** **Early May:** A sudden onset of severe nausea one evening, leading to sweating and eventual vomiting. After a few hours, I started feeling better. **Mid May:** During a flight to Japan, I felt anxious when my girlfriend mentioned her own nausea. This triggered my fear of vomiting, causing me to become extremely nauseous and gag often. My condition worsened in Japan, marked by persistent nausea and diarrhea. I was apprehensive about eating, limiting myself to plain foods like rice, bread, and proteins while trying to stay hydrated. **Early June:** Upon returning from Japan and feeling somewhat better, I had a family dinner, after which I vomited everything I had eaten. Consequently, I faced intense nausea, stomach issues, diarrhea, and ongoing gagging in the following days. My gastroenterologist recommended an ultrasound, and I ended up in the hospital due to unbearable nausea. A CT scan revealed colon inflammation, resulting in a diagnosis of colitis and a course of antibiotics. The ultrasound revealed that while everything appeared normal, my liver showed signs of being fatty. **Mid June:** At my subsequent appointment with the gastroenterologist, she suggested a colonoscopy and endoscopy. Both procedures included biopsies and returned mostly normal results; however, she mentioned the presence of a hiatal hernia, which she dismissed as a non-issue. The physician remained convinced that acid reflux was the root cause of my symptoms and prescribed Voquenza. I requested further testing, such as a gastric emptying study, which she reluctantly agreed to. My general practitioner advised me to avoid dairy, gluten, and soy. Testing for celiac disease returned negative. **Late June:** My symptoms continued in fluctuations as before. **Early July:** After the 4th of July celebrations, I endured a severe episode of nausea and gagging, perhaps related to my holiday meals. The aftermath included multiple days of intense nausea and stomach discomfort. **Mid July:** I returned to the hospital due to sharp abdominal pain. The staff administered Reglan, which caused a severe reaction. An ER physician suggested that anxiety was the likely culprit behind my vomiting and nausea, a diagnosis that I found dismissive although I acknowledged my anxiety does exacerbate my symptoms. Blood work taken at the end of July indicated abnormal thyroid levels, prompting a referral to an endocrinologist for further evaluation, with a follow-up blood test to track trends. **Late July:** A visit to an esophageal surgeon revealed that the previously dismissed hiatal hernia could be significant enough to contribute to my symptoms. She planned additional tests to determine whether surgery might be beneficial. At the time I'm writing this, those tests are yet to be conducted, but she recommended a strict FODMAP diet. Although I tried adhering to it, I occasionally cheat, particularly with Coke to ease the gag reflex, despite knowing it’s not aligned with the FODMAP principles. I remain committed to avoiding gluten, dairy, soy, and oily foods. **Early August:** My symptoms appeared to stabilize, creating a sense of optimism. The gastric emptying test results were normal. **Mid August:** During a follow-up with the thyroid specialist, I reported feeling better. Another round of blood tests indicated my thyroid levels had improved. I was advised to return for more tests in three months, skipping an immediate follow-up. The day that followed, however, my nausea returned with a vengeance, leaving me feeling completely defeated and uncertain of the next steps. **Investigative Tests Conducted:** - **Early June:** CT scan revealed inflamed colon. - **Early June:** Ultrasound indicated a slightly fatty liver. - **Mid June:** Colonoscopy and endoscopy found hernia but nothing else significant. - **Mid June:** Blood tests showed low vitamin D, high calcium, and abnormal thyroid levels. - **Mid July:** Blood retest showed better vitamin D, slightly elevated calcium, consistent thyroid levels. - **Early August:** Gastric emptying test returned normal. - **Mid August:** Blood tests indicated improved calcium and stabilized thyroid levels. **Symptomatology:** - **Nausea:** Often felt, fluctuating in severity (1-10). - **Gag reflex:** Highly sensitive, typically resulting in dry heaving. - **Diarrhea:** Seen more often than vomiting. - **Constipation:** Occurred for a few weeks but later resolved. - **Nauseous sensation:** Commonly localized in the mid to upper abdomen. - **Abdominal pain:** Infrequent, but some discomfort in the same area. - **Feeling overheated:** Possibly anxiety-related, often accompanies nausea. - **Diminished appetite:** Resulting from fear of nausea, contributed to substantial weight loss. **Medications Currently Taken:** - **Zoloft 100mg:** Taken consistently for two years. - **Bupropion 300mg:** Also taken consistently for two years. - **Zofran:** Generally taken daily since returning from Japan; effects are inconsistent. - **Voquenza:** Started in late June with no noticeable difference. - **Mirtazapine:** Introduced in mid-July; appears to assist with gag reflex. **General Status:** I am persistently nauseous each day, although the gagging has slightly improved since beginning Mirtazapine. I feel caught between the gastroenterologist's insistence on acid reflux and the surgeon's focus on the hernia. My situation is increasingly untenable, and I'm struggling to manage my daily life, avoiding outings due to the fear of illness. Recommendations for a competent doctor in Northern NJ or NYC would be greatly appreciated, along with any suggestions or insights into my predicament.

