After suffering with cramps and a near-constant feeling of nausea for several months, Desiree Haight's symptoms worsened in November to the point she had to go to an emergency room.
The Calgary woman worried it was a relapse of a condition she was afflicted by in 2005, when she was hospitalized for three months and needed a feeding tube, eventually dropping to a body weight of just 98 pounds.
She'd already lost roughly 30 pounds by November — dropping from about 150 lb. to 120 lb. — and what worried her most was doctors weren't able to diagnose her symptoms back in 2005, and instead referred her to a psychiatrist when she was healthy enough to be released.
"They couldn't find anything [after] batteries and batteries of tests," she said of her previous hospitalization.
"The psychiatrist said I was stuck in a fight-or-flight mode."
This time around, however, the emergency room doctor was more familiar with her symptoms and narrowed things down with two simple questions: did hot showers or baths give her relief, and was she a regular cannabis user?
An answer of yes to both led to a diagnosis — cannabinoid hyperemesis syndrome.
"It's a very unique clinical syndrome that is characterized by a number of unique presentations," said Dr. Eddy Lang, who serves as the department head for emergency medicine in the Calgary zone, as well as scientific director of Calgary's emergency strategic network.
"What I mean by that is patients who are cannabis users will often present to our emergency department with uncontrolled vomiting that will occur anywhere from a few hours to even a day or two or more."
What also makes the condition interesting, said Lang, is that most sufferers figure out — usually on their own — that hot showers and baths bring relief.
"That's a giveaway, because there's really no other disease I know of where taking a hot shower or bath relieves the nausea component," he said, adding the sound patients make is another clue.
"Usually, people who come here with food poisoning will vomit a couple of times an hour at most. People with [cannabinoid hyperemesis syndrome] can vomit five, six, seven times every 10 minutes. And the vomiting is [of] a very deep, guttural nature. We can almost make the diagnosis by hearing it."
A self-described heavy cannabis user for more than 20 years, Haight said she often turned to marijuana as a way to relieve stress or anxiety — and feelings of nausea.
At her worst point in November, Haight said she was vomiting up to 30 times a day, which sent her to the ER.
"Just retching. Even the act of retching will give you relief, some kind of relief," she said.
"That small moment. The only relief you can get is when you retch. Maybe you'll get five minutes of not being nauseous, and maybe the hot water tank will fill up again in that time."
Not well known
Not much is known about cannabinoid hyperemesis syndrome — it was first written about in medical literature in 2004 — but there are some prevailing theories as to what causes it and why.
"A main theory is that in individuals who use cannabis excessively, perhaps they have "burnt out" their endocannabinoid system to some degree and thus compromised a normative mechanism to suppress vomiting," said Matthew Hill, an associate professor at the Hotchkiss Brain Institute at the University of Calgary.
"As such, once vomiting is triggered, because the endogenous system doesn't function properly, it becomes intractable and so develops into hyperemesis. As of now, however, this is just a theory though as no one has really been able to figure this out."
Hill notes a specific threshold hasn't been identified yet for triggering it.
"Nor do I think it's clear why only a small subset of individuals who use cannabis regularly develop this syndrome," he said.
Awareness, said Lang, for both medical staff and cannabis users, is important.
"We're seeing articles in the New York Times about it. We're seeing more and more attention being paid to it, especially now that a number of jurisdictions have legalized," he said.
"I think it was always there, but for sure the awareness within the health-care community is on the rise."
It's also not tracked closely by health-care officials in Canada, as it often presents as something else, said Lang.
The same is true in Washington State, California and Colorado — where recreational cannabis is legal at the state level.
Officials there don't track the number of people who are diagnosed with cannabinoid hyperemesis syndrome.
"It's tricky to sort out in the very first few presentations because it does, in some ways, just resemble simple food poisoning and can respond to the exact same treatments we would use for someone who has picked up a stomach bug," said Lang.
Capsaicin cream also used
Patients are usually given anti-nausea medication — which blocks dopamine receptors in the brain — along with hydration.
"One other thing we're looking at now is to sort of emulate the hot shower phenomenon. We're applying generous, even copious amounts of capsaicin cream," said Lang.
"Capsaicin is the molecule that is active in hot peppers … we're rubbing it on the torsos of these patients, and some of them are getting relief that way too."
In a city the size of Calgary, with four busy emergency departments, Lang says he expects doctors see "three or four cases a month," of cannabinoid hyperemesis syndrome.
And the prognosis is good for sufferers. Lang says they will recover fully, as long as they stop using cannabis.
Now on the mend, Haight says she hasn't touched cannabis since November, and she doesn't intend to for the foreseeable future.
"I feel like, for me, I have smoked more in a lifetime than most people have, so I'm good," she said.
"I don't feel like I'm missing out. The worst too is that it's self-inflicted."