Severe Nausea Attacks - new symptom

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Hello,

A couple of months ago I was happily minding my own business and had a sudden very intense spell of nausea. It felt like my stomach was wringing itself and was severe enough for me to be unable to do anything as I was son the verge of vomiting for a few hours. It felt like a stomach bug and I put it down to that.
A couple of weeks passed and I started having these attacks more frequently. I say attacks as the nausea is intense with 2-5 hours of dry heaving, stomach pain and acid/food coming up my throat and they often come on very suddenly. I can feel fine one minute and be severely nauseous and heaving the next. I literally want to stop existing when they happen (I particularly hate nausea/vomiting).

They most commonly occur later in the evening, during the night or early in the morning.

They are disturbing my sleep and starting to take over my life. I am starting to get too scared to go anywhere as I don't know when they're going to strike. I am starting to fear eating.

I've had frequent nausea for some time as I have ongoing stomach issues, but it's been relatively mild, infrequent and has always responded to anti-nausea medication (Stemetil) so it has been manageable. These new nausea attacks do not respond to anything I've tried, including two prescribed anti-emetics - Stemetil and Ondansetron.

I've also tried ginger, digestive enzumes, Ibergast, peppermint capsules with food. I've tried Pepto Bismol for temporary relief during attacks, also to no avail. Tonight I've just introduced 1 capsule of betain HCL with my main meal (6pm).

I have a diagnosis of PoTs.

I had a gastric-emptying test in 2017 which showed I was emptying OK (I don't know if that's worth a repeat). I'm trying to stay calm and I've been colouring during nausea attacks as they're naturally anxiety-inducing - and also I want to make sure the nausea isn't anxiety (I don't think it is).

I have a gastro doctor but I don't know when I'll next see her, with the Covid-19 situation.

I have a moderate fear of vomiting so this is pretty much the least favourite symptom I could conjure up. I'm struggling quite a bit as I don't know where to go from here and it's making my life harder than it already was. Initially I thought it was just a random, short-term symptom but it seems here to stay and that's a bitter pills to swallow (pun intended)

Thoughts, advice and suggestions welcome! Thank you :)
 
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Your symptoms need proper investigation so it should'nt be a problem particularly if the Stemetil is not working. Powerful drug. Ordinary GP should be able to help if you would have to wait to see Gastro specialist. If it was me I would not hang about waiting to see a specialist.
I agree. Ordinarily I would have gone to see a GP but it's such a strange time, so I decided to hang on until my consultation with my gastro doctor - which is due next Thursday (hoping it'll be adjusted to a phone conversation rather than cancelled). I don't know what consultations/procedures are being carried out currently as I've had a couple of things postponed.
Stemetil even works on my travel sickness - it can usually get rid of any nausea of any origin for me so this is all rather strange.
 

lenora

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Actually, Booksellercafe, now's a perfect time for a face to face (mask to mask) chat with your Dr. There aren't as many patients and it would be much better if you could do it in person instead of over the computer. My Internist has been great about doing this very thing and she told me that plenty of doctor's are the same. So....check it out and you may be able to get in on Monday.

One thing though, at least here in Dallas, they're meeting you outside the door (or in your car), taking your temp., and asking you questions. They are doing this one patient at a time, and there's no backlog of patients. When you get into the office, you don't go into the waiting room but are instead immediately whisked into the office & wait there for the Dr. Mine's rather fast, so I didn't have to wait. You should get this attended to ASAP as intestinal matters can be dangerous if you let them go. You'll probably have a few tests, but that's good...a baseline is set. Yours, Lenora.
 

Zebra

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Hi, @Booksellercate

I am concerned for you.

I agree with Andy and Lenora that you should get this checked out by a gastroenterologist as soon as you are able.

I think your symptoms warrant a full workup. Protracted nausea and vomiting is not normal.

Plus: You poor thing! Vomiting is SO yucky. I hate it, too!

I would hope that the first thing your GI orders is an upper endoscopy. An endoscopy would allow for the visual examination of both the structure and lining of your esophagus and stomach as well as allow for the snipping of a few tiny biopsies to examine more closely under a microscope. I had one under twilight sedation, and it went smoothly.

I believe Andy mentioned a barium swallow exam, which would/should probably be the second step in your work up.

I live in the States, and my doctor skipped the barium swallow and went with an Esophageal Manometry, which, frankly, is a more precise test, but I don't know how the NHS feels about it.

It's amazing technology that can take measurements from your upper esophageal sphincter all the way down into your stomach. It can measure what your esophagus is doing at rest and measure how it performs over a series of swallows. It can also diagnosis a hiatal hernia!

I have had this test twice. It's a pretty unpleasant experience, but there are ways to make it better/easier, which I would be happy to share with you if that test is in your future.

Would you be willing to keep us posted @Booksellercate, and let us know how it goes?

