To go to A&E just for medication?

[Lookingforadvice36767]

I suffer from a chronic stomach issue - they haven’t quite figured out what it is - they are thinking it’s more of a ‘functional’ bowel disease because the tests I’ve had done so far haven’t shown much (but there’s also been a bit of disagreement between various doctors about a couple of rare diseases it could be).

One of the main symptoms I get is severe nausea, I’ve been given gold standard antiemetics (Ondansetron which is normally only used in chemotherapy patients, I’ve tried every other antiemetic but this one works the best).

Normally the oral tablets is enough, however when it’s really bad only an IV controls it because it works quicker and is more efficient.

I struggle to eat and drink properly as a result of this, and have lost quite a lot of weight on and off too (they tried to fit an NG tube a couple of months ago but I couldn’t tolerate it at all and became quite distressed because I had a very traumatic procedure on my throat at the beginning of the year and can’t tolerate anything being put near my throat now).

The GP can’t do anything else, the hospital are quite reluctant to do anymore testing, so it’s literally a case of controlling my symptoms when they appear.

I’ve woken up today and I’m really struggling, I’ve taken the oral tablets and I’m still struggling - should I go to A&E for the medicine to be given through an IV or sit it out?

It’s getting me so down, it’s honestly making me feel suicidal thinking I could possibly spend the rest of my life feeling like this - I don’t have any quality of life, I don’t go out because I feel so rotten and unwell 99% of the time

Ring 111 and they can direct you to most appropriate care. Is there an outpatient clinic for your condition your go can refer you to?

I'm sorry you feel do poorly op but A & E is so busy everywhere right now that you could be sat or even stood there for hours feeling so unwell and they may turn you away , do you have a local walk in / urgent care you can go to instead ?

I have a minor injuries unit but they said they only usually treat injuries/do x-rays etc, so wouldn’t be appropriate to go there either

I don't know why people on here keep saying ondansetron is used only in chemo patients when this is just untrue. If you're in hospital having an operation or on IV it is more than likely you will be given ondanstetron over cyclizine as it is stronger and more affective. It's not specifically for cancer patients. I just thought I would clear this up because I have seen this mentioned several times now and it's just untrue.

I would speak to a gp at your surgery if you can, they should be able to refer to a&e (or elsewhere) for the drip, which will also reduce time you're waiting about.

Hope you're feeling better soon

Do you have other health conditions? (Bone problems (clicky joints, dislocations, osteoarthritis, rheumatoid arthritis) BP issues, skin problems, food allergies? Have you had any viruses in the last year or so (including Covid)? Have you a history of ibuprofen or other anti inflammatory use?

@rainbowdashsneeze

I don't know why people on here keep saying ondansetron is used only in chemo patients when this is just untrue. If you're in hospital having an operation or on IV it is more than likely you will be given ondanstetron over cyclizine as it is stronger and more affective. It's not specifically for cancer patients. I just thought I would clear this up because I have seen this mentioned several times now and it's just untrue.

I know this is true - however it’s a reason my GP gave as to why they couldn’t prescribe it to me even after the consultant asked them to, that they could only give it to cancer patients - and why I now have to get it from the hospital or privately.

Some of the doctors have also been reluctant to carry on giving it to me for my stomach problems, but without it I would probably be in hospital on a weekly basis!

I don’t know why the UK restrict drugs like this because they work so well for other things too, and can really help a lot of people who suffer!

Ondansetron is not only used in chemo patients. I was prescribed it for morning sickness and my 8 year old son is prescribed it for nausea associated with migraines. I don't think A&E would be much use. You'd be waiting for hours and they may not treat you anyway. 111 would be best but it sounds like a terrible situation for you. What dose of ondansetron are you taking by mouth?

That sounds awful to live with. I agree with ringing 111 and seeing what they suggest.

Why are the hospital reluctant to do more tests? There must be something that's causing this, have you had any scans?

Ondansetron is the first line antiemetic for most conditions. Not just for chemotherapy.

I don’t know why the UK restrict drugs like this because they work so well for other things too, and can really help a lot of people who suffer!

Licensing issues, sadly.

I wouldn't go to A&E; they're generally manic at the moment and I'm not sure they'd treat you even if you'd been there for hours. You're likely to be triaged quite low down in priority, although I'm not at all demeaning the nausea and how horrendous this sounds.

111 might be your best bet? I'm sorry

OP, the GP absolutely can prescribe ondansetron. For whatever reason, they are unwilling to. You should not have to pay privately or have the hassle of obtaining the drug through the hospital.

@Justilou1

Do you have other health conditions? (Bone problems (clicky joints, dislocations, osteoarthritis, rheumatoid arthritis) BP issues, skin problems, food allergies? Have you had any viruses in the last year or so (including Covid)? Have you a history of ibuprofen or other anti inflammatory use?

I have rheumatoid arthritis and a history of steroid use for the RA

@Bundlebuns

Ondansetron is not only used in chemo patients. I was prescribed it for morning sickness and my 8 year old son is prescribed it for nausea associated with migraines. I don't think A&E would be much use. You'd be waiting for hours and they may not treat you anyway. 111 would be best but it sounds like a terrible situation for you. What dose of ondansetron are you taking by mouth?

