Hell is hyperemisis

[Chrisgm]

Hello, I'm here to seek out advice on how to, if possible manage the devious condition in the subject line; specifically related to hospital admission. My wife and I are on the verge of 12 weeks (after two miscarriages in 6 months).

My wife has been admitted 4 times in a month (discharged after 24 hours each time). Each time our experience at the hospital has been marked by mixed advice from Drs and nurses. Care has been for the most part superb but unfortunately on occassion also unhelpful - copy and paste notes, ignoring advice on what does and does not work and one nurse talking about discharge before ny wife even reached her bed.

The third time she was admitted to the gynae ward and the care was excellent and was told if admitted again a care plan would be put in place. Excellent is not the right word, the nurses and doctor on this ward are I am sure fairly close to being canonised by Pius.

Sure enough a week later and a fourth visit became necessary but on being admitted to the short stay ward (where discharge seems to be the motivating kpi) there seemed to be no initiative to follow previous advice.

My worry regards a fifth visit. Should this happen, what is the best way to navigate the triage systen? I realise we are at the mercy of available beds, conscientious care professionals and a condition that does not seem to inspire research. Also, whilst I can politely remind those in blue and purple about recommendations, getting angry seems irrational to our ends and the receipt of good care.

Has anyone got any insights on how to succesfully master triage? All shared experiences welcome. I only have one request, please no mention of ginger.
Thank you folks.

Have you been in touch with these guys? :
www.pregnancysicknesssupport.org.uk
If not, give them a call to tomorrow

A great charity which can advise you about all aspects of hyperemesis. They will know HG friendly consultants in your area and give you the best advice.

I suffer with HG, as do many women. There is a great Facebook group and Mumsnet group. We all have lots of experience and advice. It's hell!

I had HG 4 times.
It is hell and was not taken seriously when I was having my dc.
For me bed rest was unavoidable.
Ice cubes to suck and sparkling water through a straw was all I could tolerate until 16 weeks.
After that I could manage about a teaspoonful of blended vegetables with rice hourly until around 28 weeks.
I had to have the bedroom windows open and all doors closed so that any smells were kept at bay.
I had to be asleep by 7pm or I would be vomiting all night.
Sorry you are going through this.
I was never admitted during early pregnancy as nobody believed me.

Firstly, yes HG is hell. Hugely misunderstood by the public and many medical professionals which can make getting proper care difficult.

I 100% agree with the above advice of contacting Pregnancy Sickness Support. Their helpline will be open on Monday. They are fantastic and can give you the name of a HG friendly consultant in your local area.

Is she on any medication? Many of us have found that the first line drugs (cyclizine, promethazine etc) don't work and we need ondansetron. But getting prescribed is can be difficult. It's worth doing some reading up and going in armed with info. Here are the RCOG guidelines
www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg69/

Sympathy to your poor wife. Some people do find the symptoms improve around 14 weeks, others around 20 weeks. Some (like me) are stuck with it the whole through, but even in that scenario, it's very likely the symptoms will lessen compared to the hideous first trimester. Symptoms also to you, I know how worrying it is for partners and how much impact it has - both emotionally and physically as you pick up the slack.

P.s. It's totally ok to punch people who suggest ginger....

PSS also have good guidance on their website about food and drink which might be easier to keep down. If she can try and keep hydrated (easier said than done!) she might be able to avoid/reduce hospital admissions.

Personally I found sugary drinks easier to keep down than water. Some people drink flat Coke, lemonade, juice from tinned fruit. Personally I found that sipping Lucosade helped a bit. She can try sucking ice cubes or eating liquids foods (like jelly).

Food wise, I could only stomach small amounts of bland salty carbs - mash and gravy, super noodles, salted crackers, toast.

www.pregnancysicknesssupport.org.uk/help/eating-advice/

I also found Pregnacare vitamins make my nausea worse. Maybe try just folic acid and Vit D until 12 weeks, and just the tiny Vit D pills after that?

Come over to the hyperemesis thread as people there have various experience of getting medical help.
www.mumsnet.com/Talk/pregnancy/2986523-Hyperemesis-Support
I had hospital admissions with my first two pregnancies and found the doctor's fine but the midwives or nurses horrible and unsympathetic. They had no understanding of the condition. This time round I had ondansetron prescribed, that and forcing food and drink down had helped keep me it of hospital.

I have recently had a few admissions for dehydration/ ketones etc

I've found the mix of medications, not letting myself get hungry or tired has been helpful. 20 weeks now and finally able to eat a bit more

Well thank you, you have all taken the time to offer some very helpful replies. Interesting to hear about the pregnacare, that sounds familiar. Thank you also for links to the hypermisis and Pregnancy Sickness Support pages, I will be calling the number.

Cyclizine hasnt helped and it burns her when introduced intraveinously. Odansetron and metaclopramide working in tandem seem to get some results but it is very tricky to be certain if this is true some days.

It has made me think that learning to put in a drip would be a great skill to have and save a trip to a&e and the triage lottery.

Finally, you all seem very courageous to me (4 times and no admission!). I also think that had I not seen my wife go through this I probably would have been fairly blase about just how serious a condition it is. Why on earth do we still use the term 'morning sickness', it doesnt really point out the problem.

Thank you once again folks, I appreciate you taking the time to offer your thoughts and advice.

P.s. good to have the ginger advice in writing, is it legislative I wonder?

Poor wife it is horrendous! My advice (working in system) when you present to triage if thats how you have to do it is to tell them the only thing that has worked is x,y,z and that she needs to see gynea or obstetrics. The other thing you could do either through your GP or by discussing it directly with the hospital team is to initiate a plan yourself that everyone would be happy with, neither you or them want your wife to be bouncing in and out of hospital. This might include agreeing to contact the ward directly so triage not required, or if you/your wife are willing to inject the anti-sickness drugs some areas will teach you to administer this yourselves at home if appropriate. Is she going in literally just to get rehydrated? (Drip) then home? Cant take oral meds?

Dont be scared to suggest a plan yourself if this continues, honestly nobody would take any offence and would welcome the initiative, its hard to coordinate this happening from hospital side when its quick in and out and never seeing the same team.

Best of luck, mine significantly improved from 20 weeks onwards

Get hold of ketostix -
http://www.pharmacyfirst.co.uk/ketostix-reagent-strips-for-urinalysis-pack-of-50.html?gclid=EAIaIQobChMInqzPosqb1gIViLXtCh32mgfmEAQYASABEgIi9DD_BwE
You can buy them on amazon etc too.
That way you can monitor ketones at home.
Usually need to be seen if 2/3 +. It gives a good indicator of starvation / dehydration but it's not definitive.
I'm so glad she is on ondansetron- it saved my life.
People will suggest ginger all the time. They are ignorant but trying to help. I was on cyclizine & ondansetron and some GPs and nurses were still suggesting it. I almost strangled one GP.

Also a HG sufferer and want to add that staying hydrated is a huge problem and should definitely be your main priority. My Dr told me not to worry about not eating as my body would provide the nutrients but if i could manage a tiny something that would be enough.
It's also 100% normal to be able to cope with one drink one day and then not the next. I rotated between just plain water to orange juice for about 3 weeks then could only stand Apple and pear squash and then back to water... There were more but you get the idea. So don't panic if you can't find a drink.. you might come across one you've already tried that will work later on.
And as much as it sucks definitely check ketones. Because my midwife got angry that I never got admitted into hospital when apparently I should have been. At least 4 times. It's better sometimes to have the terrible service but be seen than just ignore it and try and ride it out. Good luck!