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DEAR DR. ROACH: My son started having gastrointestinal problems in high school. Approximately three years ago, they became so intense that he couldn’t work. Last May, he finally had surgery for gastric reflux. This helped with the persistent vomiting, but he is still experiencing intractable nausea. After a year of tests and trials of every anti-nausea medication known, he finally was told that he has cyclic vomiting syndrome. He also was told, basically, “We don’t know how to treat it.”
He currently is on a trial of a tricyclic antidepressant, but wasn’t given much hope that it would help. Could you suggest any possible treatment? He is only 28, and I can’t imagine him living with this and not being able to work or participate in life forever after. – M.S.
ANSWER: Cyclic vomiting syndrome (CVS) is best described in children, but is certainly described in adults. It is called “cyclic” because there are periods of multiple vomiting episodes (lasting from one day to a week) interspersed with periods of completely normal health. Children have 12 cycles per year on average, while adults have four. CVS has been associated with migraine headaches, and treatment for migraines is sometimes successful in treating CVS, so it’s possible CVS represents a variant of abdominal migraine.
CVS is a difficult diagnosis to make, as it can be easily confused with other causes of recurrent vomiting. Both children and adults often go a long time with incorrect diagnoses, sometimes getting surgeries, like your son did.
Treatment should be administered by a clinician experienced in this condition, and unfortunately, that doesn’t seem to be the case with your son. In one series, 3 in 17 adults with CVS had a complete response to tricyclic antidepressants, but 13 had at least some response. So I would hold out more than just a little hope for some benefit. Other medications that have been tried include sumatriptan (normally used for migraine), ketorolac (a powerful anti-inflammatory medicine) and prochlorperazine (usually used for nausea, and I’m sure your son would have tried it).
I would strongly suggest you contact the Cyclic Vomiting Syndrome Association to get more information and suggestions for an expert in your area, at www.cvsaonline.org.
DEAR DR. ROACH: I have noticed that the medical profession uses a number of standard words in different ways. For example, “negative” is usually good, and “positive” often is bad news. – N.M.G.
ANSWER: It’s true that we in medicine use words differently than they are used conversationally. “Negative” and “positive” are examples: We would like the biopsy to be negative for cancer, and if the HIV test is positive, that’s not good. Doctors also use the word “complaint” to describe the patient’s chief concern; it’s not that we think people are being annoying.
DEAR DR. ROACH: Can skim milk or oat bran cause gas? – J.R.
ANSWER: Both certainly can cause gas. Skim milk contains the milk sugar lactose, to which many people are intolerant. In mild cases, it causes some gas; severe cases can cause diarrhea. Oat bran is a good fiber source, and all good sources of fiber can cause gas, especially if taken in amounts that are greater than the person is used to.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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