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What Causes Abdominal Problems, Diarrhea And Vomiting?
Question: My son is 13. He started vomiting XXXXXXX 21, 2015. Then he got a really bad headache. He continues to vomit & have headache. Yesterday he started having diarrhea. We have been to express care they said virus. He has gotten dehydrated once so we spent the day at hospital getting fluids. He started having blurred vision and problems with his neck. We took him straight to ER they did MRI CAT Scan & lumbar puncture. Everything came back normal. They said his neck problem was just a muscle. He was having spasms or something at the hospital. It was very scary. They sent us to a children's hospital. They gave him more fluids & said he was having migraines. They referred us to pediatric neurologist. She did MRA & blood work. The MRA was normal. Blood test indicated high titers for mono & CMV also low white blood cell count. She added more meds to several he was already on. Took him off some also. His stomach started hurting worse than his head. They did CAT Scan of abdomen & EDG. Everything normal. He is still in pain in abdomen & head. Still throwing up & now diarrhea. He has missed 4 weeks of school. We are very concerned that he is not getting better & no medicine has helped. Do you have any ideas?
Brief Answer:
This needs a more thorough examination and new intellectual input.
Detailed Answer:
Dear XXXXXXX
I am so sorry for your son. I read your history with concern and am alarmed that despite all the tests that he has gone through, he doesn't seem to be improving. Clearly, something is being missed or is being overlooked. His symptoms seem to be generalised - there are head symptoms, abdominal problems, diarrhoea and vomiting. Someone would have straight-out thought of migraine, brain tumours, etc.
Since the doctors have already checked for these straight-forward things, I would suggest that they have a group input or discuss the problems of your son in a departmental meeting and go over the case till they reach a consensus.
I can think of a high blood-pressure causing some of the symptoms - did they check the BP properly? How much was it? What about a simple urine test? A urinary test for catecholamines is also warranted as diarrhoea and a high BP can occur when these chemicals increase in the urine due to some rare tumours in the body.
What about fever?
Children with a Mono titre or CMV are generally found to have HIGH WHITE CELL COUNTS and not low counts ... how have they explained the discrepancy?
You say he is on more and more medicines ... which ones? I need to know the generic names and the doses of each medicine that he has been given so far, as well as the time-line of each ... which one was started when, stopped when, and so on. You can easily prepare a time-line using plain paper and draw a horizontal line, marking days on it, and showing which medicines were used during which period, along with the symptoms corresponding to the dates therein ... then take a photo or scan the drawing and upload it here. It might also help to see his MRI scans. What is MRA? What is EDG?
I hope you will revert with the answers to the above questions as soon as possible.
Thank you and may God bless you and your family.
Dr. Taher
This needs a more thorough examination and new intellectual input.
Detailed Answer:
Dear XXXXXXX
I am so sorry for your son. I read your history with concern and am alarmed that despite all the tests that he has gone through, he doesn't seem to be improving. Clearly, something is being missed or is being overlooked. His symptoms seem to be generalised - there are head symptoms, abdominal problems, diarrhoea and vomiting. Someone would have straight-out thought of migraine, brain tumours, etc.
Since the doctors have already checked for these straight-forward things, I would suggest that they have a group input or discuss the problems of your son in a departmental meeting and go over the case till they reach a consensus.
I can think of a high blood-pressure causing some of the symptoms - did they check the BP properly? How much was it? What about a simple urine test? A urinary test for catecholamines is also warranted as diarrhoea and a high BP can occur when these chemicals increase in the urine due to some rare tumours in the body.
What about fever?
Children with a Mono titre or CMV are generally found to have HIGH WHITE CELL COUNTS and not low counts ... how have they explained the discrepancy?
You say he is on more and more medicines ... which ones? I need to know the generic names and the doses of each medicine that he has been given so far, as well as the time-line of each ... which one was started when, stopped when, and so on. You can easily prepare a time-line using plain paper and draw a horizontal line, marking days on it, and showing which medicines were used during which period, along with the symptoms corresponding to the dates therein ... then take a photo or scan the drawing and upload it here. It might also help to see his MRI scans. What is MRA? What is EDG?
I hope you will revert with the answers to the above questions as soon as possible.
Thank you and may God bless you and your family.
