Diagnosis (2019 documentary): Rumination Syndrome (episode 5 review)
- Feb 17
- 6 min read
How do you survive when your body rejects everything you try to nourish it with? For Lashay Hamblin, a 17-year-old student from Utah, life had shrunk to the size of a plastic tube. For over two years, she had been unable to keep down food or water. Every meal ended in immediate regurgitation. To stay alive, she relied entirely on a PICC line and a port—a direct intravenous route for nutrition that carried a terrifyingly high risk of fatal sepsis.
In the fifth episode of the Netflix documentary Diagnosis, titled "Question of Trust," Dr. Lisa Sanders navigates one of the most sensitive minefields in medicine: the intersection of physical symptoms and behavioral health. This episode is a gripping case study on the dangers of medical bias, the desperation of a family running out of time, and the difficulty of accepting a diagnosis that sounds like an accusation. This review dissects the journey from a mysterious raccoon bite in Costa Rica to a breakthrough involving the simple, yet profound, act of breathing.
Patient Profile
Patient: Lashay Hamblin
Age: 17 years old
Location: Morgan, Utah
Presenting Complaint: Intractable vomiting (regurgitation) immediately following the ingestion of solids or liquids. Severe weight loss, dehydration, and reliance on Total Parenteral Nutrition (TPN).
Inciting Incident: Symptoms began shortly after a family trip to Costa Rica, where she was bitten by a raccoon.
The Clinical Mystery
Lashay’s life was dominated by a relentless cycle: eat, vomit, repeat. Unlike the violent heaving associated with a stomach flu, Lashay’s vomiting was often effortless—the food simply came back up. However, the consequences were severe. She was perpetually dehydrated, suffering from chest pain, and experiencing fainting spells whenever she stood up.
Her medical history was fraught with trauma, not just from the illness, but from the medical system. Because she was a young woman presenting with vomiting, doctors frequently defaulted to a diagnosis of Bulimia Nervosa. They insinuated the vomiting was self-induced or "in her head." This dismissal caused the family to build a fortress around Lashay, rejecting any suggestion that the condition might be behavioral, viewing such diagnoses as an insult to her suffering. They were convinced the cause was a pathogen—likely related to the raccoon bite she sustained in Costa Rica just days before the symptoms started.
The Detective Work: Differential Diagnoses
The "wisdom of the crowd" was tasked with untangling a complex web of symptoms. Was the vomiting causing the fainting, or was the fainting causing the vomiting? Was the raccoon bite the key, or a red herring? Below is a structured review of the differential diagnoses discussed:
Bulimia Nervosa:
The Theory: Medical professionals initially flagged this eating disorder, assuming the regurgitation was intentional purging.
Status: Rejected. Lashay demonstrated a desperate desire to keep food down and lacked the body dysmorphia typical of bulimia. Furthermore, the metabolic alkalosis and specific electrolyte imbalances often seen in bulimia were inconsistent with her presentation.
Parasitic Infection (Cryptosporidiosis or Baylisascaris):
The Theory: Given the raccoon bite in Costa Rica, the crowd strongly suspected a zoonotic infection. Baylisascaris procyonis (raccoon roundworm) or waterborne parasites like Cryptosporidium were top contenders.
Status: Ruled Out. While the timing was suspicious, extensive stool sampling and infectious disease workups came back negative. The "red herring" of the raccoon bite is a classic example of post hoc ergo propter hoc fallacy (assuming A caused B just because A came first).
Cerebral Spinal Fluid (CSF) Leak:
The Theory: A tear in the dura mater surrounding the spinal cord can cause low pressure, leading to severe headaches and nausea that worsen when upright.
Status: Ruled Out. While Lashay had positional symptoms, she lacked the hallmark "thunderclap" positional headache that defines a CSF leak. A "blood patch" procedure (injecting blood to clot the leak) had been considered but was deemed unnecessary.
Addison’s Disease (Adrenal Insufficiency):
The Theory: A viewer suggested this rare endocrine disorder, citing the "classic triad": "Pooped (fatigue), Puking (vomiting), and Posturally Hypotensive (dizziness)."
Status: Ruled Out. Cortisol stimulation tests did not support adrenal failure.
Eosinophilic Gastroenteritis:
The Theory: A digestive disease characterized by eosinophils (white blood cells) infiltrating the gut wall, causing inflammation and regurgitation.
Status: Ruled Out. Biopsies of the GI tract did not show the requisite eosinophilic infiltration.
Postural Orthostatic Tachycardia Syndrome (POTS):
The Theory: POTS is a dysautonomia where the heart races upon standing, causing dizziness and fainting. Lashay tested positive for this on a tilt-table test.
