Nausea

January 7, 2008 3:05 PM

My good friends suffers from severe nausea during pregnancy. She is seven weeks pregnant now. It is not just morning nausea, and she is very sick. She went to the doctor and tried most home remedies already, but nothing works.

Doctors in our country tend to see pregnancy as a beautiful natural thing that should not be messed with. That's good, usually, but she is having a very hard time now and from what we see online, doctors in other countries are sometimes able to do more.

The only medication for sickness that she can get is a combination of meclozini hydrochloridum (12.5 mg) and vitamin B6 (25 mg), which she takes twice a day. Unfortunately, it does not seem to do much. She tried morning sickness bands, ginger, eating small amounts during the day, eating a cracker before getting up, etc. During her last pregnancy (during which she was also sick, but not as bad) she tried accupuncture. Eating small amounts helps, but not enough. Prenatal vitamins do not seem to make it worse.

The nausea is very reminiscient of migraine-nausea (she suffers from migraines and I used to too, so I recognize a lot of what she says). She is very sensitive to light and hard sounds and cannot watch television or even look at a computer screen. She does not throw up and her urine did not show signs of ketosis (the doctor did not perform any other tests on the urine).

My questions are:

• Do you know a specific medication or a specific test that she might discuss with her doctor?
  
• The GP called a gynecologist, but I wonder if it makes sense to go to a specialist with experience with nausea?
  

If you have any other advice it is also welcome.

posted by davar to health & fitness (24 comments total)

I know that it's hard to drink anything while one is nauseous, but dehydration does make nausea worse. Maybe she can try to increase her fluid intake? Without overdoing it, of course.
posted by sotalia at 3:15 PM on January 7, 2008

Do a search for hyperemesis gravidarum and see if that applies. Some women take Phenergan but I can't tell you if that will be useful in her situation.

IANAD blah blah blah.
posted by otherwordlyglow at 3:22 PM on January 7, 2008

I guess Phenergan is Class C but Zofran is class B.
But the reality is that different things work for different women. Go see a different doctor.
posted by otherwordlyglow at 3:25 PM on January 7, 2008

Also, one last bit of actual advice, get your friend to sign up for the forum at Altdotlife. There's a whole thread called When "Morning" Sickness turns Hellish: Meds, tips, support, etc..
posted by otherwordlyglow at 3:27 PM on January 7, 2008

Phenergan sucked ass, in my opinion. The only thing that worked for me was half a unisom - the blue tablet (doxylamine succinate). Sometimes this is recommended in combination with B6, but I didn't find it made a difference. I believe the unisom/B6 is still prescribed in Canada as a single pill, maybe someone can verify.

Protein at every meal also really helped me.
posted by peep at 3:39 PM on January 7, 2008

For all three of my pregnancies I was severely nauseous and throwing up constantly until . . . I started taking Phenergan. I tried Zofran which immediately took the nausea away for about 5 minutes and then it returned. The only thing that worked for me (and I tried every thing) was the Phenergan, but it does make you quite sleepy/tired/knocks ya out.

What helped with my morning nausea was taking 1/2 a Unisom and some B6 - but that only helped for the actual morning-time sickness. During the day I stuck with the phenergan - and I was religious about taking it.
posted by Sassyfras at 3:59 PM on January 7, 2008

My Mom was sick as a dog throughout each of her pregnancies. A few things on the homeopathic side worked (all were approved by her doctor and the other doctor in the family):

Chewing on thin slices of raw ginger. This is good stuff. I do it and I'm not pregnant, either, but it does help with nausea.

Meyer Lemons. Do you live in California? The lemons I get off my tree are sweet enough that I just eat them whole, but I'm kinda crazy like that. If you're not a hard-core sour fiend, sniff them, juice them, lick them, anything helps.
posted by arnicae at 4:38 PM on January 7, 2008

Mothering Magazine has published some interesting pieces on the use of marijuana to combat severe nausea. I believe the general line of thought on this is that you want to ingest it in a manner other than directly smoking it, but IANADoctor/Midwife/Hippie.
posted by padraigin at 5:12 PM on January 7, 2008

I had extremely bad morning, noon and night sickness. The only advice I can give you: first, try not to go too long without eating anything. An empty stomach for a prolonged period of time makes nausea worse. Worse to the point of constant dry heaves. Try even a cracker or dry piece of rye toast.
Ginger ale and weak tea with honey are good first thing in the morning. If you're still really suffering and can't keep anything down then a trip to the local hospital is warranted. They'll hook you up to an IV and try certain anti emetic drugs safe for pregnancy.
7-10 weeks along is usually the peak of illness misery so just keep that in mind. I know it's difficult but the time will pass and by week 13 it should disappear completely. It did with me. It was a total 180. I began eating constantly and feeling great.
Best Wishes.
posted by GoodJob! at 5:12 PM on January 7, 2008

Have food/crackers by the bed and eat it before you get out? As in, really before, don't even stand up. Don't work?
posted by lundman at 5:14 PM on January 7, 2008

When I had severe morning sickness I adored Slim-Fast shakes. Fluids were easier to tolerate than solids, and the Slim-Fast had vitamins and extra protein in it. Once I got a can of Slim Fast down I could usually tolerate some dry Kix cereal or a cracker. Of course, you shouldn't use them to replace meals, but when you can't get anything down, a shake is better than nothing.

