My Current Hyperemesis Gravidarum Medicine/Vitamin Regimen

It’s been a while since I’ve updated you all on what I’m currently taking med-wise for the hyperemesis gravidarum.  The good news is that right now the vitamins are outnumbering the drugs.  Hooray!  This means I can keep down vitamins!

Remember: I am taking all of these under the very specific guidance and direction of my midwives.  With any vitamin or medicine you need to consult your medical care team before starting.  Some of these interact with each other and must be taken on a specific timetable.  Always ask before taking a medicine, vitamin, or herb.  Especially if you are pregnant or nursing!

So, without further ado, here is what I’m on:

Drugs:

  • Nexium 20 mg – 1 tablet at night
  • Zofran 8 mg ODT – 1 tablet before rising in the morning

Vitamins/Herbs:

It’s a lot of pills and tablets to swallow, and I’ve really had a hard time remembering to take everything.  I noticed, though, that when I miss doses my body lets me know.  When I forget the cal/mag/pot I get horrible leg cramps at night.  When I miss the multivitamin and the iron I feel dizzy and out of breath.  Or at least more dizzy and more out of breath than usual.

To help me remember to take these, even when I’m out and about, I’ve started putting the day’s worth of vitamins into a little plastic glad-ware cup.  I toss the cup into my purse, and wherever I happen to be at vitamin time, I can break out my little plastic cup-o-vitamins and start swallowing pills.

Taking my meds and vitamins every day at the correct time has really helped improve the way I feel both physically and emotionally.

 

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Natural Ways to get Iron

This Sunday, I’ll be jumping off my previous posts of the week and talking about iron.  Since I recently found out that I’m pretty anemic, it seems like a good topic choice.

“Molly,” you might ask, “Why don’t you just get an iron pill?”

A very good and very important question.  I don’t get along well with iron supplements.  First and foremost, they aggravate the nausea.  It’s a huge part of the reason I do not take a prenatal vitamin.  The high iron just makes me ill.  They also can be very constipating, and believe me, I get enough of that from the Zofran.  Finally, they can be difficult for your body to absorb.

Nutritional supplements can be good, but often they pass right through your body.  The trick is to get your vitamins and minerals from food.  For the vitamins that I do take, I try my best to find companies that source theirs from foods.  New Chapter vitamins (my daily vitamin) are sourced from food.  So is Floradix, my new iron supplement.

Sourcing nutrients from food also means they’re easier on the stomach.  So far, I’ve not thrown up a New Chapter vitamin (everyone knock on wood!), and the Floradix seems to sit pretty well, too.

I would like to find some other ways to safely and gently incorporate iron into my diet through simple and easy changes to my eating.  Now, anyone who has had HG knows that this can be difficult.  Finding snacks that don’t make me sick can sometimes be a challenge, so I did what anyone would do!

I called my mom!

And when you call in my mom, she springs into action in a big way!  She pulled out her trusty copy of Prescription for Nutritional Healing and went straight to work looking up foods for me to try.  Some of the ones she listed included (but is not limited to):

  • Bananas
  • Apples
  • Dark leafy greens (NOT spinach)
  • Purple grapes
  • Plums and prunes
  • Carrots
  • Dried Apricots
  • Liver (yeah right!)
  • Meat
It also listed foods to avoid (also not limited to):
  • Milk
  • Cheese
  • Other dairy products
  • Sugars
  • Chocolate (damn!)
  • Spinach

Wait a second.  Avoid spinach?  Apparently so!  According to the book (and wikipedia backs this up), spinach contains a compound called oxalate that can block the absorption of iron.  Good to know!

I also asked the good folks over at the Natural Parents Network Facebook page for some gentle and natural ideas to help with adding iron into my diet.

Those ladies came through in a big way.  I got a big thumbs up on the Floradix, but they had some other suggestions as well.  I’m not sure how ready I am to try powdered colostrum or terramin clay (or where I can even find those things!), but they also suggested some simple things like:

  • Cast iron skillets (check!)
  • blackstrap molasses
  • Stinging nettle infusions (will have to check and see if that’s safe for pregnancy)
  • Avoid corn and wheat (not sure how well I can do that since I’m on a bread-heavy diet right now)
  • Fresh parsley
  • Turnip greens and carrot tops
  • Foods high in vitamin C to help the iron be absorbed into my body

The most appealing suggestion, though, was to try out some green smoothies to see if they are palatable to me.

