Wednesday 3rd July
I
had felt sick since the previous day when my
eleven month old had been sick and had assumed initially that my nausea
had the same cause. When it persisted I did a pregnancy test to
reassure myself that I wasn't pregnant only to discover that I was.
Given the effectiveness (or rather ineffectiveness) of the medications
tried in my previous hyperemesis gravidarum pregnancies, the fact that
ondansetron is effective but usually difficult to get a prescription
for in the UK and that preemptive medication is more effective, I had
intended to make sure a doctor had agreed to prescribe me ondansetron
before I next got pregnant. I booked an appointment with a GP at my
surgery
for the following morning with the intention to ask for ondansetron and
failing that an urgent referral to an ob and a very lovely friend
contacted some private obs to find out the likelyhood of an ondansetron
prescription and how soon I might be able to get an appointment.
Without medication I knew that within a week I would be very debilitated
and that within two weeks there was a high chance of being hospitalised
so time was of the essence and I was concerned about whether I would be
able to get the medication in time. As soon as my husband got home
from work (and I could go without the six year old who would cotton on
quickly if she saw some of the things I was buying), I went out to the
shops to buy various things that I needed such as pregnancy vitamins,
pregnancy sickness bands (which I feel compelled to use even though they
don't work) and various drinks and snacks that I would need. That
evening once the children were in bed,
my husband and I sat down together and went through our plan from
before the previous pregnancy updating it based on our present
circumstances and on what we thought worked well or otherwise last
time. I stayed up late printing out various research papers relating to
ondansetron and to preemptive treatment and information from Pregnancy
Sickness Support and pregnancysicknesssos.
Thursday 4th July
Although
still able to eat, my nausea was pretty constant and I was concerned
about how soon I might go downhill. My appointment was midmorning so I
had time to order a few bits and pieces online that would be helpful. I
went in to see the GP who I didn't feel especially optimistic about and
explained the current situation, my previous experiences of hyperemesis
gravidarum and the fact that I was keen to avoid hospitalisation and
listed all the medications I had previously
had that had either been insufficient, ineffective or resulted in
abreaction. She agreed that Idefinitely
needed to be given something and I said tentatively, "Ondansetron is
supposed to be effective and is safe in pregnancy." She then told
me that she had had it after a hospitalisation as she had suffered
hyperemesis gravidarum in her pregnancies and so she was happy to
prescribe it. She queried whether it was safe for breastfeeding but
thankfully I had recently contacted the Breastfeeding Network to check
the safety of various antiemetics during breastfeeding and she was happy
with the information I had obtained. As she was unsure of the dose,
she phoned the Pregnancy Assesment Unit (PAU) at the local hospital and
asked a midwife. The midwife then started saying that if ondansetron
didn't work then there was "nowhere to go" after that (which is untrue
as steroids are an option and are in the hospital protocol that I
obtained via Freedom of Information Act request) and that "every
pregnancy is different" (a classic phrase used by medical professionals
to suggest that women who have had HG previously should still wait until
they are very sick before arranging or getting
treatment) so I should "work through the ladder" or medications that
previously hadn't been effective. My heart sank as I feared that the
ondanstron which had seemed so close would now be snatched away but my
GP asked to speak to a consultant and I said that the ondansetron was
actually less likely to work if I got it later when I was more sick due
to working through other medications which had been shown not to work
for me already. I don't know which consultant she spoke to but based on
the conversation it seemed that she had also had ondansetron and said
that with my medical history it made sense to have it straight away so I
was started on 2x4mg/day with the option to increase it up to 2x8mg/day
if necessary. I was so relieved that I almost cried in my appointment
and I don't think I have ever been so happy in my life about being given
a prescription. It was so amazing and I really felt like God's hand
was there giving me the
right doctors so that I was able to get the medication I needed as
early as possible. My local pharmacy unsurprisingly did not have it in
stock and said that they couldn't get it in until the following day so I
started phoning pharmacies in other villages. The first one I got
through to could get it in for mid afternoon and it turned out that my
husband needed to stop in that village on the way home from work so
rather than me trail out with the two children when feeling unwell in
order to get it a couple of hours sooner, he picked it up. According to
the leaflet in the packet it can take 1-2 hours to take effect and I
was beginning to wonder if it was going to work for me when around 2 1/2
hours after taking it I felt a noticable improvement in the nausea. In
addition to all this excitement, I was also packing and preparing to go
away to Birmingham the following day in order to attent the Pregnancy
Sickness Support Trust
Conference on the Saturday. I was very thankful that the ondansetron
appeared to be helping as I knew that if it didn't there was a good
chance that I might not be able to attend the conference.
