Hyperemesis 101: What it is and how you can help

The British royal family on Buckingham Palace ...
The British royal family on Buckingham Palace balcony after Prince William and Kate Middleton were married. Kate wears a wedding gown by Sarah Burton. (Photo credit: Wikipedia)

Since the news yesterday about Kate Middleton and her hospitalization due to hyperemesis gravidarum (HG), I’ve seen a pretty significant bump in traffic (mostly thanks to an Inquisitr article about hyperemesis), and since many of my new visitors may not be completely familiar with hyperemesis, I thought it might be a good idea to give a brief overview on what HG is, what it isn’t, and how you can help those who suffer with this illness.

What is hyperemesis gravidarum (HG)?

You’ve probably seen many news outlets referring to Kate’s illness as extreme morning sickness or even just plain morning sickness.  While morning sickness is related to HG, the two are not the same.  Morning sickness is often a normal part of pregnancy and can be handled with home remedies, fresh air, and occasionally small amounts of medication.  HG at its most basic certainly is an extreme form of morning sickness in the same sense that measles is an extreme form of a skin rash.  For HG sufferers, the vomiting and nausea is so severe that we can lose 10% or more of our body weight, become severely dehydrated and malnourished, and even miscarry or lose our own lives.  For some HG sufferers, the danger becomes so great that they are forced to terminate very much wanted and planned for pregnancies.

Unlike morning sickness, HG often doesn’t respond at all to home remedies, and even common morning sickness medications cannot control the illness.  In order to combat the illness, many HG sufferers are placed on 24 hour IV fluid drip either through the traditional IV lines that are placed in the arms or through more permanent PICC lines or other forms of central lines that are placed in the big veins around the heart or through the jugular vein in the neck.  We often have to receive our medications through either these lines or through a pump that delivers the medication below our skin at sites placed in our abdomens or upper legs.

HG sufferers often find themselves on a variety of medications, what we call our HG cocktail, to combat the different aspects of the illness.  Medications like Reglan move food more quickly out of the stomach so it can’t be thrown up as easily.  Zofran, in high enough doses, blocks the body from vomiting.  Drugs like Nexium combat the persistent reflux that causes food to almost spill from our stomachs as we move, bend, or roll over in bed.  Meclazine or Benadryl (sometimes both together) help fend off the nausea.

In addition to the physical illness, many HG sufferers find themselves becoming severely depressed and isolated.  Because many people don’t understand the differences between HG and morning sickness, HG sufferers may withdraw from relationships to protect themselves from people who do not understand the illness and attempt to help by offering platitudes, home remedy ideas, or even scoldings and harsh words.  Some HG sufferers become suicidal either as a result of the severe depression and isolation caused by the illness or as a side effect of the medication (Reglan).  Sometimes HG sufferers experience hallucinations and other extreme mental disturbances as a result of becoming so severely dehydrated and malnourished.

How long does it last?

Unlike traditional morning sickness, HG often lasts through most, if not all of the pregnancy.  While many doctors promise a swift end to the illness at around 12 weeks, many HG sufferers find that the nausea and vomiting is actually at its worst during this time.  This can be a terrible emotional blow to a woman holding on that 12 week mark as the end date to the suffering.

While some HG sufferers vomit constantly for the entire 9 months, many do find some relief during their 2nd trimester.  The HG never truly goes away, but for a time, the vomiting and nausea can reduce somewhat or even cease altogether.

Following the period of respite in the 2nd trimester, most HG sufferers experience what is referred to as the Third Trimester Relapse.  During this period, the nausea and vomiting return, but in some cases the physical changes of the woman’s body means that the 1st trimester HG cocktail may not work.  She may need to work with her doctor to find a new combination of medications to combat the illness.

Typically, once the HG sufferer gives birth and no longer carries the placenta, the HG disappears.

Are there any lasting effects of hyperemesis?

HG can have effects that last long after the birth of the baby.  The severe vomiting can cause tooth decay and other dental issues.  Depression and PTSD are common in HG survivors.  Many continue to have food aversions long after the HG has left them.  For a very unlucky few, the vomiting and nausea continues for some time after the birth of their baby.  A small number of women even have trouble breastfeeding because the oxytocin rush causes them to feel nauseated.  Most HG survivors develop some degree of emetophobia, fear of nausea and vomiting.

What can I do to help?