My best wishes,
Z
 

PatJ

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I've had frequent nausea for some time as I have ongoing stomach issues, but it's been relatively mild, infrequent and has always responded to anti-nausea medication (Stemetil) so it has been manageable. These new nausea attacks do not respond to anything I've tried, including two prescribed anti-emetics - Stemetil and Ondansetron.

I've also tried ginger, digestive enzumes, Ibergast, peppermint capsules with food. I've tried Pepto Bismol for temporary relief during attacks, also to no avail. Tonight I've just introduced 1 capsule of betain HCL with my main meal (6pm).
Here is some misc. info that might help until you can consult with a doctor:
*Histamine*
From Plum on PR:
Nausea for me is histamine related. Food allergies, high histamine foods. meat that isn't fresh etc all cause bad nausea for me. Low histamine diet and the occasional antihistamine aimed at nausea helps me.

*Coca-cola*
From CCC on PR:
Not sure if this helps, but we've had a doctor tell a family member with severe gut issues to sip coca cola just 1 teaspooon at a time to manage nausea. It worked well.

From Rufous McKinney on PR:
I knew several pregnant women with severe morning sickness who could only consume coca cola.

*Mix of reasons*
from Crux on PR:
Zofran is an anti-emetic that antagonizes 5HT 3 receptors. If serotonin is stuck in the gut, nausea can result.
B-6 may help to metabolize the serotonin, relieving nausea, if that's the cause.

Increasing gut acid can help nausea. HCl, ACV, etc.

When my cortisol gets low, I get nauseous. I'll take salt tablets to stop the vomit. The chloride is the active ingredient.

Liver trouble can also cause nausea.

*Acupressure P6 point*
There is an acupressure point on the wrists that can be manually stimulated to help relieve nausea and motion sickness.

*Relief Band*
The Relief Band is an electronic device that sends small electrical pulses into the P6 acupressure point so you don't need to manually stimulate it. It has been clinically tested and has FDA approval.

Misc tips:
* A few quick sniffs of rubbing alcohol (don't overdo it!) can sometimes relieve nausea
* Activated charcoal - for stomach related nausea
* Baking soda - 1/8 - 1/2 tsp in 1/2 glass warm water. Seems to help some chemo patients quickly even when nausea medications don't work.
 
Messages
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Location
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Actually, Booksellercafe, now's a perfect time for a face to face (mask to mask) chat with your Dr. There aren't as many patients and it would be much better if you could do it in person instead of over the computer. My Internist has been great about doing this very thing and she told me that plenty of doctor's are the same. So....check it out and you may be able to get in on Monday.

One thing though, at least here in Dallas, they're meeting you outside the door (or in your car), taking your temp., and asking you questions. They are doing this one patient at a time, and there's no backlog of patients. When you get into the office, you don't go into the waiting room but are instead immediately whisked into the office & wait there for the Dr. Mine's rather fast, so I didn't have to wait. You should get this attended to ASAP as intestinal matters can be dangerous if you let them go. You'll probably have a few tests, but that's good...a baseline is set. Yours, Lenora.
Lenora, thank you for the encouragement. It's Bank Holiday here on Monday but I will go on Tuesday and stop dithering.
My experience with doctors with these 'non-specific' symptoms has not always been positive - but it would be irresponsible for me to not go and at least try to talk to one. And amongst the many indifferent doctors, there is often one who will take a little more interest and perhaps even escalate it :)
 
Messages
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90
Location
Kent, England
Hi, @Booksellercate

I am concerned for you.

I agree with Andy and Lenora that you should get this checked out by a gastroenterologist as soon as you are able.

I think your symptoms warrant a full workup. Protracted nausea and vomiting is not normal.

Plus: You poor thing! Vomiting is SO yucky. I hate it, too!

I would hope that the first thing your GI orders is an upper endoscopy. An endoscopy would allow for the visual examination of both the structure and lining of your esophagus and stomach as well as allow for the snipping of a few tiny biopsies to examine more closely under a microscope. I had one under twilight sedation, and it went smoothly.

I believe Andy mentioned a barium swallow exam, which would/should probably be the second step in your work up.

I live in the States, and my doctor skipped the barium swallow and went with an Esophageal Manometry, which, frankly, is a more precise test, but I don't know how the NHS feels about it.

It's amazing technology that can take measurements from your upper esophageal sphincter all the way down into your stomach. It can measure what your esophagus is doing at rest and measure how it performs over a series of swallows. It can also diagnosis a hiatal hernia!

I have had this test twice. It's a pretty unpleasant experience, but there are ways to make it better/easier, which I would be happy to share with you if that test is in your future.

Would you be willing to keep us posted @Booksellercate, and let us know how it goes?

My best wishes,
Z
Thank you for your response.

