Dr. Hive -- frequent vomitting- what could it be

[Shellydon]

I have a 9 year old boy that has been having issues with vomiting and diarrhea since April.  Once each in April, May and June, he woke up at 4:00 am with stomach cramps.  He proceeded to vomit 6 or 7 times from about 4:00 am to 10 am, then have diarrhea until 1:00 pm.  In between bouts of throwing up, he felt fine.  He doesn't run a fever, no one else in the house gets sick.  He doesn't feel sick like you do with a stomach virus.  I have done food logs and there isn't anything he is eating that is unusual the day prior to vomiting.  He didn't get sick in July or August, but did in Sept and November and then again this morning.   Prior to April he had only thrown up one other time in his life.

 

 The only life change is that a new family moved in next door in April and ds plays with them almost everyday.  They do not report getting sick.

 

Any ideas of what to look at or for? 

[clementine]

Look up CVS - cyclic vomiting syndrome.  It may fit with what he's experiencing?

 

Edited January 31, 2018 by clementine

[Shellydon]

Thanks. I am not sure if cyclic vomiting syndrome fits. He doesn't have the extreme nausea that is described. I have no idea what else it could be though

[displace]

CVS, maybe a food allergy/allergen, possibly a chronic infection, though the pattern doesn’t fit. IBS is maybe possible. If you see your pediatrician they may just send you straight to GI.

 

I assume no concerning symptoms like excessive thirst, weight loss, bleeding...

[plansrme]

Is there a history of migraines in your family?  This is the first question our ped. asked years ago when my son had similar symptoms.  There was (all of the men in my husband's family have migraines), so case closed as far as he was concerned; apparently there is a strong link between migraines and CVS.  My son's bout didn't last that long--several times over 6 months or so, with nothing since, so nothing like the horror stories that you may read about CVS.

[Amy in NH]

Similar problem ended up being little kids drinking soapy bathwater when playing in the tub .

[Sandwalker]

Does he have constipation problems?

[EmilyGF]

My daughter vomits if she's eaten too many sweets the day before. (But maybe that's ruled out by the food log?)

[Stacia]

Could it be something environmental like you or the neighbors getting the yard treated w/ chemicals, the kids play in it later that day, & your ds ends up sick in the middle of the night? A location or thing they play with sometimes but not frequently? A detergent or change in something like that w/ something he encounters only once in awhile? A slow/small carbon monoxide leak? (I had a friend that was sick off & on for almost a year & it turned out there was a small carbon monoxide leak in her house. On days she went out a lot, it didn't affect her as much, but when she was home a couple days in a row, she would get sick.)

 

I guess in addition to a food journal, I would keep an activity journal, if possible. Where, when, what he did the day before he got sick, etc....

[Michelle in IL]

One of mine did this for a while. He would wake up queasy and didnt feel like eating. Then he would eventually vomit. He was lethargic and pale. He usually felt better and started to eat about lunchtime. No one else ever got sick. I finally linked it to an early supper the night before. If we ate an earlier supper than usual and he didnt snack before bedtime, he would be sick the next morning.

 

I try to make sure he has something within an hour or so of bedtime. And if he wakes up queasy I encourage him to eat something right away. It hasnt happened in quite a while.

[mominco]

My dd was like that,turned out to be IBD.

Keep an eye on it and see if you get the pedi to check for blood in poop.Gi issues MAY start that way.

Does he eat popcorn,tomatoes or strawberries or seeds?

Edited to add -pm me if you have any specific questions!

Edited February 3, 2018 by mominco

[blondeviolin]

The one I have that does/did this was diagnosed CVS which has grown into migraines.

[kroe1]

Parasites, vitamin A toxicity, food allergies, bacterial infections, autoimmune disorders, abdominal migraines although those usually do not have the diarrhea, foreign bodies, poisoning.

[gardenmom5]

1ds had issues, where every three months, he'd have progressively worse symptoms of vomiting, lethargy, pain .    it was eventually determined (by my chiropractor- after many tests  at the children's hospital) he had a pinched nerve in his spine. once that was taken care of, he stopped having problems.

 

I would also look at the catchall cyclic vomiting syndrome.   that was one of the things we looked at for him.

https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161

cvs foundation -http://cvsaonline.org/

 

for cvs - I'd really pay attention to where you get your info.

 

does it happen only after playing in that house?   there could be anything he's exposed to there - from drugs to toxic mold.  or even foods he eats as a snack there.

 

I'd also not allow him inside their house.  if it continues, then you know it's not the house.

 

eta: you said nothing happened in july and august.  months more likely to play outside.

Edited February 3, 2018 by gardenmom5

[gardenmom5]

First, a good GI doctor may need to do some testing to rule out some things and check to see how healthy things look on the inside.

 

 

 

Our ds was also found to have a hiatal hernia. He is very hypermobile as well. 

 

 

does he have ehlers-danlos?

my sister does - hyper mobility is part of the diagnosis.

