Black bits in vomit, could it be blood?

[Pavlovthecat]

I am taking diclofenac long term 50mg x 3 daily (occasionally miss one dose a day) have been on them since christmas 2012. I started taking omeprazole after getting some mild indigestion about 2 months ago? I sometimes forget to take it, but mostly I do.

I have kept an eye out for the whole 'coffee granules' in my sick so thought I knew what it would look like.

I threw up yesterday after experiencing a little indigestion, I had only eaten yoghurt for breakfast, and nothing the night before that had anything dark in it.

In it was what looks like tiny bits of toast crust, dark brown/black small flecks. I realise I have seen them before recently (am sick from time to time, put it down to meds) but had actually thought it was toast!

Anyway, had painful indigestion this afternoon, then a craving for chocolate which I ate, then threw up after taking some indigestion tablets. Again there was quite a lot of dark, not the creamy brown of the chocolate.

Should I check this out with gp when I see them tomorrow? What does it mean if it is blood/a tear etc? what would they do? How serious is it?

tuttu problem is, I can go see the other gp in the practice, but he was the one who gave me repeat prescriptions for diclofenac, for 8 months without omeprazole. It was only after speaking to a pharmacist friend who told me that it was procedure to prescribe omeprazole alongside long term NSAID use that I questioned it. Even then, that was when I called OOH to check if I can take other meds together and asked about omeprazole. She said 'only if you have been having indigestion, which indicates increased acid otherwise it is not really needed'. and that was not even a Dr in that practice.

So, from December to August I was takine 150mg diclofenac daily, with a break of about 2 months without any stomach protection.

luckily I told that OOH doctor that I had been having indigestion (I had been) and so she prescribed it. But before then, I did not realise how serious it was. I was aware that sometimes it is prescribed, some others I know take both together, but I guessed that was if there was a reason to suspect a potential problem. I now realise that there is a potential problem with all long term NSAID use.

Could the diclofenac have done damage prior to when I started the omeprazole and this blood is from an ulcer or something already there? Or would that have healed by now. I had been having indigestion on and off for a a few weeks before I started it.

And. thinking back, I was sick a few times before August and spoke to the other GP at the doctors surgery about it before August. And I remember the toast thing then, but did not add it all up properly then as I also had recently changed to tramadol and put the vomiting down to that. The GP did not relate vomiting to the diclofenac, and changed my tramadol use to slow release as thought the vomiting might be because of my body disliking the tramadol in the mornings. And I did not think to ask him about omeprazole then.

sorry, that was a ramble

on the plus side...I have not been sick today.

I don't know enough about it to answer all your questions Pavlov. All I know is, as soon as I, and FIl, were started on long term NSAIDs we were given Omeprazole. When I had had 2 episodes of indigestion, that I have never really suffered with previously, the GP doubled the dose and stopped them to give my stomach a chance to calm down.

She changed me to a Cox2 and continued with the Omeprazole but I got indigestion again, so she stopped them and won't give me them anymore. IME it is unusual to have no Omeprazole alongside longterm NSAID's.

The coffe grounds are old blood rather than fresh blood. You might have an ulcer, or an irritated patch in your stomach which is bleeding periodically, thus making you vomit. That is what was happening with DS1. He had an endoscopy to see what was going on, given a drug to treat the ulcers for 6 moths, then another endoscopy, whch was clear. He hasn't been allowed NSAIDs since.

In your shoes, I would have a chat with your pharmacist friend, or perhaps phone NHS direct and speak to them to see what their opinion is.

oh crap. I hope they don't find an ulcer or similar. I really cannot bear the prospect of no NSAIDs. I rely on them to keep moving

I think I will maybe call the other GP in the practice and ask his view. He is fine with me telephoning rather than going in to ask advice, when I am not ill and don't need to see him face to face. I will see what he says once I tell him what I am worried about. I was not explicit with my GP today that I was worried I had a stomach bleed but I was clear that there were dark bits that I thought might be blood. This time, I will be clearer about my concerns and see how he wriggles out of a direct question

I will also give my pharmacist friend a call tomorrow see what she thinks.

Our PCT have given guidance to GPs to try not to use diclofenac (we use ibuprofen or naproxen first as they are safer), to always give a protector like omeprazole or lansoprazole with them and where possible to avoid them all together and use paracetamol-based painkillers where possible instead.

Cox-2s are generally being avoided (or at least only used where other things have failed) due to the risk of cardiovascular events.

It sounds like your pharmacist friend is more on the ball than your GPs are.

Viperade I think she is! But then, she is involved in the PCT too and goes on regular update training. Not sure my GPs do that, they are both quite set in their ways.

I have had both napraxen and Ibruprofen. I threw up horrendously on napraxen for some reason, and the GP felt ibruprofen was not strong enough (prolapsed, torn lumbar disc). I have stopped it, in august actually for a few weeks as I became worried about stomach problems and also read about long term use weakening of the joints, but unfortunately after two days of not using it i was in a lot of pain and unable to stand straight.

I think we've spoken before about your back Pavlov, sorry to hear it's still bad.

Are you taking paracetamol based stuff as well? We usually follow the route:
Paracetamol, if that doesn't work try Co-Codamol 8/500, if that doesn't work Co-Codamol 30/500 and only go to NSAIDs if no relief with those.

If we bring an NSAID in we continue the paracetamol based product alongside it so we can use the lowest dose possible.

