[23F] With persistent nausea, vomiting, and abdominal pain

What might be happening

Based on your symptoms—persistent nausea, vomiting, abdominal pain above your belly button radiating to your upper stomach, diarrhea, fatigue, migraines, and loss of appetite—here are some possible explanations:

1. Gastroparesis

   • Gastroparesis is a condition where the stomach empties more slowly than normal, leading to nausea, vomiting, abdominal pain, and loss of appetite. Your symptoms, especially the relief from pressure on your stomach and worsening when lying down, align with this condition.
   • Diagnosis typically involves a gastric emptying study, which measures how quickly food leaves your stomach. Treatment often includes dietary changes (small, frequent meals), medications to improve stomach motility, and symptom management.

2. Functional Dyspepsia

   • Functional dyspepsia is a chronic disorder causing upper abdominal pain, nausea, and loss of appetite without identifiable structural abnormalities. Stress and anxiety, including your emetophobia (fear of vomiting), may exacerbate symptoms.
   • Treatment focuses on managing symptoms with medications like proton pump inhibitors, dietary adjustments, and stress reduction techniques.

3. Small Intestinal Bacterial Overgrowth (SIBO)

   • SIBO occurs when there’s an overgrowth of bacteria in the small intestine, leading to nausea, diarrhea, and abdominal discomfort. While bloating is a hallmark symptom, it’s not always present.
   • Diagnosis involves breath tests, and treatment typically includes antibiotics and dietary changes.

4. Peptic Ulcer Disease

   • Ulcers in the stomach or upper intestine can cause pain, nausea, and changes in stool consistency. While your CT scan was normal, ulcers are often diagnosed with an endoscopy or testing for H. pylori bacteria.
   • Treatment includes medications to reduce stomach acid and antibiotics if H. pylori is present.

5. Thyroid Dysfunction

   • Although your hypothyroidism is managed with levothyroxine, thyroid imbalances can sometimes contribute to fatigue, nausea, and gastrointestinal symptoms.
   • Your doctor may want to recheck your thyroid levels to ensure they’re well-controlled.

Your family history of stomach cancer is important to keep in mind, but your normal CT scan is reassuring. However, further testing, such as an endoscopy, may be warranted if symptoms persist or worsen.

What you can do

While waiting for your GI appointment in July, here are some steps you can take to manage your symptoms and prepare for your visit:

1. Symptom Management

   • Eat small, frequent meals that are easy to digest (e.g., soups, smoothies, or bland foods like rice and bananas). Avoid fatty, spicy, or acidic foods.
   • Stay hydrated by sipping fluids throughout the day, especially if you’re experiencing diarrhea. Electrolyte drinks can help prevent dehydration.
   • Use your prescribed Zofran to manage nausea as needed.

2. Lifestyle Adjustments

   • Avoid lying down immediately after eating, as this can worsen nausea. Instead, sit upright or prop yourself up with pillows.
   • Try gentle abdominal massage or applying a warm compress to your stomach to ease pain.

3. Track Your Symptoms

   • Use MDandMe to journal your symptoms daily, including details like pain severity, nausea frequency, stool changes, and appetite. This will help your GI doctor better understand your condition.
   • Record any medications or remedies you try and whether they help.

4. Stress Management

   • Since anxiety can worsen nausea and vomiting, consider relaxation techniques like deep breathing, meditation, or gentle yoga.
   • If your emetophobia is significantly impacting your ability to cope, discussing this with a mental health professional may be helpful.

What you should look out for

While your symptoms are concerning, they don’t appear immediately life-threatening. However, you should seek urgent medical attention if you experience any of the following:

• Severe or worsening abdominal pain that doesn’t improve with pressure or position changes.
• Vomiting blood or noticing blood in your stool (black, tarry, or bright red).
• Signs of dehydration, such as dizziness, dry mouth, or reduced urination.
• Unintentional weight loss or persistent fatigue that worsens.
• Fever or chills, which could indicate an infection.

It’s frustrating to wait for answers, but you’re taking the right steps by seeking care. If your symptoms worsen or become unmanageable, don’t hesitate to visit an urgent care or emergency room for further evaluation.