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Emesis, spontantous

ncheart
0 Recommendations

Hi,

I really am not comfortable asking this, but I just have to. Has anyone had problems with emesis in correlation to any type of HD issue?

Enlighten me please?
NC HEART

18 replies

lkay

NC,
First I had to look up emesis to see what it meant (vomiting for the rest of you!) - I think I may have known that term once upon a time.... I'm sorryto hear you are having that as a problem.

Is this a new for you since your HD began?

From this side, I hate to ask but do you have a history of eating disorders of some sort? A number of the sisters here have battled that problem as well.

And you can ask anything and everything here - it a totally unbiased and non-judemental group.

Sorry I can't be more help,
Laura

ncheart

Laura,

Sorry, I should have said vomiting, but I do not like saying it nor doing it.

No, I do not have a eating disorder. I understand that some people do and can respect the feelings they have that might lead them to get caught up in the act of vomiting.

My situtation is totally different. I at times seem to spontatanously eject food or drink within a 10 mins. of eating no matter how hard I struggle to keep the food down.

I can also get sick from taking a shower that is to warm or perhaps getting over heated from any form of physical activity. I guess that is why I was asking if anyone experienced this too.

I have asked the doctor's and they all tell me that it is strange or weird or worse give me that look as if I had nothing better to do than to make this stuff up!

Just like when I tell them I have an allergy to atrophine, I am constantly told, no you do not. I state well... the last time I was given that drug.. it caused my heart to stop and the paddles of life were used to bring me back.

So, I say as the doctor's instructed me then, I have a allergy to this drug.. and that is that.

sorry for getting off the point.

The emesis... I hate it and I would not subject myself to it, especially since it causes so much pressure on the heart and the aorta.

I have only had this problem for the past 4 years, plus or minus and it is intermittent . The doctor once told me I had hyper-emesis disorder and when I went home I too looked it up. Boy did that make me mad, because I already knew I was throwing up way too much!! He could have saved me the $$$ it cost for his opinion. (haha)

So, any feed back would be so much appreciated.

smokefreeme

I personally have not know anyone with that particular problem but there just has to be something they can do for you. I can't even imagine what you must be going through. I will add you to my prayer list and home someone somewhere comes up with something to help you. Diane

ncheart

Diane,

You are so sweet. I really appreciate it more than you know. Prayers are the best thing I believe one can do for another.

I just get so tired of all of this at times and other times I am very able to handle it all. I am sure that others experience much more difficult ordeals, but this can be hard.

I have to find a very bland diet I think.
Thank you again for your support, if you hear of anything please forward it ok.
NC Heart

lkay

Until this is figured out can you ask your doctor for an anti-nausea drug? there are good ones out there , especially the ones used for cancer patients.

The fact that heat provokes this attack leads me to think it is connected to your central nervous system somehow.

Have you ever looked at

http://wrongdiagnosis.com

you can put in symptoms and come up with a list of possible causes. That might help you, but I just tried it and put in vomiting and heat sensitivity and it tells me the problem is pregnancy !

I hope you are laughing,
Laura

rstep

Good Morning, My mom has this problem and the doc has checked her for several things - esophogus spasms and muscle thickening and stomach ulcers. Ulcers can cause inflamation and if near the inlet or outlet of the stomach can cause stricture. If warm water causes symptoms to appear, would wonder if it's not some sort of spasm? Take care - Robin

arizona1

I am thinking that you may have problems with orthostatic intolerance. I learned of this diagnosis when joining my chronic fatigue group out of Northern Virginia. The symptoms you talk about, are symptoms in this area. The vomitting and the reaction to heat are just two of the many that exist. If you would like more information, I can direct you on the path.

Hugs,
Kathi

Ecksunbeam

Dear NC,

Are you taking a beta blocker? Vomiting can be a side-effect of beta blockers.

Hang in there--

Sherrie

arizona1

What are the symptoms of Orthostatic Intolerance (OI) conditions?