I'm glad I posted - it can be alarmingly easy to become accustomed to a situation/feeling/symptom, even one that impacts your quality of life. Others reminding you that your symptoms are worthy of concern and should be looked at is reassuring. I have a lifelong fear of 'wasting people's time' and 'making a nuisance of myself' - which too often leads to passive acceptance. The nausea is no better than the dry heaving and vomiting, I've learned.

I had an endoscopy in 2016 but I'm hoping they won't consider it too soon for another. I'll put a case forward.

I've never had a barium swallow but after years of trouble, and with a worsening and change in my symptoms, I might also have a case for that now.

I will of course come back and update. Not least because it's helpful for others to see how these things pan out :)
 
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Here is some misc. info that might help until you can consult with a doctor:
Thank you for taking the time to help write out such an extensive list of things to try which might help. I'm willing to try anything at this point! With such a non-specific symptom, it can be hard to know where to start looking.
I already take an antihistamine - a nurse said it can work quite well on some causes of nausea but the Coca Cola one I've not heard that so I'll go out and but a little bottle and give that a try. I also have some sea bands somewhere (lifelong 'travel sick Tracy' here!). Baking soda and HCI I also have. Activated charcoal I'll order - I had some at some point..

Thank you again. It's reassuring to know there are still some things to try.
 
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@Booksellercate Since you have already had an endoscopy, you could ask your GI doc if the biopsies are still available to test for mast cells. Excess or miss behaving mast cells can cause gastritis and nausea. You say you are already taking an antihistamine. It was only when I took combined H1 + H2 antihistamines did my nausea improve. H2 alone did not do the job for some reason.
 

Hip

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I've also tried ginger, digestive enzumes, Ibergast, peppermint capsules with food. I've tried Pepto Bismol for temporary relief during attacks, also to no avail. Tonight I've just introduced 1 capsule of betain HCL with my main meal (6pm).
Lemon essential oil (Citrus limonum) is something to consider for nausea. This is a 5-HT3 antagonist, and 5-HT3 antagonist are good for nausea and vomiting.

You can take say 5 to 10 drops of lemon essential oil (mixed into a tablespoon of cooking oil) orally. The UK eBay is a good source of inexpensive essential oils.

Ginger is another 5-HT3 antagonist, but lemon essential oil may be stronger.
 
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I have a diagnosis of PoTs.
I got this from My POTs, once the gag reflux start it does not stop I heave empty, I got a hernia from it. Each time I started ended in the emergency room dyhadration + POTs not good combo. Doctor gave the med they give cancer patients for nausea and that has kept me out of trouble. Nothing for me worked either (except hospital meds strong enough).
 
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I would consider trying capsaicin. It's the component of the spicy peppers.
It has "anesthesic like" propierties (I know that it sounds paradoxical).

I have chronic nausea, daily, for +20 years. It's the hell. I tried a lot of stuff (including diets, supps, Ondansetron and other meds, ginger, herbs... Etc).

Along with Cocacola (or gas water) it's the only thing that helps somewhat.

There is one study on "Functional Dyspepsia" :

https://pubmed.ncbi.nlm.nih.gov/12030948/?from_term=Capsaicin+nausea&from_page=3&from_pos=9

Anyway, be careful with the dose if you try. Maybe in your case it doesn't work or even makes you worse.

For me, capsaicin capsules didn't work. So I have to chew a very little portion of a spicy pepper and when I notice the spicy in the mouth then I swallow.

Maybe the important thing is to do that capsaicine make contact with stomach's mucose.

There is also chilli pepper's sauces. It's another good option.

But remember! Be careful if you try, I couldn't sleep well if someone gets worse for an advice given from me.

:angel:

PS. Mast Cells and Autonomic Nervous System can be others things to consider.

Do your nausea get worse when your POTS is worse too or when you have PEM?

Hugs!
 

lenora

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Hello Everyone......This is the second time today that I've read about people having their main meal @ 6:00 p.m. I'm wondering if it may be something as simple as moving the time to 4:00 p.m. or, if that's impossible, make lunch the main meal.

For years I've found that if I eat late, then trouble soon follows. My husband, who turns 76 this year, is now the same way. I know that having alcohol will definitely make you sick, even if it is just wine. ( No, I'm not the head of the local Temperance Union.:)) Try eating at a different time, and perhaps in smaller amounts and if you're fortunate, your troubles may be over. It hope so, anyway. Personally, I couldn't eat late because I'd be awake all night with tummy troubles of some sort of another. I wish you well. Yours, Lenora
 

lenora

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Hi Patrick......I just wanted to say that the Earth Clinic tips were, for the main part, very helpful. However, I do want people to be aware of the fact that charcoal will absorb medications after a short time of use. Thus, they can't be used too often.

Candied ginger is a great one to have on hand. You can cut it into even smaller pieces, thus not feeling overwhelmed with a huge piece of ginger that may feel that it's burning the mouth. It's much better in smaller piece. Besides, sometimes it's expensive to buy, so why waste it? Store it in the freezer & it's easier to cut.
 
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