Conversations with Sarah - Part III

My friend Sarah has been busy working on her hyperemesis story, and it is here at last! I am going to post it below.

As I've mentioned before, Sarah is a local mum with three kiddos. Her first pregnancy came with normal morning sickness, her second came with moderate hyperemesis, and her third came with severe, life-threatening hyperemesis. This in itself is extremely unusual, as most HG mums have HG with their first and all subsequent pregnancies (*sigh*).

Without more ado, let's hear from Sarah!!

"After a mild/moderate case of HG in my second pregnancy, I vowed that I didn't want to get pregnant again. Then I changed my mind, saying I'd reconsider it when Katrina was 3. Her third birthday came and went in early 2007 and I began to want another baby, just without a pregnancy. I figured we'd adopt. I got a flyer from a Christian social service agency that does adoption and even mentioned my idea to a few friends.

"In May of 2007 my period was late. Then it was really late, so in early June of '07 Vong and I got a pregnancy test from Target and, lo and behold, it was positive! Vong was happy, I was a mixture of joy and dread, hoping that I would not have another HG pregnancy. I was only 4 weeks pregnant and I was feeling great. Week 5 was good, but in week 6 I got food poisoning (I think). Maybe the HG really did begin that quickly--I don't know. I just know that I was very sick, very fast. I knew the HG was back. I began to have horrible anxiety that robbed me of sleep. I had intrusive thoughts of suicide. My nausea was becoming debilitating. I could hardly eat, but was hopeful that I wasn't vomiting yet.

"I made my first trip to the ER for fluids at that time. I don't think I was really dehydrated but I went to the ED anyway in a search for help. They gave me 3L of fluid, Phenergan, and Zofran. They sent me home with a script for Zofran since that is what worked for me during my last HG pregnancy. This time around the Zofran did nothing. I was very nauseated and my anxiety was through the roof. I couldn't sit still, I felt like throwing open the front door and running away, I couldn't sleep, and I was still contemplating suicide. I called my counselor and she told me to go to the ER. I called my OB and the nurse practitioner told me to eat something and be glad that I was pregnant. I called a crisis hotline and the counselor told me to do some prenatal yoga and informed me that the fetus was a natural yogi who assumed yoga positions in the womb. No joke. The counselor was such a joke herself that I hung up on her and her stupid yoga facts.

"It came to a head in mid-June of 2007 when, one afternoon, I knew that if I did not get help immediately that I would kill myself that night. I had a plan in mind and I could visualize myself doing it. I had never had to bear that much anxiety and that much dread at one time, and I could not handle it anymore. I told Vong and my dad how I was feeling, called the OB and told them, and they all urged me to get help. A friend came to get the girls and my husband and dad drove me to Good Sam's ER.

"The ER took me seriously. They gave me a private room with glass walls, moved everything out but the bed and a table, and opened the blinds. A social worker came in, assessed the situation, and told me that she thought I needed to be an inpatient until I could get more stable. A doctor came in and asked me if I was sure I was pregnant. I said yes, I was sure. Then he asked me how I knew for sure that I was pregnant. Odd. I explained that my period was late and that I had a positive pregnancy test at home. They ordered an ultrasound anyway. That was my first glimpse of Natalie, looking like an elongated space alien with a teeny tiny beating heart. I was 7 weeks pregnant at the time.

"Good Sam didn't have any room in their psych unit so I was transferred my ambulance to a county-run hospital in the East Valley. It was not very nice but not terrible, either. It seemed run-down but at least it was clean and safe. I was admitted to a locked unit where I had to strip down in front of a female staff member and don a pair of blue surgical scrubs. I could only wear panties under the scrubs since bras posed a hanging risk. They took away my belongings and showed me to my room. It was 5 AM and I was exhausted but had way too much anxiety to sleep.

"Life on the psych unit is very routine. In the morning you get weighed and they take your vital signs. Then you wait around for breakfast. After breakfast are dr. visits, counseling sessions, and groups. After lunch are more groups and a few lame recreation options, followed by visiting hours. Then comes dinner, yet another group, some free time, then bed. The food was really bad, especially for someone who doesn't feel well to begin with. It was during my week there that I began vomiting.

"I guess going to that hospital was a good idea. I hated being there but the staff was fantastic, and there were two ladies on the unit that I felt made it worthwhile. One had just given birth to triplets and had severe ppd/psychosis in which she became homicidal. Yet she was the nicest gal--just goes to show what depression and hormones can do. Another lady was pregnant and was very anxious about it since she nearly died in the delivery of her prior child. Her doc told her not to get pregnant again, but she did and was terrified. Meeting those women helped me realize that pregnancy is not the dream that most people think it should be and that I was ok for seeking help.

