[HN Gopher] Living with Nausea: My Story in Six Charts
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       Living with Nausea: My Story in Six Charts
        
       Author : janpio
       Score  : 122 points
       Date   : 2025-01-31 17:37 UTC (14 hours ago)
        
 (HTM) web link (www.c82.net)
 (TXT) w3m dump (www.c82.net)
        
       | jastanton wrote:
       | I cannot believe how exhausting (and expensive) this
       | investigation has been for you. I had a GI surgery and one of the
       | possible outcomes was permanent nausea, and when I woke up I had
       | nausea for about 3 months and it was horrific. The symptoms
       | resolved on their own after a while, and for a time I believe
       | them to be psychosomatic, so I began meditation. In the end I
       | don't know, but that must be scary.
       | 
       | I'm curious if fecal microbiota transplantation has been
       | discussed? From what I can tell the gut biome is under studied
       | and the effects are pretty scattered and wide. Thoughts?
        
       | cmclaughlin wrote:
       | I will be honest, I only skimmed the article... But I did not see
       | any mention of exercise. Not sure if the author will read this,
       | but the best way I know to increase metabolism is to walk or
       | swim. Ideally work up to something more intense like yoga or
       | weightlifting as you start to feel better. Basically, activity
       | work at building up an appetite and eat high fiber foods.
       | 
       | Also check out the fodmap diet to get your gut in order before
       | working up to exercise.
        
       | hvs wrote:
       | As someone with Crohn's disease (thankfully now in remission) I
       | can fully relate. Nausea is the worst symptom because it is so
       | debilitating. You don't want to do anything when you are
       | nauseated and when it goes on for months that affects every part
       | of your life.
        
         | wholinator2 wrote:
         | That's so interesting. I have crohns' (definitely not remission
         | but not flare either), and nausea has never been a thing for
         | me. It's just pain and the usual incomplete digestion if i
         | stray at all out of my heavily restricted diet. How did you get
         | remission? I'm about to have to up my remicade dose
        
           | hvs wrote:
           | Mine is primarily in my large intestine, so it's like a weird
           | combination of Crohn's and UC, which could be why it causes
           | so much nausea. Remission for me was just sort of luck and
           | time. I was first diagnosed at 28, was on a ton of steroids
           | followed by about 20 years of Imuran. After a colonoscopy my
           | GI doctor said that my colon shows no sign of damage anymore
           | and that since Imuran increases risk for cancer that I should
           | consider trying to reduce my dosage. After about a year of
           | reducing I was totally off with no return of symptoms. Now
           | I'm just on mesalamine. So, TL;DR, I got lucky. Good luck
           | with your treatment.
        
             | spondylosaurus wrote:
             | Knock on wood, mesalamine has been good to me too. (Not
             | quite remission atm but promising improvements.) IIRC most
             | of its effect is in the large intestine, so it generally
             | works better for people with UC, but I'm the same in that
             | my Crohn's is mostly colorectal.
             | 
             | Unlike you I haven't had nausea as a primary symptom
             | though, knock on wood. It's weird/interesting how much
             | variance there is between Crohn's patients... fast food
             | destroys me, but then you hear about people whose safe food
             | is McDonald's :P
        
       | interdimensi0n wrote:
       | Is it same as the case + solution in this video w Forstall?
       | 
       | https://www.youtube.com/watch?v=IiuVggWNqSA&t=2490s
        
         | coolspot wrote:
         | That's a very good and funny interview, thank you!
         | 
         | TLDW: Steve Jobs cured Scott Forstall's chronic nausea by
         | almost dedicating a wing in a hospital.
        
           | CharlesW wrote:
           | Actual TLDW (parent commenter might not've watched through
           | the aside): Steve Jobs brought the "world's best
           | acupuncturist" to Scott Forstall in the hospital and
           | literally saved his life.
        
             | coolspot wrote:
             | It is impossible to watch only till the aside about
             | dedicating the hospital wing without learning about the
             | acupuncturist. Those two are connected. You're not fun.
        
               | CharlesW wrote:
               | Fact check: Correct!
        
