Wednesday, April 1, 2015
The Morning Sickness Myth
There are some commonly accepted terms in the English language that hold very little resemblance to what actually can occur in reality. The term "morning sickness" is such a term used frequently to describe the length of time during pregnancy when a woman is most likely to be sick- typically during the first trimester. I am currently almost 13 weeks pregnant and have a deep grievance with the misnomer of "morning sickness". I am convinced that a male came up with this description- knowing nothing of what women can actually experience. Or perhaps it was a lucky woman (hate her) who actually experienced "just morning sickness". Whoever coined the term, they have done a severe disservice to those of us who aren't quite so lucky as to only have "morning sickness".
If you are one of the lucky ones who fits the standard mold of typical morning sickness symptoms, count yourself blessed. If you are one of the cursed that has a story similar to mine- God bless you, sister. You are not alone. No matter where you fall on the pregnancy sickness spectrum, I write this piece in order to help spread understanding that this journey of pregnancy isn't a pleasant one for all of us. So before you pass someone off as being overly dramatic when they talk about how sick they've been, or before you casually offer pat remedies of "preggie pops" and gingerale, take a moment to gain some understanding of the other side and just how severe "morning sickness" can be.
Before I go any further though, I feel compelled to lay out a few disclaimers. First and foremost, I am in no way saying or implying through this "airing of pregnancy grievances" that I am ungrateful to have the blessing and ability of growing a precious life in my womb. I know that it is a privilege and I am beyond thankful for each life that the Lord has given us. I look forward to holding this sweet babe more than anything. After giving birth to 3 healthy babies and also having experienced 2 painful and heartbreaking miscarriages, I am ever-aware and grateful for the life that currently grows within. But the journey... the journey getting there is not a smooth one for me. Secondly, there will be some frank, matter-of-fact, "this is my reality", TMI-pregnancy talk that goes into this blog entry. If you embarrass easily, don't want to know such details, or get squeamish please quit reading. Thirdly, I can be sarcastic. Pregnancy brings it out in me more. You have been warned. If you don't want to read such a take on pregnancy, go break out your sunshine and roses article about pregnancy where every pregnant woman has a glow, never throws up, only gains 10 lbs. and leaves the hospital in her pre-pregnancy jeans. There are some out there. I relate in NO WAY to any of them. I want to flick those women in the noses. Fourthly, I know this is not every one's experience. Some women have had it much worse; I pray most have had it better. This is my experience.
"Morning Sickness"- it's something I had heard multiple times before even getting married or considering having babies. Like many other naive, uninformed people, I thought of pregnancy through rose-colored glasses. Someday I would marry Prince Charming and start a family. We would leap for joy upon seeing the positive pregnancy test and bask in glorious wonder during 9 months of bliss as my tummy expanded and baby bumped around inside. Sure, there may be some morning sickness, but through those rose colored glasses, I envisioned maybe waking up in the morning and feeling a little queasy, perhaps even spitting up a bit in the sink as I tried to brush my teeth. Having an aversion to smells, maybe... having a craving for pickles and ice cream, certainly, because that's what they do in the movies. No problem. I would be ready. I would be armed. I would read the pregnancy how-to books. My nightstand will be prepared with crackers and ginger to nibble on before getting out of bed and from there I'd be "good to go" for the rest of the day. After all, it's "just morning sickness".
And then reality hit. A year after marrying my Prince Charming we did, in fact, gather around that positive pregnancy test and for 2 weeks basked in the "parents-to-be" glow. And then the morning sickness hit at 6 weeks gestation. Whoa.... What was this? Around the clock morning sickness? Incessant vomiting? Non-stop nausea? No one had warned me about this. By my 8 week appointment with the OB I was begging for relief. I had been couch bound and hurling for 2 weeks straight and thought I was going to die. He prescribed Zofran, and though it didn't cure the 24-hour nausea, it did lessen the vomiting. I was able to once again keep most foods and liquid down and looked forward to that magical week 12 everyone talked about when I would be past the worst of it. Unfortunately that magical week didn't come for me until 22 weeks along. It was a miserable 5 1/2 months. I still threw up almost every day, but the Zofran was enough to allow me to function so I plugged along and finally gave birth to our daughter.
