Findings underscore importance of prevention efforts
by velvetmoon on Fri Jun 19, 2009 12:00 AM
by heart_and_soul on Fri Jun 19, 2009 12:00 AM
I can imagine how worried I would be if I were you. I would want the MRI as soon as possible. Depending on where a tumor is in the brain, I am afraid that yes even a small one could cause a lot of problems. I would want to know what it is and start taking care of it. You have a beloved baby and you want to be there for her for a long long time!Wishing you all the best ~Sarah
mom of Andy 26, dx GBM/PNET 1/09
by faith11 on Fri Jun 19, 2009 12:00 AM
On 6/19/2009 velvetmoon wrote:Hi I just have few questions. I had a baby girl in Aug 2008 and had what I thought was really bad morning sickness for the whole 9 months but unfortuantly I the nausea/vomiting/dry heaving never subsided. I get sick one-four times a day and have had very few days of relief in between. I have been to numerous doctors with extensive GI workup including negative CT scans of ABD/Pelvis, neg abd u/s, neg hydascan of gallbladder and numerous blood work with GERD, celiac disease etc all ruled out. And a negative upper endoscopy. I had an abnormal MRI of the brain showing a 2mm brain lesion in the left thalamus..unspecified with a slight increase of CSF behind my left eye are according the neurologist. The neuro doctor said it was a tiny spot and probably nothing to worry about and to repeat the MRI in 6 months. I am due to have it this month. I am wondering if my symptoms could be this bad and prominent with such a small tumor and if anyone else had a similar situation that turned out to be brain cancer? The fact that almost everything else has been ruled out and the abnormal MRI brain is my only abnormality. The GI doctor I saw this week ..is very concerned and said that whenever he has a patient with unexplained nausea,vomiting and dryheaving with an abnormal MRI of the brain no matter how small ..he takes it very seriously and he said I should too and have the MRI repeated ASAP!! Should I be worried..please any help would be greatly appreciated.
Please look into this more. My mother's symptoms before we knew it was a brain tumor was nausea as well. Get a second opinion or something, you need to get started on this quickly.
by terimarie on Fri Jun 19, 2009 12:00 AM
by predisposed on Fri Jun 19, 2009 12:00 AM
Info on chronic nausea and vomittting.
Functional Nausea and Vomitting
There is a group of patients who have unexplained chronic nausea and/or vomiting. In the past these patients were
labelled as having psychogenic vomiting. However, there is little evidence that such a condition exists. Rather, these
patients usually have a functional gastrointestinal disorder (functional nausea and vomiting).
This article describes the three important syndromes in adults that clinicians need to recognise: cyclic vomiting
syndrome, functional vomiting, and chronic idiopathic nausea.
Cyclic vomiting syndrome presents with stereotypical episodes of acute nausea and vomiting that may be severe.
Patients are generally well between attacks. Cannabis use can cause a similar syndrome. Patients may respond to
antimigraine therapy or low dose tricyclic antidepressant treatment. Functional vomiting is rare and presents with more
frequent vomiting episodes. Rumination needs to be distinguished from functional vomiting by careful history taking.
Tricyclic antidepressants are also useful in functional vomiting whether or not there is associated depression. Chronic
idiopathic nausea refers to patients with bothersome nausea occurring several times a week usually not associated with
vomiting. Its treatment is poorly defined but a trial of antidepressant therapy anecdotally can be helpful.
Nausea and vomiting are relatively common
complaints in the community, although patients and
doctors sometimes confuse the terms (Table 1). In a
study from a representative population living around
the Mayo Clinic (USA), 3% of people reported nausea
once per week, while nearly 2% had daily nausea.
A total of 2% reported vomiting monthly or more
frequently.1 There is an important, albeit uncommon,
group of patients who despite an intensive diagnostic
evaluation have no clear cause found for their chronic
nausea and/or vomiting. These patients are currently
classified as having functional nausea and vomiting.2,3
In the past, all chronic unexplained vomiting was typically
labelled as ‘psychogenic’. Classic papers were published
on the topic, notably one in the 1930s4 and another in
the 1960s.5 These authors assumed their patients had a
psychogenic cause because nothing else was found, but
no attempt was made to assign a modern psychiatric label
or compare their patients with controls.
More recently, a Japanese study reported data from
59 patients with presumed psychogenic vomiting, and
for the first time systematically evaluated personality and
psychiatric status.6 In this case series, all the patients were
given a psychiatric diagnostic label and most (53%) had
‘conversion disorder’, while others (36%) were suffering
from depression. However, there was no control group,
and referral bias might explain the high rate of psychiatric
labelling. A study from the Mayo Clinic subsequently did
include appropriate controls,7 and found that psychiatric
diagnoses were similarly distributed in patients with
chronic unexplained vomiting and organic disease controls.
