Apparently the Hyperemesis Gravidarum Isn’t Completely Gone

Yeah, the title says it all.  I got a not-so-nice reminder last night that I’m not normal right now.

I’d been feeling off for a couple of days: tired, lots of reflux, and just a general feeling of things not being quite right.  Tie that in with a busy weekend that involved lots of walking around the farmer’s market and exploring Solvang and playing and just generally overdoing it, and you’ve got a recipe for nastiness.

At lunch yesterday, I felt really lightheaded.  Washed out.  My face and lips felt cold and clammy.  I ate lunch and chased the feeling away.  I kept trying to keep that feeling away with food, but by the time Mr. Grasshopper and I were driving home from work (we carpool), I told him about it and said that I thought I might start taking Nexium again.

It’s not that I was feeling heartburn.  It’s that the food kept trying to crawl back up my throat.  Yuck.

I felt worse and worse as the evening wore on.  I made the mistake of powering through it.  Very dumb.

Right before the Grasshopper’s bedtime, it hit.  I lost my dinner.  I lost my afternoon snack.  I even managed to dig deep and lose part of my lunch.  I guess you could say that we get the job done in this house.

The worst part though was that I panicked.  Thank God my husband was there in easy calling distance.  He kept me from going down that mental rabbit hole of fear.  He just kept reminding me that I wouldn’t go back to where I was, and that I was going to be okay.  The Grasshopper, bless her, wanted to help, too, so I sent her to wet a washcloth for my face.

As soon as I got through story time, I went to my bed and fell asleep hard.  Not an, “Ahhh.  I think I shall sleep now,” but one of those sleeps where your body and mind just kind of force you down.  Also not fun, but apparently my body needed to rest and heal itself.

I ended up taking a Zofran last night and a Nexium this morning since I was still feeling some reflux.  I’ve still got that heavy tired feeling hanging around, so I stayed home from work to rest this morning a little more.  I’m also pushing calories to make sure I get my furnace going again.

Lesson learned:  Don’t overdo it.  One exciting activity per weekend is enough thankyouverymuch.  And if I start feeling not quite right again, I will not be “powering through it.”  This isn’t a marathon.  The end will come with time, not effort.  I just need to go easy and take it slow.

Therapy for my Emetophobia is Helping!

I mentioned previously, in my Travelling with Emetophobia post, that my emetophobia has been getting worse.  This played out again in church on Sunday when the child in the row behind me started coughing and my first thought was, “Oh, my God.  I hope he doesn’t puke!   EEEK!”  Yeah, so it seems like the emetophobia has started to spread out a little and make me uncomfortable about other people getting sick too.  Kind of like with the retching baby on the plane.

Good thing for me, though!  Last week I called the therapist my husband and I saw last year.  He didn’t seem completely sure what he could do to help, but he said he wanted to meet with me to find out more and see if we could come up with a plan.  I appreciate how candid he was in that respect.

We met yesterday at lunchtime, and I had to explain what I went through with the HG and how it affects me day-to-day.  He listened carefully and took notes in that disconcerting way that therapists do.  Ultimately, he came up with a few coping ideas for dealing with my anxiety:

  • Live in the moment.  Remember that it’s the Fear of the Fear that causes the panic.  Live in the moment by reminding yourself that you aren’t sick right now, so there’s nothing to be afraid of right now.
  • Shift your focus.  The panic comes from your brain working itself into circles.  Don’t start down that path to begin with.  If you feel yourself starting to go down that hole, breathe and consciously shift your focus to something unrelated to the fear.  A dinner table example might be the good conversation with the family.
  • Say a mantra. Come up with a mantra to keep from going down the hole of panic if you start getting scared.  Not something to say over and over until you freak (“I’m gonna be ok. I’m gonna be ok. I’m gonna be okay. OMG I’M SO NOT OKAY!!!”), but something calm to say once to trigger yourself to calm down.  You might have two mantras: one if you hear someone else coughing or retching (“Thank goodness that’s not my problem!”) and one to keep from going into panic about germs and being sick (“You were good yesterday, you’re good today.”)
  • Keep a talisman. Get a few anti-anxiety pills from your doctor in case you do start having a panic attack.  Head it off at the pass.  Like the zofran you keep from last year, you probably won’t need it, but just having it there will bring a sense of comfort and control.  If you start feeling scared, remind yourself that you have this if you need it, and you don’t need to fear the fear.  Stop thinking of this as a “crutch.”  It’s not a crutch.  It’s a positive tool to help bring control to an otherwise out of control situation.  It’s a talisman.