 

 

 

 

OP-

keep an activity log, everything.

gastroenterologist

pediatric neurologist.

[Shellydon]

First, a good GI doctor may need to do some testing to rule out some things and check to see how healthy things look on the inside.

 

The fact that the vomiting is following a cyclic pattern and always begins in early morning is significant, and would automatically rule out many other things. My son has cyclic vomiting syndrome. Usually there is nausea and usually (USUALLY) not loose stools. (My ds is always constipated after an episode). But loose stools afterward is not out of the realm of possibility. I would encourage you to begin to keep a log or diary for your ds. Record when vomiting begins, when it ends, what he ate before, what possible triggers could there be, pain level, what was he doing just before, etc. If this pattern continues, you can take it with you to the doctor. Be warned that most doctors are not familiar with this and may never have treated this condition during their years of practice. So it really needs to be ruled out or in by someone who actually has enough knowledge to do so, which may mean travel for you.

 

Our ds was also found to have a hiatal hernia. He is very hypermobile as well. 

 

Since things are following a cyclical pattern for your ds, it wouldn't hurt for you to become familiar with the symptoms and characteristics of CVS, if for no other reason than to confirm in your mind that this ISN"t what is wrong.

 

Some of the things that have launched my ds into an episode are:

 

Fever/cold

Change of weather

Excitement-something good is happening

Stress-something he is dreading or stressing over

 

Even playing basketball after having a carbonated soda (bending to pick up the ball, flooding the hernia with acid, then CVS begins within an hour). This happened twice.

(CVS can be triggered by acid reflux; it's a known trigger).

 

Usually with CVS you vomit four to six times an hour, lasting four or more hours....and this all occurs with a cyclic pattern...beginning at the same time of day once or twice a month, etc, for at least several months. (You seem to have met this criteria, at least from what you've posted).

 

If you and your doctor have ruled things out and are at a loss, I would suggest this: Under the guidance of your doctor, try giving him some CVS rescue meds at the first sign of an attack. Usually, it's Zofran (for vomiting), Benadryl (to make him sleep) and if there is pain, you could try Ibuprofen. The idea is to catch it VERY early, go to bed and go into a deep sleep as soon as possible. If he has CVS, he will (if caught early in the attack) respond to this and the episode can possibly be aborted. He will sleep until noon most likely, get up and be fine. If it's something else going on, you would not see such spectacular magic happen. (Again, the doctor may not even be aware of CVS and this type of aborting/treatment meds).

 

For ds, we ended up learning the only way to lessen his pain was to take Ibuprofen out and add in hydrocodone to the rescue meds. And none of this works unless you take the meds in time. You can't go to sleep unless you can stop the pain. You can't abort the episode unless you can fall into a deep sleep way before the cycle takes hold.

 

So, if I were you, I would find a good GI and have some testing done. Rule things out.

In the meantime, I would get a notebook and record meticulous details  every time this happens.Take it with you to the doctor.

Research CVS. Know what it is and what it isn't.

If the pattern continues, get a GOOD doctor to help with a trial of rescue meds to see if it will abort an episode.

 

 

If there are any internal tests, request a copy on CD for your notebook.

 

 

Keeping this detailed notebook can go a long way in helping you see the big picture and to determine just how cyclical this is or isn't.Knowing whether it's cyclical  is very important and critical in information. This notebook can help with his diagnosis, whether CVS or not.

 

If you ever need to know, there is an online board for CVS.  http://cvsaonline.org/message-board/  

 

Hopefully, you will find that this is not what is going on, and I hope this helps.

 

Your doctor may quickly find that it's something else going on, but if everything is ruled out first, I would try the above steps and find someone who can rule/out or in with 100% accuracy. Because you can treat CVS, but you've got to know for sure first.

 

I know my post is getting long, but I need to quickly add one more thing: My son's GI doc was quite sure at first that his problem was acid reflux because he found that ds has a hernia. Please know that reflux doesn't behave in a clock-work like pattern. That is the give away here. I knew this because of all the reading I had done. Ds felt it wasn't reflux as well, because of the pain level. Doubled over on the bathroom floor for four or more hours vomiting is NOT reflux, especially when, hello, it happens again the same time  of day the next month and lasts the exact same number of hours. However, in my son's case, he has both reflux and CVS. So please keep this in mind, too. 

Thanks ladies!  Looking into this now

 

I have a suggestion for you:

 

If you go to that message board I linked to, you can ask there if there are others with the same symptoms as your son. Meaning, do they have all the usual things that CVS brings, but without the nausea? Ginny is the moderator. She could probably answer that for you. She is very educated about CVS. She runs the board and answers lots of questions. Her daughter lived with CVS for 10 years. You could introduce yourself and get lots of information there. I would specifically ask her about CVS and vomiting in a pattern in the absence of nausea. Everything else lines up so closely with CVS.