My Hyperemesis Gravidarum Protocol

Doctor

Preparation

  • Make sure I have a doctor who is on board with my treatment plan and willing to let me continue nursing barring pelvic rest or self-weaning on Gabi’s part.
    • Comment –  Consultation appointment on 10/8 with Doctor – AWESOME!!!!!  She believes that early, aggressive treatment helps reduce the severity of the HG
  • Consult doctor regarding early ultrasound to rule out possibility of ectopic pregnancy.
    • Comment – Will schedule u/s for around 5-6 weeks
  • Start taking prenatal vitamins months in advance to make sure my folic acid levels are high assuming prenatal vitamin will not be tolerated in pregnancy
    • Comment – Take 5 Mg folic acid + 100 mg B6 + stomach-friendly multivitamin (skip the prenatal) – New Chapter Every Woman’s One seems to sit very well.
  • If Gabi has self-weaned by the time we are trying to conceive, do a liver detox.  This cannot be attempted while breastfeeding.
    • Comment – Gabi still nursing, so just taking milk thistle sporadically.  no research to back this up, can’t hurt, may not help, discontinue Milk Thistle upon receiving positive pregnancy test
  • Find potential snack ideas for AM eating
  • Source various vitamins: sublingual B6, sublingual Folic Acid
    • Comment – sublingual B6 available from Lassen’s.  Sublingual Folic Acid doesn’t seem to exist.
  • Purchase supplies of Folic Acid, Unisom, B6, Ginger, ketostix
    • Comment – Do this in November following the consultation appointment
  • Ask Daycare to help daughter deal with the emotional issues and sense of insecurity this may cause for her
    • Comment – spoke to Daycare about this on 9/14, she knows what we may be dealing with and will help daughter with the emotional strain this will have on her
  • Investigate PrimaBella wristband
    • Comment – definitely worth a try, according to Dr should also investigate acupuncture
  • Pad your weight.  Currently at low-end of weight for height, so she wants me up at the higher end of weight for my height.  Not overweight, but with more padding.
    • Comment – Eat balanced, nutrient-rich foods, remember tips from nutritionist for snacks like olives, milkshakes, etc

Upon Receiving a Positive Pregnancy Test Result

  • Continue taking Multi-vitamin as long as possible, but discontinue when it is no longer tolerated.
  • When prenatal is no longer tolerated switch to Folic Acid only
    • Comment – Be aware that folic acid can cause stomach upset and reduce dosage as necessary
  • Begin taking ginger supplement and continue as long as tolerated.
    • Dosage – 500 mg 2x/day
  • Begin taking Unisom (Doxcilimine Succinate)/B6 immediately on getting positive pregnancy test and continue through pregnancy.  These are more effective if taken together.
    • Dosages:
      • Unisom – 1/4 tab 2-3x/day with 1/2 tab at night, no more than 75mg per day
      • B6 – up dose to 150 mg/day divided into separate doses over the day
  • Begin taking fiber supplement immediately on getting positive pregnancy test
    • Comment – Only take if you can drink lots of water or it will have the opposite effect.  If not, take colace or other stool softener
  • Order PrimaBella wrist band
  • Before rising in the AM eat small snack.  Continue as tolerated.
    • Comment – Eat/drink every 30 minutes.  This should be a full-time job, and may be one of the few things that keeps this under control

At first Sign of Nausea

  • Continue Unisom/B6
  • Continue Ginger as tolerated
  • Begin using Prima Bella wrist band
  • Begin taking 8 mg ODT zofran every 6 hours upon 1st sign of nausea – take a dose 30 minutes prior to rising in the morning (or if placed under tongue in the night, pull it out so it can dissolve)
    • Comment – Rx in hand for full month’s supply.  Insurance appears to cover this with $25 co-pay
  • Begin taking stool softener immediately upon starting Zofran – Colace or Senekot
  • Take other anti-emetics as tolerated to support the Zofran, explore possibility of steroids with doctor
    • Comment – Many to choose from, Dr will be seeing me often to ensure things stay under control, will tweak as necessary