He said that learning to use those little techniques takes practice, but he complimented in saying that I’ve actually got a pretty good handle on it already with the way I was able to talk myself down from panic on the plane.  I told him about some of my fear and reservations going into an HG pregnancy, and he drew me back to the points he made that I listed above.  I can use those to deal with the anticipatory fear of HG just like with the emetophobia.

He reminded me of my own words:  I’ve been through this before.  I know what to expect.  I know that I will be getting the best medical care available.  Some days will be good.  Some days will be bad.  Live in the moment.

It actually didn’t take that long to talk about.  I still had half an hour left!

Like a good blogger, I took the opportunity to plug my site!  Okay, well, I didn’t really “plug” it, but I did talk about how I’m channelling my anxiety and energy into something positive: helping other women who have had, do have, and will have again HG.  He seemed pretty pleased with that, and he talked about the positives that this whole thing will bring:

  • I will have the ability to give back to the community through writing and the ability to receive support through sharing my experience, something that appeals to my activist mindset.
  • In a morbid sense, odd things make for good blog posts.  Hang onto that on crappy days and remember to watch for the weird.  This plays right into my somewhat sarcastic and slightly twisted sense of humor.  Yeah, if I have to go to the hospital, I’m so making my husband take the camera.

The biggest thing he focused on was that I wouldn’t be suffering for nothing.  Interestingly enough, he didn’t talk about that “something” as being the baby.  In a weird sense, that’s okay.  When I was pregnant with the Grasshopper, I reached the point where I was so detached that I didn’t really care that much about that.  I just wanted to get through the damn pregnancy and get her out.

He focused on the “something” as being my contribution to the community, my contribution to other women and families in sharing my experience.  In that sense he helped me find a way to bring value to the HG itself.  It’s certainly a means to an end, but in approaching the journey in this way, it makes the horrible means a whole lot easier to get my head around.

Another thing that appealed to me was when he pointed out that this will be like a science project.  What does a really aggressively managed case of HG look like?  What does HG look like when a woman does have the proper support of doctor, family, community, and friends?

I really like science.  The idea of thinking of this whole thing as an experiment really appeals to me.

Ultimately, I left the session feeling empowered and uplifted.  We both agreed that I probably wouldn’t need a follow-up any time soon.  The tools he gave me are ones that I need to practice, and, as another positive, the chances to practice those really do come few and far between.

He said if I do start struggling with depression as a result of having HG, he’s absolutely willing to see me to talk things over.  Talking out loud, and saying the words can be healing.

Ultimately, we parted with smiles all around and a hearty, “See you later!”  “Hope not!”

Yesterday was a good day.  I can do this.

Travelling with Emetophobia

Travelling with emetophobia can be brutal, and since having hyperemesis gravidarum, emetophobia is a real problem for me.  When we travel in the US, it’s not so bad.  You don’t have to worry so much about drinking the water or not having the right enzymes to digest the cheese.  Stuff like that.  Japan was not an issue at all.  Japan is so clean you could probably eat off the street and not get sick.  It was so clean that we could do stuff like eat food from street vendors outside the temples without much concern.

Latin America, not so much.  You can’t drink the tap water, and they don’t have the same health regulations for food vendors.  I managed okay in Nicaragua.  That was before the emetophobia really settled in and got comfortable in my head.  Ecuador was pretty rough.

I started having major food aversions in Ecuador.  I think I would have been okay, had I not gone to the grocery store with my mother-in-law and seen the crate of frozen turkeys just sitting out by the big double-doors leading to the outside.  Having just given a presentation at work on food safety, I was horrified.  I could practically see the bacteria crawling across it.  I imagined puddles of turkey juice settling onto the floor.  I didn’t eat much that day.

I spent a lot of the trip fighting off panic.  It was pretty rough.  I was not able to enjoy several of my favorite foods.  I had to force down my mother-in-law’s phenomenal ceviche, which is ridiculous because the shrimp are grown and harvested by my father-in-law so I know exactly where these shrimp come from and I know that they’re unbelievably fresh and packaged and handled safely.  Safer even than the US.  It’s also ridiculous because they’re the cleanest people I know.  My mother-in-law’s nickname is Mrs. Clean.  She mops her floors daily.  She keeps the cleanest house I’ve ever been in.

