Hive Help - Medical WWYT Next??

[easypeasy]

I have a medical question and am looking for ideas / input / experiences that any here might have! This is regarding my great aunt.

She has been feeling nauseous all the time. She can barely eat anything now - no more than one or two bites of anything at any one time, really. She's lost weight. She has always had the keenest sense of smell (unfortunately) and now everything smells super strong and is also triggering nausea.

She is in her 70s. Isn't pregnant (lol). Has diabetes (type II, but managed and isn't taking insulin, whatever that might mean).

Recently had a CAT scan (I think?) of her stomach area, a colonoscopy, and an endoscopy. Everything came back clear, except she has a medium-sized hernia (which isn't new, but the nausea is). She has been taking antacids regularly for a week (prescription strength) but says it hasn't changed anything.

Any suggestions on what to try next? What type of doctor to see? Her PCP is useless (imesho) but the gastroenterologist wasn't much help either since the tests all looked good. He just said if the hernia doesn't respond to antacids, they could consider surgery, but it really wasn't that bad.

fwiw, she vomited after a recent outpatient procedure following anesthesia, which she has never done before.

I'm out of ideas, the doctors aren't giving any useful suggestions - but the poor lady is exhausted. She doesn't sleep well and is eating like a bird. She feels better when we are *trying* to figure out what's going on, so I don't want to just shrug my shoulders at her, but I honestly don't know where to go next.

 

(most likely unrelated, but she also has nerve damage in her back and is doing steroid shots now but will most likely need back surgery. Again, I doubt that is relevant, but there it is just in case. She also had a long history with a specific antidepressant and went off that after 30 or so years. Tried a different one with horrific results (omg) and is now anti-depressant free, but will need to start one again soon but, again, after the last time, we are all a little skittish about it while she is already feeling unwell)

Edited March 30, 2023 by easypeasy

[prairiewindmomma]

In the meantime, are giving her an anti-nausea drug and does it help?

[Corraleno]

Has she had her B12 levels checked? Nausea, vomiting, fatigue, loss of appetite, and weight loss can be symptoms of B12 deficiency. Older people tend to need more B12 because they don't process it as efficiently. Also, use of antacids can make it B12 deficiency worse by interfering with absorption.

Has she had her thyroid levels checked? Hyperthyroidism can cause nausea, vomiting, and weight loss.

If she takes medication for diabetes, but she's barely eating and hasn't adjusted the amount of medication she takes, could her blood sugar be too low? 

 

[Katy]

They need to fix the hernia before trying anything else. 

[Pawz4me]

2 minutes ago, Katy said:

They need to fix the hernia before trying anything else. 

I think so, too. Or at least get an opinion from a good GI doc. I know someone who has a hernia that causes nausea. 

[Mrs Tiggywinkle Again]

I’d start with the hernia fix.  That can cause some unusual symptoms. Is she on any new medications or taking new OTC drugs?

in the meantime have her ask for a prescription strength anti nausea meds. It sounds weird, but I often give my patients alcohol prep wipes to sniff and that works as good as Zofran in wiping out nausea. I’m on Ozempic which can cause severe nausea, and those are working great for me. Zofran is a good drug but like all meds can have side effects, so I am using other methods first.

Edited March 30, 2023 by Mrs Tiggywinkle Again

[SoCal_Bear]

I hate to ask this...but has she had covid? There are some long covid people who suffer from gastro issues that you describe. Long Covid symptoms often won't pop up after 2 or 3 months after Covid.

[Corraleno]

Depending on the procedure, there can be real downsides to hiatal hernia surgery (like inability to belch or vomit), and the hernia can come back, so doctors generally don't recommend it unless the hernia is causing serious problems. Something like 2/3 of people over 60 have some degree of hiatal hernia (including me), and only a small percentage of those are candidates for surgery. Personally, I would try to eliminate all other possible causes of the nausea before resorting to surgery, especially since she has had the hernia for some time but the nausea is new.

[pinball]

Did she have a brain CT?

does she have headaches, too?

any other neuro symptoms?

[GoVanGogh]

I have those symptoms that were attributed to my young onset Parkinson’s diagnosis. The doctors said being hyper sensitive to smells often goes with losing sense of smell, which is a main symptom of Parkinson’s. Brain goes in to overdrive, trying to sort out smells, but is getting mixed signals. I didnt believe it at the time. I felt like I was in my first trimester of pregnancy all over again. I was going through menopause at the time and every single doctor did a pregnancy test first. I felt like I was always smelling rotting spinach. Fast forward a few years, last night DH asked me why the kitchen smelled like vomit. I couldn’t smell anything. Alas. The compost bucket had gone icky and needed dumped outside. (I have been sick and didn’t think about taking it out. Oops.) 