       | drewg123 wrote:
       | I had GI surgery, and afterwards, I had an "Ileus" (intestines
       | don't move food through), which is apparently a low probability
       | side effect. I was utterly miserable for a week, with horrible
       | nausea and vomiting. Even water. If my wife had not made me go
       | back to the hospital, I'd probably have died from dehydration.
       | 
       | I cannot imagine living with nausea for months or years.
        
         | dillydogg wrote:
         | Depending on the risk factors (prolonged surgery, open surgery,
         | opioid use, hypokalemia, NG tube placement) postoperative ileus
         | is seen in 10-20% of people after GI surgery.
         | 
         | Not to minimize the terrible subjective experience you've had.
         | I wanted to point out that it isn't that uncommon.
         | 
         | https://www.ncbi.nlm.nih.gov/books/NBK558937/
        
       | GlenTheMachine wrote:
       | So my kid has ARFID. I am not a doctor, but what I have learned
       | is that eventually, anything that causes nausea associated with
       | eating can progress into ARFID, even if the original underlying
       | cause resolves. ARFID is technically an eating disorder, like
       | anorexia, but it isn't related to poor body image; it is,
       | basically, a food aversion to, well, food. All food, or nearly
       | all. This is what happened to my kid; there's an underlying
       | disorder that can be treated with meds, but when not treated
       | causes nearly constant nausea. Once we diagnosed and treated the
       | underlying cause, the nausea didn't go away. My kid's brain had
       | learned to associate eating with being sick, and that association
       | persisted even when the original illness resolved.
       | 
       | My kid at one point was admitted to the hospital for two weeks
       | because said kid had lost so much weight. They inserted a gastric
       | tube, and kid discovered that kid did not become nauseous when
       | fed through the tube. We knew kid had ARFID, but this was ah
       | "a-ha" moment for kid, because it showed kid irrefutable proof
       | that the problem was not a physical issue with kid's gut. It was
       | very clearly related to the experience of eating. Kid has
       | subsequently learned to "eat through the nausea" as described in
       | the post.
       | 
       | That's what this sounds like. There was likely an underlying
       | physical cause of the nausea; that cause may or may not have
       | resolved, but the nausea is now it's own thing. The OP indicates
       | a series of consults with a behaviorist; I would imagine being
       | screened for eating disorders is what that was about, but ARFID
       | is not a common eating disorder, and may or may not have been
       | considered.
        
         | FollowingTheDao wrote:
         | Your son's serotonin in his gut may still be high. Please do
         | not assume that the nausea is related to a psychological
         | disorder. My parents did this with me and it turns out my case
         | was a lot more complicated.
         | 
         | I don't know if you tried antinausea medication that blocks the
         | serotonin HT3 receptor but if you try that and the nausea goes
         | away, I would look ant increased serotonin release as a culprit
         | instead.
        
           | FollowingTheDao wrote:
           | https://www.ncbi.nlm.nih.gov/books/NBK603710/
           | 
           | "Research regarding ARFID is still emerging; the role of
           | serotonin in sensory processing and anxiety suggests a
           | potential mechanism through which neurotransmitter
           | dysregulation could influence the disorder. Moreover, sensory
           | processing issues, which are not exclusive to ARFID but are
           | also present in other conditions (eg, autism), may be
           | associated with abnormal serotonin function, further
           | supporting the need to investigate serotonin's role in ARFID"
           | 
           | https://pmc.ncbi.nlm.nih.gov/articles/PMC305267/
        
         | mncharity wrote:
         | Fwiw: Strenuous winter activities (eg mountain hiking and
         | camping) can more than double baseline calorie demand. Sitting
         | down to a base camp meal afterward can be a body-has-a-mind-of-
         | its-own saliva-gushing "FEED ME NOW!!!" experience of really-
         | need-to-pee intensity. Normally unappealing food commonly
         | becomes just fine - uncooked pasta, blocks of lard, whatever.
         | So I wonder... what happens if food-is-nauseating is repeatedly
         | hit with a hammer of the "are you going to eat that vomit, or
         | can I please have it? - it looks quite yummy" of extreme
         | calorie appeal?
         | 
         | Another thought is the breastfeeding maternal-diet envelope
         | expansion drill, of working outward from some one bland safe
         | thing, experimentally adding a thing at a time, and backing off
         | upon problems.
        