Now I have to admit:  I was not exactly sure what a green smoothie is.

If you’re clueless like me, here’s the gist of it:  Green smoothies are a fruit-based smoothie into which is blended a leafy green of some sort.  This can be spinach, kale, chard, lettuce, dandelion greens, or anything else leafy and green.  They look green, but the flavor is that of the fruit

I swung by Trader Joe’s today, and here’s what I got for my green smoothie experiments:

  • Kale
  • Bananas
  • Apples
  • Strawberries
  • Fresh medley of cut pineapple, papaya, and mango
  • Orange juice
  • Coconut milk
  • Coconut water
  • Lemons
  • Limes
  • Unsulfered Prunes (can be soaked to reconstitute for blending)
I’ve also got in my pantry:
  • Organic blackstrap molasses
  • Flax meal (high in omega 3s)
  • Agave nectar (if I need to sweeten it)
Let the experimenting begin!

In which I lose my temper at the vitamin guy

I very much lost my temper this weekend when I went to purchase vitamins.

I normally purchase vitamins at my local health food store.  I find their staff to be knowledgeable, friendly, and sympathetic.  They’ve never tried to upsell me on anything.  They simply ask me what I’m looking for, gently inquire about my needs to make sure they direct me to the correct product, and make a recommendation based on that.  They’re also a local business, which I prefer to support over a chain any day.

Unfortunately, they’re closed on Sundays, which meant I found myself yesterday in a big, chain vitamin shop trying to find my vitamin.  I asked an employee to direct me to the New Chapter vitamins, and he obliged, but as I bent down to get the one I need, he became excited and grabbed another bottle off the shelf and asked if I’d tried this other brand.  He went on for a few moments about how wonderful it was.  It was weird how excited he became.   Like a switch flipped or something.

I let him wind down, and then thanked him, but declined.  I explained that the New Chapter vitamins do not seem to make me ill at this time and with my precarious health.  I’m not interested in experimenting with another brand or even another vitamin from the same company!  This one works for me, and at this point, I need to maintain the balance of what is successful.  I don’t even take their prenatal (which I know is a very good one) because it may be different enough to send me over the edge.  I like this vitamin because it is easy to digest and doesn’t make me ill.  Also, because the contents are sourced from food, it has a high bioavailability so I know I am absorbing most of what’s listed on the back of the bottle.

His switch flipped on again, and he began to tell me about some book written by Dr. So-and-So, MD, PhD about how nausea in pregnant women is caused by zinc and B6 deficiency and how I should start taking zinc and B6.   He went on and on about zinc and how pregnant women need to take more zinc.

“Well, gaaaaaaawlleeee!  Whah didn’t Ah think about thayut!  Ah’m so stewpid.  Hurhurhur.”  (No, I didn’t actually say that!)

I did however, point out that I had, in fact, been taking plenty of coenzymated B6 thankyouverymuch.  Just under what’s believed to cause permanent nerve damage to be precise.  And guess what?  It magically didn’t work!  Do you know why?  Because I don’t have regular pregnancy nausea.  As I told him a moment ago, I have hyperemesis.  At this point I pushed up me sleeves and started showing him my scars.  “See this one?  This was my first PICC line.  It failed because my veins were shredded.  See this other one?  This was the second attempt at the PICC.  Also failed.”  Then I pulled out my pump.  “Do you know what this is?  This is a drug pump that I have to wear day and night so I get a steady flow of the medicine that allows me to be out of the house and functioning.  I don’t think a zinc tablet was going to help me.”

You will be proud.  I managed to keep a friendly tone and a smile on throughout the conversation despite the fact that I wanted to take that bottle of horse-sized pills and cram it up his read end.  When I got to the car, I lost it.  My poor husband had to listen to me rant all the way home.

