DEAR DR. GOTT:
My grandson is 29 years old. He has been suffering with cyclic vomiting syndrome since his early college years. He is in and out of the hospital because of these episodes and is so thin I am afraid for him.
The doctors say there is no cure for this condition but I am holding out hope that someone in the medical profession knows something that can help him.
DEAR READER:
Cyclic vomiting syndrome (CVS) is a little known ailment. There is no known cause and it is not known how many people actually have the disorder. One study suggests that as many as one in 50 children may suffer from CVS. Because there are several disorders that can cause cyclic vomiting, many people are initially misdiagnosed until other disorders have been ruled out.
CVS can occur at any age but is most commonly starts in children aged three to seven. Adults with the condition tend to have less frequent but longer lasting episodes. Triggers, such as infection, emotional stress or excitement, colds, allergies, the flu and sinus problems, are common. Some may experience an episode after eating certain foods, too much or just before bed. Motion sickness, physical exhaustion, menstruation and hot weather can also trigger CVS.
Cyclic vomiting syndrome has four phases. The prodome phase is the signaling indicator. It is often marked by abdominal pain but some individuals may not have warning. Sometimes an episode can be stopped by taking medication as soon as signal symptoms begin.
The episode phase is the actual nausea and vomiting. It is usually accompanied by exhaustion, paleness, inability to eat, drink or take medication, and drowsiness. The recovery phase occurs once vomiting and nausea have stopped. Energy, appetite and a healthy color return. The last phase is the period between episodes when there are no symptoms.
Symptoms include nausea, vomiting and retching/gagging. Episodes generally start at night or in early morning and can last from a few hours to several (one to ten) days. Some patients may also experience listlessness, sensitivity to light, headache, dizziness, abdominal pain, fever, and diarrhea. On occasion the nausea and vomiting can be so severe that the sufferer appears to be nearly unconscious. Drooling and excessive thirst are also common.
There is no test for the diagnosis of cyclic vomiting syndrome and it is, therefore, diagnosed by exclusion, symptoms and medical history.
Your grandson’s doctor was correct that there is no cure but CVS can be treated. Getting adequate amounts of sleep and rest are important. Medication to prevent vomiting, stop an episode already in progress or relieve other symptoms may be necessary. If stopping an episode that has already started is not possible, supportive treatment is necessary. Allowing the individual to stay in bed and sleep in a quiet darkened room can be helpful. If symptoms are severe, hospitalization to prevent dehydration may be necessary as are sedatives if the nausea persists.
Complications of this disorder can be serious. Dehydration is the most common. As time progresses and more episodes are experienced, tooth decay, esophageal bleeding or injury and bruising of the stomach or tearing of the esophagus can occur.
Your grandson should be under the care of a gastroenterologist and closely monitored during an episode.
I also urge you and your grandson to learn more about the condition and perhaps join a support group. You can find helpful resources including up-to-date information from the Cyclic Vomiting Syndrome Association. You can contact them online at www.CVSAonline.org or by phone at 1-614-837-2586.
DEAR DR. GOTT: I am a physician and noticed a potentially serious error in the units of vitamin D recommended in a recent column. You used milligrams of D whereas I am sure you meant international units (IU). This could have serious implications if anyone were able to get their hands on 800 mg.
Please print a correction in your column.
DEAR DOCTOR: I would like to thank you for pointing out my error. I did, indeed, mean to use international units rather than milligrams.
I apologize for any confusion this may have caused my readers. Vitamin D, while necessary to life, can be dangerous in high doses. I urge everyone to discuss all medications, prescription, herbal, OTC or otherwise, with his or her physician before use to ensure the proper dosage and make sure it will not interact with any other medications.
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