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hyperemesis

Specializes in Pediatrics, Nursing Education.

hello!

I am about 13 weeks pregnant. About 3 weeks ago, I was diagnosed with hyperemesis gravidarum. I had been on phenergan for some weeks before, which didn't help at all. When I was diagnosed, I had ketones in my urine (high... but she wouldn't tell me how high). At that point, I hadn't peed much in a few days, I was visibly dehydrated, along with the fact I was 8+ lbs down from my last visit a few weeks before. With my first pregnancy, I had morning sickness that was very severe... I would almost say this bad, but I had a family practice doc (who was very conservative and didn't want to intervene as long as I was coping semi-well - which I guess I understand), I didn't work outside the home, and I had a mom at home who stayed with me and pushed fluids on me during the "good times" of the day).

But the morning sickness with my first pregnancy lasted past the 6th month. I am so, so afraid that this will continue on with this pregnancy as well. So that is my first question... if I had morning sickness for a long time with my first pregnancy, are my chances of having it for not very long this time slim or is there a good chance this one will be different?

My next question: How can I have this and work? I have zofran, and now I am paying for it out of pocket because my insurance won't pay for much. It is the only way I have been able to even halfway function and even go to work. It is a wonderful drug, and it worked pretty well the first two weeks. But since last week, I am having a LOT of breakthrough n/v. I work twelves on a pedi unit (sometimes pp/nursery) and it is absolutely killing me that it is not working as well as it was... I try to push fluids at work when I am not actively sick, but sometimes I just don't have the time to drink what I need to. I can tell that it takes me at least 2-3 days to recover after working and not being able to eat and drink adequately.

In addition to the meds, I have tried preggie pops to decrease the n/v. I have tried only eating bland wet / dry foods separetly and hours apart. I have tried eating crackers before I get out of bed in the AM. What things have other people (nurses!) done to get through the day with this? I just really need some practical advice because I am not coping well... when I am not forced to go to work, I literally am in the bed for most of the day (between trips to my new home, the bathroom!).

rpbear

Specializes in OB.

I don't have any suggestions for the sickness, but you need to get FMLA paperwork from your doc so you can get the time off that you need to be healthy. It will use up your PTO but it will allow you to call in to work if you feel you can't make it that day and not have to worry about being fired.

Good Luck!

Hi Jeepgirl,

I'm not an RN yet, but I'm a doula with 8 years experience. I've had many of my clients say that they've had some great results with ginger root. I've used it for myself and sometimes it's the only thing that will work when I'm sick. You can grate the ginger root into finer pieces, and mix it in with chicken broth. Another way is to make a "tea" out of it by grating it and placing it in cheesecloth or any type of strainer. Let it steep about 5 minutes according to your taste. If the ginger works, that can very well be a good thing as I'm not away of any side effects which can effect baby. Not that I'm aware of any effects with Zofran either.

If you can't take the broth or you want ginger in a convenient form, I suggest ginger "Preggie Pops" for my clients. They can be found at http://www.preggiepops.com. Also, look for anything containing REAL ginger at a health food store.

Another answer to your question re: morning sickness continuing on as it did in your last pregnancy. As you probably know, m/s is very common in the 1st trimester until about week 14-16 (at least that's what I've noticed with clients), from there it SHOULD start to recede. But "SHOULD" is the key word here. I will say that every pregnancy is different. You could be experiencing the "usual" n/v that occurs with 1st trimester pregnancies, and that it might abate when you are firmly in your 2nd trimester. I've seen that happen so many times. Mom is very sick with her 1st pregnancy, n/v lasting the entire pregnancy (or at least to 35 weeks), and her subsequent pregnancies she may not experience any n/v. Not even "run of the mill" morning sickness. This is currently happening to my SIL now. She was pretty sick with her first pregnancy, she's currently 11 weeks and she's experiencing NOTHING like she did in her 1st pregnancy.

One last suggestion as I know this is pretty long, have you petitioned your health insurance to cover more of the Zofran? I know that Zofran can be expensive, but if you can show that it works better than, say, phenergan, there might be a good chance that they may offer better coverage. I don't know what your insurance is like, but this is just a suggestion.

Best of luck to you, and I hope that the nausea goes away soon!

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds.

I really feel your pain. I had intractable nausea during my first pregnancy that lasted the entire 9 months (I was still throwing up the day before I delivered). My OB-GYN prescribed Bendectine with the first pregnancy and I was also given vitamin B-6 injections. Bendectine is now off the market, but the active ingredient, the antihistamine Doxilamine, is found in the OTC preparation Unisom. I had very severe morning sickness with my second pregnancy also, but this only lasted through the 5th month and then abated. I was prescribed antivert with this pregnancy, since Bendecine was off the market. For your safety and for the optimal safety of your unborn child, I would advise not working until the morning sickness passes.

truern

Specializes in Telemetry & Obs.

*edited for Terms of Service compliance*

jeepgirl, LPN, NP

Specializes in Pediatrics, Nursing Education.