Fatigue, pain, cognitive dysfunction, and weakness are part of OI. Lightheadedness, nausea, and dizziness are also very common. Extreme stress sensitivity as well. Some other features are exercise intolerance, alcohol intolerance, feeling too hot or cold, heat intolerance, air hunger, and difficulty with quick movements, especially those that send blood to the feet. Not all symptoms have to be present for diagnosis. NMH and POTS and a similar cousin, Mitral Valve Prolapse Syndrome / Dysautonomia (MVPS/D) seem to run in families, and viruses or extreme stress or trauma often start a chronic bout with symptoms. For our longer list, see symptom section of the MVPS/D and OI page.

Hugs
Kathi

martzj

hi NCheart,

Kathi may be on to something here. Unless you are pregnant, hyper-emesis disorder doesn't seem to fit your symptoms because you say they are chronic now and appear to be increasing in intensity.

Here is something that may be helpful to you:

Orthostatic Intolerance
Symptoms
The symptoms for these conditions may include the following:

Excessive Fatigue

Exercise Intolerance

Recurrent Syncope or Near Syncope

Dizziness

Nausea

Tachycardia

Palpitations

Visual Disturbances

Blurred Vision

Tunnel Vision

Graying Out

Tremulusness

Weakness - most noticeable in the legs

Chest Discomfort

Shortness of Breath

Mood Swings

Migraines and Other Headaches

Gastrointestinal Problems

http://www.ndrf.org/orthostat.htm

Disautonomia......I've had a terrible time with all the above since to varying degrees most of my life. But the extreme gag response to all foods hit with acute heart attack, 41. From that point on I have lived with high levels of chronic nausea....The first year after heart attack I literally could almost never look at solid foods, much less get them anywhere near my face. I lived on Ensure Lites, milk, juices mostly...They seemed to escape the automatic gag reflex for some reason....smoothies too. A huge help has been learning to distract myself when eating now....TV needs to be on so my brain is engaged, or eat with other people so I am distracted by conversations. None of my cardios/regular doctors ever had a clue. One cardio looked blankly at me and stated, "your diet is terrible'. I've never been tested for dysautonomia or POTS but one of the treatments is beta blocker, which I've been on for over a decade now.

Pesistent emesis needs to be investigated much more thoroughly because it can damage your esophagus and the acid will eat away at tooth enamel.
There are anti-nausea drugs for cancer patients. I asked about those and was told no because I'm not a cancer patient. Maybe you will have better luck.

Take good care and be persistent about getting help for this NC,

Jaynie

Ecksunbeam

Dear NCHEART and others,

I had this gag reflex also for about two years post-heart attack. (Went down with the Big One violently gagging so this caused me big time panic.) I most experienced it first thing upon awakening in the AM like morning sickness. No doctor could answer my questions either--kept saying they never heard of it. I treated it like morning sickness--kept dry crackers by my bed to suck on before getting up seemed to help. But toothpaste really got me going. GAG! PUKE! It still happens from time to time.

I also thought it might be some kind of central nervous system reaction--the heart and the stomach ARE linked. I never did figure it out, so I will also be very interested in seeing what comes of this discussion.

Thank you for bringing up this topic.

May the Blessings Be!

Ecksunbeam

Cyclic vomiting syndrome
From Wikipedia, the free encyclopedia
Jump to: navigation, search
This article or section is missing citations or needs footnotes.
Using inline citations helps guard against copyright violations and factual inaccuracies. (March 2008)

Cyclic vomiting syndrome (US English) or cyclical vomiting syndrome (UK English) (CVS) is a condition whose symptoms are recurring attacks of intense nausea, vomiting and sometimes abdominal pain and/or headaches or migraines. CVS can affect both children and adults. It was first described in the 19th century with one of the earliest references being that of Samuel Gee in 1882. Onset of the condition is possible at any age but is seen to occur more often in a young age. Why anyone develops it is not clear since it is of unknown etiology. There is a strong suggestion of maternal inheritance. Persons who suffer from migraines in some cases also have Cyclic Vomiting Syndrome.

