Teen: frequent waves of nausea, dizzy, bloated feeling

[wendibird22]

DD had her PCP appointment yesterday. Saw an RN. At first I was put out because the RN treated this as acute illness upon hearing about bouts of nausea without letting DD fully explain all her symptoms and all that's been going on. RN did though slow down and hear her out. They did rapid strep to rule that out (it's still going around in my area), bloodwork (CBC, Chem panel, gluten AB, gluten RAST), prescribed a reflux med, having her keep a food journal, and offered an anxiety med, but we are holding off on that for now while we try counseling first. I'm not opposed to an anxiety med but feel like DDs not at a place where she's having trouble functioning day to day and so if I can get counseling going AND not have symptoms continue or progress, then I can wait on med. DD also mentioned her possible ADHD concerns (fidgeting, interrupting, constant talking, etc) and the RN is having us do the Vanderbuilt assessment (which my teacher DH is VERY familiar with). We follow up with PCP in 2 weeks.

She's been improving the past 2 days.

[zukeypur]

Glad to hear she's been improving. I hope you can get to the bottom of this and help her feel better.

[wendibird22]

Update:
All of her bloodwork came back perfectly normal. Has been on a heartburn/reflux med for 3 weeks with no change in her abdominal discomfort. DH and I, plus 8 of her teachers all completed the Vanderbuilt form and she definitely scores at the very low end in the hyperactivity category for ADHD with some attentive type behaviors also mentioned. You have to score 6 2's/3's in a category for it to be "positive" but she scored mostly 4 or 5 2's/3's. But the written comments were all about talks too much, doesn't raise hand, interrupts, and is disruptive to others. Which wasn't surprising. That's how she is at home. We did find a counselor and she had her first appointment two weeks ago. She goes again this week. Counselor seems to be a good match for her.

So 3 weeks later and we still have almost daily stomach discomfort. DD says she feels "gross" and bloated or just says her stomach hurts but she can't describe it. She says she feels badly if she goes too long without eating but then if she eats she feels uncomfortable/gross 30-60mins later. Varsity track finished 2 weeks ago so she's done with that stressor, but she's still playing a high level of soccer. She had an out of state tourney this past weekend and really struggled with stomach pain on Saturday (day 1 of the tourney). At the follow up doc appointment we saw an MD and she said given that everything looks normal to them that she'd refer us to a GI doc and to continue to pursue counseling.

I mentioned up thread that DH is hesitant to put her on an anti-anxiety med. But now my gut is telling me that we should try it and see if the stomach issues are just stress and anxiety.

[JElaineB]

The GI doc sounds like a good idea. My co-worker had similar symptoms and it turned out she has fructose malabsorption.

[Kindra178]

If I may add - while overall stress and anxiety may be lessened with a ssri, it may not help the gut symptoms. My kid had significant gastro issues and was already on a ssri at the time.

I know I keep saying this, but have you tried yoga and acupuncture?


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[wendibird22]

If I may add - while overall stress and anxiety may be lessened with a ssri, it may not help the gut symptoms. My kid had significant gastro issues and was already on a ssri at the time.

I know I keep saying this, but have you tried yoga and acupuncture?


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Thanks for the personal experience. I LOVE yoga and have had a regular home practice for many years. But I can't convince DD to give it a try. I totally think she'd benefit from it but the "H" of her ADHD tendencies make her not interested in something that tends to be more slow moving. Yep, the mindfulness that would benefit her is also not in her skill set lol.

The pediatrician recommended Strattera, an SNRI as something that might help with both the ADHD and anxiety. I haven't had a chance to research that yet and figured I'd ask the counselor at this week's appointment what she'd recommend.

[carolinacool]

The pediatrician recommended Strattera, an SNRI as something that might help with both the ADHD and anxiety. I haven't had a chance to research that yet and figured I'd ask the counselor at this week's appointment what she'd recommend.

My 13-year-old is on Strattera. I did not realize that it can also help with anxiety. He's taking it for his ADHD (attentive). We switched from a stimulant because it was really bothering him that his appetite was suppressed. He wanted to be able to eat lunch with his friends and it was becoming an issue.

He eats a little more on Strattera, which he's happy about. But he does say it can make his stomach feel off some days. Unlike the stimulant, which we could stop and start with no issues, we have to stay on top of the Strattera. If he skips more than two days, he feels pretty nauseous. Of course, everyone reacts differently to meds, but I wanted to share, given your DD's issues.

[dogmom]

Thanks for the update. The only suggestion I have is that I understand the appeal of a med that is supposed to treat ADD/ADHD and anxiety it usually isn’t the first line choice. It sounds that ADD/ADHD definitely plays a component for her. Usually prescribers trial short acting Ritalin to see if there is an improvement and if it seems to help move on to longer lasting formulations. The reasoning is these meds have a good amount of data and most prescribers have deep experience with them. These meds have very short half-life and out of the system at the end of the day. They also don’t have to be taken every day.