"Incidently, while I was admitted there I ran into someone I had known as a teenager. There he was, on the same unit as me with some big, nasty problems. It was weird and sad that he had ended up so ill.

"The psychiatrist started me on Zoloft and continuted the useless Zofran. Once I was deemed safe to go home, I was released. I had missed my kids like crazy; they were the reason that I wanted to keep living. So my husband came and got me and drove me to my dad's house. Apparently we had moved in with him so I could get better and so that we could have help with the kids.

"My poor dad. I can't imagine what he experienced watching his daughter flip out like I did. I would have killed myself in his home, too, which horrifies me in retrospect, but at the time it seemed like such a viable option. My dad has experienced some pretty rough things in his lifetime, too, but I think this shook him up.

"Anyway, I was about 8 or 9 weeks along and beginning to puke in earnest, so Vong and I got aggressive with the OB in seeking help. They decided to order a Zofran pump and, in the meantime, had me come in for fluids. I got a couple of liters in the office and got antibiotics for a UTI that I had told the OB that I had had a week earlier, but he didn't believe me. Anyway, it showed up the day I went for fluids and I got treated for it.

"I was already mad at this particular doc because he told me that HG was 90% in my head. Then he didn't believe me about the UTI and gave me advice about eating frequent, small meals of crackers. Idiot.

"Matria soon came to my dad's house and started the Zofran pump. I puked while the nurse was teaching me how to use it, then I couldn't stop throwing up. Everything I ate or drank came up again. My pee was dark and full of ketones and I lost 15 pounds in a little over a week. I couldn't sleep, got horribly constipated, and knew I needed more help than Zofran could offer.

"We fired the ignorant, cocky OB.

"Vong interviewed a new OB who said he was familiar with HG and had treated lots of women with it. He was literally a Godsend. Literally. When the Zofran pump wasn't working well, he admitted me to St. Joe's practically sight-unseen for a weekend of IV fluids. He thought the dehydration was inhibiting my body's ability to utilize the Zofran. When we told him who my first OB had been, he just smiled. We later found out that OB #1 had his teaching privleges revoked at St. Joe's because he was such a flake.

"I vomited all weekend at St.Joe's, went back to my dad's. The pump still wasn't working although we had titrated the dose to nearly the maximum. I was dizzy, I was anxious and fighting suicidal thoughts, I was dehydrated, and was horribly gaunt. I felt like a terrible mother because I couldn't take care of my kids. I wanted to miscarry, yet I wanted the baby. I pondered an abortion. Anything to end the misery.

"Around week 10 or 11 I developed terrible abdominal pain and began vomiting blood. I took myself off all meds, including the Zofran pump. Vong took me to see the OB and I began sobbing, begging the doctor to help me and to tell me I was going to be OK. I told him that I had tried to be brave and strong but that I just couldn't fight anymore. He took one look at me, assured me that he would take care of me, and admitted me to St. Joe's for a PICC.

"I was so happy to be getting a PICC. I was so stressed all the time about not being able to eat or drink enough to keep myself alive, and I had a constant and intense thirst that haunted me. I could have chugged down a 32 oz Gatorade in one breath, I am sure. Of course I would have puked it back up 45 seconds later, but I was so tempted to drink and drink. I needed fluids horribly.

"The day I was admitted for my PICC was a busy one at the hospital and the nurse in OB triage, where I lay waiting for a bed to open up on the floor, said that they would put in a peripheral IV to get me through the next 24 hours and start a PICC the next day. I told her that my last IV took 13 pokes and that I doubted anyone could get an IV going on me. She called my doc and apparently he made a few calls of his own because the next thing I knew I had a bed on the antepartum unit and a nurse came to insert the PICC.

"The nurse who did the procedure was fabulous. He was very flamboyant and self-assured, and he got the line in with no problem. I didn't even care that he stuck a huge needle in my upper arm to thred the line in my vein, up and around to my heart. I was that thrilled to get the PICC. That same evening I had a GI consult, my OB came by to check on me, the perinatologist stopped in, and I was scheduled for a nutrition consult the next day. I started getting Nexium to heal my bleeding gut, they started TPN and lipids, and I had Reglan added to my regular IV fluids. I was getting about 2000 calories a day in the TPN so I stopped worrying about eating. At that point I weighed 110, which I hadn't weighed since I was about 13 years old, except during my other HG pregnancy.