           | dgunay wrote:
           | I haven't ever had a real eating disorder, but a lot of my
           | childhood food aversions were finally broken during times of
           | extreme hunger.
        
           | gcanyon wrote:
           | The absolute best meal I've ever had was a cup of clear
           | chicken broth: my first meal after a month in the ICU without
           | eating. As the old saying goes, hunger is the best seasoning,
           | and as I always say, when you're hungry -- I mean _really_
           | hungry -- nothing satisfies like... food.
        
       | smittywerben wrote:
       | I apparently have a food allergy. I thought it was acid for
       | years. It wasn't until I moved somewhere with much higher pollen
       | levels that my stomach symptoms were way worse and I noticed the
       | cross-reactivity. Usually allergies are faster but when it's not
       | it the food makes it into your stomach and your whole body has
       | issues. It's something I'm still kind of figuring out as we
       | speak. Some people I think call it a mast cell disorder but I
       | just call it a food allergy that I take Zyrtec for. Could it be
       | described as "hives but in your stomach"? I mention this because
       | you mentioned Dramamine, which, in fact, is also an
       | antihistimine.
        
         | aaronbrethorst wrote:
         | I had (have) an undiagnosed gluten allergy, and had similar
         | issues for a couple years until I tried cutting wheat and other
         | sources of gluten out of my diet and felt like a normal human
         | being again within two days.
        
           | smittywerben wrote:
           | You have to be careful with suggesting to cut out X/Y/Z
           | foods. Said another way, I would recommend OP eat a bag of
           | gluten and see if they end up in the hospital you'll have
           | your diagnosis in 15 minutes and then there'd be no argument.
           | 
           | I'm not speaking about you specifically, parents get the
           | cutting out X/Y/Z food wrong with their kids all the time. It
           | makes people afraid of eating instead of afraid of what
           | they're allergic to. Unless you maintain a strict food
           | journal which I don't have time for why not just take 2x dose
           | of Zyrtec (I'm just a happy customer) for a week, then try
           | the gluten/paleo/soylent/steve jobs diet.
           | 
           | Edit: I am not a medical doctor and taking an antihistamine
           | to mask a food allergy is probably dangerous but I'm still
           | testing myself. OP said they tried Dramamine, which is an
           | antihistime. I've taken that along with many antacids
           | including Nexium and Pepcid which are also antihistimine.
           | Maybe mast cell disorder is what doctors have to call it so
           | someone with a peanut allergy doesn't read this and reaches
           | for zyrtec and a bowl of peanuts and throws out their epipen.
           | That's why I mentioned the pollen cross-reactivity because I
           | think my body is just overreacting so I'm making the
           | executive decision to suppress it. It's been 8 months or so,
           | I've not taken a single Nexium, only a couple pepcid which
           | for my family is basically cured. I moved somewhere with less
           | pollen because I don't like taking pills all the time.
           | 
           | Edit-Edit (I'm really focused on this topic lately): The
           | bottom line is that I reduced my cetirizine use from 15-20
           | mg/day to about 5 mg/day by moving to a place with less
           | pollen.
           | 
           | If you're experiencing something similar, pay attention to
           | any systemic symptoms and listen to your body. I had
           | eliminated almost all food from my diet to control my gastric
           | issues. But my left ear was having tinnitus. They checked it,
           | they said my ears are very clean and thought it might be
           | middle ear problems. They gave me a list of antihistimines
           | and a nasal steroid (flonase) to try. I channeled my
           | oppositional energy and thought, "Well, if they want me to
           | try it..."
           | 
           | So I bought the entire list they gave me, I took cetirizine
           | once a day, loratadine twice a day, and occasionally a
           | fexofenadine pill (along with my usual double dose of Nexium,
           | which I was desperate to discontinue) plus the Flonase for
           | good measure.
           | 
           | I started cetirizine to manage tinnitus and dizziness, which
           | are entirely separate systemic symptoms that I had never
           | associated with my gastric symptoms or food.
           | 
           | A few days later, my ears cleared, and all my gastric/reflux
           | symptoms disappeared. I quit all antacids on the same _day_.
           | When my middle ears drain, that's my canary in the coal mine.
           | It had worked so well that I wondered how long I had been
           | suffering before I moved to Pollenville in the first place
           | and just didn't notice.
           | 
           | Thanks Pollenville. You were my bag of raw gluten powder.
        
