Question: Since our last interaction, I have cut back on fast food, which has helped. I still, however, have nausea and bouts of syncopal episodes (about 1-2 per week at least). Here were some other things I thought might shed some light:

A few months ago, a doctor had put me on Carafate which is supposed to treat IBS. It made my symptoms much worse and caused stabbing pain in the area above my stomach (2 inches up and to the left of my belly button) which I had never had before. I stopped taking it after trying it for a week. It was also making me vomit bile.
The more I sleep, the less nauseous I feel.

I also recently just put some of my symptoms into google and something called idiopathic hypersomnia popped up and it can apparently cause GI symptoms. There were some other symptoms on there that correlate (when I get angry or extremely upset, my extremities seem to go numb).

I don't know if that has anything to do with what is going on, but I thought I'd give you an update as well. The nausea is still there but only severe in the morning when I wake up or late evening. Thank you!

Let me give you the rest of my daughter's history. We had been talking to another physician who was giving us good suggestions. The last time it came up it didn't get to him. This is what the doctor said the first time and the questions he has asked with answers.
Chronic IBS with Constipation with Chronic Gastritis / Under treatment

Detailed Answer:
Brief Ans-Chronic IBS with Constipation with Chronic Gastritis / Under treatment

Mostly from- Chronic IBS with Constipation with Chronic Gastritis with ?Bile reflux with weight loss

Hi Dear !! Thanks for the heavily detailed marathon updates.

My Inquisitive-Comments on last updates and query facts-
As per your submissions,You would need to live and feel like a normal human being.Dear, its messed up story with complex health issues.This would need corrective reviews with you and review- sessions with every 3-4 weeks time, to be followed meticulously.

My Primary-Clinical Opinion-
and plan to deal with your health issue-
1-From the 3 interactions and based on facts you submitted in query and updated-It may take more interactions over next few months to give the exact solution in your case.
2-Prima facie-You seem to be a case of Chronic IBS with Constipation with Chronic Gastritis with ?Bile reflux with weight loss
3-Would re-suggest following Do's -
Stool by Concentration Method-for Ova /Cyst of-Giardiasis/strongyloids for pork helminths.
4-Worsening fatigue is from chronic malnutrition-So keep up with helpings of -thin watery banana milk shakes x 2-3 times a day.
and thin watery skimmed Butter Milk
Be on -Low volume solid food each time with bland veg porridge x 2 times.
No fried,non-veg,spicy food till next orders,
No Subway,Wendys,Chicken fill- food till next orders.
Avoid beverages,
Be on Spinach with butter Milk shakes x 2 times a day-when acceptable only.
Be on Bland non-spicy diet till next orders.
Be on Plenty of fluids and fruit juice-liquids.
Take fluids- in sips Only with low volumes to avoid nausea and vomiting.
-helpings-with milk base/ or sweet skimmed watery thin butter milk base
Avoid non-veg strictly till next orders.
Since how long sever nausea is there?Any recurring diarrhoea/constipation with it?

- Nausea since mid-November (before Thanksgiving). I have recurring constipation and have had issues with it since I was a child.

How many kgs lost?What is her height?

- i started out at 173 lbs and am now down to 136. I am 5'5.5".

Is it the Lower esophageal valve / or pyloric valve ?

- Pyloric valve connecting stomach to duodenum.

Update the last blood report done?Any stool test-for ova/cyst-pls update?

- All lab values have consistently comeback normal. CBC and BMPs have been done. Liver panels come back normal. TSH and free T3 normal. No parasites in stool sample.
Any dark stools lately ?

- No they are generally a mix of yellow and brown.

Update the discharge notes from the Gastroenterologist ?

- They have no solutions for me at this time. The instructions were to take Zofran BID and Pepcid BID.

Was she in habit of street fast food / spicy,non-veg, fried, oily food?

- Occasionally would eat fast food (maybe 3 times a week at most).

What is her days diet schedule?Does she consume more of tea/coffee/and alike?

- i cannot drink a lot of caffeine as it messes with my anxiety. One small coffee with creamer is it or a small unsweet iced tea. I was told by the doctors to eat when I am hungry as I develop food aversions if I try to eat 3 meals a day. The meals are generally small (would be better if I ate them 6 times a day but I can't). I generally eat something in the late morning and again later in the evening.

