Next patient is chelsea macomb alpha 464220 34 year old lady past medical history mixed anxiety and depressive disorder and bipolar disorder 2020 and 2021 respectively medications lamotrigine 100 mg twice a day medroxyprogesterone depot injection every 12 weeks bisoprolol 2.5 mg twice per day had the past medical history svt investigations ogd june 2025 for abdominal pain and normal investigation crp 45 alp 134 crp less than 1 white cells 14.6 with neutrophils 12.7 ph 7.42 with lactate 5.8 and subsequently 7.49 with lactate 6.2 new score 1 respiratory rate 16 sats 100% on her blood pressure a 127 over 82 pulse 99 beats per minute temperature 37.9 degrees celsius blood glucose tested this presentation I also note a letter team noting a new diagnosis of type 1 diabetes I'm not I'm good sorry for that I read the notes and he's let me just check your temperature sure I'm not sure you tested though you're thinking and we tested it so I'm just gonna take gonna it I'm no that's not good I'm just take it just because I saw a letter mhmm from the system of you being referred us for diabetes mhmm you know what I think I've found your name on but it didn't look like anything happened to her someone said she had diabetes but I don't know where that came from oh no you heard anything about it no very good fine I saw you came last time you didn't have your blood sugar tested but sometimes that can make people feel really rotten but I'm sure it's a little bit high yeah yeah so it may be worth just checking to test yeah so I've been I've doing it before and that's quite high been low for that long then it's been fixed over the in 2025 how many episodes have you had symptoms are always the same it's a stereotypical type of episode you just tell me about the episode what happens yeah I still just sheds mhmm like it's just horrible I'm I'm nauseated mhmm vomit mhmm how many times do you vomit a lot like over the toilet bowl yeah vomiting vomiting vomiting is that right yeah do you ever get off the toilet and go do something else maybe for a little bit okay and then you'll back there vomiting again and how long will you be off vomiting for not very long not very minutes yeah enough to make a cup of tea no yeah maybe maybe yeah not much longer than that no do you get to drink anything no do you drink or eat anything during these episodes nothing happens if you were right so what what were you worried might happen did you correct so you have any other symptoms you have a headache headache and that's normal with the episodes you always get tummy pain is that before you vomit or after you vomit just something any particular pain or no that's it's the happen the tummy pain happens before or the after after yeah I think it's been fine mhmm and actually mhmm yeah and okay so you don't normally have a headache when you can get like some people say they get flashing lights or weakness all down 1 side of their body bit weak just a bit disoriented okay back then and before this year had you ever had these episodes what's changed this year nothing nothing no just sudden okay so worrying about the 14 year old woman in the other running after the same year old in my house yeah very tough I bet and you're by yourself yeah stressful just how about do you do anything else other than working on any or have any other jobs fine oh no no no you don't really have hobbies no no I don't it's like 1 of these big turbo boats or big batteries you know like your normal yeah just those little vape normal 1 yeah that's fine okay fine alright and then the drugs no no nothing like that not gonna say no no no that's fine and not a weed in the bed no fine that's good alright so then and what have people told you is the cause of these vomiting episodes just the mhmm things relatively I see you've had some investigations you had an upper camera test which looked fine because of anything to rupture or cause the vomiting which but is there's probably a few other tests that 1 should have test for coeliac disease that can sometimes cause more likely so people have loose to have clear association with gluten and whether there's anything going on in terms of like a migraine or something like that which can cause this certainly nothing to worry about on your blood tests because of course slightly high 1 of the liver tests is slightly up the alp that can come up when you vomit but it's been high before but you were vomiting before as well to be fair yes it may not be the same thing I've had some tummy pain maybe worth scanning your tummy just to look at your gallbladder yeah because sometimes having gallbladder problems can make you feel very nauseated okay I see some people have bandied the diagnosis of cyclical vomiting that's fine so it's a condition which people wouldn't be deaf it does sorry you feel sick yeah yeah correct yeah so just gonna sit you're the hook yeah that would be good to me thank you you said said ventasapres mm-mm yeah that's what I should do okay perfect no I don't know she's not I don't know so okay does that moment pass yeah good it's all right don't think that's effective yeah we're talking about sitting here vomiting syndrome yeah rotiform gyroscope that raises the possibility of that being the cause yeah it's when people get if you vomit or vomiting and then they get into a vicious cycle you often don't find an underlying cause but if you have sitting or vomiting syndrome I'm not certain you do and it seems likely worth trying those things like getting some some cream do you like me to pick at hands this is your best friend cream cream cream that's the company I was trying to find the beans to be honest oh yeah please can yeah help yeah so yeah now you're 12 years old and you're far away from like you know that you know yeah from a farm where oh really yeah I know like we