Category Archives: HG Treatments and Medications

Various treatments for HG: home remedies, drugs, devices, etc

Developing my 3rd Trimester Cocktail

I’m not quite into the 3rd trimester yet, but the HG has been creeping around the edges of my life.  I’ve had to start taking meds again, which is not particularly fun.

I had been waiting to take the Zofran until I really needed it.  I’ve learned that I have a hard time reading my body’s feelings since the HG.  I don’t always recognize mild nausea for what it is.  This means that I frequently wait to take the Zofran until it’s too late and I’ve already thrown up.  There’s nothing like having to scrub down bathroom in Jersey Mike’s.  Yuck.

I decided, this past weekend, that I needed to take a more proactive approach.  I called my midwives, who put me in contact with the back-up OB.  He was kind enough to write me a script for 100 8mg ODT Zofran tablets.  Thank you merciful heaven for good insurance!

I’ve started taking them regularly again.  Not much, but every single day.  I’ve also added Nexium in since I was having trouble with acid reflux. 

Of course, with the Zofran comes the joys of the Zofran side effects.  You know… that one side effect.  So I started drinking this stuff called Natural Calm, which is a Magnesium/Calcium supplement.

Natural Calm is a powder that you mix into water.  It fizzes up and becomes a lemon-flavored drink.  According to the back-up OB for my midwives, the magnesium helps stop muscle cramps in your legs, a real issue for many pregnant women.  The other benefit is that the magnesium helps you poop.  So bonus all around.

I had heard about this product during my last pregnancy.  One of my mom’s friends recommended I give this a try during my pregnancy with Gabi, but at the time I was concerned about shelling out money for the big jar of the powder only to find out it wouldn’t stay down.

Thankfully, my local natural food store held a health fair this past Earth Day, and there was a table set up with a Natural Calm rep and free samples.  She let me have a taste of it and sent me home with a handful of free samples in a variety of flavors to see which one sat best on my sensitive stomach.

At the time, she warned me to be careful with it.  The magnesium can cause loose stool in some people until your body adjusts to it.  “Trust me,” I said, pointing to my Zofran pump, “That’s not going to be a problem for me!”

I finally reached the point a few weeks ago where I could drink this, so I ended up getting a jar of it.  I got the Natural Calm Plus Calcium formula in Raspberry-Lemon flavor, and so far it seems to be helping.

So at this point, I drink the Natural Calm in the afternoon, and take a Nexium pill and an 8mg Zofran tablet before bed.  The idea is that the nighttime Zofran will carry over into the next morning.

So far, it seems to be making a big difference. I felt sad about having to restart medications, but the positive change in my overall feeling of health tells me that it was the right move.

Tomorrow, I’ll be 27 weeks tomorrow.  One more week until I officially reach the 3rd trimester.  I just need to keep taking things one day at a time.

Say goodbye to your leetle friend!

I have officially said goodbye to a certain little something that has been a part of me for the last few months.

If you guessed my left pinkie, you’d be wrong.  Besides, I’ve had that my whole life.

If you guessed my Zofran pump, you’d be dead on the money!

That’s right!  I am officially off the Zofran pump.  Completely unplugged and it’s in a box, on it’s way back to the home health company as we speak.

I had intended to wean down to zero on the pump.  This was something my home health company doesn’t do, but I got the go-ahead from my doctor to just try it anyway after I complained that Alere wasn’t wanting to humor me and wean me how I wanted.  Actually, what she said was, “Now, I’m not going to tell you to adjust the pump on your own, but you know how to do it by now, right?”  Yep.  I sure did.  And that’s just what I planned to do.

My goal was to be down to nothing by April 27th.  I think I’ve mentioned before that the constipation side effect is worse for me on the oral meds.  If I could avoid that, I definitely wanted to.

Friday, my Alere nurse told me I could unplug any time.  I told her I intended to wean down to a lower dose before unplugging.  I was still getting the equivalent of 20 mg per day.  That’s 2.5 oral doses.  That’s a lot.  She reminded me not to mess with the pump myself.  I rolled my eyes.  She was on the phone, alright?  She didn’t see me roll my eyes at her!

Sunday, something in me snapped.  I just could not bring myself to put in a new infusion site.  It wasn’t about the pain of the little needle.  It wasn’t about the pain of the horrible welts I’ve been getting all over my legs from the zofran irritating the tissue.  I was just sick and tired of being tied down.

