Tuesday, May 17, 2011

The Value of Aggressive Treatment for Hyperemesis

Knocked Up Knocked Over recently posted two articles (article 1 and article 2) analyzing why her recently-fought HG was of such (comparatively!) short duration. While there is always a part that will remain a mystery, she writes about the value of immediate, aggressive treatment in dealing with HG and preventing it from being longer than necessary:

"Can the short duration of the HG be attributed to my very aggressive treatment protocol?  I suspect that was a part of it.  I started taking the Zofran orally from the moment I started feeling not quite right.  Once I started feeling nauseated and having trouble eating and drinking, we started rehydrating very aggressively at 3 liters of fluids per day right off the bat.  While, ultimately, the IVs and PICC didn’t work out, I think having that kind of very aggressive treatment allowed me to reach the point where my mom could push enough fluids orally.  In the midst of all that, I was receiving the Zofran via the pump in very high doses, with my maximum dosage at around 39 mg per day (most doctors are only willing to go up to 32 mg per day).  We did not rely on Zofran alone, but attacked the nausea from all angles: Meclazine for the motion sick aspect of it, Nexium to prevent any potential reflux from contributing, and Benadryl to deal with any potential allergy aspects or side effects."
 She also writes:
"Here is the bottom line:  If you know someone who has HG and you are in a position to help advocate for them, please do.  Early, aggressive intervention seems to have made a remarkable difference for me.  Will every woman respond to treatment the way I did?  No.  But every woman deserves a doctor who is willing to treat her the way mine did for me because that level of treatment gives women the very best chance at relief."

I whole-heartedly agree with the concept that aggressively-treated HG can be a shorter-lived monster than the HG which is allowed to spiral out of control, because this was exactly my experience.

(As you know, I had what could be called "borderline HG" - not the monster that some of you have had to deal with (*shudder*).)

With my first HG pregnancy, which was completely untreated and allowed to get out of control, the "begging for death" part only lasted for the first 20 weeks or so, but the nausea and vomiting stayed strong and present up until birth. I also dealt with extreme exhaustion that didn't really go away until baby was about 15 months old. I also had residual postpartum nausea that stayed around for a good two years.

With my second time through, I was prepared and was able to receive homemade Bendectin and Zofran. Even though the NVP presented sooner and stronger, it did not spiral out of control into that ugly place of fear and despair that HG mamas know so well - it stayed in the "I feel like death" range, as opposed to the "somebody please kill me" range. Moreover, it left sooner, my energy levels returned sooner, and I dealt with little to no residual nausea (except for the parts I have written about in the past that I think are permanent changes to my body).

So my conclusion is the same, namely, that early, aggressive treatment of HG can make an enormous difference in outcomes for HG mothers. Unfortunately, so many, many doctors require a woman to be at a certain level of illness (i.e. should have started treating weeks ago) before handing out a prescription. It's unfortunate.



  1. "Unfortunately, so many, many doctors require a woman to be at a certain level of illness (i.e. should have started treating weeks ago) before handing out a prescription."

    This is so, so true. And once we get to that point, it's far too late. Honestly, for me, once I start vomiting I've already gone down the rabbit-hole. Once you're going down the hole it seems like it takes an act of God (or my mom) to get you back out.

    HGers should ask for and receive treatment immediately upon becoming pregnant. It is not enough to hope that "every pregnancy is different." Not to use strong language, but this is a lie. HG is, I firmly believe, something you either have or you don't.

    Treat it before it starts and you give yourself a fighting chance to beat back the monster.

    I'm glad my articles spoke to you. They were difficult to write because of the guilt I carry. It doesn't seem fair that I should be so lucky to have such a good doctor and good insurance while other women suffer. Every woman deserves the treatment I got.

  2. Knocked Up, Knocked Over - First of all, you should NOT be feeling guilty!! We are all extremely excited for you!! You are an amazing example of what an HG mother should do, and how she should be treated. In fact, I had been considering writing to you to suggest that your OB should write up your case for a journal ("The Value of Early, Aggressive Drug Therapy in the Treatment of Hyperemesis Gravidarum," etc.) so that word could get out about how helpful early treatment is. But regardless, enjoy the fluffiness!!! :)

    I actually had an interesting - and somewhat alarming - conversation with my DH last night. He puts much more faith in this VLC diet than I do, in terms of NVP prevention, and when he read my plan last night (prior to emailing it to my OB), he told me that he had been thinking that I wouldn't be taking any drugs at all unless I really needed them (i.e. got really sick) to give the diet a chance to work and assuming that I'd still probably have "normal" NVP that I could live through. My reaction was WHOA THERE, FRIEND!!! As we've been discussing on our blogs, early intervention is the one hope of the HG mother - not waiting to see if one is going to be really sick or not. So that is an unexpected tangle in the road that I am going to have to work out! Yikes!!!

    Love your blog, friend - I read every entry, even when I haven't time to comment. :)


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