Anti-anxiety meds to treat a chronic anxiety condition usually take longer to work, things like SSRI that can take up to 4-6 weeks to see clinical responses. These are usually taken every day. Once again, most of them have been issued for decades. Shorter acting anti anxiety meds are useful for acute issues, but they are not recommending for daily use. So although I understand the urge to not go poly-pharmacy, you might want to try two meds to start.

It is also hard to tell how much is ADHD vs anxiety vs both. I would say using vs is actually inaccurate wording. The reality is the clinician needs to make their best judgment after looking at the screening tools and talking to the patient and family about on what to try and what first. I realize many, many parents are hesitant to start medications on kids. But, this is a trial. It may or may not make things easier/better for your DD. You have tried no medications. So the question really should be if this trial isn’t working, why not try another approach? Nothing magical happens when you take the first pill. You aren’t crossing the Rubicon by taking these meds. You are trialing a therapeutic approach to see if it helps. (I’m mostly making this argument to your DH, because it sounds like he’s reluctant. Many, many parents I know need to reframe the meds/no meds thing to remove it from their inherent biases.)

Having gone through all this, it does sound like some attempts to address anxiety/ ADHD in a more aggressive manner is a reasonable step. However, none of this may be a cause of the GI issues, although it certainly isn’t making it less distressing to her. I think you are absolutely correct perusing the GI specialist. I would ask them if there is any chance there is an autoimmune component. Those pathologies are so insidious and great mimics it’s always worth considering when trying to sort complex issues out. Especially in females.

[wendibird22]

Thanks for the update. The only suggestion I have is that I understand the appeal of a med that is supposed to treat ADD/ADHD and anxiety it usually isn’t the first line choice. It sounds that ADD/ADHD definitely plays a component for her. Usually prescribers trial short acting Ritalin to see if there is an improvement and if it seems to help move on to longer lasting formulations. The reasoning is these meds have a good amount of data and most prescribers have deep experience with them. These meds have very short half-life and out of the system at the end of the day. They also don’t have to be taken every day.

Anti-anxiety meds to treat a chronic anxiety condition usually take longer to work, things like SSRI that can take up to 4-6 weeks to see clinical responses. These are usually taken every day. Once again, most of them have been issued for decades. Shorter acting anti anxiety meds are useful for acute issues, but they are not recommending for daily use. So although I understand the urge to not go poly-pharmacy, you might want to try two meds to start.

It is also hard to tell how much is ADHD vs anxiety vs both. I would say using vs is actually inaccurate wording. The reality is the clinician needs to make their best judgment after looking at the screening tools and talking to the patient and family about on what to try and what first. I realize many, many parents are hesitant to start medications on kids. But, this is a trial. It may or may not make things easier/better for your DD. You have tried no medications. So the question really should be if this trial isn’t working, why not try another approach? Nothing magical happens when you take the first pill. You aren’t crossing the Rubicon by taking these meds. You are trialing a therapeutic approach to see if it helps. (I’m mostly making this argument to your DH, because it sounds like he’s reluctant. Many, many parents I know need to reframe the meds/no meds thing to remove it from their inherent biases.)

Having gone through all this, it does sound like some attempts to address anxiety/ ADHD in a more aggressive manner is a reasonable step. However, none of this may be a cause of the GI issues, although it certainly isn’t making it less distressing to her. I think you are absolutely correct perusing the GI specialist. I would ask them if there is any chance there is an autoimmune component. Those pathologies are so insidious and great mimics it’s always worth considering when trying to sort complex issues out. Especially in females.

This is all extremely helpful food for thought. Thank you for taking the time.

I'm growing more comfortable in saying the stomach discomfort is stress/anxiety. This week she's hardly complained. She's had two soccer games with her normal club team (vs the premier team she played with this weekend which is a new team, new experience) Tues and Wed and played great and didn't complain of her stomach. I asked her this morning about it and she said she felt fine all day yesterday, ate fine all day yesterday, and her stomach only "sorta started to hurt" just before the game started but in her words, "once I realized we were playing an easy team to beat it went away." Tonight will be a good test perhaps. She has a try out for a new premier team. She's very much looking forward to the try out, but knowing her she will put a lot of pressure on herself to perform well and she's heading into it not having met the coach or knowing anyone else who will be there.

[georgiegirl]

I would caution against strattera. It caused stomach pain for DS. We tried it two different times (and the second time I didn’t tell him that it had caused him stomach pain before, but two days into it, he was complaining again.)

I 100% agree with dogmom. A trial of stimulants is super easy. You know if it’s working immediately. However, my kid needed a SSRI for his anxiety (he’s also on a stimulant). We’ve been off and on the SSRI because I thought it wasn’t working, but DS1 actually needed a higher dose.

DH went through a phase where he had lots of GI discomfort…for months. And he was even scoped. Turned out to be anxiety. He’s a doctor and it took him a long time to understand that his very real GI symptoms were truly anxiety.


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