       | FollowingTheDao wrote:
       | My feeling is this was caused by COVID damaging the neurons or
       | receptors of the stomach or duodenum, or, more likely that COVID
       | caused a Magnesium Deficiency:
       | 
       | https://pmc.ncbi.nlm.nih.gov/articles/PMC10445067/
       | 
       | But some thoughts:
       | 
       | If the stomach is not emptying it means it is not getting the
       | signal to empty.
       | 
       | Some of his symptoms signal high serotonin (panic attack, nasuea)
       | 
       | https://www.nature.com/articles/1300880
       | 
       | Anti-nasuea meds block the serotonin HT3 Receptor.
       | 
       | https://www.ncbi.nlm.nih.gov/books/NBK513318/
       | 
       | But the lack of gastric emptying is mostly controlled by high
       | Cholecystokinin (https://www.uniprot.org/uniprotkb/P06307/entry)
       | 
       | https://pubmed.ncbi.nlm.nih.gov/645853/
       | 
       | Now it could be that his Cholecystokinin receptors are not
       | getting this signal from the Cholecystokinin, or, since these are
       | G Protein Coupled Receptors, that there is not enough GTP in the
       | cell to create the cAMP needed for the stimulation to carry on
       | down stream.
       | 
       | https://www.nature.com/scitable/content/ne0000/ne0000/ne0000...
       | 
       | To make GTP you need magnesium:
       | 
       | https://pmc.ncbi.nlm.nih.gov/articles/PMC3400779/
       | 
       | Magnesium is one nutrient found deficient in Gastroparisis:
       | 
       | https://pubmed.ncbi.nlm.nih.gov/2012043/
       | 
       | Not to mention that low magnesium is linked to worse COVID
       | outcome.
       | 
       | Also, he said he had some tardive dyskinesia from some meds which
       | would also point to low magnesium since low magnesium is linked
       | to the disorder:
       | 
       | https://pubmed.ncbi.nlm.nih.gov/27816557/
       | 
       | Why did the ginger help? That is easy:
       | 
       | It triggers cholecystokinin signaling by activating the TRPV1. So
       | more spicy foods will probably help as well. BUT, this to me
       | would not be a long term solution since IMHO it would lower
       | magnesium even more.
       | 
       | https://pmc.ncbi.nlm.nih.gov/articles/PMC11192538/
       | 
       | EGCG in green tea also triggers this receptor.
       | 
       | So it may be that he has some genetic issue with his
       | Cholecystokinin receptor genetics that made him more vulnerable
       | to a magnesium deficiency caused by COVID.
       | 
       | https://www.scirp.org/journal/paperinformation?paperid=11741...
        
         | FollowingTheDao wrote:
         | Wow, please disregard that last post. I made a huge error. CCK
         | slows gastric emptying.
         | 
         | Will rework tomorrow.
        
       | wholinator2 wrote:
       | Hey there, i have crohns' which isn't nausea based for me but
       | definitely i understand the debilitating nature of
       | gastrointestinal issues. It really just kills your ability to
       | think, to talk socially, it completely and totally stole my
       | adolescence. I'm sure you've done endless research, I'm not gonna
       | tell you i have a cure. But if you haven't, you should look into
       | gut microbiota. My understanding is that the balance of types of
       | bacteria in the stomach and intestines has so so so much more to
       | do with our daily experience than anyone realizes. And that any
       | kind of infection or antibiotic regiment or just normal living
       | can precipitate a change in the balance that just obliterates
       | peoples lives. And we just don't know much at all about it yet.
       | I've seen many people talk over the years about experimenting
       | with different probiotics, even down to ordering exact strains of
       | bacteria to make yogurt and test. If you need a new path to
       | research and try things you can look there. As i said, doctors
       | don't know much about it yet so it you probably can't find one to
       | guide you through it. You'll have to figure it out, but it's
       | possible, people have been helped, and at the end of it all, i
       | hope it gets better for you. <3
        
