Anna's Story (That's Me.)

“Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with loss of greater than 5% of pre-pregnancy body weight (usually over 10%), dehydration and production of ketones, nutritional deficiencies, metabolic imbalances, and difficulty with daily activities. HG usually extends beyond the first trimester and may resolve by 21 weeks; however, it can last the entire pregnancy in less than half of these women. Complications of vomiting (e.g. gastric ulcers, esophageal bleeding, malnutrition, etc.) may also contribute to and worsen ongoing nausea.” –Help HER website http://www.hyperemesis.org/index.php

Before I even begin, I want to preface this by saying, my story, by far, is not the worst HG story I’ve heard. It is different, though, as you’ll read. I also just felt like it was time to write it!

THRILLED
In April of 2007, I found out I was pregnant after 9 months of trying. We were thrilled! I suspected I was pregnant approximately 2-3 weeks post conception (around the time my period was due) because I was a little queasy. I took a test, and it was negative. My hormone levels weren’t high enough to register on the pregnancy test, but I was already nauseated- I guess that should have warned me, but I had never heard of HG. When I was about 4 ½ weeks along, it was Mother’s day. I remember lying around at my grandmother’s house all day feeling awful. I could eat a little, but it made me feel worse. Smells were awful. I knew I was pregnant, then, but I hadn’t told anyone yet. I was going to the doctor the next day to confirm the pregnancy before I told my family. I was excited to feel nauseated- believe it or not. It just made me feel more pregnant- plus, I thought it was just normal morning sickness! I’m a teacher, and I worked the rest of the school year, which was only about 7 more days.

NOT NORMAL
By the last day of post planning, I felt like I was going to vomit every second of the day. I had NEVER felt so awful in my entire life! Just a note- I only vomited 3 times during my entire pregnancy. I just had that feeling (the one right before you vomit) 24 hours a day. Within a day or two, I couldn’t eat a thing. I stayed in “puke purgatory” 24 hours a day. (I read that in a Jenny McCarthy book.) I called the doctor, and she told me to try B6 and Unisom. (I had already tried every natural/herbal remedy I knew!) Nothing! I called the doctor again. This time she prescribed Phenergen…nothing! …Reglan…nothing! Zofran…FINALLY, some relief! However, Zofran is SO expensive. My insurance company would only pay for me to have 1 pill per day. I was taking a 4mg pill every 4-6 hours- even through the night! I remember spending a few hundred dollars out of my pocket to go buy one or two pills at the time. I was desperate for relief! I couldn’t eat. I couldn’t drink. I couldn’t STAND the smell of ANYTHING. My poor husband had to eat before he got home so he wouldn’t bring any food in the house. He also had to shower with scentless products. Shampoo/soap smells were the worst! After a few days of getting some relief from the Zofran and then plummeting again when it would wear off, my doctor decided to call in home health care (Alere- see link) and give me in-home IV fluids and hook me up to a Reglan pump. I tried the pump for one day and had NO change in the nausea. (By this point, I had lost 7 pounds from my already thin frame. I would have lost much more, I’m sure, if I was vomiting.) The next day, the nurse came out and changed my pump to Zofran. She also gave me a Zofran shot to give me a boost. I felt much better that night. I ate a few bland foods…also, I lived on soft drinks. The carbonation was helpful- once I had the pump and could swallow again! Thank God for the Zofran pump! It saved me, and I was/am so grateful. I don’t say this to complain, but only to explain the process of the pump. The tubing goes into a fatty part of the body. (Usually the thigh) I had to stick myself everyday with the needle for the new site. Zofran is very caustic to the skin, so my legs would become very bruised and swollen. I looked like someone had beaten me! Part of the Alere (It was called Matria at the time.) care is talking to a nurse every other day or so. I had to weigh myself, check for ketones in my urine (with test strips), and keep track of my supplies. I reported all of this information to the nurse when she called. It was all quite a process! Around this time, I ended my first trimester and waited impatiently for the nausea to end.