Sometimes Gatorade or lemonade are easier to tolerate than water. Tart things help.

I also followed my cravings closely. My doctor told me to eat whatever I wanted in the first trimester just to keep something down. So whether it was rye bread or ice cream my husband went to the store and got it for me.

Good luck.
posted by christinetheslp at 5:16 PM on January 7, 2008

You mentioned that she has already tried eating a cracker before getting out of bed, but that's not enough. For severe all-day nausea, she needs to be nibbling on saltines all day long (trust me, she should even carry some in her purse when she leaves the house) and sipping a non-caffeinated soda (such as 7-Up, Sprite, ginger ale, etc.) all day as well... The crackers and the soda will keep her stomach settled. Eat/drink them in moderation, just little nibbles and sips during the day. It works.
posted by amyms at 5:28 PM on January 7, 2008

Thanks for your replies so far! I'll check out the meds (and the marihuana?!) and discuss them and your other suggestions with her.
A few more things: she does try to get enough fluids, but it is hard. She cannot go to another doctor, even if there were another doctor that would be knowledgable (you cannot choose a doctor where we live). She is sick enough that getting dressed is a struggle. She does not leave the house. She found hyperemesis information herself as well (and got very scared after reading the horror stories on helpher.org). The only thing that doesn't fit is that she does not vomit, she is just very very nauseous. Still, it is not a condition that doctors in this country generally treat. If a women loses too much weight, she'll get an IV. If that doesn't work, abortion is mentioned as an option...
posted by davar at 5:49 PM on January 7, 2008

Late to the party, but....Compazine worked like a dream for me when I had severe nausea from repeated general anesthesia. I hope that it's an option for a pregnant woman.

I know it sounds obvious, but have you tried Benadryl (assuming it's available where you are)? My friend is violently allergic to codeine, and mistakenly took pain pills with it after surgery. She became very ill, and the Benadryl had her back in action very quickly. It might be worth a shot, though it will also make her sleepy.
posted by foxy_hedgehog at 6:03 PM on January 7, 2008

I have had 4 pregnancies (2 miscarriages at 3 & 4 months, 1 toddler, and one baby expected any day now) and have had terrible nausea and vomiting with all of them, lasting well into the third trimester. With my current pregnancy I was virtually housebound, it was so bad. I threw up or gagged all day and night long.

Some things that helped when I was pregnant 2 years ago:
- drinking spicy Jamaican ginger ale
- vanilla milkshakes
- using a neti pot to rinse out sinuses a few times a day (the sinus swelling and drainage you get with pregnancy exacerbated the nausea)
- eating protein with every meal/snack, about 6 times a day
- getting up in the wee hours (around 3 or 4am) to eat something -- a little cereal with milk works best for me
- drinking a mug of hot water with a whole lemon squeezed into it and a little honey stirred in
- keeping a lemon in my purse to scratch and sniff when I got nauseated
-eating buttered toast IMMEDIATELY after vomiting -- sometimes nausea/vomiting is triggered by an empty stomach.

All this worked fine with every pregnancy except for this last one (although the nausea was somewhat mitigated); eventually I ended up taking Zofran and it was a miracle drug -- got rid of about 90% of the nausea.

Doctors who would rather recommend abortion instead of providing relief with a drug like Zofran? I'm staggered by this.
posted by mdiskin at 6:29 PM on January 7, 2008

