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Forum Name: Psychiatric Topics

Question: Daughter's recurrent vomiting,medical or psychological?


 marianne - Mon Aug 01, 2005 5:11 pm

I am from the Philippines and I need your help.My daughter,11yo, has been in and out of the hospital starting April this year. Her first admission was because of chronic case of measles. Two wks after, she started vomitting. We admitted her to the hospital and doctors said there was fecal impaction.But after finally defecating everything she still didnt stop vomitting.Ultrasounds,xrays,upper gi series and lab tests all negative. On the sixth day,she stopped vomitting. We were discharged with no proper diagnosis,she was given antacids for 2 wks. However, she started vomitting again after the 2nd wk. We admitted her to a big city hospital better equipped and with specialists. She underwent endoscopy, ecg(to check if its neurological), xrays, lab tests - still negative. Except for a slight esophagitis as a result of the constant vomitting, not the cause and a little amoeba findings in her feces but still not the cause. Finally, a psychiatrist saw her and we were told she developed an illness trauma and a depression. We were advised to seek psychiatric help and we were discharged. Upon discharge, my daughter stopped vomitting. We all did everything to cheer her up and she started to be back to her self, she was laughing and singing again. Then we went to another city to have her seen by a psychiatrist. Even on the road, she started vomitting again. Said didnt want to see a doctor but we insisted anyway. She didnt stop vomitting all the way even in the clinic. She didnt say a word to the psychiatrist. The doctor advised me to attend sessions for my daughter. The vomitting did not stop for a week. We didnt admit her to the hosp but had her IV'd at home. School was starting then and she was in high spirits again. She's a brilliant pupil, among the top of her class. All this time though, she's having difficulty sleeping and she's itching all over her body. She cant sleep unless we rub/scratch her back, her legs, her feet. And she's also perspiring excessively esp in the back. She's always complaining, haughty to her sisters( there are 3 of them). Then came my schedule to the psychiatrist( 1st wk of July). She didnt want me to go but i went anyway. When I came back, she seemed happy and okay but two days later, she started vomitting again. Again, this lasted for about a week.Then last weekend I went out of town to see my ob-gyn, I am pregnant, 13 wks. Again, she didnt want me to go, was always calling me on the phone insisting I go home right away.I was only gone for a day. When I came home, she didnt seem sad or depressed, but the day after, that was Sunday (july 31), she started vomitting again. She is still vomitting up to now. And it is so painful to see her this way. She woke up crying and hugging me. Said, her tummy is aching again and that she doesnt want to be sick anymore. Asked why it is always coming back and why this is happening. She said she doesnt like to vomit anymore, asked if God is punishing her. Help me, please. I don't know what to do anymore, I am so
at loss. My daughter is losing weight so much, she is only 22.5 kls now and I could see sadness in her eyes. Please, what is happening to my daughter? I don't think it is my pregnancy that is troubling her bec. she was already vomitting even before I got pregnant. If there is someone there, who could enlighten me, please, I plead you to give me insights. Is this a medical case or psychological? I want to bring her to the best hospital in the country for further tests but I am afraid that if this is indeed psychological, this might only aggravate her case. She is vehement she doesnt want to see a doctor. I am so at loss. I need your help. Thank you.
 Dr. R. Perala - Thu Aug 11, 2005 11:03 pm

When I read your post, my first instinct was that this was a disorder called cyclical vomiting syndrome. This syndrome typically affects pediatric patients (around your daughters age) and is characterized by episodes of severe nausea and vomiting. Children with this disorder tend to have bouts of vomiting (usually 5-6 times per hour) that last for 24 hours to 4 days, and occur at intervals of 1 to 2 times per month. Between the episodes they are perfectly healthy. The episodes are usually very similar in symptoms and duration. The cause of cyclical vomiting syndrome is not known, but the syndrome is strongly associated with migraine headaches and is thought to possibly have, like migraine, a serotonergic origin (caused by abnormal serotonin activity) . In fact, cyclical vomiting syndrome is sometimes called "abdominal migraine". It is a rare disorder, but is worth looking into at this point, after organic causes have been ruled out and no other explanation can be found for your daughter's symptoms. Please see a pediatric GI specialist regarding this possibility. Let me know how everything works out!

Reid Perala MD
norman.perala@case.edu

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