Unexplained chronic gastrointestinal symptoms and
psychiatric disease are both common, and even if they
overlap, does not indicate a cause and effect relationship.
Indeed, there is no convincing literature that supports the
existence of a pure psychogenic aetiology for unexplained
vomiting. This is not to say that it can’t happen. Panic
disorder, for example, can present with vomiting as one of
its features, although this is probably uncommon.7 Based
on the available evidence (which for vomiting is limited),
Nicholas J Talley
MD, PhD, FRACP, FRCP, is
Professor of Medicine, Mayo
Clinic, Rochester, United
Reprinted from Australian Family Physician Vol. 36, No. 9, September 2007 695
consensus opinion has therefore favoured dropping the
term psychogenic altogether.3
Functional nausea and vomiting
There are three specific syndromes to recognise in
practice: cyclic vomiting syndrome (CVS), functional
vomiting (FV), and chronic idiopathic nausea (CIN)
(Table 2). Before labelling a patient with a functional
disorder, structural and biochemical causes must be ruled
out with appropriate investigations.
Cyclic vomiting syndrome in adults
Cyclic vomiting is a rare condition. It was first recognised
in the paediatric population but is now known to occur in
adults.8 Adults typically develop CVS in middle age (around
35 years), although it can occur at any age.9,10
Patients typically present with acute episodes of nausea
and vomiting without warning. Symptoms finally settle
completely but recur weeks to months later.9,10 Between
episodes patients are asymptomatic. Episodes are
stereotypical, ie. predictable in terms of symptom pattern,
onset and duration. Typically adults have about four discreet
episodes of nausea and vomiting per year with each
episode or cycle lasting about 6 days (range 1–21 days).
The patient is then symptom free often for months before
the exact same type of episode recurs. Typically diagnosis
is delayed for several years.
Up to one in 4 adults with CVS also has a history (or
family history) of migraine headache.9,11 It is important
to ask about cannabis use. Patients may use cannabis
to relieve nausea and vomiting. Cannabis use can also
precipitate CVS in some cases and ceasing cannabis can
lead to complete relief.12 Many patients have compulsive
bathing behaviours (multiple hot showers or baths often
waking up during the night to do so). A urine drug screen
can be helpful is you are suspicious and the patient
denies cannabis use. Some patients have menstrual
related cyclic vomiting.
Before making a firm diagnosis of CVS it is important to
rule out motility disorders of the upper gastrointestinal
tract as well as metabolic and central nervous system
diseases.2,3 Most authorities suggest upper endoscopy and
small bowel X-ray or computed tomography enterography.
Biochemical testing for electrolyte abnormalities, serum
calcium, thyroid function tests and, if indicated, tests
to exclude hypoadrenalism (Addison disease) are also
relevant. Gastric emptying testing may be considered
where available. In CVS, recent data suggests that gastric
emptying is accelerated rather than delayed in a subset
of patients.11 There are mitochondrial diseases that can
be associated with intermittent vomiting such as medium
chain acyl-coenzyme A dehydrogenase deficiency.13 This
Table 2. Rome III classification of functional nausea and vomiting
Diagnostic criteria* for nausea and vomiting disorders
Chronic idiopathic nausea
Must include all of the following:
– bothersome nausea occurring at least several times per week
– not usually associated with vomiting
– absence of abnormalities at upper endoscopy or metabolic disease that
explains the nausea
* criteria fulfilled for past 3 months with symptom onset at least 6 months before
– on average one or more episodes of vomiting per week
– absence of criteria for an eating disorder, rumination, or major psychiatric
disease according to DSM-IV
– absence of self induced vomiting and chronic cannabinoid use and
absence of abnormalities in the central nervous system or metabolic
diseases to explain recurrent vomiting
* criteria fulfilled for the past 3 months with symptom onset at least 6 months
Cyclic vomiting syndrome
– stereotypical episodes of vomiting regarding onset (acute) and duration
– three or more discrete episodes in the previous year
– absence of nausea and vomiting between episodes
• history or family history of migraine headaches
Source: Drossman DA, Corazziari E, Delvaux M, et al. Rome III: the functional
gastrointestinal disorders. 3rd edn. McLean, Virginia: Degnon Associates, 2006
Table 1. Definitions of key terms
Nausea – a painless, unpleasant, subjective feeling of wanting to vomit
Vomiting – the forceful expulsion of gastric or intestinal contents
Retching – abdominal muscle contractions with laboured rhythmic respiration
Rumination – the effortless regurgitation of recently ingested food typically
in the absence of nausea. Often the food tastes good and is re-swallowed.