Ugh, so sorry she's going through this. When I was pregnant (14 years ago), I was stuck with an old doctor that was really set in her ways. I had no sickness the first 3 months, but the next 4 months I was sick all day every day, no exceptions. I spent those months stumbling into local ERs (3 different hospitals depending on wait) in various states of dehydration. They all gave me IV fluids and sent me on my way. At home, I had plastic vomit bowls in every room of the house. I carried one around with me most of the time. There were days I was too weak to shower, so my husband helped. I wasn't working and my only required chore was to provide transportation for said husband. I couldn't walk the 30 feet to the car and I couldn't drive the 5 miles without vomiting. It was a nightmare. I lost weight when I should have gained. Even that didn't get her attention. The old doc kept saying it's normal morning sickness and issued standard recommendations. I left every appointment in tears. I kept blacking out briefly, I couldn't keep anything (even water) down, and I was very scared. I was really young, couldn't afford to pay out of pocket for another doctor, and she knew it.
It wasn't until near-8th month that a doctor at the local ER sent me home with a phenergan prescription. It fixed everything. I was able to digest a solid amount of food for the first time in months. Grr. I don't know why it took 20+ (~weekly) trips to the ER for IV fluids to get the prescription. I don't know why the dr never discussed HG, because it certainly fits. I didn't learn about HG until about 5 years after my kid's birth. The whole thing still irritates me, obviously. If I had it to do over again, I'd kick and scream (or make my husband) my way around the doctor. I definitely feel she ignored the problem, dismissed my concerns, and I simply let her. Never again.
posted by ick at 7:00 PM on January 7, 2008

I had to carry saltines and applesauce all the time when I was pregnant. I'd be teaching a class and suddenly need to eat applesauce in front of my students to keep from heaving. And I had to carry a plastic bag everywhere. It's not pleasant; my heart goes out to your friend.

Compazine and phenergan didn't help me. Zofran was a miracle in my first pregnancy; it didn't make the nausea go away but I stopped vomiting all the time and was able to eat real food. It didn't help much in the second pregnancy, but I wasn't quite as sick, and somehow muddled through. Ginger chews from this company helped a lot in my second pregnancy; I felt very sick all the time but could often stave off actual vomiting by popping one in my mouth.

You didn't ask this, but your friend should avoid reading anything like "What to Expect when You're Expecting" that describes the perfect diet she should be eating and the dire results which will inevitable follow from not eating the nutritionally perfect diet. My first son was gestationally nourished on mounds and mounds of peppermint stick ice cream (cool and creamy, easy on the esophagus if it has to come back up, and, if you can't brush your teeth without vomiting, it will also freshen the breath. My little side tip) and he is healthy as a horse. The anxiety about whether the baby would be OK didn't help when I was so sick; the baby will almost certainly be just fine.

Seconding ick, too--nurses and doctors will tend to be really blase about this kind of thing, unless you're so sick you have to be hospitalized. "That will pass soon," they say blithely, or "You just need to get used to being able to do less." Being assertive about wanting to feel better may be necessary.

Ah, the happy memories this brings up.
posted by not that girl at 8:49 PM on January 7, 2008

Ginger is effective and safe, but you have to take a lot of it. A little ginger ale isn't enough - we're talking about tea made with several ounces of fresh root.

Nausea and vomiting of pregnancy and hyperemesis gravidarum kill a lot of women. Definitely see your doctor and discuss your entire plan with her.
posted by ikkyu2 at 11:15 PM on January 7, 2008

These are all things I did during my pregnancies to control nausea:
*ate ginger chews, drank ginger ale, ate pickled ginger
*took chewable kids' vitamins instead of prenatals
*used papaya enzyme pills on recommendation of my midwife (do not overdo these, they are a digestive aid but too much too often can give you diarrhea; I took one 30 mg pill if nauseated after eating or on waking up, once or twice a day. I am not a midwife, discuss with your medical provider first - link)
*ate by grazing constantly; never eating too much, never going more than an hour or so without eating (except when sleeping, and eating as soon as I woke up)
*eating more protein than usual; I ate snack-portions of veggie slices, fake chik patties, yogurt, cheese, and egg salad (I'm vegetarian)
*getting outside every day (walking if possible), even just 15 minutes of fresh air and sunlight made a difference - leaving the window open helped too
*massage - there are pressure points that can help in the feet and hands - be careful with this as well
*sniffing citrus scents to clear my head

Upping omega-3 intake (fish oil, walnuts, flax seed) is supposed to help, as well as eating chocolate. I have no personal experience with those.

My nausea was strong and lasted all day between weeks 6-11 tapering off to none by week 14 (although soon after replaced with heartburn). I only actually threw up a handful of times but I was nauseated constantly and worse when I wore anything touching my neck, smelled cigarette smoke, strong smells (bananas, changing diapers), bright/overhead light, movie theater screens.... I basically holed up and slept it out (tylenol, which is safe to take, makes me sleepy, so I used that if I needed to), and had my husband take over as much as possible. By my fourth pregnancy I was able to use a combo of everything above and it did not make it go away but it did make it controllable and predictable. I would say the papaya enzyme pills, the grazing all day (never let my stomach be empty), and the eating more protein were my biggest discoveries. It can really knock you out (I had to quit my job) and a lot of this stuff is test-and-see. I would hope after applying everything she can find to try over the next couple weeks that she finds predictable patterns/methods to cope somewhat, since every pregnancy is different and it's usually worse at the beginning until you get your groove. Since she is not vomiting even though she is nauseated, as long as she is still managing to eat a little and staying hydrated, she should be okay. I would be concerned if she can't find ways to handle it to feel somewhat all right (by no means back to normal of course) and/or it lasts longer than the first term. I really feel for her here; good luck.
posted by Melinika at 12:05 AM on January 8, 2008

My wife suffered severe Hyperemesis during her pregnancy, to the extent that she was hospitalised several times, had to have a PICC line inserted, and eventually had to be induced about 3-4 weeks early. During the pregnancy she lost around 25KG, (55lb) and it took her about 3 months to recover fully.

