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Son hospitalized w/ nausea x 16 days

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  • Son hospitalized w/ nausea x 16 days

    I just spent night #2 in the hospital with my 15-year-old son. He has had unrelenting nausea for the past 16 days. He's had the same problem in the past; he used to get bouts of nausea for 5 - 10 days, with a mild headache and listlessness. The pediatrician diagnosed him with abdominal migraine, but many acute migraine meds failed to make him better. We went to a neurologist who put him on daily propranolol, a beta-blocker used to prevent migraine. They stopped completely. He went from having these episodes every 6 - 8 weeks to none at all. He was on the propranolol a year, then we weaned him off because the neurologist said kids can grow out of abdominal migraine. For another year he was fine, and we thought we were all done.

    This past April, he got another episode. Same thing - tried a bunch of meds with no effect. A prednisone taber was the only thing we tried which coincided with the end of the episode, so we thought that might be helping. We went to a new neurologist who recommended nutritional therapy! What a pleasant surprise that was! More protein in the diet, whey protein shakes, magnesium, vitamin D, and CoQ10 were him recommendations (my son was already taking D and had a serum level of 51).

    16 days ago we started again with the nausea. Very little vomiting. Tried 9 drugs this time, then they admitted him. Kidney/abdominal ultrasound normal, blood & urine basically normal (low K, high bicarb). Celiac labs nomal with some still pending.

    I would love for this to be related to a food intolerance so we could eliminate whatever bothers him, but since he goes months without any symptoms, I think that's unlikely. I have asked for testing for fructose & lactose intolerance, but the team thinks those are unlikely. We are seeing a naturopath next week who will be more willing to do that, I'm sure.

    If anyone has any thoughts or advice, I would appreciate it.
    My blog: Pretty Good Paleo
    On Twitter: @NEKLocalvore

  • #2
    Is he still eating wheat? Sounds like a wheat allergy to me.
    Primal eating in a nutshell: If you are hungry, eat Primal food until you are satisfied (not stuffed). Then stop. Wait until you're hungry again. Repeat.

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    • #3
      He is eating wheat. White mushy carbs are about all he can eat right now without the nausea getting a lot worse. He is 15 so he knows everything, and thinks eating paleo/primal is stupid. If we had some testing which showed he had an intolerance, it would be a lot easier to enforce a gluten-free diet. Also, he is healthy and symptom-free for months on end (except he catches whatever bug is going around, so his immune system is not very strong) so he has not been motivated to make a big change. It also makes testing an elimination diet pretty much impossible; since his symptoms are so infrequent, if he was fine we wouldn't know if it was because he wasn't eating gluten or just that he was between episodes.
      My blog: Pretty Good Paleo
      On Twitter: @NEKLocalvore

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      • #4
        Here are two less common causes of unrelenting nausea in young people I have seen in my practice. I am assuming the usual causes have been ruled out by his physicians. These possibilities would apply to the completely unexplained nausea/vomiting patient who has been thoroughly evaluated for typical causes.

        1) Superior Mesenteric Artery Syndrome - rare; normally seen in the people of slender build. Note : I do not agree with this Wikipedia article about the rarity of this condition; while it is not common, I have seen a case, so I suspect there are more than the 500 or so cases suggested in the article.

        2) Cannabis-Induced Hyperemesis - do you have any reason to believe he may have a current marijuana habit ? Given his history of similar complaints in earlier childhood I would doubt this is the cause, although it could also be a confusing coincidence that he had similar complaints in childhood, which may have had a separate cause. I have a young woman patient who resolved her recurrent chronic nausea problem promptly by quitting marijuana. (This after 3 years of severe bouts of nausea and vomiting requiring multiple ER visits and hospitalizations with no explanation found.)

        Note : I would get him psychological evaluation while the medical workup continues. Children and teens can carry around severe emotional stress manifesting as nausea/vomiting. Sometimes this is an unconscious attempt at school avoidance due to bullying, for example. It may not be a coincidence that this all flared up around the time of school starting. He should also be gently interviewed for more serious stressors; for example, is it possible he is being sexually abused, threatened, or blackmailed ?

        If you suspect emotional causes; he needs to hear that he is not blame for all the medical workup that went on. The longer time and more resources spent looking for a possibly nonexistent medical cause, the more he will feel the internal pressure to hold on to the idea of a medical cause rather than losing face and being shamed for 'wasting everyone's time' and 'making things up'. When people manifest emotional stress and physical signs and symptoms, it is very rarely intentional on their part. He needs permission to explore the emotional side without fear he will be blamed for all the workup that went before.
        Never eat anything bigger than your own head.

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        • #5
          absolutely no expert here but one of the boys at our local Celiac group had the same initial symptoms, no other GI symptoms but nausea.
          Mama to 4, wife to my love

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          • #6
            Sorry to hear that, Annika. Hopefully something can be determined soon.
            Start weight: 250 - 06/2009
            Current weight: 199
            Goal: 145

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            • #7
              He does not smoke pot or use any other substances. In terms of psych, he is a lively involved kid who was looking forward to going back to school (for the social aspects). These episodes have come during summer also, and have caused him to miss fun events, so I feel quite sure there is no conscious or subconscious avoidance-of-school issue going on. He has not had anything overly stressful going on and is pretty happy-go-lucky. He is in all honors classes and runs X-country and track.