[Carol in Cal.]

Zofran is helpful for nausea.  Sometimes anti anxiety meds are also helpful.

Also, some NPs can fix a hiatal hernia without surgery.  There is a maneuver that sometimes works, and sometimes they can teach it to you.

[Halftime Hope]

Nausea is also a common long-covid symptom.  Dd is having unfortunate experience with it.  Any chance that she had a covid infection?

 

[Arcadia]

I had the worse case of nausea with my asthma steroid inhaler in college. Once I stopped that and only used the rescue inhaler as needed, my nausea stopped. Ironically my asthma also got much better. Also, in my case, any medication that has nausea as a side effect even if it is rare would cause me to feel puky. So in your scenario, I would list out her medications and find out all the side effects and contraindications. My late mom had medications that have bad side effects so it was a trade off.

When I puked out my medication yesterday, gargling with coconut water (unsweetened) helped clear the vomit taste from my mouth. Then taking fish oil capsules helped calmed my esophagus down. Can your aunt take the unflavored protein drinks?

[blue plaid]

My MIL has been having lots of nausea which they traced to issues with her gall bladder not functioning well — so maybe check that?

[gardenmom5]

On 3/30/2023 at 11:37 AM, easypeasy said:

 

this will sound counterintuitive - but heartburn can be what you eat (for me, sugar and fat can trigger it, as well as "spices" etc.) AND/OR - low stomach acid. (often related to hypothyroid)  taking digestive enzymes with meals could be more helpful than antacids (studies are coming out they can do more harm than good.) - sometimes, I just take a glass of water with lots of lemon juice.  It really is counter intuitive, drinking acid when you feel like there is too much acid.  But it has frequently settled it down.

I had gallbladder issues that caused me to be nauseous all the time.  It also caused trouble digesting fats. (one cause of heartburn).

Nerves in the back most certainly can cause stomach issues.  I dealt with it with my son for five years, not even the pediatric neurologist did more than slap the proverbial band aid on the problem.  (he was given beta blockers).  A chiropractor diagnosed the pinched nerve in his spine (the nerve led to the stomach) - from the x-ray the pediatrician had ordered, and wrote off as not related.  It was the source of everything.  
his symptoms were  pain, vomiting (even that 1/2tsp of water I managed to get in him) lethargy.  IV's for hydration, narcotics for pain relief (which still didn't really work). Rinse repeat every three months. for five years.  it cycled according to the amount of pressure on the nerve.   keeping pressure off the nerve put an end to them.

I've also had a few experiences where my back was acting up - and I'd get nauseous.

I had horrific experience with antidepressants with one of mine - he never had a bad reaction to 5htp.  (we're doing something nondrug now that is doing wonders for his anxiety.).   

[Mrs Tiggywinkle Again]

I missed that she’s diabetic in my first reading and not on insulin. Any chance she’s been put on a new diabetes meds? All of them have nausea as a side effect, especially the GLP-1 agonists like ozempic or victoza.

[Halftime Hope]

30 minutes ago, Mrs Tiggywinkle Again said:

I missed that she’s diabetic in my first reading and not on insulin. Any chance she’s been put on a new diabetes meds? All of them have nausea as a side effect, especially the GLP-1 agonists like ozempic or victoza.

I wondered that, too, when I read it. But I thought surely her doc would have warned her...dumb assumption. She could have forgotten it too, but the medical providers later should be asking. ??

[Mrs Tiggywinkle Again]

1 minute ago, Halftime Hope said:

I wondered that, too, when I read it. But I thought surely her doc would have warned her...dumb assumption. She could have forgotten it too, but the medical providers later should be asking. ??

Literally NO ONE told me when I started Ozempic.  I googled but an elderly person might not think to do that.

[Halftime Hope]

1 minute ago, Mrs Tiggywinkle Again said:

Literally NO ONE told me when I started Ozempic.  I googled but an elderly person might not think to do that.

That's such malpractice. Some people cannot tolerate those meds -- urggh!

[J-rap]

I'd look at any changes in her day-to-day life...  different foods, med changes, etc.   Sometimes even taking meds at a different time of day than before can change how your body reacts to it. 

I'm sure this is very unlikely and probably not the right season either, but I was just reading an article this morning about the lone star tick which can cause nausea and digestive issues, sometimes months after being bit.  I think it's caused by the tick bite somehow causing a red-meat allergy in a person.

I'd also think about something like vertigo or inner-ear related issues.  Sometimes the symptoms aren't so obvious (like dizziness) but plays out in nausea, similar to someone who gets carsick.  

