Hyperemesis Gravidarum and the Zofran Pump Part 1

I have been wanting to write something about this for a while now. However, I was unsure what to say and how it would be perceived. But I have decided to write it anyway. Also, when I found out that I had Hyperemesis Gravidarum and I was getting a Zofran pump I searched the internet and found others' stories and it helped me. I hope that this will do the same for someone.

Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids." As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until they give birth to their baby, and sometimes even after giving birth.

When HG is severe and/or inadequately treated, it may result in:

• Loss of 5% or more of pre-pregnancy body weight
• Dehydration, causing ketosis, and constipation
• Nutritional deficiencies
• Metabolic imbalances
• Altered sense of taste
• Sensitivity of the brain to motion
• Food leaving the stomach more slowly
• Rapidly changing hormone levels during pregnancy
• Stomach contents moving back up from the stomach
• Physical and emotional stress of pregnancy on the body
• Subconjunctival hemorrhage (broken blood vessels in the eyes)
• Difficulty with daily activities
• Hallucinations

When I found out that I was pregnant with our third child I was so excited. Excited for many reason:
1. Can't wait to meet the new baby.
2. Love feeling the baby move inside me, I get a sense of the personality that way.
3. Love hearing the baby's heart beat.
4. Love the spiritual blessings that come with doing what I know God wants me to do.
5. Love pulling out the occasionally "because I am pregnant card" as we drive by an ice cream store.
6. Finally, I was excited to tell the boys and have them experience bring a new sibling into the world.

Now, the story begins when I found out I was pregnant. I woke up one night around 2 AM and was feeling sick... that sickness that you only feel when you are pregnant. Oh man, I wake Kurtis up and tell him that I am pregnant. Surprised, he tells me that I don't know that for sure and we would just have to wait and see. Well the next morning I rush to the Drug Store and grab an early pregnancy test. It was a full 10 day before I should start my period but I was so sick that I knew I had to be pregnant. The test confirmed my belief and the celebrating began!

Well, Christmas was right around the corner and so I had a lot to do. I made an appointment with my doctor, she did not want to see me until I was past 10 weeks. This pregnancy was really getting to me, never in the past had I been this sick this fast. I immediately start my B6 and Unisom, which had helped me a ton in past. Also, I contacted my doctor to see if she would call me in any Zofran but because I was a new patient she would not. We announce our pregnancy at Christmas and I just keep getting sicker and sicker.

When we were back in ABQ I called my doctor again, on that particular day I had thrown up around 12 times* and just could not keep anything down. She told me to go to the ER. What!?!? With my last OB if I needed IV fluids she would call the hospital and they would admit me into the the IV Therapy area so that I did not have to go to the ER. I was really upset and decided to just stick it out I only had one more week until my first appointment and I really did not want to go the ER.

*Kurtis wanted me clarify what it means to me to throw up 12 times. To me it mean that at 12 different times during the day I was throwing up, most of these sessions last around 15 minutes and I throw up 5 more times.

At my first appointment, I was given Zofran and they ordered an ultrasound to see if I was having twins or if the placenta was place in a bad spot (both of these can cause an increase in nausea and vomiting). After the ultrasound we learn that we were not having twins and the placenta is in a perfect position. The Zofran is not helping, I was still throwing up on average 10 times a day. So, my doctor tells me not to worry that I should start to feel better at the latest 14 weeks. My weight loss at this point is 10lbs.

We had planned a trip to Disney World before I knew I was pregnant. The last few day of the trip I was getting really sick and struggling to eat and drink. The day we returned home I simply could not stop throwing up, it had been almost 36 hours of no food or liquid. We call a dear friend to come over while the kids were in bed and Kurtis took me to the ER. Oh, the dreaded ER.

First of all I feel like I might die and of course they are very busy. So while in the waiting area I continue to throw up, the worst part is I just wanted to lay down but can't. After 4 hours of waiting they take me back give me IV fluids and anti-nausea medication. I fall asleep because this medication makes me super drowsy. I wake up an hour later and they ask me how I am feeling. Terrible! I am still sick and throwing up. They send me home anyways and while I am throwing up in the car I am crying. I have never felt so bad in all of my life.

I contact my doctor the next day, like the ER told me. My regular doctor is to busy to see me so they schedule me with a partner in the office. He told me to just keep eating crackers and drinking juice and that it would get better. I told him if I was able to eat cracker and drink juice I would not have gone to the ER. He laughs and tells me that I most likely have Hyperemesis but that he does not recommended any treatment until I lose 15lbs. I am really frustrated, the doctor tells me to just stay in bed when I feel sick. First of all, I feel sick ALL the time and to stay in bed is always an option with two small children, not.

