I'm an ER doctor. I'd like to provide you with my perspective and I'm going to apologize in advance if this is too harsh. Cyclic vomiters are brutal patients. They feel sick as shit and they look like garbage (but who wouldn't be after vomiting for hours?). But as far as the ER goes, here's the problem -- they're actually completely fine. Very rarely are there any electrolyte abnormalities, very rarely are there any acute intraabdominal complications (Boorhaves, perforation, gallbladder pathologies).
Additionally there is a massive psychologic component to this (which is likely warranted - I wouldn't want to feel this way.) This leads to crying, anxiety, occasional hysteria and sometimes abusive behavior to the ED staff. This also applies to the patients families.
The combination of "not sick" + "psych" + "emotional" leads these patients to get decreased priority by the ED docs and nurses. (Why dote on the annoying 20 year old when you can help the actually septic grandma or dispo the 5 other people in the waiting room.) This is a vicious cycle.
My recommendation to you and people like you is to come up with a plan before you visit the ER. Discuss this with your doctor and have him/her type a letter up for you. We had a few cyclic vomiters who frequented the ER where I trained - they were brutal patients. One day one of them, his family, and the PCP got a plan together. He came in with a letter saying something along the lines of: "I have CVS. What works for me is 2L NS bolus, zofran 8, reglan 10, benadryl, random pain med, check Chem7. Re-evaluate in 1hr. If not better try haldol. Re-evaluate in 1h. If not better: Admit to Dr. Hospitalist." Suddenly things became so much better. We always ruled out stuff as necessary, but this massively improved the patient's, family's, and ED staff satisfaction with his care. Please come up with a plan like that for yourself and discuss with your PCP before you end up pissing off your local ER. (This plan should be written up and signed by a doctor. There's a good chance we will not believe you if you say I need lots of morphine and IV benadryl.)
Best of luck to you!
PS - Please don't try marijuana. Cannabinoid induced hyperemesis syndrome is also a thing. Those guys are just boneheads. (If you think the ER staff scoffs at cyclic vomiters, wait till you see what happens if your tox screen shows marijuana.)
drjerk17 karma
I'm an ER doctor. I'd like to provide you with my perspective and I'm going to apologize in advance if this is too harsh. Cyclic vomiters are brutal patients. They feel sick as shit and they look like garbage (but who wouldn't be after vomiting for hours?). But as far as the ER goes, here's the problem -- they're actually completely fine. Very rarely are there any electrolyte abnormalities, very rarely are there any acute intraabdominal complications (Boorhaves, perforation, gallbladder pathologies).
Additionally there is a massive psychologic component to this (which is likely warranted - I wouldn't want to feel this way.) This leads to crying, anxiety, occasional hysteria and sometimes abusive behavior to the ED staff. This also applies to the patients families.
The combination of "not sick" + "psych" + "emotional" leads these patients to get decreased priority by the ED docs and nurses. (Why dote on the annoying 20 year old when you can help the actually septic grandma or dispo the 5 other people in the waiting room.) This is a vicious cycle.
My recommendation to you and people like you is to come up with a plan before you visit the ER. Discuss this with your doctor and have him/her type a letter up for you. We had a few cyclic vomiters who frequented the ER where I trained - they were brutal patients. One day one of them, his family, and the PCP got a plan together. He came in with a letter saying something along the lines of: "I have CVS. What works for me is 2L NS bolus, zofran 8, reglan 10, benadryl, random pain med, check Chem7. Re-evaluate in 1hr. If not better try haldol. Re-evaluate in 1h. If not better: Admit to Dr. Hospitalist." Suddenly things became so much better. We always ruled out stuff as necessary, but this massively improved the patient's, family's, and ED staff satisfaction with his care. Please come up with a plan like that for yourself and discuss with your PCP before you end up pissing off your local ER. (This plan should be written up and signed by a doctor. There's a good chance we will not believe you if you say I need lots of morphine and IV benadryl.)
Best of luck to you!
PS - Please don't try marijuana. Cannabinoid induced hyperemesis syndrome is also a thing. Those guys are just boneheads. (If you think the ER staff scoffs at cyclic vomiters, wait till you see what happens if your tox screen shows marijuana.)
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