Soon I hope to write some more general thoughts on health, rest, and identity, but I thought I'd write about the practical side of things first in case I can help someone else suffering with HG or nausea from other conditions.
By my third pregnancy, I had recognized that the only way to retain some semblance of health was to spend about 80-90% of my day resting. That number changed as the pregnancy went on. (It was probably more like 50-60% by my third trimester. I could take on more, but I still had to be careful not to overdo it, even when I felt well.) Also, that number depended on how much energy I expended during my "non-rest" time.
I had tried to start off my second pregnancy optimistic. I was hoping that my issues during the first pregnancy were just due to the parasite I had and that this time things would be better. During my second pregnancy, I wasn't working much, and my only child was around 2 and very verbal. I could rest a fair amount while taking care of her, so it was my least traumatic pregnancy, but I still got sick multiple times. It was nice that I was often able to start improving after 1.5-2.5 days of vomiting, though, instead of 2.5-3.5 like my first pregnancy. Since I had survived my first pregnancy in a foreign country without medical intervention, I for some reason didn't feel the need to get much help with my second pregnancy. (I kept hoping it was over each time I got better, and I was always feeling fine during my once-a-month doctor visits, so I told them I'd had some vomiting but seemed to be doing better. I may tend toward understatement. :) ) I never had any desire to get out of bed, get dressed, and go to a hospital when I had been vomiting for hours and couldn't stop. Getting out of bed was the last thing I wanted to do, so I just waited for my monthly check-ups to talk to my doctor/midwife, but by then I always seemed to be fine.
By my third pregnancy, I knew that the sickness keeps coming back (no more living in denial!), and I couldn't rest while taking care of my extremely active 1-year-old (and my 3-year-old). It also occurred to me at some point that in the U.S. there must be antinausea medicines that don't have to be swallowed and I should really ask my doctor more questions. I started off on Diclegis (Benadryl/Unisom and B12), which was generally thought to be very safe in pregnancy, but I often didn't feel well enough to swallow it by the time I was supposed to take the next dose. Sometimes I took chewable children's Benadryl because I didn't have to swallow it. I also took Prilosec during all my pregnancies because I could tell that sometimes the vomiting started after feeling a burning sensation inside me that got worse and worse. (Some women with HG are treated with a drug that is also used to treat acid reflux.)
After I'd been vomiting for several hours one time, I called the doctor. (I had finally discovered that doctors can sometimes prescribe medicines over the phone without you going in for an appointment when you're sick. Of course, now you can see doctors online, too.) She prescribed some Zofran that was chewable or can be dissolved under the tongue for faster results. We waited on the pharmacy and insurance for another 24 hours of vomiting before we discovered that my insurance would let me have a small number of them per month without going through the longer approval process. Finally, I had one, and I was able to stop the vomiting after just 36 hours! It still took a few more hours (and frequent sips of flat Coke) for my tummy to feel more settled and like I was on the mend.
I still didn't want to take them regularly since I was 8-10 weeks pregnant. While, for the most part, Zofran was seen as safe in pregnancy, there were some concerns, and I wanted to wait till as close to my second trimester as possible before taking it much. Also, my insurance didn't approve it for regular use. However, it was exciting to have something that worked!!
I mentioned the flat Coke. For anyone who may be helped by it, let me tell you some things that helped me during my pregnancy. Obviously, none of them helped enough to consistently stop the vomiting, or I wouldn't have been taking 3 different medications and spending most of my day in bed with my third pregnancy. Let me emphasize again from my first post: the only way I could prevent going downhill was to GET LOTS OF REST and not expend too much energy!! It wasn't always the same day that I overexerted myself that I would go downhill, but within 24-48 hours of trying to do too much or not getting much sleep, I would be sick again. I remember one morning during my third pregnancy, it had been a busy week, and when I woke up, the first words out of my mouth were, "I'm exhausted." Within 60 seconds, I was vomiting.
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| Sometimes slowly eating an apple could help keep the nausea at bay. Image by gunther from Pixabay. |
Aside from rest (even on days I was feeling better!! it's more of a preventative measure), here are some things that would sometimes help with the nausea (but not necessarily prevent vomiting from exhaustion):
apples (If I had been throwing up recently, I didn't eat the peel. Applesauce also works, but I buy ones without added sugar (unsweetened).)
ginger tea (This was especially helpful for acid reflux. I also sometimes snacked on ginger biscuits for nausea, but in general I tried to limit sugary snacks because they would make me feel worse in the long run.)