              The team just came in for rounds and I mentioned superior mesenteric artery syndrome; the attending said that with all the hydration he has had in the past 12 hours, symptoms from that should have resolved. This does not make sense with the information I looked up in the past few minutes. We should be meeting with the gastroenterologist this morning (should have been yesterday) and she should know more about that. Possible tests: gastric emptying study, hydrogen breath test (for fructose intolerance).
              My blog: Pretty Good Paleo
              On Twitter: @NEKLocalvore

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              • #8
                Gastroparesis perhaps? I had similar symptoms in high school. I had a gastric emptying study done many years ago and got a shrug from the doctor and a "you just have a slow emptying stomach". 3 barium swallows, 2 upper endoscopies later they actually saw food undigested in my stomach from about 14 hours prior. Interesting thing was it was peaches and rice...the pork roast I had eaten was fully digested. They couldn't explain that bit, but I was diagnosed with gastroparesis and put on a gluten free diet as an experiment. Being in high school made it very difficult to stick to the diet so I was never sure if it helped.
                When I went primal in May of this year (not totally committed at the time), the symptoms came back with avengeance. So, as of last month, I cut out all gluten and any vegetable peelings since they can make a bezoar (hairball like thing...ick) causing blockages and such. I also added in magnesium citrate since my understanding is that it's critical for enzyme (digest the food) and nerve function (tell stomach to get off its lazy duff). So far, when I'm good, my stomach works. When I eat grains of any kind...not so much.
                That was wordier than I thought....
                Anyway, I hope he's feeling better soon! Good luck!
                "So often times it happens that we live our lives in chains
                And we never even know we have the key."
                ~The Eagles, "Already Gone"

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                • #9
                  Thanks for the input... we were supposed to see the gastroenterologist yesterday afternoon, then this morning, now it's pushed back to this afternoon. We have been in the hospital 48 hours and have not even met the gastroenterologist yet. It's very frustrating. Anyway, gastroparesis is on the list of possibilities, so we might have a gastric emptying study.
                  My blog: Pretty Good Paleo
                  On Twitter: @NEKLocalvore

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                  • #10
                    Hydration would not relieve SMA syndrome. The attending physician's comment makes no sense to me. It also implies (illogically) that if the symptoms HAD been relieved by hydration, then SMA syndrome WOULD be under consideration.

                    SMA syndrome is an anatomical diagnosis. It can be tested for with certain imaging studies. Talk it over with the GI doctor. It is not anywhere near the most likely cause, but if other causes have been ruled out, it may be worth looking for.

                    PS - surgery is not necessarily the answer if SMA syndrome is found. Modest weight gain can provide enough of a fat pad to open up the SMA angle to the point where obstruction is not occurring. Therefore a protein and fat rich diet to drive your son toward optimal body weight would be a way to treat it. (Primal Blueprint, anyone?) The one case I saw was treated by weight gain successfully. It might mean giving up the cross country and working out with weights more.
                    Never eat anything bigger than your own head.

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                    • #11
                      Thanks for weighing in, Joe. I'm hoping we have a fruitful discussion with the GI doc.
                      My blog: Pretty Good Paleo
                      On Twitter: @NEKLocalvore

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                      • #12
                        We are home from the hospital. Had a very good meeting with the gastroenterologist. She went over many possible causes of his nausea. Interestingly, she brought up SMA syndrome, which surprised me. She thought it was an unlikely scenario, but worth considering if nothing else pans out. She will do a gastroscopy next week; among other things, the biopsies will check for celiac and lactose intolerance. All his celiac bloodwork has come back negative, but she seemed to think it was still a real possibility. He is on a new med, cyproheptadine, which we had tried in the past, but she thought it may have not been tried long enough.

                        This has been an utterly exhausting couple of weeks. Thanks for eveyone's input.
                        My blog: Pretty Good Paleo
                        On Twitter: @NEKLocalvore

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                        • #13
                          I am so glad that your son is home now.

                          I agree with Mark's book, based on my own personal experience and that of my patients. As the book says, even if you can't prove he has celiac disease by antibody testing, it is remarkable how many people's GI problems disappear by eliminating not just gluten by all grains from their diet.

                          Can you get your son to read The Primal Blueprint and apply it? Maybe just a 30 day trial? I know he is a teenager and "knows everything" (I have a 17 year old son of my own); maybe he can connect when he sees how a buff guy like Mark worked this all out after being down the CW path as a top runner and triathlete.
                          Never eat anything bigger than your own head.

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                          • #14
                            Annika, I'll hopefully have a minute to add some things tomorrow.

                            Joe, it's so nice to know that you're out there in the world practicing medicine. Excellent posting and great to have you here.



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                            • #15
                              I would love my son to be grain free. After his gastroscopy I may try to convince him. But if he follows his previous pattern, he will feel completely fine no matter what he eats for weeks or months until he suddenly gets another debilitating episode. Because he usually feels fine, it will be hard to prove to him that eliminating grains did him any good.

                              Transitioning at home won't be much of an issue because my husband and I stopped eating grains several months ago. However, he eats breakfast and lunch at school. If all the celiac tests continue to be negative, do you think cutting out wheat, all grains, or all gluten would be the best course of action?
                              My blog: Pretty Good Paleo
                              On Twitter: @NEKLocalvore

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