THE SECOND TRIMESTER
12 weeks passed, still sick…14 weeks…16 weeks…somewhere around this time (still had the pump), I started to feel better. I was able to work (school was starting). I felt yucky everyday at work, but I could work. I ate or drank constantly- little snacks to keep my stomach settled. The students knew all about my nausea because of my pump. They helped me do everything. I could not stay on my feet for long. Everyday was a struggle. We had planning time at the end of the day, so I was able to go home early most days. I remember getting home and lying down immediately. I would stay that way until my husband got home with dinner (I had a small list of things that I could eat.) This might not seem like a big deal, but I am NOT the type of person to come home and go to bed. I am busy, busy, busy all the time! I always have something to do, and I enjoy it, so having to go to bed everyday was foreign and frustrating for me.

BACK WITH A VENGANCE
On November 1, 2007, I went in to work. I was so sick when I got there, I turned around and went home. That was the beginning of a huge downward spiral. The HG had returned in full force. (not that it ever left.) I still had my pump- on the highest dosage of Zofran I could take- but it just wasn’t working. I think it was keeping me from vomiting, but the nausea was relentless! I was scared of the nausea getting even worse without it, so I didn’t dare get rid of it! On November 7 (I was 30 weeks by this point.), I took my first visit to OB triage. The in-home IV and pump weren’t cutting it. They gave me two bags of fluid and 8 mg of IV Zofran and 25 mg of IV Phenergen. I felt better when I left. I hung on through most of November. I cried almost every day. I was just SO miserable. My due date was January 19th, and it just seemed so far away! I knew the nausea would end when the baby came, so I just tried to stick it out. I was on medical leave- I hadn’t worked since I left on Nov. 1. (And would end up not working anymore at all) I spent my days in front of the TV, feeling awful. I had every program and channel memorized. I knew what came on each day at what time- not normal for me- I was not previously a big TV watcher. I would sit and watch the minutes tick by until I could take my next dose of Phenergen (which I was taking by mouth still- not that it helped.) I could have one extra dose of Zofran on my pump every 24 hr. I used it everyday! Thanksgiving was bleak. I look back at the pictures and I can see the paleness in my face. (and my Zofran pump strapped across my shoulder.) The week before Christmas (I was going on 36 weeks), I got as sick as I was in my first trimester. I couldn’t get a sip of anything down my throat. The nausea was unbearable. It’s really impossible to explain the misery of constant suffering over which you have no control. It was really taking a toll on me! I took two trips to OB triage that week. The second trip was on December 23. (That made a total of 5 trips to OB triage since November 1.) My family was at our annual Christmas gathering, and I was in the hospital. So sad! The doctor on call that night came in and talked to me. She said I was starting to contract a little, and I was dilated 1 cm. She offered to break my water and induce labor….YES…FINALLY!

FREEDOM!!!...right?!
I was so excited! I had an epidural almost immediately. I slept through the night as I labored. (Side note: the doctor’s gave me Ambien to sleep and it made me hallucinate- that had NEVER happened to me before- scary!) Anyway, I woke up the next morning throwing up! I threw up so many times, I lost count. My OB told me that the body does the same thing when it’s throwing up as when it’s pushing. She said, “At least something good comes out of feeling like ass.” (Funny girl!) I dilated quickly (from 4 cm to 10 cm in 45 min.) and was ready to push. I only pushed for 15 minutes! At 11:24 am, on Christmas Eve 2007, my sweet baby boy was born 4 weeks early weighing 7 lbs. 1 oz. and was 20 in. long. He was healthy and perfect. He did NOT suffer from my lack of nutrition or the medication I took. He was beautiful…what a sweet and amazing moment…the nausea will go away any minute now, and my baby is here…an hour passed…the nausea was still severe...the day passed…still nauseated! What?!