I have my regular appointment the following week with my regular doctor. Still struggling to keep anything down my mom comes out to stay and help with the boys. My weight loss at this point in 15 lbs. At this doctors appointment I start crying as I describe the last 14 weeks of torture. Finally, she takes me seriously. She sends me back down to the ER to get fluids becasue my ketones are off the chart and she schedules a home nurse to give my a Zofran pump and check on me daily.

The home care company that I use is call Alere. After the insurance approved me for these services a nurse came to my home to teach me how to use the Zofran pump, insert an infusion site and how to test my urine for ketones. She arrived and on a Friday night, the last fluids I had were given to me at the ER the day before and I had not had anything to eat for, I would guess it was 72 hours. She immediately gave me a shot of Zofran to help with the nausea and so that I would hopefully not vomit while we were talking, to bad it did not work. I got really light headed and almost passed out, I was never a big fan of shots. Anyways she started explaining the process and how the Zofran pump would work and the daily routine.

First, a nurse calls every morning for my weight, ketones, number of times I vomited/dry heaves, hours of nausea in the past 24, how much fluids I had, and anything I had to eat. I also give an inventory of medication and medical supplies I have.


Here are the syringes of Zofran that I load into the pump, I use two a day so I have a lot of them.
This is the pump with a syringe loaded.
This is the amazingly fashionable carrying case, it is to large to conceal so I just where it like a purse.
Here are the supplies I need when putting in a new infusion site. At first the nurse said that I would only have to change it every 3 days. However, to get the nausea and vomiting under control they had to increase my medication rate to the highest possible dose. The sites become very sore and so I have to change it every 24 hours and sometimes every 12 hours.
This is the needle and catheter. I put it into my belly and make sure the sticker part is really stuck.

Then I pull the needle part out by squeezing the sides, so only the catheter is left in my belly. I then put the needle in my fancy Bio-Hazard container.
I attach the tubing to the syringe and make sure all the air is out of the line.
Finally, I snap the tubing into the catheter. The red mark to the left is an old infusion site. Ice helps the old sites heal faster!


It took about 2 weeks to find the right rate for the pump... the max rate. And I was taking a phenergan pill at night to help with nausea and it helped me sleep. But every night at 2 AM I would wake up sick because the phenergan had worn off. Plus during the day, I was still throwing up between 4 and 6 times a day (better than 20 times but not the relief I was praying for from the pump) . I was eating only "bland" foods and if I had any kind of protein (I would try some plain chicken because Kurtis was really worried that I was not eating anything but bread) I would have sever stomach cramps. So really all I could eat was watermelon and biscuits. My sweet husband would come in at night and ask what he could get me for dinner and the answer was always a biscuit. He told me I was going to turn into a biscuit.

After about 2 1/2 weeks of the pump I had a really bad day, I could not stop throwing up and so I called my nurse in tears, of course, asking , "if it was ever going to get better"? She told me that she would call my doctor because she had a new medicine to recommend. Oh geez, more medication. Really? I feel like I am taking way too much medicine already but I was willing to try anything. She called me back and told me start taking Bonine three times a day. It is just an over the counter medication for motion sickness, I am super skeptical. But send Kurtis to the store to get some. I have to tell you that it made a huge difference! But it made me very, very sleepy. So, I tried taking it only twice a day to see if I would not be as sleepy. However when I lowered the dose I got really sick again, so I am just sleepy a lot. But only throw up 1 or 2 a day! Yeah!

I am now 19 weeks along and still have "bad" days about 50% of the time. On a bad day I will throw up 4 times a day and eat maybe 500 calories. On a good day I can eat almost 1200 calories. I have gained 1 lb since being put on the pump. It is difficult for me to increase the my calories because sugar is a trigger for my vomiting. And we all know that high calorie foods are loaded with sugar. I am finally able to tolerate fish and chicken but red meat is still to difficult to digest. We are taking things one day at a time and we continue to pray that things will get better.

I have to say, that without the love and support, of first and foremost my husband, I am not sure how I would have gotten this far in this pregnancy. Kurtis after getting home from a long day at work just takes over and puts me to bed. I love him so much for supporting me and not complaining, he just picks up the slack. Secondly, my parents, their love and willingness to do whatever was necessary to help our family. And finally we have some of the best friends anyone could ask for and they are here in a moment when I need them. Thank you everyone.