         | binary132 wrote:
         | Yes, I think this is an incredibly important area of research
         | that has enormous potential to affect countless people's lives
         | for the better. My wife suffered from chronic GI pain attacks
         | for years and now I have come down with an entire year of
         | symptoms (that seem to be improving overall -- but I still need
         | to do testing, but have been avoiding diagnostics...)
         | 
         | I intend to try to do something to help people in a similar
         | situation to what we went through when she was sick, but I'm
         | not too sure where to start and haven't found the time or
         | energy yet. Siggi's plain filmjolk seems to help...
         | 
         | Really important stuff
        
         | spondylosaurus wrote:
         | Another Crohn's sufferer checking in--Visibiome probiotics are
         | legit. They don't help everyone, and don't actually repair the
         | intestinal lining (which is a must for these kinds of issues),
         | but can definitely spark improvements. It's also one of the few
         | probiotics with clinical trials to back it up.
        
       | namuol wrote:
       | The emotional turmoil of trying to get help from the medical
       | system with an unknown chronic illness can be just as bad or
       | worse than the illness itself at times. I hope the author gets to
       | the bottom of things and is able to find treatment or treat
       | themselves.
        
         | nejsjsjsbsb wrote:
         | Yes when this happens you become a project manager trying to
         | persuade resources you have no control over to get on board.
         | And you are paying for them. And they may give you bad advice.
         | And you feel like shit and don't want to do it.
        
       | belmarca wrote:
       | Hi author,
       | 
       | I have an uncannily similar physical and symptomatic profile. Do
       | you experience anxiety? My symptoms were so intense and
       | unpredictable that I developed anxiety from it. I had to learn to
       | manage and distinguish both issues, which helped a ton. I never
       | had any formal diagnostic as every doc basically says
       | "everything's normal", but I now suspect a heightened stomach
       | sensibility due to multiple COVID-19 infections coupled with a
       | highly stressful period in my life. I haven't had COVID in a
       | while now and my stress levels are much lower so symptoms are
       | mostly gone.
       | 
       | I understand how debilitating and hellish it can be. I wish you
       | all the best!
        
         | steve_adams_86 wrote:
         | Before I finally got covid I read about the nausea and vomiting
         | symptoms and thought they must be rare. What kind of
         | respiratory infection does that?
         | 
         | Then I got it and my stomach was a mess for 6-8 weeks or so.
         | Oddly it got bad after the infection began to subside. It was
         | the worst part by a long shot.
        
       | jb1991 wrote:
       | If the author is reading this, might want to consider the
       | possibility of an onset of chronic "silent migraines" which can
       | have quite the nauseating effect but without the headache. I
       | suffer from them and they are debilitating. While reading your
       | article, I kept thinking it would eventually get to the part
       | where you discovered you are having migraines (which also tend to
       | run in cycles of a couple weeks to a month for many people,
       | myself included), but no mention of this anywhere, so thought I'd
       | point it out.
        
       | divbzero wrote:
       | _Zen and the Art of Motorcycle Maintenance_ describes how
       | motorcycle maintenance by the owner is qualitatively different
       | from motorcycle maintenance by a professional mechanic. The
       | professional mechanic can examine the motorcycle at a single
       | point in time, but the owner rides the motorcycle and can collect
       | observations as the motorcycle runs.
       | 
       | Understanding your body can be similar. While medical expertise
       | is absolutely worth consulting, doctors can only base their
       | diagnoses on your self-reported symptoms and on their
       | examinations at single points in time. The more data you collect
       | and report to the doctor, the more likely you can work out
       | exactly what's going on.
       | 
       | I know someone who lived with chronic discomfort, observed over
       | several years, and after many doctor visits finally pinpointed
       | the root cause. Best wishes to the author on his search.
        