"What followed were probably the hardest 8 or 9 days of my life. The reglan made me anxious and did little to get rid of the nausea. I had dry heaves multiple times a day, even from simply rolling over in bed or getting up to go to the bathroom. I couldn't watch TV or listen to music because it made me feel worse. I could still smell the lotion that the nurses wore and it made me sick. The cleaning lady used chemicals in my room that made me sick. Even people talking to me was sickening. The food service people kept bringing meal trays to me until my nurse put a sign on the door that said "NO FOOD TRAYS".

"Nights were the worst. I had nightmares that involved crippling nausea. I would wake up to heave. The staff kept coming in my room for vital signs, blood sugar checks, labs, and to weigh me. I felt like they wouldn't leave me alone. I would ask for my prn nausea meds just to be drowsy for a short time, even though the medication made me jittery after a while. I was anxious all the time and the night seemed to intensify my suffering.

"I truly believed I was going to die. I had never been so ill in my life. I feared leaving my girls without a mother but I figured that they would be OK in the end. Then one night I had a dream that I believe God sent me to assure me that I would live. In my dream I was in a hospital ER. A man came in with these clear ropes that he started hanging all around my bed, up by the ceiling. I looked up at those clear ropes and realized that they were the cords of death, waiting to entangle me (King David refers to this in the Psalms). Suddenly in my mind I knew those ropes were not mine but belonged to someone else. In my dream I told the man to take them down and carry them to someone down the hall, for whom they were intended at that time.

"When I awoke I knew that I would live.

"The one relief I got in the hospital was when my OB ordered ativan for me, should I become very anxious. I didn't know he had ordered it until my nurse casually mentioned that I could have ativan at bedtime. I jumped at the chance and took it at about 6 PM. I was out cold until the next morning. It was wonderful and it was the last full night of sleep I got for the whole pregnancy. I mentioned my pleasure to the nurse the next day and she proceeded to tell me how addictive ativan could be, just from her own experience with it. I didn't ask for it again because I was afraid of becoming addicted. So the sleepless nights continued.

"During that hospitalization I asked not to have any visitors. The only people who came were my husband, my dad, my friend Louise, and a friend from church. I remember Louise crying the first time she saw me. I guess I looked pretty bad. I have to say that all of these people are troupers who deserve accolades for the many backrubs, cleaning out my puke bucket, reading Psalms to me, and helping me to the bathroom. It could not have been a pleasant task.

"Eventually my OB thought I was stable enough to go back to my dad's house. Home health came that night to teach us how to hook up my IVs and to mix the vitamins and insulin into the bag of TPN. Since my husband is a nurse, he was comfortable doing all of the medical type tasks. He changed the bags and tubing every night, and the home health nurses came every few days to change the dressing on the PICC. I began to eat a little bit and started to gain weight. The pharmacist with the home health company was fabulous and he tweaked my TPN and Reglan so I was getting the optimum amount of both.

"The next few weeks were actually ok because I was getting nutrients in my PICC, I started eating again, and I only threw up a few times a day. I still had unrelenting nausea and the dreadful ptyalism, though, so I was pretty miserable. I tried to get up and get dressed every day and I made an attempt to play with my girls when I felt up to it. They learned to leave me alone unless I managed to stumble out of my room and offer to play. Then they would get all happy and we would play a game or something until I'd throw up and go back to bed. The sad part is that they got used to me being like that.

"As the pregnancy progressed to around 14 weeks I was eating regular food for the most part. I still had lots of food aversions and fluids were a problem because I was guaranteed to throw up nearly any liquid. But I thought I could see the light at the end of the tunnel. We were talking to the pharmacist and the OB about weaning me off the Reglan and TPN to see if I could eat and drink on my own. I still had no energy and got dizzy a lot, and I felt anxious and jittery all the time. Now I know it was the Reglan causing those feelings. In hindsight I think I would have done better with no anti-emetics, just the fluids and TPN.

"One crappy note--I was too weak to take my daughter shopping for new school clothes. I had really looked forward to that. But my best friend Jenn and her husband, Tom, took Anna out and bought her a school wardrobe. I am still grateful to them for doing it, but my heart aches that I missed it.