Pavlov have you been to a Pain Specialist? If not push to see one, likewise a spinal surgeon. It is all well and good for GP to give you painkillers but you need someone to treat the cause IMO.

Where in the country are you? If you are near me I can recommend my spinal surgeon.

Hi Pavlov,
I've had multiple vomits in the pass that were bleeds, both fresh and coffee grounds.
I wanted to try show you a pic of what it was like for me. I found on the Internet a picture of what looks very similar. The picture isn't real coffee ground blood but they have made it up to look like it.

www.moulageconcepts.com/Recipe-Example.html

I had bowl fulls of this stuff :-(

www.moulageconcepts.com/Recipe-Example.html

I have had a stomach ulcer in the past, and I also have a hiatus hernia.
But I have had these vomits when the stomach ulcer wasn't there too. And they couldn't give me an explanation.
And they were all on empty stomachs. Bowlfuls of this stuff coming up :-(

NSAIDs help my pain but I can't take :-(

With omeprazole I have vomited dark fleck bits that look like seeds / vanilla beans. I believe it was the inside of the capsule.

I had a feeding tube in the past and nurse broke up omeprazole into water to flush through tube and it was black/brown bits.

tuttu I saw a spinal neurosurgeons physio! that was as close as I got. I was promised a re-referral to them if the nerve pain, pins, needles and numbness continued after two months of physio and from there either look at surgery or over to pain clinic depending what the MRI they would have done indicated was happening now.

However, it is the GP that does the referrals, and the spinal team said they would discharge me, and the GP would re-refer once I had finished physio. I see two gps, depending on who is around. This GP is now saying she wants me to wait again, and that I should think about accepting it as it is as that what other people do.

I have an appt to see my other gp on thursday to discuss that and the blood in vomit.

the dark of that photo reeny is richer in content than what I threw up. And the liquid was not that dark, well some of it was, but most of it was more yellow, with the flecks within it.

viperade I am sure we have too. It is better than it was. I am taking amitriptyline for the nerve pain. I had sworn that my hip had become damaged as my back, hip, leg hurt sooooo badly when I moved. But the pain has eased a lot now, I am just left with bad pins and needles and numb patches as long as I take the meds.

the order I have taken meds have varied. when my back has first 'gone' over the last few years I have been prescribed 800mg ibruprofen/1000mg paracetamol and 30mg straight codiene, then reduced to normal over the counter cocodemol. Sometimes with diazepam for a few days. then a few times I was given diclofenac instead of ibuprofen or napraxen.

The last time it went at christmas this year I had codiene/paracetamol/diclofenac rather than co-codemol together. I called the OOH as it was not helping much and the OOH gp gave me solpadol (30mg/500mg x 2) and some diazepam again, along with diclofenac. I took that for several weeks then reduced to 30mg co-codemol. Eventually reduced to bare minimum co-codemol and ibruprofen, occasionally increasing as pain went up and down. Then in June my back 'went' again. I went up to 60mg/1000mg cocodemol and diclofenac. But I was not functioning well on codeine long term and gp persuaded me to change to tramadol.

Now, I am taking tramadol 100mg x 2 modified release daily, 1000mg x paracetamol daily, diclofenac 50mg x 3 daily, omeprazol 20mg x 1 daily and amitriptyline 25mg nightly.

I meant to say, I did not think to take paracetamol with tramadol and GP did not recommend. But then I thought maybe I should be as tramadol did not seem to be doing very much. Paracetamol was ace!

Hi. I don't mean to butt in but I would really keep an eye on the digested blood. I took nsaids last year after c section, and went from one bout of grainy blood in vomit one week to massive stomach hemmorage the next. Several weeks in intensive care, massive transfusions and surgery on my stomach they only just managed to save me.

Have been taken off nsaids for life, which is a nuisance as paracetamol is hardly touching my current aches and pains.

I didn't mean that to panic in any way, just to say you need to be checked out thoroughly, and be taken seriously by your doctors. Ulcers are nasty buggers.

petite oh shit! i hope you recovered ok, that must have been terrifying. I am going to keep an eye. Did you have other symptoms like indigestion etc? Where you taking omeprazole etc? I am making sure I will take this without fail and will always eat first now, never missing even one time now. I have not been sick since, but I know it is only time before it happens again, and I have had no indigestion for a couple of days. I am going to keep a very very close eye.

No I wasn't taking any stomach meds - slight medical error there - and didn't have indigestion. My main symptoms were lack of appetite, fatigue, stomach pains - all of which I put down to post partum issues (I even thought I was starting pnd).

Since I am on inexium 40mg a day. Just had another c section last week and was only allowed a tiny dose of morphine and now can have 3 g of paracetamol a day. Have been told I will NEVER have another nsaid. All that said, I was an extreme case, and have had no directly related issues since. The ulcers were caused 100% by the nsaids, and I had only been on them for a couple of weeks.

that is quite shocking that it happened so quickly and with hardly any warning. And while extreme it is worth taking note.

I am tired much of the time. But. Fatigue has plagued me long before I took long term NSAIDs so it is not necessarily something I would think of as new or concerning. And, I have an absolutely shocking appetite nowadays. I have completely lost it apart from the odd craving for chocolate but I have put that down to the meds partly suppressing my appetite especially the amitriptyline, and also partly due to some of the side effects. I am much less regular and so means I am full for longer so to speak, presumed that would be why.

I have no stomach pain. Only indigestion from time to time and that pretty much always ends in me throwing up after an hour or so of it at most.