B6 and/or B12
Preggie Pops (I actually prefer the Preggie Naturals Chews to the drops you suck on, and I'd often just bite off a piece of one, but I know a lot of people prefer the ones you suck on. The chews are harder to find. These also contain B6.)
fermented foods (kombucha, Bubbies pickles, Bragg raw apple cider vinegar) and probiotics (To be honest, it was very hard for me to want to eat these things while pregnant. Even the smell could make me feel more nauseous, but if I could make myself take a sip/bite of one of the fermented foods, it often took away the immediate feelings of nausea. I think we're still in the early stages of understanding gut bacteria and its effects on our health. Also, I don't agree with this author's assumption that rough pregnancies are always caused by H. Pylori. That's not true for everyone. There are probably a variety of causes. However, I found her tips (avoiding sugar and eating fermented foods) to be really helpful with the nausea when I could do it. She also tells how to mix apple cider vinegar, honey and water to make a drink you may be able to sip on throughout the day. http://stevenandersonfamily.blogspot.com/2013/11/the-cause-and-cure-of-morning-sickness.html )*
If I'd had time to plan more between rough pregnancies, I would have tried taking magnesium and probiotics regularly before getting pregnant again (...but I'm not a doctor! I just read books and blogs...).
Here are some of the only things that could sometimes help once I was already vomiting:
homemade beef broth (I wish this were easier to come by! :) See my previous post.)
flat Coke or Dr. Pepper (I preferred Vanilla Coke or Vanilla Dr. Pepper and stirred it to get the bubbles out. However, some people find clear sodas to be more helpful.)
Pedialyte popsicles (could help with prevention sometimes, especially if I was feeling hungry)
Zofran that dissolves in your mouth (prescription medication)
The only thing I wanted for breakfast was yogurt mixed with berries. (I bought cartons of plain yogurt, mixed them with honey or maple syrup, cinnamon, vanilla and frozen berries from a large bag and kept a large container ready in a mini fridge we kept in our room. In the morning, my husband would scoop a little bit into a bowl for me and set it on the bed so I could eat a few bites (however much I could keep down) before I got out of bed. I can't guarantee that's what other pregnant moms will want in the morning, but it was pretty much the only thing that sounded good for most of my pregnancy. (Yes, I had to eat breakfast before getting out of bed in the morning. No, saltine crackers didn't help. They didn't even sound good to me. The best thing I could do was go back to sleep, but when I got to a point where I was ready to (needed to) eat and get up, it was important to have something ready. I couldn't even get up in the night to go to the bathroom, or I'd be up for the next two hours trying to prevent vomiting.)
As far as other meals, I typically wanted beef while pregnant. Usually, the thought of chicken, pork, or fish made me sick, but I could sometimes eat pork if it had a red sauce or seasoning like carnita meat. Usually late at night, I'd want a "snack," and often what sounded good was spaghetti, so we stocked up on Stouffer's spaghetti and meat sauce frozen meals. The other frozen meal that sometimes sounded good was Swedish meatballs (I believe it was the Marie Callender's one), but I had to add a little salt. I realize the cravings may not be the same for everyone, but I recently talked to another mom who also said that she wanted the spaghetti and meat sauce when pregnant but couldn't eat the spaghetti and meatballs (same here!), so I thought it was worth sharing! :) A fried egg sandwich also often sounded good to me for lunch or a late-night snack!
By sometime in the second trimester, I was taking Diclegis at night so that I'd feel well enough to eat a little breakfast the next morning (before attempting to get out of bed) and Zofran once or twice during the day to prevent vomiting and to feel well enough to swallow a Diclegis in the evening. I was also still on Prilosec. The nurse over the phone had originally told me that I couldn't take both Diclegis and Zofran, but I had read that it was common for people with HG to take both.
I was paying for Zofran out of pocket at a pharmacy that gave me a discount and mailed it to me, so I was trying not to use it too often. I finally got a hold of paperwork from my insurance company to file an appeal to get Zofran covered and talked over the requirements with my doctor. We were able to demonstrate that we had already tried medicines they considered the first line of defense, but then I told my doctor that I still couldn't get it because I didn't have hyperemesis gravidarum. My doctor assured me that I did have it, and the paperwork was filed. My first official HG diagnosis came about halfway through my third pregnancy, and I was on my way to getting insurance to cover part of the cost of a medicine that actually helped!
Around the same time, I asked my doctor after how many days/hours of vomiting I should consider going to the hospital since I had never done that in the past. She said it sounded like we should get home health care set up. I had never done that before, but that seemed like a great alternative.
Unfortunately, I found out they couldn't just be "on call" for an IV in case I got dehydrated. If I was going to be on home health, they had to set me up with a Zofran pump. Eventually, I decided to try it.
However, I got really painful welts anywhere I had poked my skin for the medicine to pump in. (Apparently the medicine is rather caustic.) This made it impossible for me to hold my 1-year-old. He was also very curious about the tubing and liked to pull on it. Also, I had a bad experience where I got it in at the wrong angle, and it was pumping medicine into a deep layer of my skin instead of where it was supposed to go. I decided I was done. Some people really do need a Zofran pump, and it’s worth the challenges. Really, though, I just needed more frequent Zofran, combined with Diclegis, and lots of rest. The home health nurse encouraged me to take both Zofran and Diclegis and to take them more regularly. My doctor encouraged me to rest but didn't emphasize it too heavily since she knew it might be impossible with two kids and didn't want to set up unreasonable expectations. I wish, though, that I had better understood how critical that was. Maybe we could have found ways to get more help sooner or for Eric to reduce his work responsibilities.
