[35M] With chronic nausea, vomiting, and hair loss
Patient Description
A 35-year-old male has been experiencing chronic nausea and vomiting for the past two years. The nausea occurs almost daily, lasting from an hour to several days, and is sometimes followed by vomiting episodes that last 24-36 hours. The patient feels gross and icky in between these episodes. Approximately six months ago, the patient noticed frequent urination and yawning preceding severe vomiting episodes. The patient has experienced significant weight fluctuations over the past two years, with continuous weight gain and loss. Abdominal discomfort with flu-like feelings is present, but there have been no changes in bowel movements, such as diarrhea or constipation. Heartburn and acid reflux are rare, and headaches or dizziness occur occasionally. The patient feels very weak and fatigued after vomiting episodes but not otherwise. The patient has not been diagnosed with gastrointestinal disorders, diabetes, or thyroid issues and does not use substances such as alcohol, tobacco, or recreational drugs. Current medications include Metoclopramide (10mg, 1 tab every 8 hours as needed) and Clonidine (1mg, 2 tabs a day). No recent changes to diet or exposure to new environments, chemicals, or toxins. The patient was in jail when the symptoms first appeared and suspects stress may have been a factor. Additionally, the patient has noticed extreme hair loss during showers over the past 9 months to a year, losing hundreds of strands each time. No family history of gastrointestinal disorders, diabetes, thyroid issues, or other chronic illnesses. The patient is unsure if thyroid function has been tested recently.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, here are some possible explanations:
Chronic Nausea and Vomiting
- Gastrointestinal Disorders: Conditions like gastroparesis (delayed stomach emptying) or cyclic vomiting syndrome could explain your chronic nausea and vomiting. These conditions often require specialized tests for diagnosis.
- Stress and Anxiety: Given that your symptoms started while you were in jail, stress and anxiety could be contributing factors. Chronic stress can significantly impact gastrointestinal function.
- Medication Side Effects: Metoclopramide is used to treat nausea and vomiting, but long-term use can sometimes cause side effects, including worsening of symptoms.
Frequent Urination and Yawning
- Diabetes: Frequent urination can be a symptom of diabetes. Although you haven't been diagnosed with it, it might be worth checking your blood sugar levels.
- Thyroid Issues: Thyroid dysfunction can cause a variety of symptoms, including frequent urination and fatigue.
Hair Loss
- Nutritional Deficiencies: Chronic vomiting can lead to nutritional deficiencies, which might contribute to hair loss.
- Thyroid Dysfunction: Thyroid issues can also cause hair loss. Given your other symptoms, it might be worth getting your thyroid function tested.
What you can do
Chronic Nausea and Vomiting
- Consult a Gastroenterologist: A specialist can perform tests like gastric emptying studies or endoscopy to diagnose conditions like gastroparesis or cyclic vomiting syndrome.
- Stress Management: Techniques like mindfulness, meditation, or counseling could help manage stress and potentially alleviate some of your symptoms.
- Dietary Changes: Eating smaller, more frequent meals and avoiding foods that trigger nausea might help. Keeping a food diary using MDandMe can help identify triggers.
Frequent Urination and Yawning
- Check Blood Sugar Levels: Consult your doctor to rule out diabetes.
- Thyroid Function Test: Ask your healthcare provider to test your thyroid function to rule out any thyroid-related issues.
Hair Loss
- Nutritional Support: Ensure you are getting adequate nutrition. A multivitamin supplement might help, but consult your doctor first.
- Consult a Dermatologist: A specialist can help identify the cause of your hair loss and recommend appropriate treatments.
What you should look out for
Given the chronic nature of your symptoms and the potential for underlying serious conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe Dehydration: If you are unable to keep fluids down, you may need IV fluids.
- Unexplained Weight Loss: Significant, unintentional weight loss should be evaluated by a healthcare provider.
- Severe Abdominal Pain: This could indicate a more serious underlying condition that needs immediate attention.
Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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3 mo ago