If Oral Meds begin to fail

  • Begin testing urine daily for ketones
  • If ODT zofran begins to fail and I am not able to take in food/liquids, begin IV fluids
    • Comment – Will work with home health providers to determine what the best options for these will be.  May use Ivs in conjunction with Zofran pump.
  • DO NOT WAIT FOR KETOSIS TO OCCUR BEFORE BEGINNING IV FLUIDS
    • Comment – Dr more interested in how I feel in general that a ketone number.  +1, +2 is bad.  She wants me to be at trace/0, but if I’m feeling crappy, that’s a more important indicator.
  • If nausea continues, add other meds to find balance. Last time: meclazine (concerns about cleft palate), Benadryl.  Prefer to find ones that are approved for Lactating mothers if I am still nursing.  www.motherrisk.organd Dr. Thomas Hale, pediatric pharmacologist @ Texas Tech Med School (and founder of InfantRisk (806)-352-2519) will both be good references
    • Comment – Dr is happy to work with these groups, and is fairly confident that as long as we aren’t doing anything really intense, all the medications she’s using are safe for me and my daughter and the zyg.
  • Keep close eye on condition of veins and IV locations and have PICC placed before all usable veins are taken up
    • Comment – Zofran is acidic and causes scar tissue in veins to build up quickly, Dr wants to avoid PICC if at all possible.  Higher risk of complications with these.

If Weight Loss Continues into 2nd Trimester

***Disaster Scenario***

  • If I continue losing weight into the 2nd trimester and I am unable to eat, attempt to place an NG/NJ tube
    • Comment – preferable b/c digestive system stays working and doesn’t damage liver, Dr hasn’t had one successfully placed due to hospital restrictions, but she knows other drs and is willing to work the system if necessary to get one for me.
  • If NG/NJ tube doesn’t work, add TPN
    • Comment – Avoid if at all possible.  This really is the disaster scenario.

Non-Medical Assistance for Pregnancy

  • Keep a close eye on mental health and deal with feelings of depression/despair immediately.
  • Take care of personal hygiene as much as possible (try using Gabi’s toothpaste to see if that’s easier on the stomach)
  • Provide Juan with clear guidelines on how to advocate for me so he feels empowered and knowledgeable on when to step in
  • Inform work early and provide educational materials about HG so that they will know what I am facing before it hits.
    • Comment – Contact HR right away to discuss it with her and get coaching on how to work with managers on the issue.
  • Develop a plan with HR and with Dr to determine when/if disability leave is needed.
    • Comment – If I am feeling awful and need to rest, Dr will write me out early.  A little leave early can often save a lot of leave later on.
  • Inform people early of pregnancy, especially those that will see the most impact: Daycare, our parents, siblings, friends, etc
  • Give HelpHer links to friends, family, work, etc
  • Talk to friends about guilt/isolation/etc – ASK FOR HELP
  • Reach out in HelpHer Forums for support
  • Spend extra/special laying down/quiet time with Gabi
  • Arrange for a cleaning service to come in and clean the house to take the burden off Juan
    • Comment – Juan doesn’t seem super hip to this idea for some reason.  Will find name/number to hand him if he changes his mind.
  • Keep up with people via facebook/email/etc as much as possible, especially if I am homebound
  • Journal, blog, vlog, something

22 thoughts on “My Hyperemesis Gravidarum Protocol

  1. I wish I could be your next-door-neighbor so Juan and Gabi could eat at my house.

    I love the special laying down/quiet time idea. Beautiful.

    Do not feel guilty about any time missed from work. HG is like dying a slow death. People on chemo are excused from work, no questions asked. HG causes our bodies to feel poisoned. If you can’t work a normal schedule, do not try.

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  2. Thank you for such a witty take on HG. I have had 2 children with severe HG, I am planning for third now and your list here is brilliant and helpful. I have been making a list and preping everyone for the day, if it comes. I am always hopeful that this will be the baby that doesnt bring HG. Havent been so …yet. Maybe this time around. I am usually positive even THO im so sick and miserable. Reflecting on the blessings in my life and knowing the outcome is precious “BB”. GOd Bless and thank you again.

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    1. Hi Nikki. I have that wish, too, but I’m preparing for the worst. I’m afraid that if I don’t, I will be devestated when HG hits. The reality is, it’s a genetic thing. You either get it or you don’t. At least that’s what my research and reading is telling me. For me, the best I can do is prepare and be ready for it. While I know I will probably still have it, hopefully with very aggressive treatment I won’t suffer quite as painfully.

      I wish you all the best!