My third pregnancy was when I really began to come to terms with the fact that I needed to minimize my energy expenditure if I wanted to preserve my health, but I had no idea I'd still be dealing with that 6+ years later. I began to have a great deal of empathy and understanding of people with chronic health problems (who often look normal when they're around other people), but I had no idea that I was becoming one of those people.
*Note: I can no longer eat (or at least need to really minimize) some of the foods mentioned above (like cinnamon, yogurt, probiotics, and other fermented foods) due to histamine intolerance, so that's something to keep an eye out for!
Zofran that dissolves in your mouth (prescription medication)
The only thing I wanted for breakfast was yogurt mixed with berries. (I bought cartons of plain yogurt, mixed them with honey or maple syrup, cinnamon, vanilla and frozen berries from a large bag and kept a large container ready in a mini fridge we kept in our room. In the morning, my husband would scoop a little bit into a bowl for me and set it on the bed so I could eat a few bites (however much I could keep down) before I got out of bed. I can't guarantee that's what other pregnant moms will want in the morning, but it was pretty much the only thing that sounded good for most of my pregnancy. (Yes, I had to eat breakfast before getting out of bed in the morning. No, saltine crackers didn't help. They didn't even sound good to me. The best thing I could do was go back to sleep, but when I got to a point where I was ready to (needed to) eat and get up, it was important to have something ready. I couldn't even get up in the night to go to the bathroom, or I'd be up for the next two hours trying to prevent vomiting.)
As far as other meals, I typically wanted beef while pregnant. Usually, the thought of chicken, pork, or fish made me sick, but I could sometimes eat pork if it had a red sauce or seasoning like carnita meat. Usually late at night, I'd want a "snack," and often what sounded good was spaghetti, so we stocked up on Stouffer's spaghetti and meat sauce frozen meals. The other frozen meal that sometimes sounded good was Swedish meatballs (I believe it was the Marie Callender's one), but I had to add a little salt. I realize the cravings may not be the same for everyone, but I recently talked to another mom who also said that she wanted the spaghetti and meat sauce when pregnant but couldn't eat the spaghetti and meatballs (same here!), so I thought it was worth sharing! :) A fried egg sandwich also often sounded good to me for lunch or a late-night snack!
By sometime in the second trimester, I was taking Diclegis at night so that I'd feel well enough to eat a little breakfast the next morning (before attempting to get out of bed) and Zofran once or twice during the day to prevent vomiting and to feel well enough to swallow a Diclegis in the evening. I was also still on Prilosec. The nurse over the phone had originally told me that I couldn't take both Diclegis and Zofran, but I had read that it was common for people with HG to take both.
I was paying for Zofran out of pocket at a pharmacy that gave me a discount and mailed it to me, so I was trying not to use it too often. I finally got a hold of paperwork from my insurance company to file an appeal to get Zofran covered and talked over the requirements with my doctor. We were able to demonstrate that we had already tried medicines they considered the first line of defense, but then I told my doctor that I still couldn't get it because I didn't have hyperemesis gravidarum. My doctor assured me that I did have it, and the paperwork was filed. My first official HG diagnosis came about halfway through my third pregnancy, and I was on my way to getting insurance to cover part of the cost of a medicine that actually helped!
Around the same time, I asked my doctor after how many days/hours of vomiting I should consider going to the hospital since I had never done that in the past. She said it sounded like we should get home health care set up. I had never done that before, but that seemed like a great alternative.
Unfortunately, I found out they couldn't just be "on call" for an IV in case I got dehydrated. If I was going to be on home health, they had to set me up with a Zofran pump. Eventually, I decided to try it.
 |
| This is a Zofran pump, i.e. torture device. Seriously, if the Zofran tablets aren't working for you, this may be a good fit for you, but it was not a good fit for me. |
However, I got really painful welts anywhere I had poked my skin for the medicine to pump in. (Apparently the medicine is rather caustic.) This made it impossible for me to hold my 1-year-old. He was also very curious about the tubing and liked to pull on it. Also, I had a bad experience where I got it in at the wrong angle, and it was pumping medicine into a deep layer of my skin instead of where it was supposed to go. I decided I was done. Some people really do need a Zofran pump, and it’s worth the challenges. Really, though, I just needed more frequent Zofran, combined with Diclegis, and lots of rest. The home health nurse encouraged me to take both Zofran and Diclegis and to take them more regularly. My doctor encouraged me to rest but didn't emphasize it too heavily since she knew it might be impossible with two kids and didn't want to set up unreasonable expectations. I wish, though, that I had better understood how critical that was. Maybe we could have found ways to get more help sooner or for Eric to reduce his work responsibilities.
My third pregnancy was when I really began to come to terms with the fact that I needed to minimize my energy expenditure if I wanted to preserve my health, but I had no idea I'd still be dealing with that 6+ years later. I began to have a great deal of empathy and understanding of people with chronic health problems (who often look normal when they're around other people), but I had no idea that I was becoming one of those people.
*Note: I can no longer eat (or at least need to really minimize) some of the foods mentioned above (like cinnamon, yogurt, probiotics, and other fermented foods) due to histamine intolerance, so that's something to keep an eye out for!