I was sick of standing up and having the pump fall off the floor.  I was sick of having the pump bag get tangled in my purse straps.  I was sick of the thing beeping at me for no apparent reason.  I was sick of having to lay in bed waiting for the lidocaine to kick in so I could stick myself.  I was sick of everything about the stupid thing.

So I didn’t plug in.  I just… decided not to.

And things went well.  Really well.

It was a nervous 72 hours.  I figured if nothing happened in 72 hours, I would be home-free.

72 hours passed uneventfully.

This past Friday, I talked to Alere and agreed to send the pump back.  I boxed it and FedEx picked it up yesterday morning.

I am officially and completely free of the thing.  And I’m not taking any Zofran at all.

I’m at the point where I’m still taking the oral Meclazine and Nexium, but Dr. Awesome has given me the go ahead to start reducing those as well.

I’ve also been able to add some other stuff in to my diet: adult vitamins and probiotics.  Have I mentioned what a huge fan of New Chapter I am?  They’re pricey, but totally worth it in my opinion.

It’s been a thrilling week.  I still get tired pretty easily, and by the end of the day, I am completely cashed out, but I am not throwing up anymore!  What a huge victory!

National Prescription Drug Take Back Day!

How appropriate to us HGers!

My friend Caroline runs this fun blog: Today is a Holiday.

Each day, she posts info on a new holiday.  Today’s post could not be more relevant, since I’m officially done with my pump and am mailing it back on Monday.

Let’s all dispose of our drugs appropriately!

Also, you should subscribe to this blog!  It’s lots of fun.

And don’t forget to vote!

Yeah, I’m blogging about poo.

Okay, just a word of warning.  This post contains some serious TMI.  Yeah, I’m going to blog about poo.  If you don’t like it or if that squicks you out, go ahead and skip this post.  That’s okay.

So anyway, I had an appointment with Dr. Awesome this morning.  I was very pitiful.  It was pretty sad.  I am feeling like utter crap.  I’m trying to avoid the F-bomb here because I know my mom reads this, but that’s the way I’ve been feeling lately.  Horrible.

Dr. Awesome went ahead upped my zofran dosage to the full 32 mg.  Since I don’t want to wake my carcass up at night to take it, she suggested doing every 4 hours.  That’s bunching it up a lot, but that’s okay.  She also had me add in benadryl to see if that helps with the nausea.  We talked a bit about fluids.  Since I’m able to drink still, she doesn’t want to make me a pincushion just yet.  She did say to not worry so much about eating solids and mostly just worry about fluids.

So I’m worrying about fluids.  Thankfully there is a Jamba Juice a few blocks from my house.  I can still drink those.  There’s one called the Protein Berry Workout that is working out fine for me at the moment.  I have them put whey protein in there along with fiber and a daily vitamin.  So far so good.

We also talked very briefly about medical marijuana, something that is legal in California and does seem to help HGers.  I haven’t made up my mind on this yet, and I may or may not post about it if I do.  I don’t smoke pot, and I have no interest in smoking it, but if there is something there that might help then it may be worth at least thinking about.

She also wrote me off of work completely until April.

Now on to the fun part of this post.  Along with the high doses of Zofran comes an interesting… ah… side effect.  Zofran stops you from vomiting.  It stops everything from coming out of your body.  And I mean everything.  This is the part of the blog where I talk about poo, so feel free to stop reading now if you wish.

I hadn’t pooped in about a week.  Ouch.  That’s not good.  In fact, it’s so not good that when she went to do a quick ultrasound, she couldn’t see anything because I’m so full of poo.  Faaaantastic.

We talked about what I’ve been taking for the constipation issues: colace, fiber gummies, fiber boosts in my smoothies, senekot…  Time for more invasive measures she said.  Time for an enema.

So this afternoon, I made friends with Mister Fleet.  Actually, it was the Walgreens brand, but same thing.

That was an embarassing shopping trip, let me tell you!  Bless her heart, the young lady checking me out didn’t say a word or bat an eyelash.  Although maybe she did.  I was very carefully avoiding looking her in the eye, so it’s possible that I missed her reaction.