Rumination should be distinguished from vomiting even though patients will
often refer to their problem as vomiting when they present with this condition
THEME Functional nausea and vomiting
696 Reprinted from Australian Family Physician Vol. 36, No. 9, September 2007
is most often seen in children, but if there is any concern
testing should be considered.
During an acute episode, patients with CVS may require
hospital admission for intravenous fluids and intravenous
antiemetic therapy. Another approach is to prescribe
antimigraine therapy at the onset of an attack, particularly
if there is a personal or family history of migraine. A triptan
such as sumatriptan (a 5HT1 agonist) can be effective for
acute migraine and for CVS. Triptans can be given as a
subcutaneous injection or nasal spray, or orally in the early
stages of an episode. Remember triptans have a risk of
inducing vascular problems in ischaemic heart disease,
ischaemic stroke and uncontrolled hypertension.
For the prevention of attacks of cyclic vomiting, one of the
most effective therapies appears to be low dose tricyclic
antidepressant treatment.9,11 This is based on anecdotal
data as there are no clinical trials. However, use of drugs
such as desipramine, nortriptyline or doxepin in a median
dose of about 50 mg/day does seem to be helpful in
practice and should be considered unless there is an active
contraindication. In one uncontrolled study, 24 patients
received amitriptyline up to 1 mg/kg/day for at least 3
months; 93% had a reduction in symptoms and 26% went
into remission.11 Beta blockers (eg. propranolol) may also
help prevent episodes.
In a uncontrolled study, newer antiepileptic drugs,
specifically zonisamide and levetiracetam, appeared
beneficial as maintenance medications for almost threefourths
of patients evaluated.14 Other drugs have been
tried (eg. ketorolac, prochlorperazine) but all therapies are
based on anecdotal evidence only.
In patients with menstrual related cyclic vomiting, the oral
contraceptive pill can be helpful for prevention of episodes.
Psychiatric disease appears to be uncommon in
patients with CVS.9 If depression is present it should be
treated on its own merits. Providing support is important
Functional vomiting is thought to be very rare.
Functional vomiting is defined as recurrent unexplained
vomiting at least once per week that is not cyclical.3,15
Careful history taking will rule out rumination syndrome
or an eating disorder. Rumination syndrome refers to
persistent or recurrent regurgitation of recently ingested
food into the mouth; it is not vomiting (Table 1).16 The
patient either spits out the food or re-chews and swallows
it. There is no preceding retching and typically no nausea.
The regurgitant material is often pleasant tasting! While
rumination was once thought to be rare in nonretarded
adults, it may not be uncommon and is probably more
frequent than FV. Rumination is a clinical diagnosis that
is important to recognise as it is easily treated (Table2). Rumination is thought to be an acquired habit. Habitreversal using a breathing technique to halt regurgitationcan be easily taught to patients (diaphragmatic breathing)and can be curative.17
2). Rumination is thought to be an acquired habit. Habit
reversal using a breathing technique to halt regurgitation
can be easily taught to patients (diaphragmatic breathing)
and can be curative.17
Eating disorders need to be excluded.3,18 In particular,
sensitively ask the patient questions that may reveal a
distorted body image or self induced vomiting. Expert
management with the help of a psychiatrist is required for
bulimia or anorexia nervosa.
Management of FV remains difficult.18 Maintenance of
nutritional status and psychological support are essential.
The role of psychiatric disease is unknown. Tricyclic
antidepressants may be prescribed and anecdotally
can help some patients whether or not there is
by jackiekay on Fri Jun 19, 2009 12:00 AM
I would also want to have a more definitive answer about what is causing this horrible problem for you. 2 mm is very small--probably too small to tell what it is for sure. As somebody else said, cancer tends to grow very quickly so I would not panic about that although I would want to keep a close eye on that lesion. Somebody I work with just went through a similar problem except hers was more severe headaches that caused nausea. She was very worried after seeing her doctor for the MRI report & being told there was a small lesion on her thalmus. It ended up she was diagnosed with migraines. Her headaches were quickly resolved with the correct medication. My husband developed migraines after all the crapola he has been through. It seems I have read that there is a type of migraine that results is gastric problems rather than headaches. I can't remember where I read it, but I would google "different types of migraines" or "gastric migraines." Keep trying different combos until you get a hit. I hope you get this resolved quickly so you can enjoy your new family member without this dark cloud over you.
by Marlee49 on Sun Jun 28, 2009 12:00 AM
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