Friday 5th July
I
felt pretty bad
in the morning (although still fully functional) until around 2 1/2
hours after taking my ondansetron and worried slightly whether 4mg was
enough but once it had kicked in I was pretty good. We set out on our
journey and although I still felt nauseated if I didn't eat/drink
frequently enough diligently following my plan to eat and drink
something at least every two hours meant I was okay although I found I
was unable to eat a normal sized meal in one sitting as I would start to
feel much more nauseated once I had eaten a certain amount.
Saturday 6th July
I
managed the conference. I was so pleased as the previous year I was
about eight months pregnant and too ill to attend and I had been looking
forward to being well enough for this year. I had to be diligent about
snacking and drinking in order to stay okay and could only eat a small
lunch but I actually felt
reasonably normal albeit still a bit shocked by the events of the last
few days.
Sunday 7th July
After
what felt like a mammoth trip and lots of sleep disturbance due to the
eleven
month having a cold and being disrupted by all the travelling I was
pretty tired and felt
sick in the morning but again it improved around 2 1/2 hours after
taking the medication. I had been wearing long sleeved tops to hide the
sea bands from my six year old who would have recognised them from my
previous two pregnancies but in a
heat wave this was not really the most comfortable and it's not like
they actually make any notable difference so I decided to stop wearing
them. By this time I was not feeling like I really needed to have my
evening medication as soon as it was due so I tried having it slightly
later in the hope that this would improve the morning.
Monday 8th
July
Breakfast
is usually my smallest meal of the day anyway but I was unable to eat
all of my usual portion. I really tried to and I kept thinking, "That's
4mg of iron" but I just couldn't do it. Once my medication kicked in, I
felt better and I did my usual frequent drinks/snacks and tried not to
overdo it and was reasonably okay. Since I felt well enough that
evening I waited until bedtime to take my ondansetron as first thing in
the morning was definitely my worst time.
Tuesday 9th July
Although
I
didn't feel good in the morning, taking the evening medication last
thing before bed definitely made a difference. I could still only eat a
reduced portion of breakfast but I felt less nauseated
and more functional. I had a blood test first thing which had been
booked three weeks earlier and although I was slightly regretting it by
the time I got there I was actually able to walk there. I walked slowly
on the way back rather than normal speed but was so worn out that I had
to lie down and rest until my husband had got everything
ready to go to the optician and then on for a picninc lunch in the
Botanical Gardens for my Auntie's birthday. In previous pregnancies I
wouldn't have even managed the walk to the doctors surgery so although I
found it pretty arduous and exhausting, it was absolutely amazing that I
was able to manage our day out. Once we got home I had to rest for a
couple of hours because I was so worn out but then I was able to get up
and do a few bits and pieces.
Wednesday
10th July
After
a tiring Tuesday, I didn't think I would be up to much but I was
surprised to find that I was able to manage all the normal stuff at home
in the day such as washing, cooking etc which I was very pleased
about. I still needed to be careful about my eating but frequency was
become less critical from a nausea control point of view but was still
needed due to my inability to eat a full sized meal in one sitting. In
the evening I popped to the Coop (about 250m away) to pick up a few
things and by the time I got home I needed to sit down for a rest and
felt like I'd done something much more
strenuous. Although I'm glad to be
capable of more, in some ways it is reassuring to be tired more
easily. When I had a first trimester miscarriage, my nausea was fairly
similar without medication to what this is so far with medication but I
did not have any tiredness or impairment in my capability so the
presence in a reduced form of symptoms I usually have but didn't have
then seems like a positive sign.
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