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Charogat
Charogat, Doctor (non-pediatrics specialty)
Category: Paediatrics
Satisfied Customers: 1803
Experience:  Licensed in both NYS and NJ with experience in surgery (adult and pediatric) and medicine.
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Am requesting support for 13.5 year old son who has diagnosis

Customer Question

Am requesting support for 13.5 year old son who has diagnosis of reflux oesophagitis. Had upper and lower endoscopies Has been symptomatic for last 16 months Treated with lansoprazole - made him worse. Havemodified his diet as I think he is dairy and gluten intolerant. He is currently on 10 mg Amitriptyline 2x a day and 4 mg Melatonin as sleep a problem. He has had numerous other medications but nothing is helping nausea. He copes ok with abdominal pain but is so fed up with the nausea. He is just about coping with school after a long period of absence. Have moved him to a closer school with less pressure as problems arose when at previous school. Symptoms exist in all contexts. In the past domperidone and odensetron did not help. I am encouraging him to drink a lot of water and he has an adjustable bed. Saw his consultant last week who basically told us to get on with it - nothing more can be done medically so it is about psychological support (he has this through me) and pain management. He finds reflexology helps a bit with pain as does guided imagery. Dr does not seem to think there are issues with gastroparesis. Does not think any issues with food allergies and was dismissive of tests I had done via nutritionist for food sensitivities. Son has mild Aspergers, above average intelligence and no behavioural problems other than those of a normal child. He is getting very depressed and so am I. Doctor told me to stop seeking help for him.
Submitted: 2 years ago.
Category: Paediatrics
Expert:  Charogat replied 2 years ago.
Charogat :

Hi.

Charogat :

I would love to be of help to you.

Charogat :

Can you please tell me which medications he has tried (I know you said numerous). Also, has he had any outside counseling?

Customer:

He has seen a clinical psychologist who has helped with pain management and getting him back to school. Problems arose at the end of his first year of high school (age 12) . Happy at school but high pressure, an hour commute each way. Had friends and was coping with work However lots of homework and long school days so got very tired as was having to do home and school work 7 days a week at times. Had gastroenteritis in Feb 2013 - very unusual for him and then again in April 2013. Although he had only one episode of vomiting in Feb 2013, had nausea for a week. Thought he was just getting motion sickness on bus to school. Flared up in June 2013. Missed a lot of school in last academic year though had good periods. Have moved him to a closer and less pressured school. He is not happy about this. Nausea constant throughout - during holidays when away and Xmas. No changes in home circs over this time.

Charogat :

Has he tried any anti-anxiety medications? Has he tried any anti-nausea medications?

Charogat :

If he has, then which one(s)?

Customer:

Amitripyline (but that is for neuropathic pain at this dose) . For nausea, odensetron (no effect). Initially was given domperidone . Think the domperidone was alongside the PPI which made him feel worse.

Charogat :

Has he had testing for H. Pylori?

Charogat :

(H. Pylori is a bacteria that is sometimes found in the stomach and when eliminated can decrease the incidence of some types of stomach upset)

Charogat :

Have you found any help with the diet modification?

Customer:

Came back negative. I also had him tested for food intolerance via a nutritionist (IgG which I know has questionable scientific basis) and he came back sensitive to wheat gluten dairy corn in the main. I know fro experience that bread and milk products upset him. he has symptoms whatever he eats but certain things really exacerbate it.

Charogat :

Okay.
1. There may be questionable scientific basis - but you are the parent - and for whatever reason - whether it is IgG or something else, you know your child well enough to see that certain foods do not agree with him. That is NOT something to be disregarded.
2. Has he taken any other anti nausea medications, or only the one you mentioned?

Charogat :

Actually, from all you've told me so far, my biggest concern is the amitriptyline. I understand that his problems pre-date his taking this medication, but this medication can also be causes of many of his symptoms.

Customer:

I was told domperidone was for sickness but I know it is a promotility medication. He was also given levomepromazine and odensetron.

Charogat :

Here is a link to drugs.com that will show this to you.

Customer:

Actually, the amitriptyline has been the most effective drug he has taken. The nausea predated him taking that by 5 months.

Charogat :

In what way has it been helping him?

Charogat :

Also, does he take it during the day or at night? (This question is really an aside, as I want to mention that it can help with sleep - which he is now taking melatonin for)

Customer:

With sleep (although he is now taking 4 mg melatonin a night) and pain.

Charogat :

But it hasn't decreased his nausea?

Customer:

He takes it morning and night. Originally he had it to help with sleep which was very difficult due to abdo pain and nausea.. It has not decreased nausea.

Charogat :

It sounds like he needs to find another anti-anxiety. I am trying to find something that would cover both his nausea and anxiety better

Charogat :

I can't see if you've responded at all. Are you still there?

Customer:

The amitriptyline is for neuropathic pain . The psychologist rated his anxiety - not high. If anything his score showed depression but that was after a year of gastric problems. Don't know how he would have scored before. He has mild Aspergers - above average intelligence, no behavioural issues, no obsessive behaviours, not routine driven but has had difficulties in forming lasting friendships as cant read social cues well.

Charogat :

Is his neuropathic pain separate from his abdominal issues - or is the amitriptyline treating his stomach pain? Are they thinking he has gastro paresis (which would also be neurogenic and might not have been what they were trying to treat with Domperidone?)

Charogat :

I've been trying to look up some of this - namely the Domperidone, but as we don't have it in the USA I am not very comfortable commenting on it.

Charogat :

I think you would be best served if I opt out of this question and see if maybe another specialist will feel more comfortable answering it.

Charogat :

Would that be okay with you?

Customer:

No, it is the abdo issues and the amitriptyline is for his stomach pain. The GP gave him domperidone but the specialist has not so I assume he does not think he has gastroparesis. He has not explained why not but son is growing normally and putting on weight - if anything slightly overweight.

Charogat :

It doesn't sound like gastroparesis, which is what had me wondering.

Charogat :

Would you be okay with me opting out in hopes that someone else might be able to help you better?

Customer:

Ok. Thanks anyway

Charogat, Doctor (non-pediatrics specialty)
Category: Paediatrics
Satisfied Customers: 1803
Experience: Licensed in both NYS and NJ with experience in surgery (adult and pediatric) and medicine.
Charogat and other Paediatrics Specialists are ready to help you

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