Seeking advice: gagging / dry heaving while exercising

Feb 24, 17 14:04

Post #1 of 16 (18918 views)

Alrighty, you can rest assured I have reached wits end if I turn to an internet forum for medical advice. At this point I am running out of options. I have been trying to figure out a strange medical issue for about 8 months now. Starting last August I began to gag or dry heave under the two distinct circumstances listed below. There is no nausea, pain or other symptoms associated with this.
#1 When exercising hard for more than 15 minutes. This is worst in the pool. I haven't really been able to swim in 6 months. For biking and running I am ok going long and easy and also very hard intervals with good recovery. So it is more race-like efforts which consistently trigger gagging. There is no nausea- just gagging until I stop exercising. Cold temps seem better than warm ones.
#2 I have the same gag reflex when I encounter strong smells- both good and bad. This has gotten better over time and cutting coffee (sadness) has helped. If I happen to encounter strong smells like diesel fumes while riding or running= instant gagging.
So, I've been really proactive about figuring this out since it is driving me nuts. At this point we have ruled out all the most likely suspects (GERD, ulcers, tumors) through the following tests:
-Blood work including celiac panel (fine)
-Endoscopy (ok, no real signs of acid reflux, small hiatal hernia which is common)
-Gastric Emptying Study (alas the radioactive eggs I had to eat gave me no super powers and the results were fine)
-CT Scan of stomach/torso (fine)
-Brain MRI (wanted to rule out potential neural causes, no red flags)
-CT Scan of Throat (clear)
I was on the prescription antacid Pantoprazole (80mg) for 4 months. Nothing.
I am on low-dose Amitriptyline working under the theory that I might have hyper-active nerves in my stomach/esophagus. Not sure this is doing anything.
At this point I don't have a clear way forward. Heading up to Mayo Clinic is under consideration. Hoping to get this figured out so I can race 70.3 World Championships in Sept.
I'm also hoping someone here maybe knows someone who has had similar problems and figured out a solution. Any ideas, ST?

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 24, 17 20:09

Post #2 of 16 (18849 views)

I have some problems with dry heaving when running. Unlike you, however, I get a bloated feeling before I heave. Not really a true nausea, just a feeling of being very full. I attribute my problem to not eating enough or swallowing air and it only occurs on long runs. Do you think you could be swallowing air?

The one thing I noticed about your tests is that none of them really looked into the cardiac side of things. Looking at your pictures on your homepage you appear a little too young to have heart problems but stranger things have happened and stomach issues can be caused by the heart and since this occurs during maximal effort that's when your heart would act up. That of course does not really explain why it happens with smells.

Being bothered by smells would lead me to think that it's being caused by some kind of neural stimulus.

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 25, 17 18:12

Post #3 of 16 (18755 views)

Is dynamic endoscopy a possibility (eg, endoscopy while exercising)? Or at least immediately post-exercise when the gagging is occurring? Perhaps the increased respiratory effort is causing collapse of the soft tissues in the larynx / pharynx, triggering your gag reflex. Sorta like brachycephalic airway syndrome in dogs.

Re: Seeking advice: gagging / dry heaving while exercising [suahoi] [ In reply to ]

Feb 27, 17 7:29

Post #4 of 16 (18652 views)

Yikes, I don't think so. Being under full sedation limits your ability to exercise! Also if I stop exercising as the gagging occurs it subsides usually within a minute or less.

Chris

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 27, 17 7:38

Post #5 of 16 (18644 views)

could this be some sort of vaso vagal cardiac issue?

see a doctor

Sweet wrote:

Alrighty, you can rest assured I have reached wits end if I turn to an internet forum for medical advice. At this point I am running out of options. I have been trying to figure out a strange medical issue for about 8 months now. Starting last August I began to gag or dry heave under the two distinct circumstances listed below. There is no nausea, pain or other symptoms associated with this.
#1 When exercising hard for more than 15 minutes. This is worst in the pool. I haven't really been able to swim in 6 months. For biking and running I am ok going long and easy and also very hard intervals with good recovery. So it is more race-like efforts which consistently trigger gagging. There is no nausea- just gagging until I stop exercising. Cold temps seem better than warm ones.
#2 I have the same gag reflex when I encounter strong smells- both good and bad. This has gotten better over time and cutting coffee (sadness) has helped. If I happen to encounter strong smells like diesel fumes while riding or running= instant gagging.
So, I've been really proactive about figuring this out since it is driving me nuts. At this point we have ruled out all the most likely suspects (GERD, ulcers, tumors) through the following tests:
-Blood work including celiac panel (fine)
-Endoscopy (ok, no real signs of acid reflux, small hiatal hernia which is common)
-Gastric Emptying Study (alas the radioactive eggs I had to eat gave me no super powers and the results were fine)
-CT Scan of stomach/torso (fine)
-Brain MRI (wanted to rule out potential neural causes, no red flags)
-CT Scan of Throat (clear)
I was on the prescription antacid Pantoprazole (80mg) for 4 months. Nothing.
I am on low-dose Amitriptyline working under the theory that I might have hyper-active nerves in my stomach/esophagus. Not sure this is doing anything.
At this point I don't have a clear way forward. Heading up to Mayo Clinic is under consideration. Hoping to get this figured out so I can race 70.3 World Championships in Sept.
I'm also hoping someone here maybe knows someone who has had similar problems and figured out a solution. Any ideas, ST?