Dr. Taher
Above answer was peer-reviewed by :
Dr. Raju A.T
MRA is special MRI that shows blood vessels in the brain. EGD is scope to look at esophagus and stomach. I can't find any where to upload medicine list. So I will try to type it. As of yesterday he was taking Topamax 50mg 1 morn 3 night. Wellbutrin 300mg 1 morn. Protonix 40 mg 1 morn. Carafate 1GM every 6 hours. Compazine 10 mg every 6 hours. Benedryl 25 mg every 6 hours. Midrin every 4 hours. Toradol 10 mg as needed for pain. Imitrex 50 mg at onset of migraine. We talked to our primary care physician today & he said he's taking to much medicine. He told us to stop Midrin, reduce topamax to 1 morn 1 night. Stop benedryl. Reduce compazine to 1 morn 1 night. Continue carafate. Continue protonix. Continue Wellbutrin. When this started he took Zofran for nausea. It didn't work so they switched to reglan. It worked as far as him not vomiting for 6 days but still had abdominal pain. They gave him Ativan .5 mg in ER. It help ease headache a little. Neurologist gave him Ativan 1mg to see if it would ease it again but it didn't work. He has taken tramadol for pain didn't work. He has taken fioricet for pain didn't work. Headache has went down on pain scale from 7 to 5. Abdomen has went from 5 to 7. He blacks out sometimes for about 5 seconds. I thought at first it was because he got up to fast but it has happened when he's sitting and laying. His bp has been normal. He has never had fever. Sometimes he looks flushed like he has a fever but he doesn't. Most of the time he's pretty pale. He sleeps a lot. He says it helps to lay down. The head pain is behind both eyes. We have had him checked by eye dr. He said everything looked good. Our primary physician suggested today we take him to a children's specialty hospital to see if they can figure out what's going on. The neurologist says we should take him to GI Dr. We just don't know what to do. We are very concerned. He's a good boy. He was making good grades until he got sick. Now he's getting farther & farther behind. We have a meeting with school Tuesday to try and figure out how to help him so he doesn't have to repeat grade. I'm definitely relieved that you think more needs to be done. Because my husband & I do also. We just don't know what. Thank you!
Brief Answer:
I think he is still on too many drugs
Detailed Answer:
Dear XXXXXXX
The main issue here is the combination of symptoms of headache even when he is lying down, vomiting and some episodes of diarrhoea. With a normal BP, rarer causes of headache seem to have been ruled out. The physicians looking after him seem to be right in surmising that this might still be just migraine; however, if that is so, I think he is still on too many drugs!
I would suggest that you arrange for an appointment with a specialty Pediatric Hospital where pediatric specialists of all kinds would be available. At this point of time, I really cannot do any guess-work. As you say, he seems to be responding to the present line of treatment. I understand that you are under pressure regarding his school performance. However, when you look at it in the right perspective, the possible loss of one academic year is not something that will destroy his life or his career; an undetected growing illness is much the worse alternative, wouldn't you agree?
If you are religious, and more important, if he is, too, then do resort to prayer. You will be surprised at the power of suggestion that prayers bring.
I analysed your child's medicines. It appears that there is one line of medicines here that would cater to his vomiting (i.e. the gut) (the Carafate, the Reglan, and the Protonix), and the other line catering to the possibility that this is all due to migraine (the rest of the medicines); in addition, there are anti-depressants and anti-anxiety drugs (Wellbutrin and Ativan) and pain-killers of all shades and power (Toradol and Midrin). You need a good doctor and not a primary care physician to figure out which group of medicines need to stay and which need to be removed. For example, it is a good idea to use Wellbutrin for a short while, but not for long if there is no depression here. For another. a call should be made on whether it is all GI or all migraine ... we cannot continue ALL groups of medicines for ALL time. A trial of eliminating one group is not such a bad idea as it will give the doctors time to re-consider the diagnosis, and will allow your son and the both of you to breathe a bit and see where the thing is going. However, this trial MUST BE UNDER MEDICAL SUPERVISION.
I will await your follow-up question as and when the need arises for you to contact me. Be blessed.
Dr. Taher
I think he is still on too many drugs
Detailed Answer:
Dear XXXXXXX
The main issue here is the combination of symptoms of headache even when he is lying down, vomiting and some episodes of diarrhoea. With a normal BP, rarer causes of headache seem to have been ruled out. The physicians looking after him seem to be right in surmising that this might still be just migraine; however, if that is so, I think he is still on too many drugs!
I would suggest that you arrange for an appointment with a specialty Pediatric Hospital where pediatric specialists of all kinds would be available. At this point of time, I really cannot do any guess-work. As you say, he seems to be responding to the present line of treatment. I understand that you are under pressure regarding his school performance. However, when you look at it in the right perspective, the possible loss of one academic year is not something that will destroy his life or his career; an undetected growing illness is much the worse alternative, wouldn't you agree?
If you are religious, and more important, if he is, too, then do resort to prayer. You will be surprised at the power of suggestion that prayers bring.
I analysed your child's medicines. It appears that there is one line of medicines here that would cater to his vomiting (i.e. the gut) (the Carafate, the Reglan, and the Protonix), and the other line catering to the possibility that this is all due to migraine (the rest of the medicines); in addition, there are anti-depressants and anti-anxiety drugs (Wellbutrin and Ativan) and pain-killers of all shades and power (Toradol and Midrin). You need a good doctor and not a primary care physician to figure out which group of medicines need to stay and which need to be removed. For example, it is a good idea to use Wellbutrin for a short while, but not for long if there is no depression here. For another. a call should be made on whether it is all GI or all migraine ... we cannot continue ALL groups of medicines for ALL time. A trial of eliminating one group is not such a bad idea as it will give the doctors time to re-consider the diagnosis, and will allow your son and the both of you to breathe a bit and see where the thing is going. However, this trial MUST BE UNDER MEDICAL SUPERVISION.
I will await your follow-up question as and when the need arises for you to contact me. Be blessed.
Dr. Taher
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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