(First, the sentences that are in (bold italics) are my own words, all the other information I found via Currentphychiatry.com, please take time to check it out also, there is a lot of useful information! I was diagnosed in December of 2013, with Cannabionoid Hyperemesis Syndrome, if you are reading this take into consideration that I am a person, I was diagnosed with this, I am having a hard time believing just as most of you will too. I enjoy feedback, and your opinions, positive or negative. I also apologize for the big word, but I did copy and paste so I could get the information accurate. I really want people to know about this, I love pot, and miss it terribly, I have to take pain medication now, and anti nausea pills and stool softeners because of the pain meds, but its better then vomiting uncontrollably which is what I was doing, I wasn’t even able take a sip of water without throwing it back up.)
“Cannabinoid Hyperemesis Syndrome (CHS) is characterized by years of daily Cannabis use, recurrent nausea, vomiting and abdominal pain, compulsive bathing for symptom relief, and symptom resolution with cessation of use.”
(I have smoked pot, since 1993, and since about 2007, I have smoked about a joint an hour, at least twelve hours a day. I was stoned all the time, I used for a pain reliever.)
“In 2011, 18.1 million people reported Cannabis use in the previous month; 39% reported use in 20 of the last 30 days. A high rate of use and a relatively low number of cases suggests that CHS is rare. However, it is likely that CHS is under-recognized and under-reported. CHS symptoms may be misattributed to cyclic vomiting syndrome, because 50% of patients diagnosed with cyclic vomiting syndrome report daily Cannabis use. There is no epidemiological data on the incidence or prevalence of CHS among regular Cannabis users.
“Prompt recognition of CHS can reduce costs associated with unnecessary workups, emergency department (ED) and urgent care visits, and hospital admissions.”
Mechanisms of action
“Cannabis has been used for centuries, so it is unclear why CHS is only recently being recognized. It may be because of higher THC content through selective breeding of plants and a more selective use of female buds that contain more concentrated THC levels than leaves and stems. Alternately, CHS may be caused by exogenous substances, such as pesticides, additives, preservatives, or other chemicals used in marijuana preparation, although there is little evidence to support this.
“The mechanism of symptom relief with hot bathing also is unclear. Patients report consistent, global symptom improvement with hot bathing. Relief is rapid, transient, and temperature dependent. CB1 receptors are located near the thermoregulatory center of the hypothalamus. Increased body temperature with hot bathing may counteract the thermoregulatory dysregulation associated with Cannabis use. It has been proposed that splanchnic vasodilation might contribute to CHS symptoms. Thus, redistribution of blood from the gut to the skin with warm bathing causes a “cutaneous steal syndrome,” resulting in symptom relief. “
(So in other words, the way pot is grown is more than likely the issue)
Diagnostic approach
“Four key features should be present when making a diagnosis of CHS:
· heavy marijuana use
· recurrent episodes of severe nausea, vomiting, and abdominal cramping
· compulsive bathing for transient symptom relief
· Resolution of symptoms with cessation of Cannabis use.
“Compulsive, hot bathing for symptom relief was described in 98% of all reported cases, and should be considered pathognomonic. CHS patients can present with other symptoms, including polydipsia, mild fever, weight loss, and orthostasis. Although lab studies usually are normal, mild leukocytosis, hypokalemia, hypochloremia, elevated salivary amylase, mild gastritis on esophagogastroduodenoscopy, and delayed gastric emptying have been described during acute episodes.”
(The only way I would stop throwing up is if I was in a hot bath or shower, I was to the point where I would sleep in the bathtub. Waking up and refilling it.)
“Diagnosis starts with a history and physical exam, followed by a basic workup geared towards ruling out other causes of acute nausea and vomiting. Establish temporal relationships between symptoms, Cannabis use (onset, frequency, amount, duration), and bathing behaviors. A positive urine toxicology screen supports a CHS diagnosis and can facilitate discussion of Cannabis use. It is important to rule out potentially life-threatening causes of acute nausea, vomiting, and abdominal pain, such as intestinal obstruction or perforation, pancreaticobiliary disease, and pregnancy. The initial workup should include a CBC, basic metabolic panel, liver function tests, amylase, lipase, pregnancy test, urinalysis, urine toxicology screen, and abdominal radiographs. The differential diagnosis of recurrent vomiting is broad and should be considered. Further workup can proceed non-emergently, and should be prompted by clinical suspicion.”
(I was tested for all of the above, and everything came back as it should. I still had a tough time believeing that what was supposed to be keeping my pain to a tolerable level was making me so sick)
“Treatment of acute hyperemetic episodes in CHS primarily is supportive; address dehydration with IV fluids and electrolyte replenishment as needed. Standard antiemetics, including 5-HT3 receptor antagonists, D2 receptor antagonists, and H1 receptor antagonists, are largely ineffective. Case reports have described symptom relief with inpatient treatment with lorazepam and self-medication with alprazolam, but more evidence is needed. A recent case report described prompt resolution of symptoms with IV haloperidol. Treating gastritis symptoms with acid suppression therapy, such as a proton pump inhibitor, has been suggested. Symptoms abate during hospitalization regardless of treatment, marking the progression into the recovery phase with abstinence. There are no proven treatments for CHS, aside from cessation of Cannabis use. Treatment should focus on motivating your patient to stop using Cannabis.”
(I quit smoking pot when I spent over a month in the hospital, and about 3 weeks in I quit having symptoms. It’s not proven but I read in my research it can take anywhere from 14 hours, to up to 2 weeks for symptoms to cease.)
“Acute, hyperemetic episodes are ideal teachable moments because of the acuity of symptoms and clear association with Cannabis use. However, some patients may be skeptical about CHS because of the better-known antiemetic effects of Cannabis. For such patients, provide informational materials describing CHS and take time to address their concerns or doubts.”
(I hope some of you found this interesting and maybe even useful, I plan on keeping people updated, on what I find out about this, different stories that I find of people diagnosed with CH, I am also working on my first video blog for CHS, I am already on YouTube under Madonna Regis, I have Neurofibromatosis Type 1 which is also a not so common disorder. I could write a book of my life, hospital visits, Doctors love me because I always have something that they don’t get much of. Terrible but true. I feel as though I was put here to help the medical field grow!)
All text in quotation are from Cannabinoid hyperemesis Syndrome: A result of chronic, heavy Cannabis Use by Jie Chen, MD. and Robert M McCarron, DO. as published in Current Psychiatry. October 2013.
http://www.currentpsychiatry.com/home/article/cannabinoid-hyperemesis-syndrome-a-result-of-chronic-heavy-cannabis-use/7f745b490668efc93ec5bab9da3bfdc1.html
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