Update any of the test reports like -USG/CT abdomen/Endoscopy/ or Lab tests for blood and stool.

- I have had a colonoscopy, EGD, Hida scan, and ultrasound. My GI doctor said he may do a gastric emptying study.

Any food intolerance test was done?Does she have any dislike for bakery products or dairy products?
- I have no consistent issues with food except pork (unless cured like ham or bacon) and sometimes ice cream makes me cramp but milk makes me feel better). The doctors tested me for celiacs and it came up negative.

I have also been suffering from worsening fatigue. The stomach symptoms have been going on since August of 2012, but they did not become a constant battle until November 2015. I am also a registered nurse and one day we were practicing on a blood sugar machine and we were asked to test our own and mine was 61 after having a hashbrown and iced mocha (the cold seems to help with pain and nausea). The nurse training me made me eat a pastry and have some water. I noticed that my hands do shake a lot but they've always done that so I didn't really think anything of it. I have been feeling weaker the past couple of months and it feels like it comes on all of a sudden. Thank you so much for your help!!!

On days I don't work, I usually eat lunch between 11 and 2 (usually the heavier meal, sometimes Wendy's spicy chicken wrap or Chick fil a sandwich). The smaller meal I eat around dinner time because it makes it easier to sleep. That is usually soup (veg, chicken noodle, beef barley, etc).
- On days I do work (I work nights and am a bedside nurse on a postpartum unit). I eat PB&J on wheat bread for "breakfast" around 9 or 10p. I eat a turkey breast sandwich with provolone cheese and mustard on wheat bread. I actually ate this last night and my stomach was fine.
How many times you eat a day?
- Twice. Sometimes three but very rarely and they are small.
What are the regular food items in daily diet?
- Milk, soup (various), turkey sandwiches, cheese, spaghetti, various lean cuisines (usually something with beef or chicken and vegetables).
Do you consume non-veg most of the time?
- I am assuming you mean without vegetables. I do but I really am trying to change that by eating an apple daily and incorporate more salads but I feel like the salads never sit with me.
Is it fried /spicy/oily food, which you eat mostly?
- I would say I eat more fried food than I should, maybe 3 times a week.
What do you eat-in fast food counters?is it nonveg/fried/spicy food?
- I usually only go to three places and this is what I order:
- Subway: Turkey and pepperoni on honey oat bread with provolone cheese and sweet onion sauce (vidalia onion)
- Wendy's: Just a spicy chicken wrap (no fries) it has cheese, lettuce, and some kind of ranch dressing with a spicy chicken breast
- Chick fil a: spicy chicken sandwich with no pickles and a handful of fries (on a good day)
How frequent you take beverages a day?
- Not often as I need to. Maybe 2 glasses a day. I'm trying to set up a pact with some other girls at work to keep up with drinking water.
How frequently you take fruits?
- Maybe twice a week. Either through a fruit smoothie (like Naked juice) or apples or applesauce. I like grapes and strawberries but I don't like many other fruits
any dislike for any particular fruit and food items,with which you get more nausea/or throwups?
- pulled pork BBQ (which makes me sad because it used to be a favorite), SOMETIMES onion, pizza, and ice cream (I still drink milk and eat cheese and tolerate that fine.

Would await more details on the above and on points besides these, if you could submit more data, as this would give leads to the possible.

