hyperemesis help/advice

[etta166]

Hi all,

I'm suffering from hyperemesis again with my third pregnancy, and it is starting to really get me down. I'm not really capable of doing any normal daily acitivties at the moment (i.e. working, looking after my kids, cooking, cleaning, well anything really). I've got a very supportive GP, but he doesn't have much experience of the condition. I've seen the specialist nurse at King's who is fantastic, and as a result I've reached a point where I'm not starving or dehydrated, but I'd obviously like to try to improve thinkgs a bit more.

Here's what I'm taking/doint so far, and any further advice would be very welcome:

Anti-emetics: cyclizine, metaclopramide, domperidone (all 3 times a day)

Anti-acid: ranititdine

Folic acid 5mg

eating and drinking little, as often as posssible and whatever I can face eating whenever

resting as much as possible

Things that don't work (tried and failed so far):

P6 accupressure

ginger

vitamin B6

Thanks!

[Strawbs]

I was medicated at 20 weeks and it backed off to just a few times a day rather than the 20-30 a day (I had become dangerously dehydrated) but I can see you already are! The only things that helped me on top of this was ice lollies and sucking on fruity polos, whilst I had one of those in my mouth I didnt feel sick at all, as soon as it was gone it would return so needless to say I went through packets of the buggers..

Are you able to get someone to come in and help you? Even just for a few hours a week to pre cook meals and put them in the freezer for the kids so all you need to do is heat up and serve, a cleaner to help you keep on top of the house?

I really hope you find something as it really is horrid x

[Saffron]

Why the H2-blocker ranitidine, and not the proton pump inhibitor omeprazole (or similar)? If you're trying to suppress acid production in the stomach, a PPI would give you more complete suppression than an H2-blocker.

You say you've tried P6 acupressure, but did you also try P6 acupuncture? I think acupuncture would be a more potent treatment for this type of acute problem.

Carlsson et al 2000: http://europepmc.org/abstract/MED/11027909/reload=0;jsessionid=6kaoqsLYh5b6ZcdBuY3Z.0

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.

A study by Knight et al (2001), however, was not able to show an effect. Whereas in a more recent investigation, Habek et al (2004) did demonstrate a positive effect of P6 acupuncture on reduction of hyperemisis in pregnancy. So, the jury's still out scientifically, but it might be worth a try.

Giles Davies at 15a Barry Road is an excellent acupuncturist with experience across a broad range of areas including pregnancy, contact mob. 07739 414210. He's also very reasonably priced, and an exceedly nice person. He and his wife have grown children, so he's really understanding about pregnacies and family issues from a person perspective.

Hope you're feeling better soon. xx

[hellosailor]

Oh goodness you poor thing, that's just horrible. I had hyperemesis and like you couldn't operate at all, just lay horizontal all day throwing up every few minutes, and I had no kids, I often wonder what will happen if I have the condition again with a second pregnancy, as how on earth do you look after the child you already have when you can barely stand up??

I didn't start medication until I was 14 weeks and after that it took the edge off enough for me to function in a basic way, or at least get up rather than lying on the bathroom floor all day! Before that I found that acupuncture did have some effect in relieving it, albeit quite temporarily. But then I only just started having the acupuncture before deciding to take the medication Kings gave me, so I didn't get to see how much effect it might have had if i'd stuck with it. Dan Bevan at Health Matters has lots of experience treating women with severe morning sickness and also with hyperemesis and is

lovely. There are lots of recommendations on here for him if you look.

Are you just taking folic acid? I found that the multivitamin Pregnacare made me throw up immediately as the iron can

exacerbate the hyperemesis so I just took folic acid separately. No ginger products worked at all (tea etc) except sometimes the firey jamaica Ginger beer fizzy drink seemed to take the edge off - maybe the bubbles help in some way..

I had terrible headaches with it so used one of those gel eye masks you get that you can put in the fridge to make them cold and that helped sometimes..

As you're doing, always try to pre-empt the sickness by eating a tiny bit even before you 'feel hungry'.

reading, looking at a screen, even texting were a complete no no, I had to ask my partner to do it if I needed to send a text as I couldn't get to the end of writing one without being sick, have you noticed if reading or looking at screens might make you feel worse?