Nearly 2 years later I went into my second pregnancy a little wiser. I scheduled my first appointment for the earliest they would see me- right at 6 weeks- and I wasn't going to leave the office without a Zofran prescription. By the time my next appointment came 4 weeks later, I was in the office crying that the Zofran wasn't working. I was throwing up multiple times a day- the worst day I can remember I had lost count after 14. When my stomach was empty, I would throw up bile, when that was empty, I would dry heave. I went from the bed, to the couch, to the bathroom, and not much of anywhere else. My 2 year old memorized every Disney movie we owned almost word for word, because that's all I could manage to do with her. My doctor wanted to try a new "non medicated" device on me in conjunction with the Zofran. Since Zofran was the only medicine I had known anyone to take and it wasn't working for me, I was game to try anything. I don't even remember the name of the device, but it was basically a tight wrist band that gave electrical shocks to the pressure points on your wrist every 90 seconds. It did nothing to alleviate the sickness, just added to the frustration of the whole situation. Because who doesn't want something sending shocks into their wrist every minute and a half and still be dealing with continuous vomiting. I put up with the device for almost 10 days before determining it was not going to work and was back in the OB office begging for something- anything. Finally, it was here I was given the only thing that works for me to alleviate the constant "morning sickness"- Prednisone, also known as, steroids. Once again, it didn't take away every single symptom. I still felt nauseous daily, and I was still throwing up several times a week, but I was able to regain some functionality. The "morning sickness" this time around lasted until 25 weeks and then ultimately I gave birth to a healthy son.
Another 2 years went by which included one miscarriage, and then another positive pregnancy test that would give us our third child. By now my doctor knew my history and I was given the Zofran right away and allowed to start the steriods by week 8. As was my previous experiences, each pregnancy gets worse, and this time a 3rd medication had to be added to combat severe ulcer and acid reflux issues. Despite the 3 meds, I still threw up frequently, felt nauseous almost 24/7, and didn't make my "no more vomitting" turn-around until 28 weeks. Having 2 kids to care for made things even more difficult. At 31 weeks I was put on modified bed rest for 3 weeks due to low amniotic fluid levels and possible pre-eclampsia symptoms. It was miserable. I was "emergency-induced" to have my second son at 38 weeks and was sure then that I was done with this baby-making journey. I knew I had always wanted 4 kids, but I couldn't imagine going through another pregnancy and having 3 kids to try to care for in the process. It was an overwhelming thought.
When we passed the typical 2 year time span and there was no new pregnancy to report, I had mixed emotions. On one hand I wasn't sure our family was complete, on the other I didn't have a strong urge or even willingness to go through another pregnancy. Each one was progressively harder on my body. Harder on me mentally and emotionally. Harder on my family. We didn't do anything "permanent" to prevent, yet we weren't intentionally trying for anything either.
In the fall of 2013, my oldest daughter began praying every night for another baby in our family. Oh boy... What do you do with that?! We couldn't discourage her prayers, yet we weren't encouraging them either. We just told her it was up to God. Another year passed, and we had a big surprise when I took a positive pregnancy test while on vacation in Florida in August of 2014. The pregnancy dread set in, but with it an excitement that this was God's answer to whether or not we were done growing our family. Because of timing issues I made my first appointment for 8 weeks and was getting by at home with some of my kid's left over Zofran prescriptions. The "morning sickness" never hit hard and I was feeling optimistic, as I wasn't feeling nearly as sick as with my previous pregnancies. I thought I had hit the lottery and caught a lucky break this time around. Just 3 days before my first appointment, the reason behind why I wasn't feeling as sick fell upon me. I began the painful, difficult process of going through my second miscarriage. You can read about that in my previous post "Silent Suffering". The effects of the miscarriage lasted nearly 4 months, required multiple doctor's appointments, and took a physical and emotional toll on me and my family. Ending the family-building journey with a miscarriage seemed to be such a sad closing to a large chapter in our lives. But I was coming to terms with the fact that maybe my body couldn't go through another pregnancy.
