Living with Nausea: My Story in Six Charts

Fwiw: Strenuous winter activities (eg mountain hiking and camping) can more than double baseline calorie demand. Sitting down to a base camp meal afterward can be a body-has-a-mind-of-its-own saliva-gushing "FEED ME NOW!!!" experience of really-need-to-pee intensity. Normally unappealing food commonly becomes just fine - uncooked pasta, blocks of lard, whatever. So I wonder... what happens if food-is-nauseating is repeatedly hit with a hammer of the "are you going to eat that vomit, or can I please have it? - it looks quite yummy" of extreme calorie appeal?

Another thought is the breastfeeding maternal-diet envelope expansion drill, of working outward from some one bland safe thing, experimentally adding a thing at a time, and backing off upon problems.

> After four hours, I should have had 10% or less in my stomach but in December 2023, I had 41% remaining, which indicated gastroparesis. [...] The second study I had in September 2024 showed 8% remaining, at which point my gastroparesis was considered resolved but my symptoms persisted.

I have a pet hypothesis that a non-trivial chunk of the "problems" discovered with medical testing are not actually problems but just expressions of the surprisingly wide variation in how humans work. Maybe this was just a thing that happened and not a condition that auto-resolved?

> In August 2024, I learned of a clinical trial [...] Ultimately, the medication didn’t have any positive impact on my nausea but also didn’t cause negative side effects.

Did you end up in the placebo arm, perchance?

Persig argues that the problem is more than just point in time vs continuous, it's that the typical mechanic doesn't care, they are neither careful nor interested. It's the same with doctors. Unless you have something straightforward: a tumor, a broken bone, a bacterial infection, etc... it is quite difficult to get a doctor _interested_ in solving a difficult problem. They don't have time for you and they aren't interested in subtlety.

If your problem can't be addressed with antibiotics or pain meds, then it's "let's try SSRIs for the next six months and see how it works".

I know someone who semi-specializes in treating GI conditions that present like this (unknown cause, vague diagnosis). It's a very difficult area to work in because non-specific GI symptoms can be the result of a wide range of things, from physical obstructions to nervous system problems and even stress.

This blog post is great because the author keeps an open mind. One of the challenges with functional conditions that can possibly overlap with mental health is that some people (not this author, speaking generically) become extremely defensive at any suggestion that the condition might be related to stress, anxiety, or depression. My friend has a whole strategy of asking questions about the person's life, job, relationships, and life changes around the time the condition started. With surprising frequency, patients will remember the start date of their GI conditions specifically because it happened near something stressful (death in the family, layoffs, new job, etc.). I don't think this applies to the blog author, but keep in mind for anyone else reading this with similar symptoms.

Stress-triggered conditions have a bad property of becoming self-reinforcing. The initial stressor might be gone, but the person is stressed about the constant problems with their conditions. Understandably so!

She says it's common to have people spontaneously get better when they get a new job, go on a long vacation, enter a new relationship, or other large life changes. It's also common for patients to start SSRIs with another provider and "coincidentally" the GI symptoms get better. It's also common for other providers to blindly prescribe medications that worsen GI symptoms if they aren't paying attention.

The hard part for her broaching the subject with patients who don't want to hear it. There's a huge resistance to any path of inquiry that patients think as "all in your head" diagnoses. It's understandable, but at the same time most people don't understand that your nervous system operates throughout the body (not just the "head" or brain) and the activity of the GI system is heavily modulated by the nervous system.

The author explicitly mentions they collected all this data hoping it would be valuable to the specialists they have seen, but found they consistently were uninterested in it — an experience I can say is nearly universal for chronic illness sufferers I know in the US.