*edited original post quoted for TOS compliance*

Ooops, sorry... forgot to mention that starting at 5 weeks I was taking the B6 and unisom until I was getting no effects and then started on the phenergan. Maybe I should ask my doc if I should even try to start back on it? My doc didn't mention continuing on with it after she gave me to zofran, but it is OTC and on our little "approved OTC" list to treat ourselves we're given at our very first appointment. But it seemed as though that mix was pretty uneffective by the time I stopped taking it. I will try the ginger. I am going to start calling my insurance company again about the Zofran this week.... last week we started on Wednesday, and it was a bad week due to Christmas to get through to anyone. I really appriciate ALL the comments from everyone on this thread. Thanks.

Ginger always helps me with n/v and calms my stomach. They sell ginger tea in bag form, I don't if it will work as well as ground fresh ginger. Lipton makes a ginger tea and I always drink that when I am sick-- I know your way worse but it might help calm your stomach. Take care I hope you feel better soon!

I am so sorry you are so miserable......my sister had severe n/v for about 25 weeks or so in her last pregnancy, it was unremitting and only Rx zofran seemed to have brought relief (at a great price).

I am going to ask the participants in this thread NOT give any sort of medical advice, esp. to discuss specific medicines and dosing. This is a nursing support board, not a medical advice board, and solicitation and dispensing of medical advice is strictly against our Terms of Service. It is also against the Nurse Practice Acts of most states, unless you are an advance-practice nurse who is licensed to dispense Rx---even for OTC meds, we are disallowed from doing this.

If you have questions, please see the Terms of Service at the bottom of each page or ask any moderator for clarification and help.

To the OP: I hope you feel better soon. I feel for you; I hope you find resolution soon. Meantime, rest up, take care and hang in there. It's a good thing pregnancy does not last forever. Meantime, I hope your dr/midwife can help you find solutions to your misery.

PS: I was given Rx Antivert and B-6 combo for my misery, Like VickyRN. Ask your dr/midwife about these! NEVER attempt meds or homeopathic remedies when pregnant, w/o running them by your HCP first. Homeopathic remedies , especially, are NON-standardized and may NOT be safe for some individuals.

Burnt Out, ASN, RN

Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

I feel for you! I had HG in both of my pregnancies. My first pregnancy it lasted until 18 weeks and with my 2nd it lasted until about 20 wks but it started a little later.

I couldn't work much when I had HG. So I think it would be a wise choice to talk with your ob/gyn about work: it is important for you to stay hydrated and it can be difficult when you are at work.

Zofran and Phenergan really helped me both times. I also did the Unisom/B6 combo-it worked if I was mildly nauseated (if I could catch it before it got really bad!). I was put on Reglan with my first pregnancy, but it didn't help and I have a severe reaction to it.

Some things that helped me cope with HG:

Eat what you feel like eating. If I wanted grilled cheese, I ate.

Eat small meals (sounds like you've been doing that-seperating dry foods and liquids)

Sniff lemon slices (fresh) or lime. I would suck on lemon slices (I would drink my H2O that way) or suck on lemon drops.

There is a website for women and their families about HG: they've got good tips there. http://www.helpher.org/index.php

I am so sorry to hear that you are having such a rough time with your pregnancy. I've BTDT x 4!!! I say that only to give you hope that when it's all over, you actually do become willing to try it again!! (Love those make-me-forget-the-bad-parts pregnancy hormones! :)

With pregnancies 1, 2, and 3, I was a part-timer and subsequently a stay-at home mom, so I was able to survive with A LOT of help from hubby and family, while getting my daily fluids through PICC lines, and using mega-doses of IV Zofran. Unfortunately, pregnancy #4 was a surprise and happened days before the start of my 3rd semester of nursing school!!! Sheer willpower and shooting up Zofran during lecture breaks kept me from wanting to curl up in the corner and cry until it was all over. (OK, OK, so I DID do that a few times too! ;)

Clinicals, of course, was a whole different story. The Zofran "took the edge off," but the plethora of strange smells could send me running to the bathroom at the drop of a hat. I quickly learned that "smell prevention" was very important. For some strange reason, sniffing alcohol wipes (sometimes!) helped to break the incredible waves of nausea. I think that I equated isopropyl alcohol with "clean," which helped.

The other thing that sometimes helped was chewing on mints... all day long. I went through MANY tins of Icebreakers mints. Some days they worked, and other days they made me gag.... but the few moments of relief were worth it.

That was a common theme in all of my pregnancies... what worked to calm the nausea today, might be the CAUSE of it tomorrow. I wish you good luck in finding those things that can give you some long moments of relief.

PLEASE PM me if you want to chat... I really do know how hard it is and am always willing to lend an ear to a fellow HG sufferer!

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

I did Zofran, but my MS was never that bad (I did start taking the Zofran prior to when it would have started though).

My sis had HG, plus gastroparesis. She ended up with a PICC line and some IV Zofran and IV Reglan.