         | colechristensen wrote:
         | Persig argues that the problem is more than just point in time
         | vs continuous, it's that the typical mechanic doesn't care,
         | they are neither careful nor interested. It's the same with
         | doctors. Unless you have something straightforward: a tumor, a
         | broken bone, a bacterial infection, etc... it is quite
         | difficult to get a doctor _interested_ in solving a difficult
         | problem. They don't have time for you and they aren't
         | interested in subtlety.
         | 
         | If your problem can't be addressed with antibiotics or pain
         | meds, then it's "let's try SSRIs for the next six months and
         | see how it works".
        
           | JadeNB wrote:
           | > It's the same with doctors. Unless you have something
           | straightforward: a tumor, a broken bone, a bacterial
           | infection, etc... it is quite difficult to get a doctor
           | _interested_ in solving a difficult problem. They don't have
           | time for you and they aren't interested in subtlety.
           | 
           | I didn't realise how true this was until I started trying to
           | obtain treatment for asthma that is slightly different from
           | the apparently easy kind. I literally had a doctor get raise-
           | his-voice angry with me because he thought a medicine should
           | treat my asthma, but it measurably had no effect. Anyway, I
           | saw a summary re-posted on Imgur, probably from Twitter, that
           | I think summed it up:
           | 
           | > doctors in medical dramas when a patient has a mystery
           | illness: I must examine every symptom and run every test! I
           | won't rest until I've cracked this case!
           | 
           | >
           | 
           | > doctors irl when a patient has a mystery illness: hmm, have
           | you considered that you're faking it?
        
         | ghostly_s wrote:
         | The author explicitly mentions they collected all this data
         | hoping it would be valuable to the specialists they have seen,
         | but found they consistently were uninterested in it -- an
         | experience I can say is nearly universal for chronic illness
         | sufferers I know in the US.
        
           | wordpad25 wrote:
           | doctors don't have any experience doing that and are set in
           | their ways
           | 
           | Maybe, it's diagnosing chronic conditions is an opportunity
           | for a disruptive startup?
           | 
           | Crowd sourced diagnosis detective work!
           | 
           | Call it DrHouse.io, you dump your data and hobbyist doctor
           | investigators try to figure a diagnosis that fits all the
           | symptoms
           | 
           | Top ranking users collect mad fees from "commissioned"
           | diagnosis.
        
             | anticorporate wrote:
             | Sounds like a site that would fill up immediately with
             | diagnoses of wifi exposure, delayed vaccine reaction, and
             | chemical exposure from chemtrails.
        
               | wordpad25 wrote:
               | hey, that's a niche too
               | 
               | just tag it in a non-offensive way (deep-state related?)
               | and allow other users to filter it out
        
         | gcanyon wrote:
         | Shoutout for _Zen_ -- it 's one of my top ten books and I love
         | it to death. The discourse on the nature of quality
         | fundamentally changed how I perceive the world and interact
         | with it: when someone likes something I dislike, I remember
         | that quality is the interface between the observer and the
         | observed, and there's no right or wrong to that (beyond the
         | extreme/obvious cases). I learned that from Pirsig, and I'm
         | grateful.
        
       | simonbarker87 wrote:
       | For those with no clear diagnosis for similar leading to "It's
       | IBS" I _highly_ recommend gut directed hypnotherapy. I am as
       | science, tech, engineering as you can be but after 3 months of
       | similar (but not as bad) symptoms as the author I happily tried
       | the Nerva app at a dieticians recommendation. This was after
       | every test you van do ruled out anything life threatening,
       | bacterial or physical.
       | 
       | It started to work for me very quickly and helped me isolate
       | triggers (none were food, all work and stress related, even
       | though I didn't feel stressed at all) and now, after about 3
       | months the I'm mostly fine again.
       | 
       | The mind gut connection is strong and very very real.
       | 
       | I hope the author continues to get better.
        
       | kqr wrote:
       | > After four hours, I should have had 10% or less in my stomach
       | but in December 2023, I had 41% remaining, which indicated
       | gastroparesis. [...] The second study I had in September 2024
       | showed 8% remaining, at which point my gastroparesis was
       | considered resolved but my symptoms persisted.
       | 
       | I have a pet hypothesis that a non-trivial chunk of the
       | "problems" discovered with medical testing are not actually
       | problems but just expressions of the surprisingly wide variation
       | in how humans work. Maybe this was just a thing that happened and
       | not a condition that auto-resolved?
       | 
       | > In August 2024, I learned of a clinical trial [...] Ultimately,
       | the medication didn't have any positive impact on my nausea but
       | also didn't cause negative side effects.
       | 
       | Did you end up in the placebo arm, perchance?
        