And that brings us up to date: Still raw from a miscarriage, but trusting that God still held our future, we began 2015 feeling grateful for renewed health and the family that we have. And then, just 5 months after my difficult miscarriage, it came as HUGE shock when I was suddenly taking another pregnancy test and was surprised by the positive results. My mind raced.... What are you doing, God?? What if I miscarry again? How can I go through that again?
Because of the recent miscarriage I went in to see the doctor just before my 5th week to have my blood levels checked. My blood levels confirmed the pregnancy and my levels looked healthy and an appointment was set for half way into my 6th week. I went ahead and requested a Zofran prescription while I was in there because I had already started to feel really sick. This was definitely different than the miscarried pregnancy from 5 months earlier when I hadn't felt that bad. Just how different it would be from all previous pregnancies would soon be discovered.
I had decided to switch doctors just before miscarrying in the fall, and decided to stick with my new OB for this newly discovered pregnancy. By the time my appointment came around at 6 weeks, I was already in the complete throws of "morning sickness". Worse than I had experienced in any pregnancy before, and the Zofran wasn't touching it. I went in and had to give a brief run-down of my history of severe sickness and what we had tried in the past and what had finally worked in the past. For better or worse, my new OB is more conservative when it comes to giving prescriptions, particularly steroids. Since he didn't have direct experience with my pregnancy history, he wanted to try a new medication and avoid the steroids if possible. I reluctantly but hopefully agreed to try this new medication, Diclegis, in conjunction with the Zofran. And this is when things started to go downhill very quickly. This is when I became familiar with the more appropriate term for my pregnancy condition. It wasn't just morning sickness. For severe cases, it is termed hypermesis gravidarum. You can google the technical definition but here's my take on it: absolute and utter misery and extreme sickness during pregnancy with little to no relief no matter what you try.
At just 6 weeks along and on 2 prescription meds, I was already bed-to-couch-to-bathroom-bound. Unable to stand or even move much due to severe nausea that would lead easily to vomiting. Think of the worst case of the stomach virus you have ever had and extend that awful 24-48 hour bug over the course of 6 weeks, and you may come close to understanding the misery. My days began to blur together. As the weeks progressed, the symptoms grew worse. I would wake up in the morning when my kids did, but often couldn't even bring myself to transfer to the couch until well past noon. I couldn't even make it to the bathroom for the rounds of vomiting and had to rely on puking into a bowl instead. In between vomiting, the nausea was crippling. It felt as though there was a volcano ready to erupt at any time just below my throat- like the food I was able to get in my system would just sit there, threatening to come back up at any time. I lived primarily on water, occasional ginger ale, plain baked potatoes, and chicken and rice soup- but I had to take the chicken out- it required too much chewing and led to gagging and vomiting.
I had suggestions out the wazoo on what could help me- some bizarre, some worth trying, some not even feasible because I couldn't stomach the thought of the suggestion none-the-less actually try it. My snarky side wanted to throw stuff at these well-meaning people and shout, "Sure- the meds I'm on aren't helping, but a frozen ginger-pop will be my miracle cure."
