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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31618
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I had shoulder surgery July first and started getting nausea

Customer Question

I had shoulder surgery July first and started getting nausea a coulple after surgery after I started taking tramadol which I stopped taking after about a week. It now September and I still have nausea. I have had MRI C Scan, and endoscopy and 5 blood tests. Endoscopy showed a small ulcer and some gastritis. Treatment has not helped. Before the nausea would come and go. Now I have it all the time. It extends from the upper abdomen into my throat and radiates into my head. Any ideas?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello,

I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

I would consider following for the nausea you are experiencing;

1) Esophageal spasm
2) Esophageal motility disorder
3) Esophagitis

4) Gastroesophageal reflux disease (GERD)

Following treatment may help you;

a) Calcium channel blockers (diltiazem, nifedipine) decreases the spasm and improves the movements of the esophagus.
b) Relaxation techniques.
c) Esophageal spasm and esophageal movement disorder (dysmotility) often shows good response to antireflux therapy, even in the absence of typical gastroesophageal reflux symptoms.
d) Reassurance and control of anxiety if present.

Anti reflux therapy is;

1) antacids; Maalox

2) acid blocker; Prilosec

3) loosing weight, if overweight.

4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products

5) avoiding large meals. Eat 5 small meals in a day.

6) wait three hours after the meal before you sleep.

7) elevate head end of the bed by 8 inches.

Following also would be helpful;

A. Herbs;

1) Cranberry
2) Peppermint

B. Homeopathy

1) Nux Vomica
2) Pulsatilla

C. Nutrition and supplements;

1) Multivitamin; vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
2) Probiotic supplement
3) Omega 3 fatty acid
4) Avoid; cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.

5) Also avoid; white breads, pastas, and especially sugar, red meats,
6) Eat lean meats, cold water fish, tofu, beans, olive oil

Helpful investigations to establish and confirm the diagnosis are;

1) Esophageal manometry; evaluates esophageal motor pattern.
2) Esophagram / Barium swallow
3) Ambulatory esophageal manometry
4) CT scan of the chest.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Nausea is the unpleasant, painless sensation that one may potentially vomit. Nausea significantly affect quality of life. The causes of nausea and vomiting are iatrogenic (doctor induced like medicines), toxic, or infectious causes; gastrointestinal disorders; and central nervous system or psychiatric conditions. Following are the main causes (apart from what we had discussed above);

A. Central nervous system

1) Migraine

2) Space occupying lesion in brain (Mass lesion)

3) Labyrinthitis

4) Ménière's disease

5) Pseudotumor cerebri

B. Gastrointestinal symptoms;

1) Gastroparesis

2) Irritable bowel syndrome

3) Non ulcer dyspepsia

4) Peptic ulcer disease

5) Cholecystitis/cholangitis (gall bladder problems)

6) Hepatitis (liver inflammation)

C. Hormonal

1) Thyroid disorders

2) Diabetes

3) Adrenal disorders

D. Psychiatry disorders

1) Anxiety

2) Depression

3) Conversion disorders

E. Infections.

Chronic nausea is usually a pathologic response to any of a variety of conditions. Gastrointestinal etiologies include obstruction, functional disorders, and organic diseases. Central nervous system etiologies are primarily related to conditions that increase intracranial pressure, and typically cause other neurologic signs. Numerous metabolic abnormalities and psychiatric diagnoses also may cause nausea and vomiting. Evaluation should then turn to identifying the underlying cause and providing specific therapies. When the cause cannot be determined, empiric therapy with an anti vomiting (antiemetic) medication is appropriate.

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