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Nausea, difficulty eating solid foods, constipated, phrenic nerve damage, pericardial cyst removal. Where to go from here?

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Gastroenterologist, Surgical
Practicing since : 1984
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Hello, I have been suffering from nausea and difficulty eating solid foods for over a year now. The specialists in Canada are baffled and have given up on me. I know you need a lot more information but do you have any suggestions for me on where to go from here? Gastric and duodenal polyps have been diagnosed but my colon is currently clear. I am constipated due to needing narcotic pain meds but keep that in control with milk of magnesia. The breathing has been attributed to phrenic nerve damage by the Mayo, that occured after pericardial cyst removal. I have lost close to 80 pounds as a result of the severe nausea. Further information will be provided if needed, I am not sure what more to add.
Posted Sun, 15 Apr 2012 in Digestion and Bowels
 
 
Answered by Dr. Ajit Naniksingh Kukreja 9 hours later
Hi,

Thanks for posting your query.

I can understand your agony and will try my best to help you out.

I will be able to understand your problem and answer you better if you could give me some more information such as:

Firstly let me know what happens when you take solid food?

Is the nausea persistently present or have you developed aversion to food?

Is there any difficulty gulping down the meals, I mean dysphagia?

When was the last gastroscopy done?

Are you able to take liquids? Is the nausea present with liquids also?

Is the weight loss secondary to inability to take food or is there any other pathology?

Do you have diabetes?

Have you been investigated for stomach flu?

Get back to me with this data and I will try my best to help you out

Awaiting your reply

Regards
Above answer was peer-reviewed by
 
Follow-up: Nausea, difficulty eating solid foods, constipated, phrenic nerve damage, pericardial cyst removal. Where to go from here? 1 hour later
Firstly let me know what happens when you take solid food?Is the nausea persistently present or have you developed aversion to food?

I have persistant nausea. If I eat solid food it sits in my stomach and forms a painful lump. Often about one half to 2 hours later I will throw up. If it is even slightly acidic I get agonizing abdominal pain which I take buscopan and large amounts of ginger ale for. The abdominal pain extends into my back. It takes time but the pain subsides when I feel gas start moving in my bowel which was completely absent during the pain. My gall bladder was removed 15 years ago. I take zofran which makes me able to function. Interestingly during the prep for my last colonoscopy (I did a 4 day liquid diet and 3 days of bowel prep) I felt the best since this all started. I was drinking XXXXXXX juice and ginger ale, my stomach felt better and I had more energy. Quite remarkable!!! I also get relief from very cold items - such as slushies or ice milk.

Is there any difficulty gulping down the meals, I mean dysphagia? Right now my meals consist of boost or rice crackers which I have to consume slowly or I do have nausea.

When was the last gastroscopy done?

My last gastroscopy was May 2. It showed many polyps but no gastric outlet obstruction.

Are you able to take liquids? Is the nausea present with liquids also? I take liquids in the form of boost or ginger ale and sometimes powerade. If I consume them too fast I do get nauseos.

Is the weight loss secondary to inability to take food or is there any other pathology?The weight loss is from inability to take food. I am still overweight, I have to admit. I am 6 feet tall and 236 pounds.

Do you have diabetes? No my sugar is normal.

Have you been investigated for stomach flu? Yes. No flu but the preceding event to all of this was a case of stomach flu with strep throat.

I have also had a gastric emptying test which shows slow gastric motility. I have had an upper GI barium test. My brain has had a CT scan and they have also done a Ct scan of my abdomen with contrast. The abdominal CT showed an echogenic pancreas which I don't know what it means. I have several hemangiomas on my spine and liver.

It has been determined that some of my small bowel has fallen into the space previously occupied by my left kidney.

Doctor I hope this information is helpful to you. I actually cried when I noticed you had answered me already. If you deem it fitting for me to see a specialist of your choosing (or yourself) I will attempt to raise some money to see if it is even possible. It will be tough but getting my health back will be worth it.

I am off to bed. Thank you so very much.

XXXXXXX
 
 
Answered by Dr. Ajit Naniksingh Kukreja 2 hours later
Dear XXXXXXX,

Thanks for posting your follow-up query.