I quit brushing my teeth, absolutely couldn't do it- I resorted to wiping them off with a paper towel. I went 4-5 days in between showers because I simply couldn't stand that long and when I did get a shower, it was always followed by an intense episode of puking. My hair was nearly matted to my head and constantly itchy. My hair even started falling out. My lips were constantly peeling skin from them. I stunk. I was too sick to care. I didn't leave the bed or couch, never the less my house. I couldn't care for my kids. My husband and mom stepped in to take over laundry, food, and cleaning duties. We wouldn't have survived without their self-sacrifice. My kids would come into my room to do their school work on the floor while I "supervised" from the bed. I couldn't even make them lunch, or get them a drink. I had to have them bring me water and food. Ava took over breakfast and lunch duties on many days, or Shannon would have to premake lunches before he left. The kids had free-reign over the house and would leave it in shambles. We were constantly in disaster-mode, as much as my hubby tried to keep up between work and laundry and dinners and bedtime- it was just too much. The inability to help made me feel worse. There were days when I would just break down and cry. Feeling constantly sick was physically, mentally, and emotionally taxing. There seemed to be no end in sight. The only relief came while I slept, but would resume as soon as I woke and another day would repeat like the one before. I spiraled into terrible thoughts, almost to the point of praying for a miscarriage just to bring relief from the cycle of sickness. Then I would feel guilty for having these awful thoughts. And in the rare moment when I would feel slightly better, I was crippled by those same thoughts and worried and cried that I might in fact be miscarrying. It was all taking a toll on me.
By 8 weeks pregnant not only had the Hypermesis symptoms worsened, but the side effects of the medications I was on were in full swing. Zofran is clearly labeled with warnings about causing headaches, and as one who often suffers migraines, I was not exempt from this side effect. The lesser talked about side effect of Zofran, however, is constipation. (Yep, here comes the TMI). Crippling constipation. Having started the Zofran at 5 weeks, I was on my 3rd week of being backed up and unable to pass anything more than rabbit pellets from my system. Granted, I wasn't eating a lot or keeping down a lot, but even then, quite a bit had built up in my digestive tract, and it wasn't moving at all. I tried everything- juices, fiber pills, fiber drinks- nothing brought relief, just extra gas pains, which were blocked from passing too, and just added to the misery. It caused constant burping, which always threatened to evolve to vomiting. The back up got so bad that I could no longer keep soup down- there was simply no where for it to go. I would almost immediately throw up after trying to eat. I was in a constant cycle of hunger-caused nausea, then trying to eat, then throwing up, then feeling hungry and nauseous and weak, and the cycle continued. Then the debilitating stomach cramping started. I would sit on the toilet, often for over an hour, and have little to show for it except a trash can full of vomit- nothing like having both ends active at once. If something did manage to pass, it was extremely painful, and disappointingly non-helpful as it brought no relief. You know those spiked, prickly seed pods that fall from trees in the autumn? Imagine the feeling of trying to pass one of those, but it never quite passes. Sometimes it comes close, but seems to get stuck and just sits there until your next hour long session in the bathroom. The cramps don't go away, but they don't produce any relief. Debilitating is the only way I can describe it. Awful. Nothing glamorous about this. The situation became urgent, as I was in danger of dehydrating from not keeping anything down, and in danger of becoming impacted from not getting anything to pass. I ultimately had to resort to calling my OB on a Sunday and sending my husband out for an emergency purchase of a Fleet Enema. Just another thing to add to my lovely experience. Gross. Disgusting. Nothing magical about this. The enemas did, thankfully, bring some relief. But until I am off the Zofran, these enemas will be a part of my bi-weekly routine.
By 9 weeks pregnant, I had found a solution to the terrible constipation, but was still severely sick- throwing up multiple times a day to the point of throwing up bile and then dry-heaving. I had an unceasing burning/fullness-sensation in my stomach and terrible reflux unlike anything I had ever experienced. After a little research, (hello, Google) it was discovered that the Diclegis I was on could cause and worsen symptoms of ulcers for those that are susceptible to ulcers. Of course. Why not. Because I needed to add one more thing to my issues. One more thing to keep me from functioning and taking care of myself and my family.
Just 2 days before my 10 week check-up, I had reached a new level of desperation. I hadn't kept anything down but sips of water and a few bites of food in 3 days. I had lost 13 pounds in 5 weeks. I was weak and at a mental breaking point. My mom volunteered to come over, and despite not wanting to be seen in such a condition, I didn't protest. She brought with her some contraband Prednisone from my sister's arthritis prescription. Within an hour after taking it, I was able to get out of bed. I was able to take a shower. I still threw up after the shower, but was then able to eat and kept that food down. Just 2.5 mg and I was able to sit up and feel more human. Once again, the pill I had needed with my 2nd and 3rd pregnancies seemed to be the miracle cure for this one.