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Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 27, 17 7:45

Post #6 of 16 (18635 views)

Since it is worse in the pool, could it be a form of motion sickness? Have you tried an antihistamine like dramamine or meclizine or others? I don't know how these would affect your athletic performance, or their safety during high level exercise, but may be worth a try after you discuss with your doctor. Good luck.

Two wheels good. Four wheels bad.

Last edited by: DrTriKat: Feb 27, 17 13:14

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 27, 17 7:51

Post #7 of 16 (18630 views)

I suffer from this from time to time as well, although I have never reached out for medical advice. Same as you, it seems to happen when it is warmer out rather than cooler conditions and when I am pushing the pace or exhausted from a longer effort. I have never had it happen in the pool although it has happened when swimming in the intracoastal of Florida when the water has been very warm, typically around the end of July & August. I have always attributed this to a combination of exertion and the stink of dying seaweed or algae bloom...sometimes the smell is strong although even when it is less noticeable, I smell it more when exercising.. When I am running it seems to happen in the first 1-2 miles, to note, I typically do not do a warm up prior to my runs. When cycling, it typically happens to the middle or end of my ride. I have noticed on my rides, I am especially prone to smells, the sight of road kill can set it off, even if the wind it blowing in the opposite direction. I've even dry heaved from what I THOUGHT was a dead animal in the road, which turned out to be a rag or dirty shirt. Every time I get the dry heaving sensation, if I back off or stop exercising, it quickly subsides.

I am curious in what you find out. Good luck.

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Feb 27, 17 8:09

Post #8 of 16 (18612 views)

I had something somewhat similar, except usually running. Traced it to histamine release from the running motion causing a post nasal drip. Not excessive, but enough to cause issues of the gagging and heaves to where I have to stop completely. Experimented (through physician) with an antacid and allergy medicine(clairitin) 1 hour prior to exercise. Seems to have helped most of the time. I rarely use now unless doing a hard run but seems to have really helped with symptoms.
I'd continue investigation with your physician until you find "your" cause. Good luck

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jun 13, 17 11:03

Post #9 of 16 (18243 views)

I was an intensively training bodybuilder for 6 years before this kicked in. Now I find it impossible to do abs, running, or more than 15-20mins of intense lift... and forget about squats and deadlifts (instantly cause gagging). Doctors will hypothesize that it's acid reflex or post- nasal drip, and give you a nasal spray (at least my 4 have). Unfortunately, even if you get an endoscopy, you won't learn much. I am currently trying a few things to solve this, and I think I finally know the cause of this condition.
It's been 3 years since this condition kicked in, but until then I noticed a red flag about the changes in my life. I use to eat a rediculous amount of food and take tons of protein powder supplements and creatine. I have 2 hypotheses. Either there is a god who hates bodybuilders making gains, who gives out this weird condition at the peek of us making these gains... or there is a correlation between diet over time and this mucus condition. As a Bio B.S. Degree holder, one thing that I've learned about mucus production is that it is secreted to keep cells safe from infection. Therefore, one of 2 things is probably happening. Our immune system may be week or we already have an infection (yes possibly for years). This can be caused by blood pH being too acidic, micro bacteria parasites in the small intestine, or constant exposure to a food allergy. I doubt it's a food allergy because I've already tried every diet imaginable and still the same mucus occurs. Thus, leaving the other 2. I am currently trying "Parasmart" cleanse, which some people said works. And I am also making my pH more basic by increasing freash vegetable intake. Nexium is also a good pH balencer. If these remedies don't work then it's probably a weird syndrome.

P.s. I've had the mono virus in middle school, and this stays in your system for life... this may somehow contribute.

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jan 5, 21 15:46

Post #10 of 16 (7418 views)

Good day to this older chat;

I was hoping to come in late to the game and someone has over the past years worked out a solution to this.
I myself am suffering from the same issue, the running or working out part is less of an issue and more a awkward encounter dry heaving next to people while I am running, however I seem to be less and less able to swim laps and the coughing and dry heaving in the pool is for sure atracking the eyes of the life guards.

