Monday, August 27, 2007

Hyperemesis Gravidarum

Hyperemesis Gravidarum is a rare pregnancy complication, afflicting only about 2% of pregnant women. ¹ “HG is a debilitating and potentially life-threatening pregnancy disease marked by rapid weight loss, malnutrition, and dehydration due to unrelenting nausea and/or vomiting with potential adverse consequences for the newborn(s).” ²

I was diagnosed with HG at a Reno emergency room on August 16, 2006. It began as just severe nausea and vomiting leading to dehydration, which they treated with antiemetics and IV fluids. However, the condition worsened. I went to the ER in Reno twice before resigning from my job and flying home to Southern California. I was so weak I could not care for myself. I didn’t want Scotty to have to take care of me although he tried very hard to do so. My Mom said to come home and I did. I had to be in a wheelchair at the airport, and when they brought me down to where my sister was waiting for me, she didn’t even recognize me! My niece had said I looked like my father when he was going through chemotherapy.

The day after I got home, I was rushed by ambulance to the hospital. My muscles were cramping up and I was very weak. I was admitted and this time in addition to IV fluids, I also needed potassium.

My potassium was very low, so low that they ordered an EKG to make sure my heart was okay. They also kept me on the floor with heart patients to be monitored over night. I believe I had tried just about every anti-nausea medicine that has been made by the time this story is through. After I was released, I was still unable to keep anything down.

The simplest things we do everyday, things we take for granted, I was unable to do. I could not shower without help, I could not even brush my own hair! I needed help walking to the bathroom! I couldn’t drive, I could not keep food or drink down. I was miserable.

This went on for months. I was so very frustrated and depressed and so many days I just cried and cried. I really did not know how much more I could take. I had lost over 20% of my pre-pregnancy body weight in a matter of months, I had been rushed to the emergency room twice by ambulance and once by a Della and my Mom. I was scared not only for my child, but for my own health that was rapidly deteriorating.

The doctors decided that if my child and I were going to survive we needed nutrition. Since I could not keep anything down, it would have to be intravenous. The procedure to install a PICC line was a big to-do, but once it was in and my home care established I could go home!

A catheter was carefully placed in my arm leading to a major blood vessel. The procedure did not hurt, but the care would be specific. I had a home nurse and TPN. TPN is Total Parental Nutrition, it is a complex mix of nutrition and vitamins specific to your body. It looks like milk in an IV bag, and actually smells like sour milk! I was relieved, but they still told me to try to eat, because this wasn’t a “cure” just a “bandaid” for now. I was going to be slowly weaned from the TPN over a period of time in hopes that I would be able to eat by then. My mother was taught how to care for the PICC line when the nurse was not there.

I had the PICC line for about a week when one morning I woke and my neck was swollen, I wasn’t sure if I just wrenched it somehow or what so I tried ice which seemed to help the swelling but once I removed it the swelling returned and was spreading. I knew something was not right and woke my Mother. She looked at my neck then called my nurse.

The nurse felt this was a life threatening situation and called an ambulance. I was back in the ER and they said I most likely developed a clot and they removed the PICC line.

After numerous tests and an ultrsound of my veins the results were in. I had numerous clots in the area of the PICC line which extended from my neck to half way to my elbow.

The treatment was going to be hospitalization and blood thinners. The only blood thinners they could prescribe me that would not pass to the baby was Lovenox. The Lovenox had to be injected subcutaneously… in my stomach!; Everyday for the next 3-6 months. Not to mention that I now no longer had a PICC line, so the only nutrition I was going to be able to give myself and my child was going to be whatever my body could force itself to keep down which wasn’t much. I was released only because I agreed to give myself the shots. I would have had to stay in the hospital if I could not give the shots myself. It was very painful, I never got it on the first try. I always had to poke myself more than once and one day it took me 6 tries! My stomach was so bruised I was running out of places to stick myself.

My trips to the emergency room were not over, however. I was rushed via ambulance one more time because in addition to all my other troubles, I began having fainting spells. The ER doctor told me that my symptoms could be indicative of the clot breaking off and traveling to my lungs. This too was life threatening, depending on the size of the clot, a pulmonary embolism would be treated by either medication or surgery, But… it could cause my death.

The doctor told me I would have to make a choice, because the test he would have to do to be sure, would harm my baby. I said I don’t want to do it. I was going to take a chance. I was admitted again. He did other tests and said that the blood thinners I was on may have prevented the clot from breaking off.

I lived.

I was told by my doctor that I may have to choose between my life and my child’s. I was not willing to choose. He sent one of his colleagues, a female, to talk with me the next morning and see how commited I was to having this baby. She too said there may come a time where I would have to choose because of all I had been through already physically and emotionally. I said I want this baby, this baby was meant to be. She said “then we will do everything we can to help you bring this child into the world.”

By Thanksgiving I was starting to keep some food down, although I had bouts of vomiting here and there, it was no where near what I had experienced up to that point. I had another ultrasound of my veins to see how the medication was doing. I had read that I would have further complications if my condition was not resolved by my third trimester. If the clot remained the stress of childbirth could cause it to break off and a pulmonary embolism, the blood thinners could cause bleeding complications, and should I require an epidural, if I was still on Lovenox there was a risk of permanent paralasis. Just when you think you cannot take anymore, or that it cannot get any worse…well, it can.

The results were that “there were no obvious blood clots, but there was still inflammation”. I finished out my prescription and had my last shot the day after Christmas. What a wonderful gift! I began my third trimester in January. By February I had finally gained weight… too much weight actually. I was showing early warning signs of pre-eclampsia. I was like, great what now? I had rapid weight gain, water retention, and my blood pressure was slightly elevated.

I had to be on a low sodium diet, get more rest, drink more water, and reduce stress. The doctor said that I needed to get it under control or he may have to do an emergency C section, as there would be great risk to the lives of both me and my baby. After about a week I lost 2 pounds so the low sodium diet must have been working. I shed a few more pounds over the following weeks which made my doctor happy.

Although I continued to have general weakness and occasional nausea and vomiting, I could finally drive and shower on my own, but I needed to rest afterward as something as simple as taking a shower made me quite weak.

I seemed to get a little more energy each day. I was able to enjoy my pregnancy, my family and my friends. I was apart of the world again, and I was really happy to have made it so far. As the days grew closer to my due date, I would think back on the days that I cried, that were so hard I wanted to give up.

And I think to myself…

I am so glad I didn’t. I swore to God if one more person told me I would have to make a choice, I would be very, very tempted to give in and give up. I started praying harder than I have ever prayed in my life to just take away this horrible disease so that I wouldn’t have to give up my child.

My prayer was answered. I got better slowly, but it was just enough to keep me going… to get me to the end. There was a light at the end of that tunnel after all. His name is Zane, and he is worth everything I had to go through, everything WE had to go through.

He wanted to live, and I wanted to be his Mother. I am so thankful for this gift.

¹;²Kimber MacGibbon,