“AFTER” HG
On Christmas, I was planning for my family to “bring Christmas to me” and meet baby Jacob…no such luck. I was sicker that day than I had been the entire pregnancy. I don’t know how to put the nausea into words. It was so severe that I started shaking. I was truly afraid that I might go into shock. I didn’t know how much my body could take! This continued for 48 hours. The doctors tried everything to stop the nausea: antibiotics, steroids, antiemetics, etc. I was so sick, I don’t even remember everything they tried. Oh, and the heartbreak of my new baby’s first Christmas when I couldn’t even raise my head to look at him! It was the hardest time of my life! My heart is heavy just thinking about it. Finally, the doctor’s gave me something to sleep since they couldn’t ease the nausea. Sleep was my only relief. They ran a few tests while I was there. I remember a CT scan of my stomach and my brain. Everything was normal. The nausea went up and down, and 10 days after Jacob was born, they sent me home (still sick) telling me the nausea would just continue to fade on its own.

HOME FROM THE HOSPITAL…for now
I went home from the hospital feeling confused and a little scared. I couldn’t understand why I was still nauseated! I felt better for a few days and even had my family over. (I was still hooked up to my Zofran pump, believe it or not, but the company that loaned it to me quickly came to pick it up!) I spiraled downward and by January 12, I was so nauseated, I started shaking again. (I called it “that scary nausea.”) I called the on-call doctor, and she told me to go the ER. She said, “This is definitely NOT pregnancy related!”

BACK TO THE HOSPITAL
I waited in the ER for 8 hours. There was a woman with the stomach flu there who kept throwing up. It was awful! FINALLY, I saw a doctor. He decided to admit me to the hospital. First, though, he gave me Compazine because I had never tried it before. I had a reaction to it. I can’t explain it very well- I remember feeling shaky and like the lights were too bright and like I was going to fall of the stretcher. It was really strange and didn’t help the nausea…surprise. I was grateful when it wore off! This hospital stay would prove to be the longest!! I was there for two weeks. The doctors tried everything they could think of. I had a gallbladder ultrasound, gallbladder emptying test, stomach emptying test (where I had to eat radioactive beef stew at 8 in the morning- yeah, really helpful for the nausea!), multiple CT scans, multiple MRI’s, more blood work than you can imagine. Everything came back normal. This is when things “got ugly.” Since my GI doctor couldn’t find anything wrong with me physically, he decided to call in a psychiatrist. I met with him for about 10 minutes, and his final statement was, “I’m so sorry I can’t help you, but this is clearly not a psychiatric issue.” (Uh, no joke! Could you please tell the GI doctor that?!) Also, sometime during this hospital stay, they tried giving me Thorazine. I also reacted to it. It made me “sleep” in a weird way. I could hear everyone around me, but I just couldn’t open my eyes and communicate. It was awful! The doctors told me that they sometimes use Thorazine in small doses to stop perpetual hiccups. It somehow triggers the brain to “reset”- at least that’s how I understood it at the time. They were hoping to “reset” the part of my brain that was allowing/causing the nausea. No luck! One day, after all of the testing was done, my GI doctor came in and said, “All of your results are normal.” I started to cry because I was so sick, and they could not find a cause. He told me, “Look on the bright side. Nothing serious is wrong with you.” Then he quickly left the room. He then went out and prescribed anti-depressants for me. I refused them. I was not depressed! I was nauseous! Any fool could see that- not to mention the psychiatrist that was called in said that my problem was clearly NOT psychiatric. This was SO frustrating!!! His attitude seemed to be, “Well, if I can’t cure you, you must be crazy.” Ugh!