Seriously, though, do people think before they open their pie-hole?  This guy was so intent to lecture me on nutrition, when in all honesty, he’s got no clue what my situation is.  Here’s how that conversation should have gone if he had a clue about salesmanship and customer service:

  • Me: “Can you please direct me to the New Chapter multivitamins?”
  • Him: “Yes, absolutely.  Here they are.  Was there a specific one you were looking for?  Let me bend down and get it for you so you don’t have to crouch.”
  • Me: “Thanks so much.  That’s exactly what I wanted.”
  • Him: “Happy to help.  If you don’t mind me asking, what is it about this vitamin that works so well for you?”  (see, this is an opening to find out what the customer’s needs might be)
  • Me: “Well, I like [characteristic 1], [characteristic 2], [characteristic 3].”
  • Him:  “I’m glad to hear that, and that is a very good choice to meet those characteristics.  I wonder though, I have [another vitamin] that shares those characteristics, but with the additional benefit of [random benefit].  Would that be something that would interest you?”  (and here we gently go for the upsell)
  • Me: “No, I think at this time, for health reasons, I need to stick with this vitamin that is familiar to me.”
  • Him: “That’s completely understandable, and you have made a great choice in selecting a very high quality vitamin.  Was there anything else I can help you locate today?”

See the difference there?  Now the above is good customer service and good salesmanship.  What he pulled with me was pedantic and rude.

I don’t know why this dude was crying into his soup anyway.  I was getting a friggin $50 bottle of vitamins.  Sheesh.  It’s not like I was going in for Flinstones.  New Chapter is expensive.  He made a decent, easy sale.  Too bad I don’t want to go back in there because of his I’m-so-much-smarter-than-you attitude.

As an aside, can I just say this?  YAAAAAYYYY!!!!  I CAN TAKE GROWN UP VITAMINS AGAIN!  Everybody do the happy dance!

B6 for Hyperemesis Gravidarum

The B6/Unisom combo (home-made diclectin) will be my very first line of defense against hyperemesis gravidarum in addition to the Zofran/Ondansetron.  I know that sublingual B6 exists.  I’ve heard it talked about on the helpher forums, I have imaginary internet friends who have taken it.  Why then, is it so hard to get locally?

I started by trying to get it from from my local big chain pharmacy.  As I expected, no luck.  The pharmacist’s assistant told me that all the vitamins are over on the shelves, which they’re not since I get prescription folic acid and I know for a fact that prenatals and other vitamins are available via prescription only.  Also, there was no sublingual B6 there since I already looked.  The pharmacist looked at me like I had three heads and proceeded to grill me about why I can’t just take a pill.  When I elaborated further, he suggested… wait for it… ginger.

Yes, Genius.  I just handed you a prescription for a month’s supply of Zofran, which is around $35 for the generic PER PILL (thank GOD for insurance).  My prescription is for 4 pills per day for 30 days.  Do you really, honestly think we (insurance and I) would be shelling out $4200 a month if ginger was likely to be a viable option?  All I wanted was some info on whether or not sublingual B6 could be ordered.  That’s.  It.

Clearly the chain store can’t help me with this.  Next stop, my local health food store.

My local health food store has a huge selection of vitamins.  It’s where I generally go to get all of my vitamins.  In this case, though, they’re coming up short.  They’ve got various sublingual B complexes, which on the surface sound great!  B12, B6, Folic Acid all in one little tab is a great idea.  Until I flip over the bottle and read the content.  It’s all tiny amounts of B6.  If I’m looking at taking 100-15o mg/day, 5 mg isn’t going to get me very far.

They looked into ordering it for me, but this has turned into a major ordeal.  I checked in a week after they were supposed to have ordered it, and they hadn’t ordered it.  They placed the order right then, and a few days later, they called me saying it had come in.  When I got it home and looked a little closer, it turns out it wasn’t sublingual at all, just plain Coenzymated B6. So I took it back.

When they started looking into it, their book appeared to be incorrect.  They’d ordered what appeared to be the right thing.  The numbers matched.  It’s just that the bottle didn’t specify that it was sublingual.  They said they would call the company for more info and then call me back.

A week went by.

I ran out of my multivitamin (New Chapter Every Woman’s One Daily – wonderful and non-puke inducing, expensive but worth it), so while I was in picking up a new bottle, I dropped by the supplement counter to see if they’d heard back on whether or not I could take the B6 sublingually.  After much standing around and waiting, it turned out that they hadn’t called yet.