         | borski wrote:
         | > I have a pet hypothesis that a non-trivial chunk of the
         | "problems" discovered with medical testing are not actually
         | problems but just expressions of the surprisingly wide
         | variation in how humans work. Maybe this was just a thing that
         | happened and not a condition that auto-resolved?
         | 
         | The reason this is a real condition is that it can cause
         | extreme pain and nausea. Food sticking around in your body much
         | longer than it should can cause it to begin fermenting,
         | creating gas and other unhappy products, making you extremely
         | uncomfortable and unhappy.
         | 
         | It is a rare side effect of GLP-1 meds as well, and happened to
         | me, I'm pretty sure (the symptoms fit, and it subsided 3 months
         | later when I lowered the dose).
         | 
         | To say it was debilitating would be the understatement of the
         | year. I sat on the couch for 3 months, physically lacking the
         | energy to do anything, and unable to intake the fuel (food) to
         | fix that very problem due to pain and nausea. A miserable
         | cycle.
        
       | asdasdsddd wrote:
       | The thing where food sits and ferments in your stomach is insane.
        
       | gropo wrote:
       | looking at all that data it appears that smoking cannabis is out
       | of the question to this person.
       | 
       | the person should smoke cannabis regularly until a solution is
       | found.
        
       | Aurornis wrote:
       | I know someone who semi-specializes in treating GI conditions
       | that present like this (unknown cause, vague diagnosis). It's a
       | very difficult area to work in because non-specific GI symptoms
       | can be the result of a wide range of things, from physical
       | obstructions to nervous system problems and even stress.
       | 
       | This blog post is great because the author keeps an open mind.
       | One of the challenges with functional conditions that can
       | possibly overlap with mental health is that some people (not this
       | author, speaking generically) become extremely defensive at any
       | suggestion that the condition might be related to stress,
       | anxiety, or depression. My friend has a whole strategy of asking
       | questions about the person's life, job, relationships, and life
       | changes around the time the condition started. With surprising
       | frequency, patients will remember the start date of their GI
       | conditions specifically because it happened near something
       | stressful (death in the family, layoffs, new job, etc.). I don't
       | think this applies to the blog author, but keep in mind for
       | anyone else reading this with similar symptoms.
       | 
       | Stress-triggered conditions have a bad property of becoming self-
       | reinforcing. The initial stressor might be gone, but the person
       | is stressed about the constant problems with their conditions.
       | Understandably so!
       | 
       | She says it's common to have people spontaneously get better when
       | they get a new job, go on a long vacation, enter a new
       | relationship, or other large life changes. It's also common for
       | patients to start SSRIs with another provider and
       | "coincidentally" the GI symptoms get better. It's also common for
       | other providers to blindly prescribe medications that worsen GI
       | symptoms if they aren't paying attention.
       | 
       | The hard part for her broaching the subject with patients who
       | don't want to hear it. There's a huge resistance to any path of
       | inquiry that patients think as "all in your head" diagnoses. It's
       | understandable, but at the same time most people don't understand
       | that your nervous system operates throughout the body (not just
       | the "head" or brain) and the activity of the GI system is heavily
       | modulated by the nervous system.
        
         | trainspotter wrote:
         | Great comment and matches my experience exactly. I suffered
         | from inexplicable nausea similar to the author for years, not
         | realizing the stress of my work was causing it. Ran all the
         | same tests as the author, had similar experiences with doctors.
         | Was dismissive about stress as a potential factor. Only when I
         | had a "large life change" like you described -- a sabbatical in
         | my case - did things get better.
         | 
         | Completely changed my perspective on how stress can physically
         | affect a person.
        
