- 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.
- 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
- 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