"The next part of my saga starts when my oldest daughter had a "Meet the Teacher" day at school. I really wanted to attend because she was about to begin kindergarten and I wanted to be a part of this exciting time in her life. We borrowed a wheelchair and went up to the school. My husband pushed me and my IV pumps around the school campus so my daughter could see her classroom. I remember feeling really bad that day. I had a slight fever off and on for a couple of days prior and had been taking antibiotics because my OB thought it was related to some dental work I'd had done. But during "Meet the Teacher" day I started having chills. My heart was pounding and my anxiety was growing. When we got home to my dad's house I went to bed and assured myself, my dad, and my husband that I would be ok. But by late afternoon I knew something was very wrong.

"I was admitted to St. Joe's once again for tests. It turned out that my PICC was infected and, not only that, but I had septicemia, or a blood infection. I have a mitral valve prolapse and my first fear was my heart. I wondered if the infection had fed up the line to my mitral valve that was why my heart was pounding so fast. It turns out that I had early signs of shock from the infection. It scares me so badly to write this, to think about what would have happened if I had waited even 12 hours to get help. One of my nurses told me I was lucky; it was not uncommon for their HG moms to end up in ICU with septic shock.

"The PICC was pulled and I was given massive doses of antibiotics to counter the infection. The nurses got an IV in my hand so I could still get fluids. By that point I could kind of eat so I did get trays of vile hospital food. Sometimes my husband would bring me food. I had such an advisarial relationship with food. I wanted to eat but couldn't, and on the other hand I longed to have my PICC back so I could not eat. The nausea was still so crippling and I drooled constantly. You just can't understand how bad it unless you have lived it. It is mind-altering, to say the least.

"Being septic had wreaked havoc on my blood count. My red blood cells and platelets were very low so I got 2 units of blood and hefty doses of steroids to get my blood counts up. The steroids were also supposed to help me have an appetite, which they did not. I stayed in the hospital until I could tolerate my meds by mouth and could drink enough fluids to satisfy everyone, then I got to go back to my dad's. I think I was there for about a week and a half. Sadly, I missed Anna's first day of school because I was in the hospital, but I did get to have Katrina come visit a few times. I remember that she seemed so full of life and health and I wanted to get better for her.

"From week 16 to around week 19 we kept living at my dad's house. I was still vomiting every day but I managed to put on a few pounds. By week 21 we moved back to our house. The ladies at church got together and provided us with 4 weeks of meals. I was very, very weak and so anxious all the time until I quit taking the Reglan. Lo and behold, the anxiety was better! My energy level got better all throughout the pregnancy as I took Floradix for the iron and B vitamins. I found Jenna online and she offered me the emotional support that I desperately needed. The turnaround for me was when she told me that I was a survivor. I realized at that point that I had endured things that would have killed other women and that yes, I was strong. Thank you, Jenna! You gave me hope and strength when I was crushed and hurting.

"My nausea lasted until my 30th week of pregnancy. Weeks 30-36 were the best of my pregnancy, and then the nausea came back until Natalie was born at 41 weeks and 3 days. She was born at home in a pool of warm water, surrounded my my amazing husband and my 3 healing midwives. My family and friends were in the next room and it was all I wanted in a birth. My babymoon was complete with help from family, friends, and my post partum doula. My husband made me special smoothies and treated me like a queen. I had a happy ending to a nightmare of a pregnancy.

"I am in no way done with my HG. The physical symptoms are gone but I suffer from flashbacks that bring waves of nausea over my body. I still have strong food aversions to a few particular items and I cannot go anywhere near St. Joe's hospital. Through my sickness I have had the blessing of receiving help from some amazing people. I have the joy of having two fellow HG survivors in my life, Jenna and Diana. They are my sounding board when I need to talk about my experience. And I can't say enough about my husband, Vong, who truly lived out our wedding vows to love me "in sickness and in health." He was my caregiver, mom and dad combined to the girls, and our breadwinner. I never heard him complain through the months of my sickness, even when it must have been heartbreaking for him. He was Christ to me when I was too angry to accept God's love directly. I am so proud to be married to such a man of character.

"I am thankful to my father who let us move in with him and who made me meals, changed my sheets, emptied my puke bucket, screened calls, and prayed for me, even when God was silent in that department. I am thankful to my daughters who were my inspiration for living, literally, and to my midwives who helped me reclaim joy. I am thankful to Blair and Louise and to Tom and Jenn for being surrogate parents to my girls for the many days that I could not care for them. And thank you to Natalie Praney, my Valentine baby, for the unrivaled joy you give me every day!"

What can I say? Wow!!