I take 4mg 3 x daily, however I’ve just asked the pharmacist who said I can take 8mg 2x daily so might try that

@Mamamia7962

That sounds awful to live with. I agree with ringing 111 and seeing what they suggest.

Why are the hospital reluctant to do more tests? There must be something that's causing this, have you had any scans?

I’ve had some tests done, however the 2 conditions that have been suspected are gastroparesis and alachasia (not sure on the spelling) however they are reluctant to do the tests because of funding and how busy they are (current 2 year waiting list for new gastro patients)

@Bundlebuns

OP, the GP absolutely can prescribe ondansetron. For whatever reason, they are unwilling to. You should not have to pay privately or have the hassle of obtaining the drug through the hospital.

My GP thinks I should just learn to live with it, my consultant has asked them twice now to carry on prescribing it and they’ve said they can’t… that there is red tape apparently… so I have to pay £60 for a 10 minute private GP appointment and private prescription fees just to stay out of hospital on a weekly basis

@Justilou1 what are you suggesting? As I tick a lot of those boxes and o live with an undiagnosed functional bowel disorder.

I am sorry you are dealing with this. I get nausea from time to time. Can I recommend some other things please?

• I suggest you go to see a cranial oesto. Ask them to do two things:

1. check the muscles in your neck are not tight as these can affect the nerves travelling down to your stomach and create nausea. Its a thing. BUPA pays for cranial oestos to help new born babies with gastric reflux because the birth process effect on the neck can put pressure on stomach nerves.
2. ask them to check the bones around your ears incase these are affecting your balance and therefore creating nausea.
3. and this is super important - ask them to check where your stomach is. Mine was pushed up (pregnancy, getting fatter but also stress causes you to breathe higher up affecting things) and once she move it into the right place the nausea stopped instantly.

• Try acunpuncture to rebalance your body.
• Calls Nelson homeopathic chemist and ask to speak the pharmacist who will prescribe you a homeopathic remedy to help with nasuea and post it to you. If you want to go to A&E because you are unwell I think you are within your rights to. Especially if you are feeling mentally unwell as they suggest people go there for this too.

@rainbowdashsneeze

I don't know why people on here keep saying ondansetron is used only in chemo patients when this is just untrue. If you're in hospital having an operation or on IV it is more than likely you will be given ondanstetron over cyclizine as it is stronger and more affective. It's not specifically for cancer patients. I just thought I would clear this up because I have seen this mentioned several times now and it's just untrue.

Correct, ondansetron is not only for cancer patients and I've no idea where this myth came about.

A&E I don't think is reasonable. I'd try 111 as a first port of call.

@Lookingforadvice36767 - not at all! Quite the opposite in fact!!! I was wondering if perhaps there was another medical reason that could also be utilized to get their attention!

4mg is a paediatric dose (my son started on 4mg per dose at 6 years old). If you look up the SPC for ondansetron then you can see the dose for adults and elderly starts at 8mg. Your consultant and GP should be optimising your oral ondansetron - you shouldn't be suffering like this. I hope some of the advice given by other posters helps you OP. It must be debilitating and your GP sounds dismissive

Oral
Ondansetron Is just as effective as IV. The only reason we tend to find it IV as it's a bit difficult to get it to stay out if the patient id actually vomiting.

@Lookingforadvice36767 - I specifically asked about joints and skin, etc, as I was concerned about gasteoparesis. (Am a fellow sufferer.) I was diagnosed last year (then aged 48) with Ehler’s Danlos Syndrome. (Hypermobile version.) Shocked me, as my joints suck and I would say that mostly I am stiff as a board. Probably because they’re all full of ganglions and I sound like a maraca band, and perimenopause & menopause just made everything so much better, said nobody ever. (Uncovered a leaking, deformed aortic valve, for a start… yay.) Meanwhile, it may not be this. There are about a million different forms of Ehler’s Danlos, (really, only 11 I think) the most common is the Hypermobile version (H-EDS). Don’t read too much into it, as some are bloody terrifying (and you’d probably be cactus already, and there are some virtually imperceptible ones…) There is some useful info below. Be aware that a lot of Facebook groups, information websites are USA- based and rather, erm… over-dramatic. (Stay out of USA chatrooms for love or money!) I would suggest you speak to your GP about your symptoms and ask for a referral to a rheumatologist.
www.ehlers-danlos.org/information/gastrointestinal-problems-in-hypermobile-ehlers-danlos-syndrome-and-hypermobility-spectrum-disorders/

It's quite common for ondansetron to be red-listed on the local formulary for certain indications but not for others - ie. GP can prescribe for only for palliative but care but not for anything else.

E.g. tinyurl.com/nkybvbjw

There's nothing stopping your Consultant from issuing an FP10 (green prescription) and posting it to you.

Alternatively, if you are likely to need IV on an intermittent basis they should arrange something permanent via ambulatory care - we have a few patients with such an arrangement locally.