My Inquisitive-Comments on last updates and query facts-
Dear,on reviewing the facts submitted,few points emerge from your story-
a-That at 25, since childhood you are constipated?
- Yes I have always had a problem with constipation and it does run in my family. My maternal grandmother never had diarrhea once in her life. My paternal grandmother also gets constipated a lot. As a child, I was very active in dance (1 1/2 - 3 hours per day minimum, including weekends). I did not have problems with nausea then.
b-Severe nausea, since Thanks giving?What food you had at Thanks giving party?more of pork,turkey,chicken?Did you have any drugs,alcohol,smoking events/bouts on that day ?
- It started a couple weeks before Thanksgiving and I cannot recall what I had the weeks before. In 2012 when the stomach problems first started and it was thought I had H. pylori but tested negative. They gave me the antibiotics anyway and it seemed to help. I do recall that I had a hot dog on the date it started in 2012. I was projectile vomiting, had diarrhea, and I was heaving so hard I burst all the capillaries in my face. The symptoms would occasionally flare up until Nov 2015 when it became constant.
Why you say the frequency of trouble increased after Nov,2015-thanks giving ceremony?
- I just remember it happened before thanksgiving
How frequently you smoke weed with your friends-if you do?
- I do not but have considered moving to a state that allows medicinal use for the nausea and loss of appetite.
Are you some painkillers with opioids lately?
- No. The last time I had a painkiller was summer 2011 when I had an exploratory laparoscopy for possible endometriosis (did not have endo).

c-All of your tests with doctor are normal?ExceptOGD(Oesophago-Gastro-Duodeno)-scopy, which has positive defect in nonclosure of pyloric Valve.
- Other than the biliary reflux, they were normal. However, the doctor who did the scope and colonoscopy had me back in about 20 mins after performing both procedures. I am now wondering if he tookthe time to really look.
Do you Vomit green/ or yellow fluid most of the times you throw ups?
- never green, but it is always a straw yellow and it is thick and very mucusy. I did throw up a mud brown emesis back in January 2016 that tasted and smelled so bad that I couldn't stop vomiting.

Do you get retchings (dry vomits-or heaving) with severe nausea?
- At least once a week
Whats the color of stools-is it black / or white/ or yellow brown?
- Yellow brown. I also noticed little pieces of pink that looks like skin to me. It is not bloody, but the same pink color as mucus membranes.
How frequently you move your bowels in a week? as you said you are constipated?
- 2-3 times a week at most
How many times you drink liquids/water/ or fluid intakes in a day?
- As I said, not often enough. Maybe two glasses a day (24 oz glass)
Do you get headache with bloating with cramps in stomach?what is its frequency?
- Headaches happen 2-3 times a week but I thought they were tension headaches because of where they are. I've noticed some bloating but no cramping with the headaches. The nausea usually kicks in but I'm not sure if the pain is causing it or not.
What probiotic items you take ? name and list them-what you have taken over last 8 mths?
- Metamucil probiotic. I have only taken them twice but got extremely sick and vomited before it digested (that is when I threw up the brown, extremely foul smelling and tasting emesis). I have been too scared to try anymore since.
Do you get bouts of diarrhoea after the Constipated period? Whatsort of diet and food items, help your bowels move with diarrhoea?
- No diarrhea - it comes out very soft and can sometimes be a little loose after I go for a while.
- To add, it is almost as if my body is cleaning itself out once or twice a week. I will have a very large bowel movement and at the end it seems more loose, watery and painful. It feels as if my rectum and anus are raw and they seem greasy and full of mucus (I can tell when I wipe).

I was also wondering if it could be an issue with my stomach not emptying properly. All the symptoms for bile reflux fit. I still have a specific tender spot in my upper left abdomen. Sometimes it moves but it is always upper left. I didn't know if my valve wasn't closing directly and I was getting backwash.

Sometimes when I drink water or after I eat, it almost feels like my stomach (not abdomen but the actual organ itself) is about to burst. It just feels raw and overdistended and makes my nausea worse. Sometimes I can see a very small difference on right and left side of my abdomen (the left is sometimes more distended than the right but not always -- usually when the nausea is bad or my stomach feels like its about to burst).

I also don't know if I mentioned in my last email -- I did have a stool sample for ova and parasites but it came back negative. I would be willing to submit another sample if need be.

Thank you SO much for helping me with this. This is the most in depth conversation I have had about these issues. I am to the point where I don't care if I have to repeat tests. I just want to find out what's going on. I know my eating habits are subpar and my water consumption needs to increase, but I am working toward that. I just want to feel like a normal human being again and not have to constantly worry "will this make me sick? If I'm already nauseous, should I just call off work?" I just want answers at this point. Thank you! You may also email me instead of my mother unless policy dictates otherwise

This is not a question. My daughter found a parasite. She is contacting her physician. Thank you