Administering it was not nearly as unpleasant as I thought it would be.  Okay, it was pretty unpleasant, but I had imagined it would be a lot worse.  The bottom line is, I was able to go.  It didn’t hurt to go.  Now I feel better.

For anyone in the throes of Zofran constipation, I really recommended this route.  Everything made it’s way out easily, quickly, and painlessly.  The worst part was administering the enema and having to have my butt up and my head down.  For an HGer, having the esophagus running downhill isn’t great.  Once it got things moving, which was pretty immediate, I didn’t have to strain and push, something else that’s hard for an HGer.  I just had to sit there and let it do its job.  It was surprisingly efficient.

I do recommended this.  If you can get over the embarrassment of actually having to buy it, it works.

Dr. Awesome

I wanted to take a moment to write about my doctor, and why she is so wonderful.  With her permission, I’m going to go ahead and identify her.  I truly believe that I could not be receiving better care than I am getting right now from her

Dr. Aimee Brecht-Doscher understands what HG is like.  I mean, she really does.  She’s an HG sister.  She’s an HG crusader working for the HER Foundation as an advisor.

I was nervous when I first went to meet her.  I was coming in for a consultation to talk about The Protocol, and I was worried.  I had poured a lot of time and effort into it, and I wondered if she would think I was a nutcase.  I didn’t want her to roll her eyes and think I was one of those patients.  I worried that she would glance through and say, “Yeah, yeah.  This looks good.  It’ll be fine.  See you later.”

Instead, she went point by point through my protocol.  We talked about each one in detail.  She added touches here, corrected items there, and nudged a few bullets until they fit correctly into the whole.  We spent an hour sifting through what I had written, polishing it, and getting it ready for action.  Never once did she roll her eyes.  Never once did she act like I was over-compensating for things.  Never once did she say something like, “Well, are you sure this is necessary?  You know, every pregnancy is different.  Maybe we should just wait and see what happens.”

I left her office that day with a list of updates to make to my protocol to turn it into what it currently is.  I left with a prescription for 100 8mg ODT Zofran so we could find out ahead of time what my insurance will cover.  And I left with the feeling that things were going to be okay.  Going in to that appointment, I felt nervous and afraid.  Walking out, I felt strong.  I felt empowered.  I believed, really believed, that we could get through this.

Every time I see her, I get that same boost.  It’s the way she listens.  It’s the way she really understands.  And it’s the way she’s willing to drop a nuclear bomb on this damn disease.

Right now, she’s watching me closely.  I’m going in to see her every week.  Right now is the critical time.  We’re waiting for the sickness to start.  During this time and once it starts, she wants to keep me stable.  Things can go south really quickly around the 6 week mark, and she wants to do her best to keep that from happening.  She’s not promising miracles.  She was pretty clear when she said that I would probably be very sick.  But she is promising the best medical care available.  She’s promising (and delivering) early aggressive treatment, which can make such a huge difference in the outcome of an HG patient.  She’s promising immediate home health so I don’t have to go to the hospital.  She wants to keep me home, with my family, as much as possible.  Dr. Brecht-Doscher is another one of my HG heroes.  I had excellent care last time around, but this is just phenomenal.

Another bonus:  She was an extended nurser herself, so she’s willing and able to make sure everything I’m taking is safe for Gabi.

The care I am receiving is something that every HG sister deserves.  I hope this blog will stand as a testament to that, to what HG should look like for all of us.

**********

Quick update:  Still so far, so good.  I’m actually at the point of being a little nervous about that.  I know there’s still plenty of time for my world to crumble, but right now, just a wee touch of morning sickness (you know, like normal people have) would be a nice little message from the baby that she is doing okay.  I’m feeling really tired all the time, but sickness-wise, I’m pretty okay.  Let’s just say that I am going to feel a lot better once I see that little heartbeat on Friday.

**********

Update # 2 – How to find a good doctor

I should have included this in the first place!  *facepalm*

Here’s a link to the HER Foundation referral site.  That’s how I found my doctor.

There’s also a section in the forums to help women find doctors.  Note: As with most online forums, you must be a registered member to post.

Good luck!

How much does Zofran cost?