Do you know of someone with HG or someone with really bad morning sickness that just won’t go away that you think might be a form of HG?  Here are some dos and don’ts to help them.

Do…

Call her.  Ask if how she is doing and really listen.  Isolation is a truly painful part of HG and knowing that your friends are thinking of you helps immensely.

Ask if you go for a visit, but instruct her that she is to stay in bed and not get up.    If she’s not up for much talking, you can help with some light cleaning.  A quick turn around the house with the vacuum, taking the trash out, and washing the dishes can be immensely helpful.

She may be embarrassed about the state of her bathroom, but a clean toilet is much nicer to puke into.  If you clean the toilet with baking soda, you won’t have to worry about the smell of the cleaner making her sick.  Run a load of laundry (including folding and putting away) with an unscented soap like Charlie’s Soap or Rockin’ Green Unscented.  Trust me when I say that the smell of the unscented Tide and All detergents can be a major trigger.  Change her sheets for her.  She’s spending all day in bed, and having clean sheets is a luxury.

Offer to bring meals for the family, but please keep in mind that food smells can cause the vomiting to worsen.  Bringing foods that don’t require cooking like a nice chef salad or other low-scent meal would be thoughtful.  You can also offer to run a few errands for her like a quick trip to the grocery store (might want to talk food needs with her spouse because the mere mention of food can often trigger vomiting), the pharmacy to pick up her meds, or some place like WalMart or Target to get some household basics like paper towels and toilet paper.

If she has kids, offer to take them to the park, the zoo, or on a playdate on a regular basis.  Knowing that her children are having fun with a friend can help ease much of the tension, depression, and guilt she is feeling over not being able to care for them during her illness.

When you talk to her, validate her feelings even if they do sound incredibly negative.  Offer a sympathetic ear.  Provide her with information about the illness including links to websites like www.helpher.org.  If you are close enough, offer to go with her to a doctor’s appointment to help advocate for her.  It’s hard to advocate for yourself when you are weak from malnutrition and dehydration.  Many doctors and nurses do not take HG seriously, and for that reason, having a strong advocate at her side is a must.

Give her a link to the hyperemesis gravidarum protocol section of my blog.  Having an example of what one HG survivor did to combat the illness can help her and her spouse advocate for proper treatment.

Dont…

Please don’t ask her if she has tried ginger, nibbling crackers, eating very small meals, or any other home remedy.  If home remedies worked, HG sufferers wouldn’t have to spend thousands of dollars on medication and treatments.  Please don’t tell her that a little fresh air and sunshine is what she needs.  Outside air often has smells that trigger vomiting and light can be a trigger, too.

Please don’t attempt to relate to her by telling her about your morning sickness.  She would kill for regular morning sickness right now, and hearing about other pregnant women without HG adds to her sense of isolation.  Please don’t suggest that the HG is caused by anxiety, depression, doubt about becoming a mother, or lack of love for her unborn child.  HG isn’t a psychological illness.  Though HG causes many psychological issues, the illness itself is very real and very physical.

When you visit, please don’t wear perfumes or scented lotions.  Those kinds of things can be a major trigger for the vomiting.  Just before visiting, please also don’t eat very smelly foods like garlic bread, onion rings, or other items that she might smell with her hyper-sensitive nose.

Please don’t talk about or mention food.  Conversely, if she asks you to bring something strange like a McDonald’s cheeseburger or a taco bell bean burrito, don’t chide her for eating fast food.  For many HG sufferers, this is the only kind of food that will stay down.

Please don’t express concern over whether the medications she is taking are safe for the baby.  She is under the care of her physician, and they have determined that the risks of not taking the medications (which can include death) outweigh the risks to the baby.  Most HG medicines are perfectly safe during pregnancy, but many HG sufferers still feel incredible amounts of guilt over taking any kind of medication.  Please don’t add to that guilt.

More ways to help…

If you aren’t directly in contact with and HG sufferer, you can donate to www.helpher.org to help support research about HG.

Spread the word.  HG often goes unrecognized by many doctors, nurses, and lay people.  Talk about it with them.  Keep the conversation going.  The more we spread the word about HG, the fewer women will have to suffer alone, in silence, and without treatment.

I hope this has been informative to you.  Do you know someone who has gone through HG?  What are some ideas you have on ways you can help them?  Have you gone through HG?  Tell us about your experience.  What was helpful?  What was not?

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