Answers (1)

8/16/2025, 6:21:18 PM

OpenHealth AI

It sounds like you're going through a really tough time with your persistent nausea, weight loss, and conflicting medical opinions. It's understandable to feel frustrated and uncertain about your health when dealing with such complex issues. Let’s break it down to prioritize some potential steps forward while addressing your symptoms and concerns.

Main Points:

1. You're experiencing debilitating nausea and weight loss with conflicting opinions from healthcare providers.
2. Your symptoms may be influenced by physiological factors like the hiatal hernia and possibly anxiety.
3. There are steps you can take to better manage your symptoms and make sense of your healthcare experience.

Explanation:

Persistent nausea along with significant weight loss can stem from various causes. In your case, factors like acid reflux, a hiatal hernia, and anxiety have been mentioned as potential influences. The ongoing sensitivity of your gag reflex and altered appetite further complicate the situation, making daily life difficult. Your tests to rule out other major issues are reassuring, but it's apparent that resolving your symptoms has not been straightforward.

Next Steps:

1. Focus on Diet Management:

   • Continue to explore the FODMAP diet, as recommended by the surgeon, but stick to it more consistently. This diet can help reduce gastrointestinal discomfort.
   • Consider keeping a food diary to track which foods trigger your symptoms. This may help identify specific intolerances or sensitivities that could be contributing to your nausea.

2. Address Anxiety:

   • Anxiety can exacerbate physical symptoms, including nausea. Consider incorporating stress-relieving practices such as mindfulness, meditation, or gentle yoga to help manage anxiety levels.
   • Speak with your primary care provider about possibly adjusting your anxiety medications (Zoloft and Bupropion) if you feel they are not effectively managing your symptoms.

3. Symptom Management:

   • You mentioned using Zofran without consistent relief. Since nausea persists, discuss alternative anti-nausea medications with your healthcare provider; alternatives may work better for you.
   • Staying hydrated is crucial. Try sipping on clear fluids or herbal teas to help manage nausea while avoiding high-sugar or carbonated drinks that may worsen symptoms.

4. Follow-Up on Hiatal Hernia Investigation:

   • Stay in touch with the surgeon regarding further evaluations of your hiatal hernia and the potential need for surgery. Surgery might provide relief if the hernia is significantly contributing to your symptoms.

5. Seek a Multidisciplinary Approach:

   • Considering your complex symptoms, seeking a gastroenterologist who has a holistic approach might be beneficial. Look for a provider in Northern NJ or NYC who specializes in managing gastrointestinal issues while incorporating psychological aspects of care.

6. Utilize Support Systems:

   • Explore support groups or online forums where you can connect with others facing similar challenges. Sharing experiences can offer insight and emotional support.

In Summary:

Focus on your diet and anxiety management while pursuing clarity on the hiatal hernia with your healthcare team. By taking these prioritized steps, you’ll be better equipped to manage your symptoms and make informed decisions about your care moving forward. If you need more personal recommendations or support, don’t hesitate to reach out. Your health and comfort are important.