MY FAITH IS NOT IN MAN
Thankfully, the LORD is my ROCK, and I leaned heavily on Him. The doctor’s were not my answer- HE was! Only my trust in the Lord and my precious family got me through this horrible time in my life. (Another side note: In the hospital, I was admitted to the women’s center, so my baby could still room in with me- what a blessing in the midst of a nightmare!) A dear friend brought a CD to the hospital for me during this time. She told me that it had helped her through a time of suffering. The song that really ministered to me was “Regardless of the Circumstance,” by Katherine Barnes. These are they lyrics:

VERSE
Who knows what tomorrow brings, what joy or tragedy
May be around the corner in this life of faith I lead?
Will a love be found so dear and pure to fill the deepest parts?
Will a cloud of desperation settle in my heart?
CHORUS
Regardless of the circumstance that tries to cloud my soul,
These trials are for a purpose and a time for me to grow.
That the testing of my faith will produce a greater love,
More genuine to glorify my Father up above.
VERSE
Dreams may seem forgotten or lost along the way,
Sacrificed and broken down and traded for dismay,
And a heavy heart grows weary of enduring through the flames,
Oh, but only through the fire are we worthy of HIS name.
REPEAT CHORUS
BRIDGE
Though for a little while, I may suffer grief and trials,
This I know. This I know…
REPEAT CHORUS

I know without a doubt the Lord sent this song through my friend. It spoke directly to my circumstances and served to remind me that I serve a God that does not let anything go to waste. He uses all things for His purpose…and He’s bigger than HG! Well, on January 26, I was sent home again. Again, the doctors told me that my nausea should resolve on its own. (I was also still on several anti-emetics.) I did feel better off and on.

THE FLU
On February 2, 2008, my 8 week old son caught the flu, and we had to spend 4 nights at Scottish Rite Children’s Hospital. While we were there, he got better quickly (praise the Lord!) but I started to decline again. The pediatricians said I looked like I should be the one hooked up to an IV instead of the baby!

MY HOME AWAY FROM HOME
By February 15th, after a hellish night of torturous nausea that is truly beyond words, I was admitted to the hospital again. (I should note, though I only threw up 3 times during my pregnancy, I threw up a lot postpartum.) I remember the first day of being back at the hospital. I was so dehydrated that, my lips were cracked and bleeding. My mom kept rubbing my feet for me- it somehow helped to SLIGHTLY distract me from the incessant nausea. The doctor’s gave me medication to sleep, and I slept most of the day. By that night, my sister came and helped me take a shower. She dried my hair for me. I remember having my hair dried being somehow therapeutic. Bless their hearts, my mom and sister would spend hours blow drying my already-dry hair for me. It just felt good, and I was feeling so awful at the time, it brought me some peace. After drying my hair for nearly an hour that day (it was probably dry after 15 minutes), my sweet sister rubbed my feet until I fell asleep. She’ll never know how much that meant to me! During this hospital stay, they did a few more tests and repeated my blood work. Everything was still normal. My GI doctor (whose name feels like a 4-letter word to me now) called in another psychiatrist. This one was awful. She kept asking me, “Why do you think you’re sick?” Then she asked my mom (who stayed at the hospital with me through all of this- night and day- since my husband had to work) “What do you think is causing your daughter to be so sick?” Well, obviously, if I knew the answer to that question, I wouldn’t need to be in the hospital!!! UNBELIEVABLE! Look "Doctor," I’m not crazy; I’m nauseous. I mean, really. REALLY?!! When she left, we just stared at each other in shock…WOW…there were no words for our frustration and disgust! Anyway, this time, I was sent home with a PICC line and in home care. I could give myself IV fluids, IV Phergen, and IV Zofran. This kept me out of the hospital. I still felt horrible most days, but I could care for my own medical needs now. I didn’t need the hospital anymore. During that time, we measured my nausea on a scale of 1 to 10 (10 being the worst- as in, IV fluids, no food or drink intake, IV meds, AWFUL nausea). Most of my days were between 7 and 10 at this time. 7 was a good day to me then. During the next couple of months, my nausea fluctuated. It never left. From March 16 (which was Easter) to March 21, I had all “9 and 10” days. I was throwing up and felt horrible, but I never had to go to the hospital because of my picc line. Also during this time, I was seeing a naturopathic doctor- despite tons of money spent and supplements taken, I never improved under his care.