There's also such a thing as a migraine that doesn't result in head pain, but in nausea.  (My dd had many bouts of this, probably for a couple years, before it evolved into head pain.)

Several elderly relatives in my family have put off surgery for smaller hernias for years (and one has chosen to not have surgery at all), and it never seemed to be much of a problem, so I'm not sure if I'd put that #1 on her list of things to do if it isn't bothering her much.

[gardenmom5]

1 hour ago, Halftime Hope said:

I wondered that, too, when I read it. But I thought surely her doc would have warned her...dumb assumption. She could have forgotten it too, but the medical providers later should be asking. ??

Talk to a PharmD. They have more drug training than MDs and they lecture MDs about drugs.  At least 2dd does. (but she works in a hospital. the nurses will call her too.)

I have had side-effects that are on the only found with a super deep dive into the obscure lists of possible allergies.  Most lists of side-effects don't have them.
e.g. the drug store had two? brands of temporary dental cement.  (you know for when your crown falls off . on a three day weekend.  At christmas and your dentist left town . . .glare). only one even mentioned that eugenol (ingredient in both) can trigger an allergic reaction.   yep . . I was popping benadryl like mad so I could breathe . . . Then for my adrenal support, I started taking one that had Holy Basil Leaf (in at least 50% of adrenal supports).  Gee, did you know that HBL contains - you guessed it! - eugenol!  - I had one person try to tell me it was impossible for someone to be allergic to it. Because it's "just a natural part of the leaf, and it's like cholorphyll".     . . some people's children . . .  (it's also in cloves - so I have to limit consumption of things using it. Like pumpkin pie . .  sniff)

[ktgrok]

On 3/30/2023 at 4:21 PM, Corraleno said:

Depending on the procedure, there can be real downsides to hiatal hernia surgery (like inability to belch or vomit), and the hernia can come back, so doctors generally don't recommend it unless the hernia is causing serious problems. Something like 2/3 of people over 60 have some degree of hiatal hernia (including me), and only a small percentage of those are candidates for surgery. Personally, I would try to eliminate all other possible causes of the nausea before resorting to surgery, especially since she has had the hernia for some time but the nausea is new.

This. Mine came back, and we are NOT planning surgery any time soon as after the first time I had a lot of issues with swallowing, to the point of dehydration being a real concern. 

On 3/30/2023 at 7:57 PM, Carol in Cal. said:

Zofran is helpful for nausea.  Sometimes anti anxiety meds are also helpful.

Also, some NPs can fix a hiatal hernia without surgery.  There is a maneuver that sometimes works, and sometimes they can teach it to you.

I can't see how any manipulation can repair the torn area?? I can see it helping reduce the hernia - move the stomach back into the abdomen and out of the chest, but as there is still an opening there I can't see how it would be kept from going back again? Most people have what is called a sliding hernia - it moves in and out of place. Mine does. 

On 3/30/2023 at 8:31 PM, Arcadia said:

I had the worse case of nausea with my asthma steroid inhaler in college. Once I stopped that and only used the rescue inhaler as needed, my nausea stopped. Ironically my asthma also got much better. Also, in my case, any medication that has nausea as a side effect even if it is rare would cause me to feel puky. So in your scenario, I would list out her medications and find out all the side effects and contraindications. My late mom had medications that have bad side effects so it was a trade off.

When I puked out my medication yesterday, gargling with coconut water (unsweetened) helped clear the vomit taste from my mouth. Then taking fish oil capsules helped calmed my esophagus down. Can your aunt take the unflavored protein drinks?

I'm betting you were aspirating stomach acid some, maybe even in your sleep, and that's why stopping made it get better. Aspiration of stomach acid is a known trigger. Not often acknowledged like it should be though. 

[ktgrok]

MOST diabetes meds can cause stomach upset/nausea. As can meds for cholesterol. 

Also, you said she's dealing with back pain, is she on any pain meds? Any/all of them can also cause upset stomach. 

I'd try to figure out what meds may be causing the problem before jumping to surgery in a 70 yr old who is now malnourished (so would heal slowly). 

[Arcadia]

37 minutes ago, ktgrok said:

 

I'm betting you were aspirating stomach acid some, maybe even in your sleep, and that's why stopping made it get better. Aspiration of stomach acid is a known trigger. Not often acknowledged like it should be though. 

I won’t be surprised. I always had stomach and puking issues from very young and all the amoxicillin and erythromycin taken probably made it worse. My parents didn’t know about taking probiotics during and after antibiotics or they would have bought probiotics for me. 

[Halftime Hope]

46 minutes ago, ktgrok said:

MOST diabetes meds can cause stomach upset/nausea.

The GLP-1 agonists can take it to a whole new level though.