My Story of Hyperemesis: Lowered the zofran

Wednesday, April 11, 2012

Lowered the zofran

I just lowered the zofran to .500, I think my nurse said it would be the same as 3 oral zofran pills. I am so nervous! I hope it goes well! If it does I can lower it again on Friday to what would be 2 oral zofran pills then Monday I would be on oral pills (you can only take 1 pill, twice a day)! Then Picc line out next Friday! Wouldn't that be nice!

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Causes

The cause of HG is unknown. The leading theories state that it is an adverse reaction to the hormonal changes of pregnancy. In particular, Hyperemesis may be due to raised levels of beta HCG as it is more common in multiple pregnancies (though I never had multiples). It is thought that estrogen produces nausea and regurgitation of stomach acids in some women. A recent study gives "preliminary evidence" that there may be a genetic component (the only other person in my family who has hyperemsis is my cousin). More on causes and theories go to: http://www.helpher.org/hyperemesis-gravidarum/theories-research/index.php

Symptoms

When HG is severe and/or inadequately treated, it may result in:

Loss of 5% or more of pre-pregnancy body weight
Dehydration, causing ketosis, and constipation
Nutritional deficiencies
Metabolic imbalances
Altered sense of taste
Sensitivity of the brain to motion
Food leaving the stomach more slowly
Rapidly changing hormone levels during pregnancy
Stomach contents moving back up from the stomach
Physical and emotional stress of pregnancy on the body
Subconjunctival hemorrhage (broken blood vessels in the eyes)
Difficulty with daily activities
Hallucinations

Some women with HG lose as much as 30% of their body weight. Many sufferers of HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms.

As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer (my last until 20 weeks or half way). While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until they give birth to their baby, and sometimes even after giving birth.

Treatment

Because of the potential for severe dehydration and other complications, HG is in general treated as a medical emergency. Treatment of HG may include antiemetic medications and intravenous rehydration. If medication and IV hydration are insufficient, nutritional support may be required.

Management of HG can be complicated because not all women respond to treatment. In some instances, women with HG may be able to avoid hospitalization by eating a special diet of clear liquids and bland food rich in carbohydrates,and eating before rising in the morning; while these may be of some assistance, they are unlikely to resolve the disorder on their own. Hypnosis has relieved symptoms in some cases, though the majority of women do not respond to this measure.Wristbands used for motion sickness and seasickness have been shown by one study to be effective in treating some cases of HG, but not others; these are worn around the wrist at a traditional acupuncture point, 3 finger-widths from the joint, and are available at many pharmacies.There is evidence that ginger may be effective in treating pregnancy-related nausea; however, in general this is ineffective in cases of HG. Nothing but medication and hydration have ever helped me personally.

IV hydration - this is what i do

IV hydration often includes supplementation of electrolytes as persistent vomiting frequently leads to a deficiency. A and B vitamins are depleted within two weeks, so extended malnutrition indicates a need for evaluation and supplementation. In addition, mineral levels should be monitored and supplemented; of particular concern are sodium and potassium.

After IV rehydration is completed, patients in general progress to frequent small liquid or bland meals. After rehydration, treatment focuses on managing symptoms to allow normal intake of food. However, cycles of hydration and dehydration can occur, making continuing care necessary. Home care is available in the form of a PICC line for hydration and nutrition (called total parenteral nutrition). Home treatment is often less expensive than long-term and/or repeated hospital stays.

Medications

While no medication is considered completely risk-free for use during pregnancy, there are several that are commonly used to treat HG and are believed to be safe.

The standard treatment in most of the world is Bendectin (also sold under the trademark name Diclectin), a combination of doxylamine succinate and vitamin B6. However, due to a series of birth-defect lawsuits in the United States against its maker, Merrill Dow, Bendectin is not currently on the market in the U.S. (None of the lawsuits were successful, and numerous independent studies and the Food and Drug Administration (FDA) have concluded that Bendectin does not cause birth defects.) Its component ingredients are available over-the-counter (doxylamine succinate is the active ingredient in many sleep medications), and some doctors will recommend this treatment to their patients.

Antiemetic drugs, especially ondansetron (Zofran), are effective in many women. The major drawback of ondansetron has been its cost. In severe cases of HG, the Zofran pump may be more effective than tablets. Zofran is also available in ODT (oral disintegrating tablet), which can be easier for women who have trouble swallowing due to the nausea. Promethazine (Phenergan) has been shown to be safe, at least in rats and may be used during pregnancy with minimal/no side-effects. Metoclopramide is sometimes used in conjunction with antiemetic drugs; however, it has a somewhat higher incidence of side-effects. Other medications less commonly used to treat HG include Marinol, corticosteroids, and antihistamines.

Other medications that are frequently prescribed for HG are Compazine, Tigan, Phenergan, and Reglan. These can be given orally or intraveneously, or administered as a rectal suppository. They are considered safe for use during pregnancy.^[15]

Nutritional support

Women not responding to IV rehydration and medication may require nutritional support. Patients might receive parenteral nutrition (intravenous feeding via a PICC line) or enteral nutrition (via a nasogastric tube or a nasojejunum tube).

Beyond Morning Sickness

BEYOND MORNING SICKNESS......I have read the best book on Hyperemesis and wanted all of the people who read my blog to go out and get this book and read it. You can find the book on amazon.com or go to the author's web page at www.beyondmorningsickness.com it is a wonderful book on hyperemesis. The author has also written a children's book about hyperemesis titled, Mama Has Hyperemesis, and my children loved it! The web-site also offers a great support system and other woman who have gone through hyperemesis!

Spiritual Connection!

I Thank my Heavenly Father every day for the beautiful children and family I have. I know that it is through God the Father, Jesus Christ, and the Holy Ghost that I made it through my 3 pregnancies. I know they have a plan for me, I know they love me and watch over me. Through Prayer, scripture study, and church they make it possible for me to survive hyperemesis. You need to be spiritual strong to survive hyperemesis, and the Lord will provide your way. I am happy to be a member of The Church Of Jesus Christ Of Latter Day Saints.

Hyperemesis does NOT equal abortion!

I have come across many web-sites for women with Hyperemesis that are pro-choice. Some even promote and support women who have hyperemesis to terminate the baby. This upsets me. There are positive treatment options for hyperemesis and women, children and families deserve better than abortion. I do not believe women, and families should choose abortion when there are other options to help with hyperemesis. I hope this blog helps women to choose to keep their baby because if I can do it, anyone can do it! Let us support one another!