THE SCARIEST NIGHT OF MY LIFE
One day, near the end of April, I started to feel worse…weird worse. I was light headed, extremely nauseous (I know, I was already nauseous, but this was different in a way I can’t explain.) I started throwing up, and I got a fever. All of a sudden, I started shivering. I thought I was cold. Quickly, the shivering turned to horrible shaking, almost convulsing. I was terrified. So was my family. After about 10 minutes, it subsided. I threw up again, but then I began to feel a little better. (This was “real” throwing up- like when you have the flu. HG/postpartum throwing up is often dry heaves or throwing up body fluids.... also very real, just different.) The next day, I felt the weird nausea still, and I was still light headed. That night, my fever spiked very high. My family put me in a cold bath, and eventually the fever came down. The next morning, I had no fever, so while I thought it was weird, I wasn’t sure what to do. That night, the scariest night of my life, I was about to go to bed. My sister was staying with me to help me. All of a sudden, the convulsing shakes started, and my fever started climbing. I also started throwing up. My family got me in cold bath, gave me ice chips, put a cold rag on my head, gave me ibuprofen but my fever persisted. I felt like I would faint any second, though I never actually did. My fever spiked at 107.1 degrees…don’t people get brain damage from that?! I was terrified. At the time, I didn’t know what was causing the relentless nausea, and I assumed these new symptoms were somehow related. It was the only time in my life that I truly thought I might die. We called an ambulance. Even the EMT’s were shocked at my temperature. I remember praying aloud the whole way to the hospital. My mom rode in the front of the ambulance; my husband followed behind in our car, and my sister kept my baby at home. In the ambulance, the EMT asked me my phone number, and I couldn’t think of it. I was coherent, and I remember being disturbed by the fact that I couldn’t remember my own phone number. It was all so strange. I remember in the ER being asked to sign my name at one point, and I couldn’t. I literally couldn’t control my fingers. They told me that wasn’t uncommon with such a high fever. Sometime during all of this, the doctors decided that my picc line was probably infected, and they pulled it out to culture it. They gave me meds, and eventually my fever broke, and I started to go back to feeling my normal kind of terrible instead of this ultra- terrifying terrible. After a couple of days (waiting for the culture to grow), while I was stuck in a semi-private room from hell, the infectious disease doctor came and told me that my picc was infected and started me on the necessary antibiotics. Before I left the hospital, they put in a new picc since I was still so nauseated. Okay, anyone who’s had a picc infection knows these are textbook symptoms. My issue was that no one ever told me that I should look out for these symptoms, not the IV tech who put it in, not my in-home nurses who cared for it, and not my GI doctor (who I called and told that I was having these symptoms!). This was such a nightmare! About my semi-private room, (which was not in the women’s center, which meant my baby couldn’t room-in with me) the girl in the room with me was diagnosed with diverticulitis (I think.) She kept running to the bathroom (which was on her side of the curtain) with diarrhea and vomiting…AND…she didn’t close the door. NOT helpful when you’re extremely nauseated. Her girlfriend also stayed with her the whole time, and she had a cold, so she kept snorting and hacking and snotting. So GROSS! To top it all off, I had the most pathetic excuse for nurses I’ve ever had. One refused to call the doctor and ask if I could have some crackers! I was there for 4 days, and, praise the Lord, this would turn out to be my last hospital stay! (We later figured out why the picc infection symptoms were worse at night- that was the time of day that I gave myself my IV meds, so each night I was pushing the infection through my picc line, into my bloodstream…nice.)