He did call them the next day and left me a voice message saying that the 100 mg, which I bought, is not sublingual but the 25 mg is sublingual and would I like to go ahead and order that.

I’ve tried to call them several times this week and hit voicemail every time.

At this point, my frustration level is pretty high.  Why is it so hard to get sublingual B6?  I’d like to get it locally so I don’t have to fool with shipping, but this is just getting ridiculous.

I just want my vitamins already.

Update:  It took a few weeks, but my local health food store finally came through for me!  Yippee!

Disclaimer: I received no compensation for the products I mentioned in this post. These are simply what worked for me. Links are not affiliate links.

New Folic Acid Reccomendations for Pregnant Women

Doctor

Motherisk.org has recently published some new guidelines for folic acid supplementation before and during pregnancy.  Previously, women who were pregnant or trying to get pregnant were told to take 0.4 mg per day to prevent neural tube defects.  The new recommendation is to take 5 mg per day.

I was all set to write a post about what neural tube defects (NTDs) are, the causes, the risk factors, etc as a background to the Motherisk article.  I got partway through the Wikipedia article, and discovered that this kind of research is not really necessarily the best idea for someone like me.  Considering that after I read The Hot Zone in high school and was briefly convinced that every twinge, every runny nose, every cough were signs that I had Ebola, I should have known better.

Here’s a short summary of what I gleaned from the NTD article (here it is if you’re braver than me):  A NTD is basically an opening that occurs in the spinal cord or brain, where the spinal cord doesn’t fuse properly in utero.  Spina Bifida is the one I heard most about during my last pregnancy.  NTDs are the most common form of birth defect and occur in about 1 in 1000 births in the US, and worldwide about 300,000 infants are born with NTDs.  Common is a relative term here.  For US moms, that’s around a 0.1% chance (assuming no other factors like previous history, genetics, etc).  Pretty low.

What they’ve determined, though, is that folic acid deficiency seems to be a major contributor.  According to the Motherisk article, studies showed that in women with high risk of NTDs, folic acid supplements reduced the rate of recurrence of NTDs by 72%.  (here’s the cite given by Motherisk)  The takeaway here is that folic acid is important.

We know that.  That’s why our doctors and midwives have been telling us to take our folic acid.  So why now the change?   Why now are they advising us to up the dosage?

Apparently because women are not taking their vitamins.  From the article:

Compliance is less than optimal among women using prenatal vitamins, rendering many women unprotected against neural tube defects. Taking a higher dose of folate will allow achievement of protective folate levels, even with partial compliance.”

I will be the first one to say this:  Guilty as Charged.  When I was pregnant with my daughter, I did not take prenatals.  I happily took them prior to getting pregnant, but as soon as the HG hit I stopped.  There was just something about them that did not sit right.  Maybe it was the whole trying to swallow a giant horse pill thing, hmm?  Yeah, that’d probably be a big part of it.  Once I turned the corner mid-2nd trimester I was able to take Flintstone vitamins, but that was it.

Gearing up for things a second time around, I know what’s coming.  I know I likely won’t be able to take vitamins of any sort after a certain point.  I’m definitely in the non-compliance class.

It’s never as simple, though, as just taking more vitamins.  You need to treat vitamins with respect.  Some vitamins, if taken in too high doses, can cause pretty serious problems.  Vitamin A is a good example of this.  Based off the article, though, the risks for taking high doses of Folic Acid are pretty minimal, the main one being that it could potentially mask a B12 deficiency (pernicious anemia).  They are there, though, so I would really encourage you to read through that section of the article and talk it over with your doctor before swallowing folic acid pills by the handful.

In talking to my doctor, she agreed that it might be a good idea for me to take the 5 mg dose considering my circumstances.  She did tell me that the body won’t store folic acid over long periods, so if I’m not able to take it at all during the 1st trimester, it won’t be there by the 2nd trimester.  Additionally, high doses can cause stomach upset, so when I do get pregnant at some point, she’ll want me to reduce my intake.  No sense in upsetting my stomach with vitamins when it’ll be upset enough on its own.  So now I have in my hot little hand a sparkly new prescription for 5 mg per day of folic acid.

Also, can anyone tell me what the funky little symbol is that I see on the back of my vitamins?  It looks like a drunken U:  µ.  Is that just a fancy way to write mg?