I generally will eat just about anything.  I love trying new foods, as evidenced by my willingness to eat octopus stuffed doughnuts outside Asakusa temple in Tokyo.

Savory little pastries with octopus arms inside. NOM.
Savory little pastries with octopus arms inside. NOM.

This emetophobia, though, has put the kibosh on that.  Now, I see restaurants or food vendors and all I can imagine is warm refrigerators and putting cooked meat back on plates that held raw meat and chopping veggies on the raw chicken cutting board.  All I can imagine is salmonella hell.

The plane rides were rough too, particularly coming back.  I always get a little woozy on airplanes.  The air is stuffy, they move around a little.  No big deal though.  These days, when the smell of the plane hits my nostrils, I immediately have to start fighting the panic.

On the way back–Guayaquil to Miami–there was a baby a few seats in front of us who kept having coughing fits.  I kept imagining I was hearing retching noises.  That’s a new one on me.  Usually it’s just me throwing up that’s a problem.  I kept imagining that I felt nauseated.  When we were landing in LAX, I actually had to talk myself down from an actual panic attack.  You know, you start breathing fast and your brain starts going around in circles.  I felt like I would be sick.  I felt trapped.  I felt like I couldn’t breath or get out.  I had to close my eyes, clamp my mouth shut, consciously slow my breathing, and talk myself down.

I think the emetophobia is getting worse.  Maybe it is time to start dealing with it.  Frankly, though we don’t have any travel planned, the thought of getting onto an airplane makes me feel extraordinarily uncomfortable.

This is the place where I usually start giving tips and pointers on dealing with things.  I don’t have any tips for dealing with this.  I’m at the point where I need to suck it up, make some time, and call my doctor to get a recommendation on a good therapist.  From what I gather, emetophobia is pretty difficult to deal with.  I am absolutely not interested in doing any kind of exposure therapy.  Hopefully my doctor will have some good information for me.

Anyone know how to deal with this kind of thing when you travel?  I mean aside from travelling with a whole bunch of Zofran.

Emetophobia, How I love thee. Not really.

You know, I managed to survive my last bout of hyperemesis gravidarum with almost no long-term effects.  Considering some of the things other HGers have to deal with in the aftermath, I’d say that’s pretty lucky.  The only thing I really came away with is emetophobia.

Ah, emetophobia.

For those of you who don’t know, emetophobia is a fear of vomiting.  It can manifest in people in different ways.  For some just reading the v-word is enough to trigger panic.  Other people have trouble with seeing, hearing other people puking.  For me, it’s just if I throw up or get nauseated.

I first realized emetophobia was a part of my life when my daughter was a baby, she picked up a stomach bug, and, of course, gave it to me.  I expected discomfort.  I expected misery.  What I did not expect were the flashbacks and the panic attacks.  My husband tried to console me and remind me that it wasn’t HG.  The rational part of my brain knew this and agreed with him, but that part in the back, that lizard part, went into total fight or flight mode.

When I had HG, normal “sick foods” were triggers.  Water was a trigger.  Because of this, when the stomach bug hit, I stopped eating and drinking.  It was bad enough, that in retrospect, I really should have gone into the ER.  I wound up not eating much of anything for close to a week.  I got below my HG weight.  It was bad.  Really bad.  It took me a month to get back to normal and close to six months to get the weight back.

Emetophobia isn’t a discomfort with throwing up.  It’s not that it’s simply unpleasant and I don’t like doing it.  Does anyone find it pleasant to puke?  It’s an intense fear.  The intensity is akin to fearing impending death.  It’s as if vomiting will kill me.  I know it’s not rational.  I mean, duh.  That’s why it’s a phobia right?  If it were rational we’d call it self-preservation.

I’m not sure if what I have is actually technically emetophobia or more like PTSD from the HG.  Maybe the two aren’t mutually exclusive.  All I know is that when I catch wind that a stomach bug is going around I freak the heck out.

My doctor has been kind enough to write me a prescription for 15 tablets of 8 mg ODT Zofran.  I’ve got 13 left.  How sad is it that I know exactly how much Zofran I have at all times?  Maybe Dr. K is enabling my fear by writing the prescription, but honestly, I felt a lot safer once I knew it was there.  I haven’t gone into emetophobic panic since I had it filled.  It’s my safety net.