I hope you get to feeling better soon.

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

Clinicals, of course, was a whole different story. The Zofran "took the edge off," but the plethora of strange smells could send me running to the bathroom at the drop of a hat. I quickly learned that "smell prevention" was very important. For some strange reason, sniffing alcohol wipes (sometimes!) helped to break the incredible waves of nausea. I think that I equated isopropyl alcohol with "clean," which helped.

The other thing that sometimes helped was chewing on mints... all day long. I went through MANY tins of Icebreakers mints. Some days they worked, and other days they made me gag.... but the few moments of relief were worth it.

I forgot this! The smells were what got me! Mints were a God send! I couldn't eat Taco Bell or hot dogs for a good part of this pregnancy because of the smells! (And try telling a preggo not to eat Taco Bell!)

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds.

I forgot this! The smells were what got me! Mints were a God send! I couldn't eat Taco Bell or hot dogs for a good part of this pregnancy because of the smells! (And try telling a preggo not to eat Taco Bell!)

Still have a hard time with hamburger, chicken, and eggs. My food preferences changed permanently. The "smell" of the artificial sweetener aspartame also made me sick (incredibly, I could smell this from a room away).

I remember throwing up being so commonplace, that I would go right back to eating, trying desperately to keep something down. I would eat all the time, trying to keep the nausea at bay. I found out that if I had SOMETHING in my stomach (usually a carbohydrate), the nausea would not be as bad. I would eat very small portions throughout the day and evening. I also remember standing outside on a bitterly cold winter's day with the cold wind blowing in my face, trying to not throw up my small meal I had just ingested. The cold wind helped diminish the nausea. Iced tea also seemed to help.

Ahhh, but it was worth it. I now have two beautiful healthy grown children. If I had to, I'd do it all over again.

rehab nurse

Specializes in rehab; med/surg; l&d; peds/home care.

i had hyperemesis with both my pregnancies, and i had it all the way to birth. i was in the hosp all the time for iv's. i had a lot of medical problems, so i was very high risk.

anyways, i saw that you had some trouble getting zofran. my insurance company is the same way. i can only get 9 per month (i still use it for my migraines, but i did help immensly with the n/v of pregnancy). i don't know what dose you were prescribed, but i had my doc write for 8mg tabs, and i broke it in half to make 4mg. this was done with my doc's knowledge of course. maybe you could ask your doc to write the script like that, at least it would double what you're currently getting.

i had a terrible time with smells. i hope you feel better!

jeepgirl, LPN, NP

Specializes in Pediatrics, Nursing Education.

i had hyperemesis with both my pregnancies, and i had it all the way to birth. i was in the hosp all the time for iv's. i had a lot of medical problems, so i was very high risk.

anyways, i saw that you had some trouble getting zofran. my insurance company is the same way. i can only get 9 per month (i still use it for my migraines, but i did help immensly with the n/v of pregnancy). i don't know what dose you were prescribed, but i had my doc write for 8mg tabs, and i broke it in half to make 4mg. this was done with my doc's knowledge of course. maybe you could ask your doc to write the script like that, at least it would double what you're currently getting.

i had a terrible time with smells. i hope you feel better!

Rehab nurse... what a great idea! I will ask her!!!!

I really, really appriciate all of the feedback on this thread. I am calling my doc again today and I will ask about a lot of different things we can do to help make me feel better.

Iwish you a very happy and healthy pregnancy!

Some of my patients have had pretty good luck with fresh lemonade. Try to use very little or no sugar. I have also used the "sniff the alcohol swab" on nauseated post-op patients....never tried it for hyperemesis but it probably wouldn't hurt unless you are constantly sniffing them.

I had hyperemesis with my pregnancy many years ago. For me, the phenergan helped to keep some foods down. Yes, I would still have some N/V, but at least I was able to keep some things down. I also did not follow a typical hyperemesis diet. On my rare "good" days, I ate what I wanted. On those days, I could keep pizza down but not the "sensible" bland food.

I also believe hyperemesis often has a psychiatric or emotional component which hampers the physical treatment. I'm not saying that all hyperemesis patients are mental cases....I just think many have something else going on that needs to be addressed in order to help facilitate the resolution of the hyperemesis.

I know how miserable hyperemesis can be and I hope you start feeling better soon.

HillaryC, RN, CRNA

Specializes in Adult SICU; open heart recovery.

I've never been pregnant, nor am I an OB nurse, but I used to have a friend who had hyperemesis gravidarum for all four of her pregnancies. I lived with her family and helped take care of her the summer she was pregnant with one of her kids, and the two things I remember working for her were peppermint tea and, to a lesser degree, plain baked potatoes.

I hope you feel better :nurse: I'm miserable if I have nausea for a couple of hours, let alone nine months. You guys are my heroes.

rehab nurse

Specializes in rehab; med/surg; l&d; peds/home care.

i'm glad you liked my idea....hope your doc will do it for you! that zofran is so expensive, but it works!

take care of yourself.

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