The Twist: Dr. Sanders and the specialists determined that POTS was the secondary diagnosis, not the primary one. The severe dehydration from the constant vomiting was causing the POTS symptoms. Treating the POTS would not stop the vomiting; they had to stop the vomiting to fix the POTS.
The Turning Point: "It's Not in Your Head, It's in Your Reflexes"
The breakthrough came from a video submission by a young woman who had suffered the exact same symptoms. She described the vomiting not as nausea, but as an automatic ejection—"like a hiccup." She introduced the term Rumination Syndrome.
The challenge was communicating this to Lashay and her family. They had been gaslit for years by doctors implying Lashay was making herself sick. Dr. Sanders had to carefully explain that Rumination Syndrome is not an eating disorder and it is not "fake." It is an unconscious, acquired reflex. The brain and the stomach have learned the wrong pattern: when food hits the stomach, the abdominal muscles contract instead of relaxing, forcing the food back up.
The Diagnosis: Rumination Syndrome
Diagnosis: Rumination Syndrome
Pathophysiology
Rumination Syndrome is a functional gastrointestinal disorder. It is characterized by the effortless regurgitation of most meals following consumption. Unlike vomiting, there is no retching or nausea.
Mechanism: It involves abdomino-phrenic dyssynergia. Typically, when we eat, the diaphragm relaxes to allow food down. in Lashay’s case, the abdominal wall contracts while the diaphragm relaxes, creating a pressure chamber that shoots food back up the esophagus.
Etymology
Derived from the Latin ruminare, meaning "to chew the cud." It refers to the way ruminant animals (like cows) regurgitate food to re-chew it. In humans, it is a pathological reflex.
Treatment and Standard of Care
The Cure is in the Breath: The treatment for Rumination Syndrome is remarkably low-tech but highly difficult: Diaphragmatic Breathing.
The Logic: It is physically impossible to vomit/ruminate while engaging the diaphragm in deep breathing. The two muscle actions (rumination contraction vs. diaphragmatic expansion) are mutually exclusive.
The Program: Lashay attended an intensive inpatient program at Nationwide Children's Hospital in Ohio. The treatment involved biofeedback and eating meals while strictly focusing on deep, belly breaths to override the vomiting reflex.
Outcome: The documentary captures a triumphant moment: Lashay eating a steak dinner—and keeping it down. The port (her lifeline and her greatest risk) was removed.
Current Standard of Care (2025):
Behavioral Therapy: Diaphragmatic breathing remains the gold standard.
Baclofen: In refractory cases, this muscle relaxer may be used to reduce the pressure of the lower esophageal sphincter.
Education: Validating the patient’s experience is crucial. As seen in the episode, framing the condition as a "habit" or "reflex" rather than a "psychological disorder" is key to patient buy-in.
Patient Update (2025)
Lashay’s journey post-filming highlights the reality of chronic functional disorders—they require maintenance, not just a one-time cure.
Status: Lashay has successfully moved on with her life. Following the show, she was able to attend college and travel, things that were impossible when she was tethered to an IV pole.
Recovery: While she has experienced occasional flare-ups (common with Rumination Syndrome during times of stress), she now possesses the tools (breathing techniques) to manage them independently without medical intervention.
Advocacy: Her episode has become a primary resource for parents of children with "mystery vomiting," helping to distinguish Rumination Syndrome from Bulimia early in the diagnostic process.
Key Takeaways
🗝️ The "Psychosomatic" Stigma: The biggest barrier to Lashay’s cure was the stigma of mental health. Because doctors dismissed her as "bulimic," the family rejected any diagnosis that involved the brain. Dr. Sanders had to bridge the gap, explaining that a "behavioral" issue can be a physical reflex, not a choice.
🗝️ The Raccoon Red Herring: In diagnosis, timing is everything, but correlation is not causation. The raccoon bite happened before the sickness, so the family assumed it caused the sickness. This cognitive bias delayed the real treatment for years.
🗝️ POTS as a Symptom, Not a Cause: This case illustrates the importance of hierarchy in diagnosis. Lashay had POTS, but treating the POTS wouldn't fix her. The POTS was merely the body’s scream for hydration.
🗝️ Low-Tech Cures: In an era of genetic sequencing and robotic surgery, Lashay was saved by learning how to breathe. It reminds us that understanding basic physiology (muscle mechanics) is sometimes more powerful than advanced pharmacology.
🗝️ The Danger of TPN: The episode highlights the extreme risk of long-term IV nutrition. The central line was a ticking time bomb for infection; removing it was a life-saving procedure in itself.
Keywords: Diagnosis Episode 5 Review
Diagnosis Episode 5 Review
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