Wednesday, 10 July 2013

Hyperemesis Gravidarum Pregnancy Four - The Early Days

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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