Saturday, December 04, 2004

What throws up must come down

I have caught the G.I. bug my kids were enduring all week (and to think I thought I'd dodged that bullet). There is nothing like sitting up nauseous, doubled in cramps to make me think back to my pregnancies.

Hyperemesis Gravidarum (literally "elevated vomiting of pregnancy") is morning sickness on steroids. I had it for my first two pregnancies. Each time I lost between 10-15 pounds in my first trimester and was so debilitated by nausea that I was confined to the house for about seven weeks. Before leaving for work each morning my spouse would bring up a cooler with water, gatorade, a banana and some crackers in it. On a good day I could keep down half the banana and some fluids.

The nausea was persistent and intense. It had the baseline depth of sea sickness. Ordinary events -- getting undressed, having a conversation, smelling water boil -- were enough to send me retching to the bathroom. And unlike the vomiting I'm doing tonight, the vomiting of hyperemesis neither relieved the nausea nor ended quickly. Once started, the vomiting seemed to gather momentum with each retch. It could take up to 10 minutes for it truly to abate. I distinctly remember thinking that if someone told me I'd feel that way for the rest of my life I would kill myself. That was the first time I realized the power of hope for keeping people alive.

Atul Gawande wrote an article on the subject in The New Yorker, July 5, 1999 ("A Queasy Feeling: Why We Can't Cure Nausea"). It used a pregnant woman with hyperemesis gravidarum as a case study, thought it also looked at chemotherapy patients and people with inner ear problems. It's an excellent article and Gawande, at that time a medical resident, is a great writer and thoughtful ethicist. His essays are available in his book, Complications: A Surgeon's Notes on an Imperfect Science. But I digress.

Gawande's article said that women do not cite labor pain as a reason to avoid future pregnancies. But women did say that a past experience of intense nausea with pregnancy limited their subsequent number of pregnancies. The condition can become life threatening; some women even abort pregnancies if they are not able to get the condition under control. Thankfully my condition improved right about the time they wanted to begin IV nutrition and I got away with only a trip to the hospital for IV hydration.

If you're trying to treat at home, there is a long list of products you can try. These include
Sea Bands (sea sickness wristbands that stimulate pressure points on your wrist)
Ginger (some positive evidence, though I've also read it can trigger miscarriage in the first trimester if high doses are used)
homeopathic symforicarpos or nux vomica
Vitamin B6 (in specific doses -- talk with your care provider)

I had some success in my third pregnancy with acupuncture. Another woman I know got temporary relief when injected with her own urine (it only sounds extreme if you're not faced with unending nausea).

There are drugs that provide relief for many women: phenergyn and Reglan are two I know of. Of course the advisability of taking them during pregnancy, especially the first trimester, is always questionable.

A great on-line resource for women (and families of women) with Hyperemesis Gravidarum is, website of the Hyperemesis Education and Research (or HER) Foundation. I wish it had been around when I was in the throes of my bouts; it was founded in 2000 by a nurse who endured nine months of nausea and vomiting. Bless her soul!

I vowed that if ever I knew of a woman with hyperemesis, I would gladly take in meals for her family so she wouldn't have to cook or smell food or that I would go keep her company if she was home alone, isolated in her misery. Please let me know if you fit this description.

And if you're pregnant and sick while reading this, my deepest sympathies go out to you. Fortunately the end product is usually worth it. And hospital food has never tasted so sweet as the meal after you deliver your baby and that nausea vanishes faster than you can say placenta.


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