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  3. Just wanted to say Bravo to you. I am following your blog and going through similar feelings/thoughts. I had severe HG with preg # 1 & #2 from week 6 – week 15, worsened because I did not get proper medical treatment. It was pure hell and I dont know how I survived, I was literally wanting to die. Looking at my two kids does make it worthwhile. I was recently preg a 3rd time, all the way through 9.5 weeks – absolutely no HG. I was ecstatic. But the baby miscarried, out of the blue. I didnt have my HCG levels tested so Im not sure if I was lower on the HCG. I am now pregnant with #4 and 6.5 weeks today and here it comes – nausea and that crappy taste in the mouth. I started Zofran immediately and am doing everything I can to just get through each moment without throwing up. I am praying this HG does not get as severe as the other two, since I am treating it early. I do sometimes feel resentment at people who only get MS, or nothing at all. I work daily to try not to feel that way and am trying to stay more positive. Good luck on your endeavor and future pregnancy.

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    1. I know what you mean about feeling some resentment toward people who don’t get HG. Like you, I try really hard to remind myself that we all have our own battles to fight, but when you’ve been feeling awful for weeks and months on end or when you really just are wishing you could have a normal pregnnacy like everyone else, it’s hard.

      My heart goes out to all the HGers suffering through the holidays. I was lucky and I missed the holidays last time around. It must be especially painful to have to suffer at a time when things are supposed to be so full of cheer.

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  4. you made me think of something as far as prep goes, if you think HG will hit during holidays, maybe prepare for HOlidays (including wrapping before TTC)! I know there is no way I could do holiday shopping even just for the kids with HG. And there is really no way DH could handle it-lol

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  5. Just wanted to thank you for sharing your journey! I had severe HG with my first. I’m actively contemplating #2 and will take a page from your action plan!

    Best wishes to you over the next few months!

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  6. Has your thyroid function been tested? It’s one of 4 things mentioned on the help her medical protocol for hg women. Mine was fine before pregnancy of hg but has swung to underactive since birth and it wasn’t checked when I was ill, despite hg. Lots of hg women have thyroid problems and I only ask because you mention your metabolism. The molecule the baby makes, hcg, can mimic thyroid hormone according to some scientific studies I’ve read, i was just discussing it on ‘the whining puker’s blog. Thinking of you xxx

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  7. I am SO glad I came across your site. I feel your pain. I had severe HG with my first pregnancy & lost over 20 lbs (I weighed 100 lbs went down to 80 lbs) and had a PICC line put in. It was horrible & made me very deppressed. 7 years later I end up in the ER thinking I have a stomach flu or food poisoning only to find out Im 6 weeks pregnant. I too am emetephobic and began to dread the onset of HG like before. Sure enough the dry heaving wouldn’t stop & after pumping me with 3 bags of IV fluids & Zofran with no relief, I decided to head home to be sick in privacy at the least. My immediate words to my bf was that we needed to get an abortion because there’s no way I could handle going through what I went through the first time. He agreed to it if it was necessary but really didnt want to go through with that option, however couldnt stand to see me severely sick constantly either. I had a recommendation for medical marijuana, which was prescribed by a Dr. before I became pregnant for anxiety & anxiety induced anorexia which began after having my first child. I of course contemplated using MMJ while pregnant for fear of any health risks, but after doing much research online & finding many reports from other women with HG who were also given zofran with little or no relief & found that medical marijuana was the only medicine that helped. So I decided to give it a try after reading a 15 year study/research by Dr. Melanie Dreher which showed no significant negative effects on newborns or 5 year old children. I too have found that the only way I can keep from excessively vomiting & keep food down is to moderately smoke before & after eating. I felt guilty at first & of course concerned of what others might think but its the only way that I feel I can remain sane & maintain a healthy weight during the pregnancy. If anyone knows a Dr. in California or can please help me in finding a Dr. that is familiar with medical marijuana as treatment for HG it would be greatly appreciated.

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    1. There should be plenty of Doctors in California familiar with medical Marijuana. There offices are usually right next to dispensaries. I do the same thing and it prevents me from having to get IV’s, I don’t think I could have survived otherwise.

      My daily life:

      -wake up super early vomit and go pee
      – smoke medical MJ
      – take phenegran (every 6 hours) and prilosec once a day
      – Drink about 8oz of water
      -take a shower or bath (baths, i usually take one when im really really nauseated and wait in the tub for my medication to kick in)
      -get out of shower and smoke , drink other 8 oz in my water bottle
      -eat breakfast ( fruit, cottage cheese) things that wont interfere with my H.Pylori diet
      – I am a stay at home mother and have my own business but ive stopped taking orders because i am so sick

      – snacks & water through out the day:
      organic eggs, fruit, veggies, grilled cheese, rice , chicken…. all sorts of natural food that will help fight the H.Pylori and HG Broccoli Sprouts are great at helping getting rid of this bacteria.

      i also have edibles that i get from the medical MJ dispensary , I usually eat half a cookie in the afternoons … it takes about 1-2 hours to kick in. I hope some of this is helpful to you and others suffering.

