I wrote to mumsnet towers a while ago to ask about adding something to their hyperemesis page www.mumsnet.com/pregnancy/hyperemesis. i don't know if any of you have read it, it's got a good attitude as it takes it seriously and they've got some information about it but I don't think its as helpful as it could be. I'm concerned that it's thin on proper advice but full of negatives, if I was suffering with HG, didn't know anything else about and came across this I think i'd just want to kill myself.
I also think that there should be some different comments from sufferers - if you look at the mumsnet page, there are some quotes of advice from sufferers but they're mostly quite negative, a bit irrelevant and I think the list of good and bad things to throw up somehow trivialises the condition as it looks a bit jokey. We need some better quotes and some positive ones from those of us who have actually managed to get some effective treatment.
I've written something that I think they should add, if any of you are up to it, could you give it a read (see below) and make comments and tell me if there's anything I've missed.
Hyperemesis gravidarum (HG) is a severe form of pregnancy sickness which affects between 1 and 3% of pregnant women. Historically, it was mistakenly thought to be a psychosomatic illness and women were treated as though they had a psychotic disorder. This view has been comprehensively disproven by numerous research papers in recent decades, and it is now known to be an illness of organic origin, although its causes have yet to be fully understood. There is a persistent common belief that no drugs should be given to women in the first trimester of pregnancy. This is not true. There are a number of effective anti-emetic (anti sickness) drugs which can safely be taken in early pregnancy. Unfortunately, the erroneous views that HG is a psychosomatic conditions and that no drugs are safe in the first trimester still persists in many places, shockingly, even amongst GPs and midwives. Sadly, many women still come across unsympathetic health professionals who are ignorant of current treatment methods.
How do I know if I have HG?
If you are suffering from persistent nausea and/or vomiting which is preventing you from eating and/or drinking then you may be suffering from HG. With ordinary nausea and vomiting of pregnancy (NVP), the sickness does not interfere with your ability to eat and drink enough, you should not be losing weight and you should be able to continue to care for yourself and your family although you may not be feeling too great. With HG, sufferers often need help caring for themselves, never mind look after their family. The illness can be completely debilitating for weeks or even months. If you're not sure, the HER foundation website who have a fact sheet to help you determine whether or not you are suffering from HG
www.helpher.org/mothers/hyperemesis-or-morning-sickness/index.php
Diagnosis is important as you will inevitably become dehydrated and you will need to be admitted to hospital for IV rehydration. Starvation is another risk. When your body burns fat for energy, it produces chemicals called ketones which can be detected in your urine. You can monitor your levels of starvation using ketosticks, available from pharmacies. You pee on the stick and it monitors your levels of ketones. If levels are high, you should tell your doctor or midwife. If you are worried about dehydration and ketone levels and you can't see your doctor or midwife, you can go to A&E.
Facts and Figures and FAQs
HG is worse in the first trimester for the majority of sufferers, though a significant proportion (10 ? 20%) suffer for the entire duration of the pregnancy. Unfortunately, having HG in one pregnancy puts you at a high risk of suffering in subsequent pregnancies. If you have close relatives (mothers, sisters) who have had HG, you are also at significantly higher risk of being a sufferer yourself. HG is the most common cause of hospitalisation of pregnant women in the first trimester.
Is it worse carrying a boy or a girl?
There is conflicting evidence as to whether having a boy or a girl makes HG worse, some studies say boys, some say girls.
Is it worse with twins?
Yes there is evidence that carrying more than one baby makes HG worse.
Will my baby be ok?
Babies born to HG mothers are usually absolutely fine and there is no known risk of birth defects. We are designed to produce healthy babies even when we ourselves are undernourished - the baby will be fine even though the mother herself may suffer. However, you should realise that there is growing evidence of long term health effects in some children born to mothers with HG. In some cases this is not evident until adulthood with increased risk of chronic conditions such as diabetes and osteporosis.
What are the treatments?
Initially you can be prescribed antiemetics such as phenergan, cyclizine, stemetil and ondansetron. For some women these work well and control the nausea and vomiting enough for them to eat and drink normally and many can return to normal life. You may find that one antiemetic on its own is not effective and you may need to try different combinations. If you are dehydrated, you may be admitted to hospital for IV fluids. Minerals and vitamins can be added to the drip to replace any you may have lost, as well as antiemetics.
Unfortunately, antiemetics don't work for everyone. If they are ineffective, you should be referred to an obstetrician for the next line of treatment, which will probably be steroids. These carry a small risk of cleft palate, but this will be discussed with your doctor. In a small number of cases even this is not effective and drastic treatments such as feeding with a tube directly into the stomach may have to be considered.
Will I get it in my next pregnancy and will it be just as bad?
Unfortunately, having HG in one pregnancy puts you at a high risk of suffering in subsequent pregnancies although it is possible to escape it. Some women find that the HG gets better in subsequent pregnancies, whereas others find it stays the same or gets worse. There is really no way of knowing how your pregnancies will relate to each other.
My GP is unsympathetic and refuses to prescribe me drugs - what should I do?
Unfortunately this experience is all too common. In this case you should see another GP if possible. You should also ask for a referral to an obstetrician. If you remain untreated and become dehydrated, you can have yourself admitted to A&E for IV fluids and ask to be seen by an obstetrician.
Useful sources of information
The Royal College of Obstetricians and Gynaecologists in the UK have no guidelines on the treatment and management of HG. However, the American College of Obs/Gynae (ACOG) and the Society of Obs/Gynae of Canada (SOGC) have published guidelines which can be found at the following sites

www.sogc.org/guidelines/public/120E-CPG-October2002.pdf 

www.guideline.gov/content.aspx?id=10939
Pregnancy Sickness Support is a UK based organisation run by GPs and midwives with direct experience of HG. They have a helpline which you can call for advice ? if nobody answers you leave a message and a midwife will call you back. They will be able to answer your questions about treatments and they keep a note of doctors around the country who are known to be sympathetic to HG sufferers and are willing to treat it with medication. Their website is at www.pregnancy sicknesssupport.org.uk
The Hyperemesis Education and Research Foundation (HER) is a US based foundation which was formed by HG survivors and has a mission to research the causes of HG and provide information and support for other sufferers. They have links to the latest scientific research and are actively involved in funding research, although you usually have to live in the USA to take part. There are loads of threads on every topic related to HG from women who have been through it, including very useful information about which treatment regimes worked. Their website is at www.hyperemesis.org.
Dealing with well meaning but unhelpful advice
Sufferers are often told by friends and family that it's just morning sickness, a normal part of pregnancy and you just have to put up with it. Many HG sufferers report extreme frustration at being advised to try ginger, dry crackers or eat little and often. Most of them have tried every remedy they can think of to no avail. Because most women are familiar with NVP, there is often an attitude of, well I had morning sickness and I just got on with it. HG sufferers are often left with the feeling that they are whingers and malingerers and that if only they could adopt a positive attitude then they would be fine. This can lead to further depression in what is already a depressive condition. In order to deal with this, it is important that the HG sufferer has some supportive friends or family who can firmly but politely fend off these comments. The sufferer will often have no energy to deal with it herself. If possible explain to the person giving the advice that you are not suffering from morning sickness, you are suffering from a condition called hyperemesis gravidarum.