I went into my next appointment armed with my pitiful experience over the previous 4 weeks and was ready to beg, borrow, or steal in order to be prescribed some Prednisone. I presented my case thoroughly and left his office with a scrip for steroids. He only prescribes it for extreme cases. Steroids aren't something to take lightly. I get it. They have side effects all their own, including mood changes, weight gain, fluid retention, increased blood pressure, sleep disturbance, and the possibility of suppressing your body's natural adrenal gland hormone production. He determined the risks outweighed the detriment caused by the way I was living up to that point. I was to start out with a mega-dose of 40 mg and step it down by 5 milligrams every 3 days until I was down to just 5 mg after 3 1/2 weeks. He also discontinued my use of Diclegis, and put me on Zantac 2 times a day to try to repair any ulcer damage and bring relief to the reflux.
And that brings us to today. I am on my second week of being on steroids, still taking Zofran, and now also Zantac. I never take so many medications as when I am pregnant. I am thankful for something that is working though. Some women with Hypermesis are unable to find any relief and remain sick until delivery. I can't imagine. Overall, I have had a major turn around. I seem to have fallen into a pattern of 2 good days in row, where almost I feel completely normal, save some slight nausea. Some slight nausea that I can only imagine is what text book cases of "morning sickness" experiencers feel. After 2 good days, I then seem to completely crash for one. Back to being bed-bound, but not throwing up non-stop, so I'll still take that. Then I have a mediocre day before starting the cycle again. I have been able to slowly add foods back into my diet, and it feels good to be able to eat more normally again and keep it down. I haven't weighed, but I'm sure my weight will be coming back up quickly, particularly with the steroids. The most troublesome side effect of the steroids has been the interrupted sleep. I haven't gotten more than 4-5 hours per night since starting the steroids, and even that is choppy. It is frustrating, but compared to how I had been feeling, I will take the trade off. I also have a higher susceptibility to infection while on steroids, and like clock-work, have contracted a nasty cough/sinus infection that has drained me for the past 4 days. Because, why not, let's just add something else to the mix.
Tomorrow I go back to the OB to update him on how the new meds are working. Overall, two thumbs up. I am most anxious about checking on how baby is doing. Even though I know it must be the meds making me feel better, my mind still worries about miscarrying. In a warped way, feeling so sick constantly was a small comfort in knowing that I was still pregnant and plugging along. Feeling better offers me no such reassurance. I know... It's a roller-coaster ride through crazy town.
And that is my journey with baby #4 thus far. I have another pre-approved week and a half of being on steroids before being weaned off of them. I am praying that I won't revert back to how it was before I started them. I anticipate needing to stay on the Zofran and Zantac up through the 3rd trimester, as each pregnancy the sickness lasted longer and with the last one I was still throwing up at 28 weeks.
If you have stuck it out reading this far, bless you- sorry for my wordiness. I hope it will offer some insight to those who cannot relate, and some comfort to know you aren't alone to those who can. Pregnancy sickness can't always be minimized down to "morning sickness". Pregnancy sickness, particularly HG, can be a difficult, tumultuous, worry-filled, agonizing journey. To me the only redeeming part of being pregnant is when I start to feel the baby move. But even then, I'd go through labor 100 times over to just skip the 9 months of pregnancy. I don't enjoy being pregnant, even remotely. I no longer feel guilty about saying that. It doesn't make me a bad mom. It doesn't make me a bad person. I just no longer feel a need to conform to the world's expectations of a glowing, raving, happy pregnant woman. I am still ever so grateful for the new life that will come from this. But until we get there, please forgive me if I slap the next person who asks me how the "morning sickness" is going and suggests I try some ginger pops.