Contents [hide]
1 Background
2 Diagnostic criteria
3 Treatment
4 Mortality
5 Average Age
6 Sex/Race
7 References
8 External links



[edit] Background
CVS differs from other forms of vomiting as it is an acute condition. Sufferers may vomit or retch six to twelve times an hour and an episode may last from a few hours to well over 2 or 3 weeks. Some people find it hard to conceive how anyone can vomit after that length of time, as the stomach will have emptied after the first few emeses. Acid, bile and (if the vomiting is severe) blood may be vomited. Some sufferers will intentionally ingest water to reduce the irritation of bile and acid on the esophagus during emeses. Between episodes the sufferer is usually otherwise normal and healthy. The median duration of an episode is 41 hours (Li & Fleisher 1999). In approximately half of sufferers the attacks, or episodes, occur in a time related manner. Each attack is stereotypical, i.e. in any given individual their timing, frequency and severity of attacks is similar.

Episodes may happen every few days or every few months. For some there is not a pattern in time that can be recognized. Some sufferers have a warning of an attack, they may experience a prodrome, usually intense nausea and pallor. The majority of sufferers, but not all can identify "triggers" that may precipitate an attack.

The most common are various foods, infections (such as colds), extreme physical exertion, lack of sleep, and psychological stresses both positive and negative.

During an attack a sufferer may be light sensitive (photophobic), sound sensitive (phonophobic) and may take on a semi-conscious state.[citation needed]


[edit] Diagnostic criteria
The cause of CVS has not been determined, there are no diagnostic tests for CVS. Several other medical conditions can mimic the same symptoms, and it is important to rule these out. If all other possible causes have been excluded a diagnosis of CVS may be appropriate.

There are established criteria to aid diagnosis of CVS, essential criteria are

A history of three or more periods of intense, acute nausea, and unremitting vomiting lasting hours to days
Intervening symptom-free intervals, lasting weeks to months
Exclusion of metabolic, gastrointestinal or central nervous system structural or biochemical disease e.g. individuals with specific physical causes (e.g. intestinal malrotation)

[edit] Treatment
There is no set cure for Cyclic Vomiting Syndrome, but there are medications that can be used to treat, intervene in, and prevent attacks. There is a growing body of publications on either individual cases or experiences of cohorts of CVS patients. Treatment is usually on an individual basis, based on trial and error.

The most common therapeutic strategies for those already in an attack are maintenance of salt balance by appropriate intravenous fluids and; in some cases, sedation. Having vomited for a long period prior to attending a hospital, patients are typically severely dehydrated and suffer from massive volume depletion. Abortive therapy has limited success, but for a number of patients potent anti-emetic drugs such as ondansetron (Zofran) or granisetron (Kytril), dronabinol (Marinol), and more recently dextromethorphan (Coricidin) may be helpful in either preventing an attack, aborting an attack or reducing the severity of an attack.

The prevalence of the condition is not clear. Two published studies on childhood CVS suggest nearly 2% of school age children may have CVS. However, diagnosis is problematic and as knowledge of CVS has increased in recent years more and more cases are emerging. This suggests a tendency for underdiagnosis, and thus the true figure may be higher.

CVS may be related to migraine, CVS sufferers have a much higher number of first degree relatives who have migraine than is the case in the general population. Some CVS sufferers have symptoms similar to abdominal migraine, but in others the relationship is far less strong and they can't relate to migranous symptoms. Some sufferers obtain some relief from anti-migraine treatments, but they are not universally effective.

Charitable organizations to support sufferers and their families and to promote knowledge of CVS exist in several countries.


[edit] Mortality
There is little hard evidence of death as a result of the condition. However, in severe cases the fluid loss can lead to potentially life-threatening salt imbalances and extremely high blood pressure often develops during an attack. In underdeveloped countries it remains probable that CVS may contribute to mortality. In the developed world with adequate medical interventions most sufferers can be supported during an attack and will recover from the episode. After the average three year duration of Cyclic Vomiting Syndrome, 20 percent of patients were to seen to have developed migraines. Patients seemed to go through three stages: CVS, abdominal migraines which have similar characteristics as CVS then regular migraines.

On average 50% of patients require IV fluids. Whereas rotavirus gastroenteritis has less than 1% which require IV fluids. On average the cost of treatment, testing, work absences and leave per year can total in US dollars $17,000. Most children who have this disorder miss on average 24 school days a year, and will often need tutoring to catch up on their academic studies. The frequency of episodes is higher, for some people, during times of excitement, which often leads to many family events such as holidays, birthdays and vacations being disrupted. For adult sufferers the challenge of maintaining a career or full time employment is considerable. For all sufferers there are associated quality of life issues for not only the sufferer but also for close family members.


