Cyclical vomiting syndrome - page 5

by thelema13 12,344 Views | 45 Comments

Anybody encountered a patient with this diagnosis? I had a pt come in the other day, report of vomiting x23 during past 4 hours, severe pain 10/10 in abdomen, letter from GI doctor stating she was diagnosed with cyclical vomiting... Read More

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    You only get opioid withdrawal when you've been taking them regularly for an extended period of time. Daily opioid consumption is not indicated for CVS, as the abdominal pain only occurs during a cycle, so the risk of the person with CVS developing opioid dependence is not the same as someone with some kind of chronic pain syndrome.

    Many people with CVS don't ever go to the ED. When in their prodromal stage, they simply take ibuprofen or Tylenol and some Zofran and go lie down in a darkened room.

    Migraines run in my family, and not a single one of my family members have ever gone to the ED for their migraine. Not one.
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    Quote from ~*Stargazer*~
    Migraines run in my family, and not a single one of my family members have ever gone to the ED for their migraine. Not one.
    You and yours are an exception to the bunch. The general public come to the ED for things that are non-emergent, we all know that.

    This lady may have had CVS, she may not. It was her adamant demands for dilaudid that raised me eyebrow. She would wretch whenever someone left the room, but showed no s/s when walking to the door and nurses station, begging and demanding dilaudid. The doc offered non-narcs, she refused. I am not an MD, but I'm pretty sure she was seeking. All the usual GI meds seemed to have no effect. I had never even given tigan before this lady, haven't given it since. She was just dead set on her dilaudid.
    wooh likes this.
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    Quote from thelema13
    You and yours are an exception to the bunch. The general public come to the ED for things that are non-emergent, we all know that.
    Two things: First, me and mine are part of the general public. Second, I don't have any stats to back this up, but I would be willing to bet that only a small minority of the general public uses the ED for nonemergent complaints.

    As for your patient, it's easy to wonder why someone in so much discomfort would be dead set on one specific drug; it's easy to think that they would be willing to try ANYTHING, so long as it works. But once a person gets it in their mind that "X" is the only thing that works, you'll be hard pressed to convince them otherwise.

    This perception of hers that Dilaudid was the only thing that would help her could have been based upon experience, or it could have been an idea that got stuck into her head somehow and she latched onto it. It's hard to know, unless you're the one in her shoes.
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    Ill start by saying that thanks to my Primary care doc, my life is getting better now that I have a way to treat myself at home with dilaudid 4mg and 25mg of Benadryl (if I take it at the very first signs of an impending attack). I have lived the last 10 years of my life in absolute fear. Imagine never being able to go out to dinner, take a camping trip, or even go on vacation without the fear of having an attack and facing the possibility that you may just have to suffer in pain for endless hours because an ER doc refuses to treat you. It sucks to say the least. I've been treated with every combination of drugs and various forms of treatment... so when I ask for dilaudid and benadryl, it's because I know from hard experience what works and what doesn't. I used to be treated with nubain and phenergan and that worked, but it wrecked me for hours afterwards, sometimes even a day to clear the fog. A small 2mg dose of dilaudid and 25mg of Benadryl via IM or IV is very effective and I go from wretching in pain to sitting up talking, feeling very clear headed in 5-15 minutes. A CVS attack can last for hours on end and there is nothing short of pharmaceutical drugs administered via IV or IM that will give you relief. Most experts agree that the source of CVS is the brain and most of the time attempting to treat it more as a GI problem does very little if anything to stop an attack. And to comment on patients drinking water during an attack, it's because stomach acid and bile both tastes like hell and burns, drinking water helps dilute the horrible mix of fluids being forced up. Forced vomiting helps patients as well because it momentarily causes an endorphine rush that for a short time will give you a little relief from the pain. And to add one last point, when you are in as much pain as I am or any true CVS sufferer and a Dr refuses to treat you it is unbelievably maddening and can cause a rage that would have even the most saintly person cursing at a Dr. I believe there are people out there who abuse drugs and the ER, but that isn't the case for people truly suffering from CVS. So next time you encounter a patient with this debilitating condition, please treat them with a little more care and compassion, because we sure don't want to be in the ER being poked and prodded at, and we damn sure don't like being called, or treated like drug addicts.
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    Well, thank your primary care doc for me, too. This is where treatment for chronic conditions needs to be handled, not in the ED which is for the purpose of treating acute threats to life or limb. I am sincerely glad to hear you've found a primary care provider who is willing to step up to the plate instead of punting you to the ED.
    Altra, Medic2RN, Pixie.RN, and 1 other like this.
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    I'm glad your PCP helped you prm. I wish more would help patients with this syndrome. I think it would reduce ER visits due to this problem. Many PCPs don't, so where are these people suppose to go.

    One of the CVS patients who was a frequent flyer in our ER finally got the right treatment. The patient showed up at our ER in the same condition and I requested that he be placed in one of my rooms. Fortunately, the ER Doc decided to actually admit him because something concrete for this guy had to be done. His PCP wasn't doing it for him.
    I saw him not too long ago (not as an ER patient) and he looked great and was overjoyed that the doctors had helped him where he no longer had to go to the ER when an attack occurred. He thanked me for being understanding of his medical condition and said that he hopes to never see me again. (I knew what he meant).

    More PCPs need to take the initiative to nip it in the bud, so to speak.