I went ahead and had my full Zofran script filled.  I dropped it off yesterday and then picked it up (part of it anyway) today.  No, I’m not pregnant yet.  We are going overseas for a couple of weeks, though, and I’m stealing the motto from the Boy Scouts.  I’m going prepared.  I wanted a few days worth of Z to pack into my travel kit, which basically will contain all of my first level defense items.  Unisom, PrimaBella band, B6, pepcid, ginger, etc. 

Yes.  I will be a walking pharmacy.

So at any rate, while I was getting the script filled, I asked the pharmacists assistant if she could tell me how much this would have cost without insurance.  I was morbidly curious.

She tapped a bit at her computer.  Tapped a bit more.  Got a weird look on her face and tapped a few more times.

“Ma’am,” she said, “It’s just over $2000.”

I said, “Oh, shit.”

And the promptly apologized for cursing.  She explained that she had been pretty surprised when I handed her the script.  Usually doctors only write for 8 pills at a time or 8 pills per month.  That’s all most insurance is willing to cover. 

Imagine?  Having HG and only being allowed 8 pills at a time?  That’s 2 days.  Not enough to do diddly for you.  What a cruel, cruel joke.  The sad part is, I know women in the online community who deal with this.  Regularly.

$2k.  For a 25 day supply.  And that’s the generic.  The full prescription is for 100 pills of 8mg ODT Zofran (aka Ondansetron).  You do the math on this one.

Thank God for our medical insurance.  I should start keeping track of this.  Keep a list with one side for the cost with my insurance and the other for what it would have been without the insurance.  That would be a very interesting comparison to see the end of all this.

In only slightly related news, I received more shocking information this week.  Shocking in a good way.  My sublingual B6 arrived!  The local health food store was finally able to find it.  They ordered it, and I picked it up last night.  Success!  It, thankfully, did not cost $2000.

Preliminary Review: Ginger People Ginger Chews

I’m willing to try all sorts of things to keep the nausea at bay.  Everything from home remedies to medical ones.  Despite it’s potentially fatal flaw of making the vomiting worse, one obvious choice is ginger.  With that in mind, I paid a visit to my local natural food stores to peruse their selection of plant-based and natural remedies. 

I had a hard time finding the ginger section, but imagine my delight when I saw an adorable little ginger man smiling up at me from the shelf!  Check out the guy on the front page of the Ginger People website.  How cute is that?  These folks do ginger.  Just ginger.  They’re all about the ginger.

I went ahead and selected their Original Ginger Chew.  Starting basic seems to make the most sense, and this chew is really basic.  I like the fact that it only has three ingredients:  cane sugar, ginger, tapioca starch.  No HFCS, no dyes, none of that extra junk.  I really appreciate that kind of simplicity in food, and I especially like the idea of eating simple foods when pregnant.

Another thing that I like about this particular ginger candy is that they come individually wrapped.  The environmentalist in me isn’t thrilled with the idea of individually wrapped foodstuffs, but from a practical standpoint, on something like this, it’s a major bonus to me.  It makes it much easier to toss it in my pocket, my purse, or my travel kit.  That’s why these chews went into the travel kit and the crystalized ginger, which was bulk in the bag, did not. 

While I was putting together my HG kit, I flipped over the bag and gave it a read.  It suggested dissolving the chew into a cup of hot water to make a soothing ginger tea.  Bonus!  A tea and a chew in one little package!  I was pretty nervous about trying the ginger candy straight away because of what a strong vomit-trigger ginger ale and ginger snaps were for me during my last bout with HG.  I decided that trying it as a tea when I’m not pregnant might be a little less frightening than trying it full force in the midst of HG.  Start easy.

I dropped the chew into the bottom of a mug and poured in the boiling water.

Then I stirred.  And stirred.  And stirred.  And stirred.  Those suckers do not dissolve easily in hot water. 

It took a good 5 minutes of stirring (I timed it) leaving it to do something else, 5 or so more minutes of stirring, doing something else, then stirring some more to get that sucker to dissolve.  When it finally did dissolve into the water, the resulting tea didn’t have much flavor.  This is potentially a very good thing, but for now I jazzed it up with a spoonful of honey. 

It was delicious, warming, and soothing on my very sore throat (thankyou preschool germs).  If I can tolerate warm liquids, this might be nice to try.

Even if warm liquids aren’t working, I could still ice it and sip carefully.  I really like the flexibility with this.