How many weeks pregnant are you? sending hugs, really hope you feel better soon

xxx

[Lochie]

Hi there, I'm so sorry you feel so rubbish. I had lengthy vomiting with both 2 babies and the last one was particularly bad to the point it was classed as Hyperemesis. I can tell from your post that you are at that really fed up stage where you feel totally miserable and can't envisage being pregnant one day more!! It is so horrible. I am not sure how far gone you are, but if it's still early days it can feel like such a slog knowing you've got months ahead. You are doing amazingly well coping with two other children too.

I stayed on both the obs gynae ward (Katherine Monk) at Kings on one occassion and the ante natal ward on another, though the first stay was complicated by bacterial food poisening so made me vomit even more! Particularly on the Katherine Monk ward they seemed to be specialists at dealing with Hyperemesis. I wouldn't class a GP as a specialist at all. For example at King's they told me there were 'many' drugs they could try to help reduce the vomiting and it would be trial and error until they got it right which could take 'weeks' (they class success as vomiting maybe just 2/3 times a day - still pretty horrible but your body is then able to cope) - whereas my GP would only prescribe the two key drugs (cyclizine and metaclopramide) and was unwilling to look at others. I took both those drugs. When I was admitted to the antenatal ward at a later stage I was prescribed ranitidine and was vomiting free for about 6 weeks which was amazing (still felt a bit queasy but nothing bad). It sounds like you have got good support though if you have a specialist nurse?

I have been told by someone (actually a poster on here) that cyclizine and metaclopramide can cancel each other out if taken at the same time? I can't remember who told me but it is worth asking your GP/nurse if that is true. I have also read that folic acid can increase nausea - again check that with your GP. I would clutch and straws and believe it to be true and so made the decision not to take any vitamins after about 10 weeks - I don't know if it had any affect at all but it spurred me on, obviously I was taking another risk not taking folic acid though.

In hindsight I am actually really sceptical as to whether the metaclopramide and cyclizine helped at all. I did stop taking them for a while and still vomited. When in hospital I had to have them injected into my bum and they still didn't stop the vomiting and I was told in extreme cases of vomiting they are not effective.

Some things that helped a tiny bit were freezing bottles of mineral water overnight and sipping on them each morning as they defrosted. There is nothing worse than sipping on room temp water when you feel sick. Also a few essential oil bottles from Neal's Yard which I kept on me (citrusy ones) and would sniff when I'd get a really bad wave of nausea!! Eating little and often (if you can bear it). I would be worse when I hadn't eaten for a few hours.

As a seasoned sufferer I am sure you know that you will get through it and muddle through and it'll be worth it. I feel for you - I can remember it so vividly :-( I hope someone else has some other tips for you and I praise your strength for doing it a third time! Good luck! x

[Saffron]

Lochie Wrote:

-------------------------------------------------------

> I have been told by someone (actually a poster on

> here) that cyclizine and metaclopramide can cancel

> each other out if taken at the same time? I can't

> remember who told me but it is worth asking your

> GP/nurse if that is true.

Wasn't me, but I do find that interesting. I had a brief look at the pharma profiles of these drugs out of curiosity. Both drugs seem to have some week activity on the acetylcholine (Ach) system, though with opposing effects. One is an mACH-receptor blocker, while the other increases concentrations of Ach by inhibiting the enzyme that degrades it.

Neither of these mechanisms of action is thought to be the means by which the drugs produce their main effects, one being mainly a histamine-receptor blocker, and the other interacting with the dopamine system.

I would talk to a pharmacist about this for more information. (Make sure it's a registered pharmacist, and not just a pharmacy assistant.) Hypothetically, if you wanted to reduce the possible interaction between these drugs, you might be able to take them at different intervals, eg 2 hours inbetween (just a guess).

Having read guidelines that say they're contraindicated, I also read absummary which noted they are frequently prescribed together anyway. Odd. Would be interesting to know more about this.