Happy New to all of you and hoping some new developments have been done here.

Re: Seeking advice: gagging / dry heaving while exercising [skitom] [ In reply to ]

Jan 7, 21 8:44

Post #11 of 16 (7263 views)

Sorry to hear about your gagging issues and sorry to report that mine has slowly gotten worse and I (assisted by many many specialists and tests) have not been able to determine a cause.

Always start with the basics. Occam's razor and statistics indicate to start simple and go on from there. Definitely work with a primary care physician and then specialists as needed.

The most common cause of gagging during exercise would be some form of acid reflux. This would be worse while swimming because you are in a prone position and easier for stomach acid to leak into the esophagus. Second most common would be some form of post-nasal drip. Third I would look to diet and allergies. Chlorine sensitivity can cause or exacerbate gagging. Easy to test if you can find a saltwater pool, or open water that isn't freezing this time of year. After those are ruled out you open up the door to a wider range of less common conditions....

If anyone is interested in what I've tried over the course of 4 years, here's the saga: https://docs.google.com/...duw/edit?usp=sharing

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jan 7, 21 13:13

Post #12 of 16 (7225 views)

I have been really curious about the GI-related posts that have been popping up on Slowtwitch lately.

(not a doctor) but have you tried any other anti-emetics besides metoclopramide? There is one called ondansetron that is used in the treatment of chemotherapy-induced nausea and cyclic vomiting syndrome. There have been studies done that show it can reduce gag reflex during intubation, so I wonder if it would be of any benefit. I'm just a stranger on the internet though so take my suggestion with a grain of salt. I hope you figure it out!

Re: Seeking advice: gagging / dry heaving while exercising [skitom] [ In reply to ]

Jan 7, 21 13:34

Post #13 of 16 (7217 views)

Not sure if it’s helpful or related to your issues, but I dealt with gagging for several years through 2015. What has happened/helped since then:
- had upper endoscopy and confirmed acid reflux. I didn’t have the typical burning throat reflux so never thought it was that big of an issue. I’m now taking 30mg of esomeprazole daily (nexium), and am quite a bit more conscious of when/if I eat chocolate and mint type of foods.
- had a nasal cauterization procedure in early 2016.

I’m not sure which of the two is the larger contributor to improvement, but now I can now do hard efforts In all 3 disciplines without issue.

Last edited by: Vols: Jan 7, 21 13:36

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jan 7, 21 14:53

Post #14 of 16 (7196 views)

thank you for posting your google doc timeline and roundup of all you've gone through.
Empathise with how irritating, obnoxious and depressing all of this can be for you, so kudos for keeping at it.

Your very first post you mentioned Mayo Clinic - did you go (and which one?)

The cervical issue seems to be the trigger, curious to know if when testing you maintiain a head position, or move it around to force the gag reflex.

Have you worked with a Physiologist?

Anne Barnes
ABBikefit, Ltd
FIST/SICI/FIST DOWN DEEP
X/Y Coordinator
abbikefit@gmail.com

Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jan 7, 21 16:57

Post #15 of 16 (7177 views)

Sweet wrote:

Sorry to hear about your gagging issues and sorry to report that mine has slowly gotten worse and I (assisted by many many specialists and tests) have not been able to determine a cause.

Always start with the basics. Occam's razor and statistics indicate to start simple and go on from there. Definitely work with a primary care physician and then specialists as needed.

The most common cause of gagging during exercise would be some form of acid reflux. This would be worse while swimming because you are in a prone position and easier for stomach acid to leak into the esophagus. Second most common would be some form of post-nasal drip. Third I would look to diet and allergies. Chlorine sensitivity can cause or exacerbate gagging. Easy to test if you can find a saltwater pool, or open water that isn't freezing this time of year. After those are ruled out you open up the door to a wider range of less common conditions....

If anyone is interested in what I've tried over the course of 4 years, here's the saga: https://docs.google.com/...duw/edit?usp=sharing

What a saga. I have a similar gagging / dry heaving experience. 10+ yrs of it.

I'm familiar with all tests and most medications mentioned in your saga document/link.

Can you describe how vocal chord dysfunction was ruled out? Treadmill testing and scope?

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Re: Seeking advice: gagging / dry heaving while exercising [Sweet] [ In reply to ]

Jan 7, 21 19:54

Post #16 of 16 (7148 views)

Wow, what a story.... Just brainstorming here. Most likely you have looked at all this already. Have you had your Glossopharygeal nerve tested (motor and sensory)? Lingual nerve? Arterial oxygen saturation? Wisdom teeth pulled prior to all this? Caffeine directly affects it or hot fluids? Chiropracter or physical therapist cervical spine manipulation?

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