       | WarOnPrivacy wrote:
       | From the article.                   "I tracked
       | [intensity,frequency] to help my doctors better understand how I
       | was feeling and create new treatment plans but that never
       | happened, despite mentioning it to every doctor I've seen."
       | 
       | This struck me and I'm wondering if research hospitals are still
       | a thing.
       | 
       | During last century, I could take an odd issue to a research
       | hostpial and have multiple, different groups of interested
       | medical people.
       | 
       | Not just Dr + students but also clusters of specialists. The
       | latter especially wanted every detail they could get.
        
       | geye1234 wrote:
       | Absolutely, 100% consider migraines. Headaches are far from their
       | only symptom, and headache-free migraines are a thing. Nausea is
       | a common symptom. It's worth a try, and the medication is
       | generally safe with few side effects. Consider talking to your
       | neurologist or finding another that specializes in headaches.
       | 
       | Start with triptans (which your insurance may insist you do
       | anyway), which are very cheap, and then try a CGRP blocker like
       | Nurtec, which is patented and expensive. I get migraines, but
       | nausea, depression and tiredness are far bigger effects for me
       | than the actual headache (which is normally controllable with OTC
       | drugs). CGRP blockers have been life-changing. It took them years
       | to diagnose me with migraines, in fact I had to suggest it
       | myself.
        
         | pfdietz wrote:
         | Abdominal migraine is thought to be what caused the nausea that
         | plagued Charles Darwin through much of his life.
        
         | quackscience wrote:
         | I've had headache-free ocular migraines since I was about 13 or
         | 14. Your typical aura/flashing/light sensitivity. They always
         | are proceeded by some flash and then I know I have maybe 15
         | minutes before I'm in the middle of it.
         | 
         | Anyway, two things that I find helps. The easiest one is
         | supplementing magnesium -- if I ever run out and forget to
         | order more for a couple weeks I'll inevitably have a migraine.
         | The other one is LSD or mushrooms. My friend is a science
         | journalist and covered a group of people taking LSD for cluster
         | headaches, and I figured if it was working for them it was
         | worth a shot.
         | 
         | I still get them a few times per year, but it's way way less
         | frequent now.
        
       | rubatuga wrote:
       | I hope you feel better soon. The enteric nervous system is quite
       | complex and poorly understood.
        
       | esm wrote:
       | I am sorry you are going through that. Really awful. Credit to
       | you for tracking the symptoms so closely.
       | 
       | The cyclicality of the nausea in your graph is interesting.
       | Personally, I find cyclic vomiting syndrome is underdiagnosed and
       | exists along more of a spectrum than generally assumed. As others
       | have said, there is often overlap with migraine spectrum and
       | central hypersensitivity. An underlying trigger such as a GI
       | infection in predisposed individuals can 'turn up the volume' of
       | normal enteric nerve signaling. This ultimately describes a lot
       | of functional GI conditions.
       | 
       | With central hypersensitivity, chronic pain, chronic migraine,
       | and cyclic vomiting, one of the goals becomes resetting the
       | sensory nerve volume back to a normal level. Meditation, therapy,
       | etc., can all have a role. Often, antidepressants are often used
       | at lower doses since they modulate peripheral nerves too.
       | 
       | FWIW, you may want to ask your current primary or GI/neurologist
       | about cyclic vomiting syndrome and whether to trial a TCA (first
       | line treatment, amitriptyline has the most evidence)
        
       | VoidWhisperer wrote:
       | Possibly a bit out there of a suggestion, but I had a similar
       | issue where I fairly abruptly developed more or less constant
       | nausea. Eventually, by chance after an endoscopy related to
       | figuring out the cause of the nausea, my doctor realized my B12
       | level was extremely low, and once they treated me with injections
       | once a day of b12 for a week or two, the nausea suddenly stopped
        
         | BostonFern wrote:
         | Low B12 (and folate) levels are also a symptom of tropical
         | sprue, a chronic condition which is treated with B12
         | supplements/injections and antibiotics. It's believed the
         | disease is caused by an infection, but the pathogen responsible
         | has not been identified.
         | 
         | A hallmark of tropical sprue is villous atrophy, a symptom
         | usually associated with celiac disease (sprue), so it's often
         | overlooked.
        
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