Today, though, I overheard my next door cubicle neighbor talking about her niece puking.

NO!

Honestly, though, with all the HG prep I’ve been doing, the fear isn’t as bad as it used to be.  I’m still freaking out, but I’m not panicking.  I’m not sure how I will react if I actually catch the stomach bug.  I’ve managed to avoid one since that first one I got a few years ago.

The bigger question is this: How will I react when the HG hits?  Will it be different because it’s HG and my doctor’s willing to basically drop a nuclear bomb on it to treat it?  Will I panic?  Will I have flashbacks?  Will I have the dreaded anticipatory fear kick in when I find out I’m pregnant?

Why can’t I just have a normal pregnancy?

My First Round with Hyperemesis Gravidarum (HG)

Doctor

 

If I’m a little vague on the details of my first round of hyperemesis gravidarum, it’s because my memory is pretty foggy due to the severity of my illness.  In February of 2007, my husband and I found out that we would be expecting our first child.  We were thrilled.  However, a few weeks later, I became very, very ill.  For weeks I chalked it up to morning sickness.  My doctor did his best with the information I was giving him and prescribed various medications in an attempt to bring the nausea and vomiting under control.  Nothing worked.  Any pill he tried (Zofran and Reglan are the ones I remember), I threw up.

At some point during that period, he prescribed a pump that would deliver Reglan subcutaneously in a constant drip.  This helped a little, but I was still very, very ill.  I missed work day after day.  I just couldn’t get up off the bathroom floor.  Why should I be such a wimp, I kept thinking to myself, It’s just morning sickness.  Everyone has this. 

 It wasn’t until I voiced these thoughts to my home health nurse that she told me that I had been diagnosed some time ago with Hyperemesis Gravidarum.  She pointed me in the direction of the HelpHer forums where I began to learn that I was not a wimp and I was not alone.

By this time, I was receiving the maximum dose of Reglan through my pump with little relief.  Week 12 rolled around, and my hopes for magically feeling better in the second trimester was dashed.  Instead of feeling better, the HG was getting worse.  One of the side effects of Reglan can be depression and suicidal ideation, and with the devastation I felt at seeing weeks 12 and 13 pass with no relief, the dark thoughts that had been lingering at the edges of my awareness started to creep forward persistently.  I fantasized about jumping from the 5th floor skywalk at my office and ending it all.  A few days, the thing that kept me from acting on those thoughts was the notion that I was such a pathetic person that I would fail at killing myself and that I would just wind up paralyzed and still puking.  I tried to rationalize it away as just another side effect, but things were getting worse and I was getting sicker.

I thank heaven for my home health nurse who was smart enough to continue asking probing questions until I told her finally about the “bad thoughts” I kept thinking.  She immediately called my doctor who reacted swiftly by changing my pump medication from Reglan to Zofran.  The next day, they admitted me to the hospital for severe dehydration.

Several days later, rehydrated, the Zofran in my system, and Meclizine and Benadryl added in to the cocktail, I was able to go home.  Because I was still very, very ill my doctor wrote me out of work, and I went on disability leave for a month.  During that month, due to the treatment I was receiving I was able to turn the corner and slowly wean from the drugs.  By week 17 or 18 I was off all medications.

The next 10 weeks were comparatively great.  I still had to eat only “safe” foods, and I still had to move carefully and rest often, but I felt fairly normal.  At around week 28, while on vacation visiting my family, the HG came back.  This is pretty common and is known as the 3rd trimester relapse.  Though it was not nearly as severe, I had to go back on all my old medications (except I could tolerate sublingual Zofran and didn’t need it via a pump) with the addition of Pepcid for the horrible heartburn.  The illness lasted until the end of pregnancy, although as long as I took my medications like clockwork I was able to keep the nausea/vomiting at bay.

On November 5th, 10 days past her due date, I delivered a beautiful and healthy baby girl.  The moment she was born the illness disappeared.  I celebrated by eating a hearty meal that evening while I held her.

I was lucky.  So far, the only lasting effects of the HG that I have observed are emetophobia in myself, and some weak tooth enamel in my daughter probably due to malnutrition in myself when her little tooth-buds were being formed.

So, that’s my story.  It wasn’t as brief as I expected it to be, but it will give you the background to know where I am coming from as I post about this next pregnancy.