MAYO CLINIC
After gathering stacks of medical records and referrals from my doctors, in May 2008, I got an appointment with the Mayo Clinic in Jacksonville, Florida to see if we could get to the bottom of the intractable nausea. The day before we (me, my mom, my sister, and my baby- my husband had to work) left, my nausea was at a 10. I alternated between packing and hooking up to my IV fluids. In hindsight, this would be the last “10” day that I had. We left for the Mayo Clinic (from Kennesaw, GA) on May 4, 2008. We were there for 2 weeks, and I saw so many different doctors, I’ve lost track. The Mayo Clinic experience was amazing. It is completely outpatient, so I went in to the hospital for my tests, then back to the hotel to stay and wait for my next appointment. After so many in-hospital stays, this was a welcome relief! LONG story short…after running many tests and reviewing my medical records, the doctor in charge of my case told me that, other than the nausea, I was in perfect health. He could find nothing “wrong.” He said he had seen this type of thing before, but it was extremely rare. He had seen patients who contracted nausea through different means (pregnancy, food poisoning, flu, etc) and for some reason, when the cause for the nausea was gone, the nausea didn’t leave. He said, “I assure you, this in NOT in your head. This is a real physical symptom. The nausea started in your pregnancy, and your body is just ‘out of whack.’ I expect it to be gone in a YEAR.” Wow! Believe it or not, that was actually good news to me- I thought I was going to be this way forever. This doctor also told me that he used to work in a hyperemesis clinic, but he quit because it was too depressing. He said, “Just so little is known about pregnancy nausea and hyperemesis.” (And this was from a doctor at a leading research hospital!)

TODAY
After we left the Mayo Clinic, I SLOWLY began to improve. After a month of not needing my picc line, it finally came out! This was a huge relief. I no longer lived in fear of another picc infection! It is December 2008 now. My son will turn one on Christmas Eve. I am still nauseated daily. However, most days are around a 1 or 2 on the nausea scale. Today is a yucky day…it’s more like a 4 or 5. These days are rarer now. I usually feel pretty okay. I still take 4 antiemetic drugs, including Zofran and Phenergen. I have started to back off on the amount of Zofran I take, and my body seems to be tolerating it pretty well. I still see my OB doctor every 3 months for check ups and prescription refills. (My OB was/is INCREDIBLE- she never doubted me, was incredibly proactive, and took- and is still taking- amazing care of me! If you happen to live around the Marietta, GA area and are looking for an OB group, just e-mail me!) I have become a stay-at-home Mommy and am able to do everything that I need to do to care for my baby and my home. Nausea is my constant companion, but over the many months that I’ve been sick, I’ve developed a tolerance. (One thing I forgot to mention earlier- the Mayo doctors suggested acupuncture, which I tried with no results.) I am still improving…just very slowly. My son is my joy, and I love every second with him. He’s SO WORTH IT! (If I’m still nauseated when he’s 13, I may reevaluate that feeling! Kidding!) It’s interesting to me that the worst year of my life has also been filled with the most joy. I will not, however, be having anymore children unless we decided to adopt one day. While my HG experience was not by far the worst experience I’ve heard of, it is the longest. If you have experienced post HG nausea, I would love to hear from you. Please e-mail me.

MY CONSTANT COMPANION
Like I said, “nausea is my constant companion,” but it’s not my only companion. I serve a God who will never leave or forsake me. He is constant when my health is not. He is strong when I am weak. He understands when I feel confused. He has carried me through every step of this awful time in my life. He is restoring what the enemy tried to take from me. HE is my Rock, my Strong Tower, my Strength, and my Peace! He is my HEALER, and He’s healing me daily!

“Do not be anxious about anything, but in everything by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” Philippians 4: 6-7 NIV

“And we know that in all things God works for the good of those who love Him, who have been called according to his purpose.” Romans 8:28 NIV

“I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.” Romans 8:18 NIV

Update: 7/14/2010

AND... DONE.

So, my son is 2 1/2 now, and I'm still taking an anti-emetic. I'm not constantly nauseated anymore, and when I am it's minimal by comparison. After all this time, there's no doubt in our (my husband's and my) minds that we don't want to do this again, soooo tomorrow I'm having surgery to make our decision permanent if you get my drift. :) I'm so glad to know that the possibility of another HG nightmare will be behind me! I have no doubts about this decision. I really do admire women who are willing to do this more than once, (I may question your sanity, but I admire you just the same.) but I know I can't do it again. So, with much prayer and consideration, the support of my family, and my one precious boy, I'm putting a period at the end of this way too long sentence. Goodbye, HG... glad to see you go. :)