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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Chronic Vomiting In A Child

As a baby she vomited a lot after she would drink a bottle but she was growing and gaining weight so her doctor said he thought that it would improve as she got older and her sphincter muscles became stronger. As she got older it did pretty much go away so I thought he was right. Around the age of 13 or 14 she started having episodes where she would vomit constantly for about 7-10 days. She would keep absolutely nothing down but she didn t feel sick..So not like a stomach virus. This occurred frequently so we went through many tests. Upper GI s etc. She tested negative for celiac disease and food allergies and they never found anything. The only thing that ever flagged was her serum amylase would be high. All other pancreatic enzymes were normal. We tried her on a gluten free diet which seemed to help a little ( now I know this helped some because of her eliminating a lot of the products enriched with folic acid) I work in a laboratory so I am fairly familiar with lab normals. She was a majorette and performed in numerous parades from the time she was 5 until about two years ago when she could no longer make it through a parade without nearly passing out. At around the same time she started to become very anxious and emotional. She had a couple panic attacks and started not wanting to go to school. She was unable to explain why because she had no rational reason. My daughter and I are extremely close she is my best friend and I am 100% sure that there was no bullying or arguing with friends or the typical high school girl drama causing any of the issues. She was well liked, a straight A student in honors classes. Her only issue evident to me was she was too hard on herself and pushed herself too hard. Even as a freshman she was stressing over getting into an ivy league college so I know her college choices etc stressed her some, but that was it. She spent the last half of her senior year on homebound because of her illness.I took her to another doctor, a counselor and a psychiatrist to try to figure out what was going on. The psychiatrist spent a whole 15 minutes talking with her ( all of which i was present for) and basically asked her which anti depressant she wanted to try. I asked him if we could at least do some blood work before we rushed into that. So he agreed basically just to appease me. This time her amylase was still elevated and also her folic acid level. Two different doctors told me that was fine.,but being her mother and knowing that she did not take any supplements and that her diet was that of a typical 18 yr old I still found it unusual so I did my research and discovered the MTHFR mutation. I requested that another doctor order the test for the MTHFR mutation she disagreed with me and insisted she have a HIDA scan because she was sure it was her gall bladder. I agreed to the testing, but insisted she still order the MTHFR mutation test. She did. It was no big surprise when the MTHFR came back positive and the HIDA scan was completely normal. She on the other hand said that it was fine because it was heterozygous. I immediately started her on methyl b12 and eliminated products enriched with folic acid from her diet. The vomiting for weeks was apparently due to her body detoxing itself ( if what I read was correct not only does the folic acid build up but it could also cause build up or deficiencies of other things like copper, iron etc. ) So with the methyl b12 and diet change the anxiety went away, the vomiting stopped, she graduated with high honors from high school. Received a full scholarship to college and is now in her second semester. Sounds like a happy ending right? Well here s where it gets tricky. Her mood swings are starting back, she is extremely emotional and stresses constantly. I know she cheats occasionally on her diet, but not alot. It is hard to find things she can eat that she actually wants to eat in a college cafeteria. So she is basically attempting to prepare her own meals in between her classes. She is pre pharmacy so it s a heavy load. Now she is once again vomiting every time she eats. This happens even when she is not eating any folic acid. We are on at 4 weeks now and no signs of it stopping.
Mon, 13 Jul 2015
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Pediatrician 's  Response
Hi dear,
I understand your concern,she should get examined for uric acid, liver tests,B12, folic acid,stool culture, stool for cyst and ova, ultrasound of abdomen. I suggest domperidone 1 tablet 15 min before meal for 1 month.
Follow Pezner's diet 1, avoid uric acid enriched food, take Citrarginine 1 ampule resolve with water 2 times before meal for 10 days
Hope it helps
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Suggest Treatment For Chronic Vomiting In A Child

Hi dear, I understand your concern,she should get examined for uric acid, liver tests,B12, folic acid,stool culture, stool for cyst and ova, ultrasound of abdomen. I suggest domperidone 1 tablet 15 min before meal for 1 month. Follow Pezner s diet 1, avoid uric acid enriched food, take Citrarginine 1 ampule resolve with water 2 times before meal for 10 days Hope it helps