I really appreciate the way you have elaborated the clarifications, and my first word is a word of reassurance

You do not need to come down all the way but may be you would need to consult a good gastroenterologist as we cannot prescribe medicines ethically without examining the patient.

Coming to your management:

Now that diabetes and outlet obstruction has been ruled out by gastroscopy, you need to undergo a Gastrointestinal Manometry to rule out Neuropathy, Myopathy and mechanical obstruction.

In either case what is suggested is:
1] Treat the underlying condition
2] Maintain nutrition and hydration
3] Treat the specific motility problem
4] Treat symptoms and
5] Prevent complications

There are quiet some medicines available in form of metoclopromide, domperidone etc. but need to be taken continuously, these will also control your nausea.

Diet modification in form of liquid and low residue diet is advised.

There are new therapies in form of Botox and gastric electrical stimulation is available if the medical therapy fails.

Surgery except for symptomatic relief has limited role in management of the cause.

After going through your history what I gather is that you may be suffering from gastric motility disorder.

Hope all clear, any further query do not hesitate to revert back, I am available for any follow-up query.

Wishing you a speedy recovery and a healthy life ahead.

Above answer was peer-reviewed by
 
Follow-up: Nausea, difficulty eating solid foods, constipated, phrenic nerve damage, pericardial cyst removal. Where to go from here? 7 hours later
You would need to consult a good gastroenterologist as we cannot prescribe medicines ethically without examining the patient. I have seen 2 gastroenterologists and they have said they cannot see anything wrong so have stopped seeing me.

Coming to your management:Now that diabetes and outlet obstruction has been ruled out by gastroscopy, you need to undergo a Gastrointestinal Manometry to rule out Neuropathy, Myopathy and mechanical obstruction. I will enquire with my G.P. on both suggestions, I have never been told about Gastrointestinal Manometry and that is a good avenue to explore.

In either case what is suggested is:1] Treat the underlying condition2] Maintain nutrition and hydration3] Treat the specific motility problem4] Treat symptoms and5] Prevent complicationsThere are quiet some medicines available in form of metoclopromide, domperidone etc. but need to be taken continuously, these will also control your nausea. I have taken metoclopramide which definitely is helpful, not a full 100% success but helpful. I can only take that medication for about 3 days before I get weird movements and shake. Longer than that results in severe depression. I will ask for a prescription for Domperidone. I have also used Modulon unsuccessfully. One GI Doctor suggested a medication called Resolor but it is not available in Canada yet. Is it available to you?

As I take Ms Contin for my back pain I am constipated so they also have attempted to give me Miralax which I cannot tolerate.

I did also wish to let you know that I have had a full psychiatric workup with no findings of any mental, psychological or psychogenic illness. The Doctor told me I am very well balanced.

Diet modification in form of liquid and low residue diet is advised. I will continue with Boost and the rice crackers as long as required but will aggressively pursue your suggestions.

There are new therapies in form of Botox and gastric electrical stimulation is available if the medical therapy fails.Surgery except for symptomatic relief has limited role in management of the cause.After going through your history what I gather is that you may be suffering from gastric motility disorder.Hope all clear, any further query do not hesitate to revert back, I am available for any follow-up query.Wishing you a speedy recovery and a healthy life ahead.

Thank you so very much doctor. I will continue to follow up with you if needed. I do feel from this encounter that Canadian Health care is lacking and wish you success with your future health care changes.

XXXXXXX

 
 
Answered by Dr. Ajit Naniksingh Kukreja 1 hour later
Hi

Thanks for your followup query

I would end this session with few conclusive suggestions :
1] Do evaluate if Gastrointestinal Manometry can be done ?
2] Domperidone is far safer and better than metoclopramide as it has no extrapyramidal side effects like shake etc, you can take it in full doses for as long as six months
3] Psychologically you appear well and stable so just reassure yourself
4] Diet modifications till you are able to taper your medicines
5] Resolor is available with us and I think it will be better for you as it has a very good role in managing constipation, so once it is available do go for it

Thanks a lot for your kind words and do keep informing me about your developments and do not hesitate to revert back in case of need, am always available for followup
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