[Crokes]

Didn't want to read and run but massive massive sympathies - it's horrible and feels like the end (and feeling normal) is never in sight... I hope it eases VERY soon.

PS. I tried the Morning Well CD (I'm not sure whether it worked for me or not, there were times I felt better after using it but others not!). I'm not sure where my copy is but I could look it out for you if you wanted to borrow it.

[kristymac1]

I've pm'd you

[etta166]

Thanks to all who relied - good to know I'm not alone :)

P.S. I didn't mean to give the wrong impression: I'm no superwoman. I have a nanny looking after my other 2 children for 4 days and my husband has been fantastic and cut back his working hours so he is around a lot more. I've also got a cleaner doing the housework, and great neighbours who are helping with pretty much everything else! I also haven't been to work for weeks...

I really want to get back to as close to normal as I can, so I am going to start trying out your suggestions.

[NorthcrossJo]

Gosh, poor you. It sounds truly horrid.

I don't have kids, and haven't had any pregnancies to be able to identify with you, but I do have gastroparesis and other stomach problems, which cause nausea, vomiting, etc., and I'm on similar anti-nausea medications to you (IV Cyclizine 3x daily, ODT Ondansetron 2x daily, Ranitidine). I also have daily IV fluids at home.

Things I have found to be helpful:

- Keep drinks very cold (I like the Bottlegreen lemongrass & ginger cordial, diluted with sparkling water)

- Ice lollies: I know it's not the time of year for it, but for some reason I seem to tolerate ice lollies better than liquids, maybe because it takes me longer to ingest them, so I'm not hitting my stomach with a large volume all at once.

- Liquids (especially clear liquids) empty the stomach faster than solids. Fatty foods sit around in the stomach for the longest time of all. Complan isn't that bad, or you could try any of the other supplement drinks (even things like Slimfast are relatively well-balanced) or ask your GP to prescribe something (fortisip, fortijuice, fortipudding, ensure, etc.)

- Dehydration can make vomiting worse (it certainly does in my case), so try super-hard to stay on top of your fluid intake. I set a timer to go off every 5 minutes and drink a teaspoon of something. It seems so little, but if you can keep up with it, that gives you 60 ml/hr. If you could tolerate a tablespoon at a time, that would give you 180 ml/hr.

- Salty, plain foods work for me - saltine crackers, Carr's melts, plain mashed potato, homemade bread, all in tiny portions

Things that worsen my nausea

- strong odours

- tight clothing

- eating too much at one time

I know that's probably not massively helpful - there's nothing terribly new there, and it's all very general.

I wish that I could be more helpful, but feel free to send me a message if you think I can be helpful (or if you just need sympathy)!

Jo

[sillywoman]

At college today (Midwifery BSc) we were discussing hyperemesis & our lecturer passed on that if you have it, not only are you more likely to get it next pregnancy, but that if you have a daughter she is much more likely to get it too when she grows up & has babies. It's genetic apparently. Sorry girls, but I thought it might be helpful in the future to know this nasty little nuggget so you can help your girls:(

[hellosailor]

Sillywoman, one thing I read said that if you've had it one pregnancy you're roughly 85% likely to have it in subsequent pregnancies and another thing I read said it was only 20% increased chance after having it once, what were you told in your discussion about it? I'm clinging to the idea it's only 20% increased chance....

[sillywoman]

Sorry hellosailor - they didn't give us any stats, and the possibility of having it again/ passing the gene on was only touched on briefly. The Hyperemesis part of lecture focussed more on how to manage it. Can show you my notes if you like?! :) I might try & do some digging around this weekend on the topic though - will let you know if I can find any more definitive stats.

[etta166]

Thanks again for the advice. I'm having a relatively good patch at the moment and have even made it into work today!

As for recurrence, the reason for the difference in stats that hellosailor has read is that if you had HG in a first pregnancy then the chance of recurrence is about 20% (if you have the same partner for both pregnancies). However, if you have had HG in consecutive pregnacies then you will almost certainly get it again (assuming that you keep the same partner).

I have read and been told by several professionals that it is the partnership, rather than just the woman, that causes HG. Not that that is helpful in most cases...