      I recently was tested for this bacteria called, “H. Pylori” an bacteria in the stomach, I tested positive and it is the cause of my HG. I really suggest anyone suffering from HG get tested for H. Pylori right away. Do not let your doctor say that the only way they can test you is sticking a camera down your throat to look at your stomach. There are other ways, a breath test ( not save during pregnancy) and the stool test and of course a blood test.

      Good luck! I have 27 weeks left of suffering , LOL

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      1. It sounds like you’re falling into a routine that is helping you. I’m so glad to hear that. I chose not to take medical MJ, despite the fact that my doctor okayed it. Because of the federal law banning MJ, taking it would have put my job at risk. I actually sat down and discussed it very seriously with one of the heads of HR for my company. She was very kind, non-judgemental, and mature about it. After doing some research, though, she found that, while they don’t routinely drug test people here, if they did and if MJ was found in my system my job would be at risk. Though the likelihood of being tested was slim, the risk was there. Additionally, because I blog publicly, that information would have been available for anyone to read, including my employer. I appreciated the time that she took and the fact that she went so far as to advocate for me with our legal team. The entire situation was handled with maturity and sensitivity.

        Have you started antibiotics and nexium yet to deal with the H. pylori?

        I was tested several times throughout this pregnancy, but I don’t have it. I almost wished that I had because from what I understand, H. pylori induced HG can be cured. Not just treated, but cured!

        I wish you all the best.

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      2. So, can I still be tested for the Pylori after my HG pregnancy. My son is 2 1/2 and I had HG from 6 weeks until 37 weeks with a PICC line the whole time. I’d like to rule out what I can before trying to get pregnant a second time. thank you!

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  8. Thank you, the cookies with (THC) in it really help me, especially on days i need to go places, which is impossible sometimes.

    I will be starting them today. There are so many other gastric problems that cause HG and I know this round of medication and diet might not work but, I am staying hopeful it will ease the HG symptoms. Vomiting more than 20 times a day is not normal and the last doctor i had never even mentioned the last med’s I took with my last pregnancy. He didn’t even write me a prescription or anything till i asked him to. He is an Ob/GYN on a military base and was just horrible i went in there not being able to hold down water/food for almost 3 days and he said there is nothing else he could do. I started balling my eyes out! he walked out and I was assigned a new doctor ASAP. I was so upset that he was so unknowledgeable about HG and couldn’t do anything to help me, he didn’t even tell me to go to the ER to get an IV for fluids. He was very old, about an age he should be retiring at.

    There is a legal pill form of MJ called, “Marinol”

    Thank you , I understand why your work place would not approve it. But, How can they do that to someone who has a prescription for it. It doesn’t make you loopy or out of your mind, the first few days it will hit you but after those few days you function normally. How could HR fire someone for taking a “prescribed medication” ?! I wish people were more open to this.

    My last pregnancy the last 4 weeks I was prescribed Phenergan and it worked! I didn’t have to use any medical cannabis at all. I am currently taking it but, it doesnt really help.

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    1. I’m familiar with Marinol, but my understanding is that it’s nearly impossible to get and it simply doesn’t work as well as the realy thing.

      HR handled the situation very well, I think. Medical MJ is still in a murky area. While it is legal in my state, federal law still classifies it as illegal. It’s not classified as a controlled substance like some prescription drugs. It’s classified as an illicit drug. That’s the difference. I understand their point of view and can see why they chose to err on the side of caution. Ultimately, the decision was mine to make and I chose to pursue other treatments.

      You say the Phenargan isn’t helping. Have you tried taking it in conjunction with Zofran? Sometimes the two drugs can work together to fight different facets of the HG. Probably, though, your best bet will be to get some antibiotics to kill the H. pylori and solve it once and for all.

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  9. Yes HR did do a good Job and I think the women you went to was very professional about the way she handled your situation.

    You know what? I have tried switching off and on Zofran and Phenergan but, have never taken them at the same time. I am going to try that and see how my body reacts, it would be great if the Phenergan worked for me the same way it did my last pregnancy. It was my miracle pill. I started my Antibiotics today along with Prilosec and Iron , plus the H. Pylori diet I am sticking too. Thank you for suggesting taking them together. : )

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