Phone Visit
Narrative: CHIEF COMPLAINT Mother discussing Piper's cyclic vomiting syndrome and current management with cyproheptadine during sibling's visit HISTORY OF PRESENT ILLNESS Piper is an 11-year-old female (turned 11 on the 21st, currently in 5th grade) discussed collaterally during her brother Gavin's visit. Mother reports a approximately 3-year history of recurrent vomiting episodes that was ultimately diagnosed as cyclic vomiting syndrome after extensive documentation and referral. Mother kept an 18-month calendar logging vomiting episodes before obtaining a referral. Last spring, Piper had an emergency room visit during a severe vomiting episode where she developed hand cramping from the intensity of vomiting (mother has video documentation). She was started on daily cyproheptadine, which mother describes as "a miracle." They recently met with the gastroenterologist, who approved continuation of cyproheptadine for up to 5 years. Mother reports Piper is on one of the lowest doses, with the plan to increase if efficacy wanes. Mother notes some weight gain associated with the medication but is not overly concerned. Mother also has ondansetron available. Mother discussed tapering considerations with the gastroenterologist. Mother expressed interest in establishing Piper as a patient at this practice. MEDICATIONS REVIEWED Cyproheptadine — taken daily at a low dose for cyclic vomiting syndrome; recently greenlighted by gastroenterology for continued use up to 5 years. Ondansetron — available, discussed as part of her regimen. ASSESSMENT 1. Cyclic vomiting syndrome — diagnosed after approximately 3 years of symptoms and extensive parental documentation. History of severe episode requiring emergency room visit with associated hand cramping. Currently well controlled on daily cyproheptadine per gastroenterology. 2. Cyproheptadine side effect — mild weight gain noted by mother. 3. Establishment of care — mother interested in transferring Piper's primary care to this practice. PLAN 1. Cyclic vomiting syndrome: Piper is currently managed by gastroenterology on daily cyproheptadine at a low dose with plan approved for up to 5 years of continued use. Dose may be increased if efficacy wanes per gastroenterology guidance. The physician noted that puberty may have a favorable effect on the condition and could potentially quiet symptoms down. No changes made to current management at this time as this was a collateral discussion during a sibling's visit. 2. Weight gain: Acknowledged by mother; no intervention discussed at this time. 3. Establishment of care: Mother plans to schedule Piper for her own visit to establish care at this practice. FOLLOW-UP Mother to schedule an initial visit for Piper to establish care at this practice. ICD-10 CODES G43.A0 - Cyclical vomiting, not intractable E63.1 - Imbalanced diet (weight gain associated with medication) ───────────────────────────────────────── CODES: ICD-10 G43.A0, E63.1 Source: Cloud iOS recording (2026-08-15T19:44), backfilled from device 2026-08-23