[edit] Average Age
The average age at onset is 3-7 years, but CVS has been seen in infants who are as young as 6 days and in adults who are as old as 73 years (Li and Misiewicz, 2003). Typical delay in diagnosis from onset of symptoms is 2.7 - 3 years (Li and Misiewicz, 2003).


[edit] Sex/Race
Females show a slight predominance over males; the female-to-male ratio is 57:43 (Li and Kagalwalla, 2002). CVS occurs in all races but seems to disproportionately affect whites.


[edit] References
Abu-Arafeh I. & Russell G. Cyclical vomiting syndrome in children: A population based study. Journal of Pediatric Gastroenterology and Nutrition, 21(4), 454-8 1995
Fleisher DR. The cyclic vomiting syndrome described. J Pediatr Gastroenterol Nutr 21(Suppl. 1):S1–5 1995
Fleisher DR. Empiric guidelines for the management of cyclical vomiting syndrome. [1]
Gee S. On fitful or recurrent vomiting. St Bart's Hospital Reports 18 1-6 1882
Li BU, Fleisher DR. Cyclic vomiting syndrome: features to be explained by a pathophysiologic model. Dig Dis Sci 44: 13S–8S 1999.
Lindley KJ, Andrews PL. Pathogenesis and Treatment of Cylical Vomiting. J Pediatric Gastroenterology and Nutrition 41 S38-S40 2005
Rasquin-Weber A, Hyman PE, Cucchiara S, et al. Childhood functional gastrointestinal disorders. Gut"" 45 (Suppl. 2):II60–II8 1999

[edit] External links
Cyclic Vomiting Syndrome Article
http://www.cvsa.org.uk The UK Cyclical Vomiting Syndrome association
http://www.cvsaonline.org The USA/Canadian CVS association
http://www.sicvo.it/ The Italian CVS society
http://digestive.niddk.nih.gov/ddiseases/pubs/cvs CVS page at the US National Digestive Diseases Clearinghouse, NIH Publication No. 04-4548
http://www.national-health.org/cvs.php More information can be found on the various Cyclic Vomiting Syndrome Association homepages. (link seems gone/squatted)

martzj

I just got this from Harvard Medical School newletter. It is a bit generic but may offer some direction to follow.

"The link between anxiety and physical illness

Research on the physiology of anxiety-related illness is still young, but evidence continues to grow of the mutual influence between emotions and physical functioning.

An estimated 57 million adults suffer from anxiety disorders. They share an unwarranted fear or distress that interferes with daily life. Now, anxiety has been implicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, and gastrointestinal conditions. When people with these disorders have untreated anxiety, the physical disease is more difficult to treat, symptoms often become worse, and in some cases they die sooner.

Anxiety and gastrointestinal disorders
In the two most common functional digestive disorders — IBS and functional dyspepsia (upset stomach)—the nerves regulating digestion appear to be hypersensitive to stimulation. Symptoms — abdominal pain, bloating, and diarrhea or constipation in IBS; and pain, nausea, and vomiting in functional dyspepsia — can be chronic and difficult to tolerate."

Therapies that have been successful in treating anxiety disorders are now being used to ease the symptoms of chronic gastrointestinal and respiratory diseases, and may have an important role in preventing and treating heart disease. These are the best-studied approaches:

Cognitive-behavioral therapy. The cognitive component helps people identify and avoid thoughts that generate anxiety, and the behavioral part helps them learn how to react differently to anxiety-provoking situations.

Psychodynamic psychotherapy. Anxiety is often triggered by a deep-seated emotional conflict or a traumatic experience that can sometimes be explored and resolved through psychotherapy.

Medications alone are less effective than psychotherapy over the long term; they may also have unpleasant side effects and interact with other medications. Still, they can be helpful when used in combination with psychotherapy. The most common types of drugs include anti-anxiety medications, antidepressants, and even beta blockers (which are sometimes used to treat stage fright).

Jaynie

Ecksunbeam

"Medical" Marijuana - The Facts

Medical marijuana already exists. It's called Marinol.


