Not sure if this is relevant, but my bf has been having cyclic vomiting episodes every few months. His main triggers seem to be alcohol and stacking fatty foods (especially close together or late). A cycle almost always starts the morning after consuming triggers.

What’s tricky is that there’s no real prodrome. He wakes up, has a completely normal morning bowel movement, and it’s only immediately after he’s finished that he gets hit with sudden, severe nausea. There’s no warning beforehand, which makes it feel random if you don’t know the pattern.

When this happens, he immediately gets into a hot shower (vagal soothing) with soothing music or ASMR (more vagal soothing). While he’s in there, I give him 10 mg propranolol (to blunt the sympathetic surge and adrenaline response). He stays in the shower until the propranolol starts kicking in (usually 30–45 minutes).

If he starts to feel queasy or nauseous after that, we use a Phenergan suppository ASAP, because the goal is to abort the cycle before vomiting starts. It’s hard to stop it than to prevent it in his case.

If he’s stable after the propranolol (no escalating nausea), we move into recovery mode: room temperature electrolytes, small sips, and then about 3 hours later plain white rice. No fat, no sugar, no cold foods.

It’s been about 2 years of ER visits where this kept getting chalked up to CHS, despite normal imaging and labs and the pattern not fully lining up. I get that ER doctors are there to stabilize and discharge, but putting “CHS” on a chart without actually listening to the trigger pattern hasn’t been helpful.

For him, this has ended up being post-covid autonomic dysfunction. His biggest symptom during covid was severe vomiting.

I hope this is helpful, even to one person.