After drinking the tea and not suffering from crippling nausea, I decided to have a go at just eating the candy alone.  First impression?  This thing is huge!  It feels a whole lot bigger in my mouth than it looked on the plate.  Here’s a shot to give you a size perspective.  That’s a quarter next to it to give perspective.

This is potentially a serious issue.  Big things in the mouth = gagging.  It’s easily solvable, though, by just cutting it in half and saving the rest for later.  Definitely not a deal-breaker for me.

A few munches in, the flavor hit.  It was definitely spicy, but not in a hot pepper, eyeballs on fire kind of way.  It also didn’t have that sharp, up-the-nose spice that cinnamon flavored things can sometimes have.  Instead it was just very warm, smooth, and sweet.  The chew itself did not go away quickly like I expected it to.  It was less like a taffy and more like a cross between a gummy bear and chewing gum in texture.  Maybe it was the tapioca that gave it that staying power.  It was an interesting texture and the smoothness of it meant that even if I did chew it up and swallow pieces, I wouldn’t have to worry about hard candy shards slicing into my mouth or cutting my throat coming back up.  Speaking from experience, avoiding the shards is important.

Though the chew was tasty to my non-pregnant mouth, I can definitely see the potential for pain.  With the heat it created in my mouth, revisiting that chew over the bucket would be a painful experience.  It is certainly something to try for nausea, but something I will avoid if I’m actually vomiting.

Overall, this seems like a good and tasty product.  As a bonus, if the original flavored chew doesn’t appeal to me, there are other interesting options: Spicy Apple, Peanut Ginger, and Hot Coffee Ginger.  I’m not sure how adventurous I’m willing to be with these, but the options are there if my little heart desires it.

Pros:

  • limited ingredients
  • individually wrapped for easy travel
  • multiple ways to use: candy or tea
  • soft, gentle texture
  • yummy, comforting taste
  • multiple flavor options
  • soothing on a sore throat

Cons:

  • individual wrapper may not be the most environmental choice
  • giant-sized chew could cause gagging if not cut in half
  • gentle heat could turn into burning, flaming agony if it does not stay down
  • ginger is a trigger for a lot of HGers and could make things worse

The Preliminary Verdict:  I think it’s worth a shot as a possible preventative to deal with nausea early on.  The ability to drink it as a hot or iced tea is a plus as this seems to be a more gentle option that eating the chew straight.  As far as taking this to halt vomiting that is already happening?  No way.  I would be way too concerned about the potential for the fire-breathing pain while vomiting.  Ultimately, if these don’t work for cutting HG-related nausea, they’re certainly comforting to a sore throat and may be worth keeping around for that purpose alone.

image

Disclaimer: I’m not receiving any compensation for writing this review.  This is just a product I stumbled across at the store.  No part of this is paid for by the company.

A word about ginger

I will be giving ginger a shot to help with the nausea this time around, but I wanted to very briefly make my position on ginger clear.

Ginger alone is rarely (if ever) enough to treat HG.  Ginger can be fantastic for helping with morning sickness, motion sickness, and general stomach upset, but it often will not work for HG.  To go one step farther, for many HGers, ginger is a trigger, meaning that instead of helping with the nausea, it can actually cause vomiting. 

Some of the most painful and intense vomiting I experienced during my last pregnancy involved ginger snap cookies and a few swigs of ginger ale.  Any HGer who has experienced this will tell you that ginger burns like fire coming back up.  The flavor and the spice not only burns your throat and mouth, but fills your entire sinus cavity.  And not in the pleasant, hot mustard, sinus clearing way.  In the horrible, oh-my-God-my-eyeballs-are-melting kind of way.   The pain and intensity were so bad that to this day I am not able to drink ginger ale.  I would never, ever recommend that someone suffering in the depths of HG hell ingest anything that contains ginger.

That said, I will try using ginger as a preventative measure.  I included it in my protocol, and when my doctor and I discussed this point, she indicated that it might be helpful, but that I should stop using it as soon as my body no longer tolerates it.  You will see me posting a bit about ginger, but if you have a friend or relative suffering from HG I just ask that you please keep in mind that ginger is very rarely tolerated in HG patients.  If things like ginger worked, we wouldn’t be shelling out the big bucks for the Zofran and the hospital stays.

Hopefully it helps me, but I won’t be surprised if it does not.

New Folic Acid Reccomendations

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):  An 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?