A pharmaceutical product, Marinol, is widely available through prescription. It comes in the form of a pill and is also being studied by researchers for suitability via other delivery methods, such as an inhaler or patch. The active ingredient of Marinol is synthetic THC, which has been found to relieve the nausea and vomiting associated with chemotherapy for cancer patients and to assist with loss of appetite with AIDS patients.


Unlike smoked marijuana--which contains more than 400 different chemicals, including most of the hazardous chemicals found in tobacco smoke-Marinol has been studied and approved by the medical community and the Food and Drug Administration (FDA), the nation's watchdog over unsafe and harmful food and drug products. Since the passage of the 1906 Pure Food and Drug Act, any drug that is marketed in the United States must undergo rigorous scientific testing. The approval process mandated by this act ensures that claims of safety and therapeutic value are supported by clinical evidence and keeps unsafe, ineffective and dangerous drugs off the market.


There are no FDA-approved medications that are smoked. For one thing, smoking is generally a poor way to deliver medicine. It is difficult to administer safe, regulated dosages of medicines in smoked form. Secondly, the harmful chemicals and carcinogens that are byproducts of smoking create entirely new health problems. There are four times the level of tar in a marijuana cigarette, for example, than in a tobacco cigarette

Morphine, for example, has proven to be a medically valuable drug, but the FDA does not endorse the smoking of opium or heroin. Instead, scientists have extracted active ingredients from opium, which are sold as pharmaceutical products like morphine, codeine, hydrocodone or oxycodone. In a similar vein, the FDA has not approved smoking marijuana for medicinal purposes, but has approved the active ingredient-THC-in the form of scientifically regulated Marinol.


The DEA helped facilitate the research on Marinol. The National Cancer Institute approached the DEA in the early 1980s regarding their study of THC's in relieving nausea and vomiting. As a result, the DEA facilitated the registration and provided regulatory support and guidance for the study.


The DEA recognizes the importance of listening to science. That's why the DEA has registered seven research initiatives to continue researching the effects of smoked marijuana as medicine. For example, under one program established by the State of California, researchers are studying the potential use of marijuana and its ingredients on conditions such as multiple sclerosis and pain. At this time, however, neither the medical community nor the scientific community has found sufficient data to conclude that smoked marijuana is the best approach to dealing with these important medical issues.


The most comprehensive, scientifically rigorous review of studies of smoked marijuana was conducted by the Institute of Medicine, an organization chartered by the National Academy of Sciences. In a report released in 1999, the Institute did not recommend the use of smoked marijuana, but did conclude that active ingredients in marijuana could be isolated and developed into a variety of pharmaceuticals, such as Marinol.


In the meantime, the DEA is working with pain management groups, such as Last Acts, to make sure that those who need access to safe, effective pain medication can get the best medication available.

martzj

"There is no universal antiemetic." A quote from the chapter entitled, A Queasy Feeling, p. 130 of Atul Gawande's book COMPLICATIONS; A Surgeon's Notes On An Imperfect Science. Atul is probably the only surgeon I would gladly allow to treat me on planet earth. He is the epitime of what I am seeking from medical doctors.....a healthy and agressively curious scientific attitude towards all things medical and how humans are affected by medical practices. It is almost a medical thriller....He passes on to the reader what he is discovering as he himself encounters it. There is no 'doctor-speak'. An amazing read. Atul is humane, brilliant and a questing visionary, compassionate.

Hope you are having a better day today,
Jaynie

Ecksunbeam

Thank you, Dolphin Jaynie,

I will be following up on this book recommendation. Sounds fascinating. . . .

Sherrie

ncheart

Oh wow, what amazing information. I will have a lot to read about. I did have a intern at Duke indicate the cvs thing could be an issue with me; but she was dismissed by the other doctors and I was told not to worry.

I read the info given above by Ecksunbeam and it does sound a lot like what is going on with me. I have had such severe case that I did have to go into the Hospitial to stop the spasms and get placed on IV's. I was placed on Reglan and Pecid... but nothing truly helps and the cost of meds when there is no insurance for it is difficult. So I just take me beta blocker since that is all I can afford.

I truly appreciate everyone's input. I will read more about this CVS stuff, does it have any correlation to the HD?

Ecksunbeam

If it's CVS I don't think there is any correlation to HD.

Best wishes to you,

Sherrie

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