Q: My 94-year-old Mom recently fell and fractured her pelvis in two places. The last three years she has been having problems with food coming back up on some occasions but since her fall she is having a difficult time keeping food and liquids down at all.
She was hospitalized for dehydration and they did a scope to make sure there was no blockage. There is no structural reason for the food to come up. She is on Levothyroxin, Omeprazole, Spirono/HCTZ, Hydroco/APAP and Fentanyl patch for arthritic back pain, aspirin, folic acid for anemia, a stool softener with laxative, Milk of Magnesia, SMZ-IMP 400/80 for a recurring bladder infection and cranberry tablets.
A: Initially, any trauma to the human body can lead to a variety of problems. When that person is 94 years old, that trauma may be frightening, disturbing, exhausting and difficult to deal with, leading to digestive issues, diarrhea, hypertension, dietary modifications, and more. In your mother’s case, she has had difficulties in the past with regurgitation that appear to have exacerbated since her fall.
Regurgitation is the act of swallowed food returning back into the mouth that may be voluntary or involuntary. Vomiting is the forceful act of food from the stomach out of the mouth. There are a number of reasons for regurgitation to occur, including an esophageal stricture that has apparently been ruled out, gastroesophageal reflux disease (GERD), esophageal diverticulum, Zenker’s diverticulum, Barrett’s esophagus, pyloric stenosis, a hiatal hernia, and the simple act of bending over. Vomiting might be caused by stress, fear, medication, a reaction to specific smells or odors, gastroparesis, the ingestion of tainted foods, cardiac issues and gastritis, leading to weakness and confusion because of a loss of electrolytes, abdominal pain and swelling, back pain, cough, chills, blurred vision, nausea, digestive symptoms, a rapid heart rate, blood in the stool because of bleeding in the esophagus, and a great deal more.
Omeprazole, one of her many drugs, is prescribed for symptoms of GERD and other conditions caused by an excessive amount of stomach acid. It is generally well-tolerated, however common side effects can occur when it is taken long-term and may include stomach pain, gas, vomiting, nausea and mild diarrhea. Spironolactone, a diuretic, can cause gas, stomach pain, mild nausea and vomiting. Hydrocodone/APAP with acetaminophen is a moderate-to-severe narcotic pain reliever that can cause nausea, vomiting, headache and, for those in your mother’s age group, liver failure. Fentanyl is another narcotic pain medication. If she requires both hundrocodone/APAP and Fentanyl for control, the pain may be severe enough to cause confusion and regurgitation. Both meds are very constipating. Aspirin can also cause severe nausea, stomach pain and vomiting. Over the counter Milk of Magnesia reduces stomach acid that is reported to cause nausea and vomiting.
Treatment for regurgitation depends on how severe it is and whether symptoms are present, while the treatment for vomiting might include hydrating with electrolytes, clear liquids, and avoiding solid foods until the vomiting has subsided. Perhaps your mother would do better by eating more frequent, smaller meals throughout the day, rather than three larger ones. She should be encouraged to take her time and eat slowly. She should rest following each meal, with her head about 12 inches above her feet if she is in a reclining position. She might drink liquids between meals, rather than at the same time and if possible, should increase the amount of water she drinks daily. And, without question, I strongly feel you should make an appointment with her physician, bring a list of her medications for review and attempt to determine if one or more might be at the base of her regurgitation/vomiting problem. Perhaps by changing to another drug in the same category or eliminating one drug at a time, you can resolve things. Good luck.