The only drug that was at all effective for here was Phenergan, it tended to make her well enough to be able to keep simple foods and meal-replacement drinks down.

Yet despite all that, many people suggested she was exaggerating her illness, or that it was in her head. Sadly the condition (Hyperemesis Gravidarum) is still largely misunderstood or marginalised - we found the site Help HER a great resource (although we didn't find it until after the pregnancy unfortunately).

Unfortunately there are no specific test for the condition. Check out the HER site, and go from there. If it is Hyperemesis, it's really important to do all that she can to be proactive in it's treatment. We eventually (about 28 weeks) found a nutritionist with experience in HG who was able to really help.

My wife went through her whole pregnancy with people saying "oh, the sickness will probably pass in a month or so, it normally clears up by x weeks..."

Thank god for public healthcare - we've since heard horror stories of bankruptcy and all sorts of other things. We had great care, at $0 direct cost to us.
posted by sycophant at 2:36 AM on January 8, 2008

My wife suffered from HG (hyperemesis) in both pregancies, and in the first was eventually hospitalised with severe dehydration. She needed drugs to function and recover in both cases: cyclazine (an antihistamine I think) and stemotel (might have spelt this wrong - it's an antiemetic that crosses the placenta, and they don't like to prescribe it if it can be avoided).

The real issue we found is that many medical practioners do not treat HG at all seriously. The first time round her medical care was truly appalling - fobbed off by our usual doctor multiple times ("go home, everyone gets morning sickness", while she couldn't even keep down a glass of water), until we were eventually lucky (!!!) enough to be given an appointment with a locum who more or less immediately referred her for a stay in hospital and proper treatment. We learned a serious lesson from the first treatment, and in the second case - where it became apparent that she was suffering in the same way again - we were very assertive with the doctor about the condition and the way that it should be treated. The end result was much, much happier.

I think the key thing you need to do is to educate yourself properly about the possible reasons for your sickness, and the treatment options available. Check out the HG support sites (we can't diagnose this for you, but it certainly seems to be a possibility). If you're not satisfied that the doctor is taking you seriously, see a different one.

Neither of our kids (age 4 and nearly 1) have had any problems related to the drugs - both were born happy and healthy, and have remained that way. YMMV of course.
posted by bifter at 3:32 AM on January 8, 2008

Oh, forgot to say that my wife had some (small, but noticeable) benefit from reflexology.
posted by bifter at 3:35 AM on January 8, 2008

Thanks everybody, for the advice and for sharing your experiences. I really appreciate it. I am so sorry to read that some of you had such an awful time during pregnancy. I had a pregnancy related complication during my last pregnancy and remember the complete dismissal by midwives and doctors. I agree that she needs to be assertive. I don't think doctors in this country are necessarily unwilling, they just really don't know much about it. They don't know about the successful treatments in other countries. She seems lucky compared to some of you though, in that her doctor does seem to take her seriously.

not that girl your advice about not worrying about healthy things is spot on. She is normally quite health concious and it does bother her a bit that the things she does keep down are soda and potato chips. She realizes that at this point everything she can eat is good.

I'll share your advice with her. I'll let you know if there is something that works for her.
posted by davar at 4:00 AM on January 8, 2008

One more piece of advice, since it hasn't yet been mentioned and may be relevant further down the line. I had pretty bad nausea for the first five months of this pregnancy (coming up to six months now).

A lot of the things listed by others above helped with the feeling of nausea during the day (though I'm afraid it never disappeared completely), but it took me a while to work out that the evening puking which really kicked in around month four, was caused by acid reflux rather than 'classic' morning sickness. Dosing myself with liquid gaviscon (www.gaviscon.com), which has been approved by my GP even in relatively large quantities, has helped enormously. I'm now feeling much better in the daytime, and have entirely puke-free evenings.

I second the suggestion of signing up for altdotlife, mentioned above by otherworldlyglow - it's a good place to vent or find sympathy from people who are going through the same thing. And I also wanted to reiterate that your friend should just eat what she can, not worry if that doesn't include anything green and take it as easy as possible. Dealing with feeling sick all the time is hard work as it is.
posted by melisande at 9:03 AM on January 8, 2008