This sticky is for all those Canadians out there that suffer from HG. The following is my observations thus far of HG treatment in Canada and what you can do to get better treatment.
The first thing your doctor will prescribe will be Diclectin. They will probably give you instructions to take it 4 times a day. However, Motherisk in Toronto has conducted a new study which shows that it is safe to take up to 8 Diclectin a day. Print off this study to show your doctor or have you doctor call Motherisk (1-800-436-8477) or visit their website (www.motherisk.org) to verify this. I have had friends increase their dosage from 4 to 8 Diclectin a day and they say that they noticed an improvement in how they felt.
Next your doctor will probably tell you to take Gravol in conjunction with the Diclectin. You can take 50-100mg every 4-6 hours, up to 200 mgs a day.
If the Diclectin and Gravol does not help enough (which probably it won't as these are usually not effective enough in treating HG), your doctor will prescribe any of the following: Chlorpromazine (Largactil), Prochlorperazine (Stemetil), Promethazine (Phenergan), or Metoclopramide (Maxeran). My experience has been that Canadian doctors will most likely prescribe Maxeran. You can take 5-10 mg of Maxeran every 8 hours.
Your doctor will most likely add to this combination (of Diclectin, Gravol, and Maxeran) Ranitidine. You can get this over the counter as Zantac. Take 75 mg once in the morning and 75 mg once at night.
If you reach a point where you can't keep anything down for anywhere from 24-48 hours, get in touch with your doctor. Your doctor will most likely arrange for you to get hydration. This is a quicker route of getting fluids than just showing up at the hospital as your doctor can call the ER ahead of time and they can have everything ready for you. Just hope and pray there is not any huge emergencies ahead of you! Sometimes though if the ER doesn't have any beds available, they are willing to set up your IV with you sitting in a chair. This can be a quicker way to get the fluids if you desperately need them. Just some suggestions to make your time in the ER a bit more comfortable -- ask the nurse to warm your IV fluids ahead of time and ask for a heated blanket to keep you warm. If they aren't heated, those IVs can make you really cold!
While in the ER, a doctor will assess you as to whether you need to be admitted or not. Usually if you aren't too bad off, they will send you home after just getting the fluids. If you aren't showing any signs of improving with the fluids, they will usually admit you. Once admitted, they will keep you on an around the clock IV of saline and meds. They will also add vitamins to your bag. The hospital nutritionist will likely meet with you to discuss what would be appropriate for you to try eating and what you most likely will keep down. However, I've found that their suggestions don't always work! Just go with what you can handle and don't let them force you to eat stuff you know you're just going to promptly throw up.
While in the hospital, see if you can stay in a private or semi-private room. HGers usually get lumped in with the women on bed rest on the maternity ward floor. This can be a diaster for an HGer as I found out during my second hospital stay. When you have HG you need lots of rest and quiet. Women on bed rest however usually feel pretty good but are bored so they have lots of visitors and watch movies all the time! Not very restful and quiet for someone with HG!
You will usually be kept in the hospital until you are stabilized, typically around 4 days. They will probably keep you on IVs until a day or so before you go home. Then they will take you off the IVs and see how you handle oral medication and keeping some food down. If you handle those 24 hours well, they will send you home. If you get worse again, they will keep you longer. Don't let them send you home before you are stablized! If they send you home too early, you will just end up back in the hospital in a couple days time and you'll have to go through the whole hassle of going to the ER, being admitted etc.
If you are finding that your doctor isn't very knowledgable about treating HG, switch!! Ask to be refered to a specialist such as an OB/GYN or a Perinatologist. These types of doctors will know how to be more aggressive with the HG and may prescribe other drugs such as Ondansetron (Zofran). With my first pregnancy I continued to go to my family doctor. While she was very compassionate about the condition I was in, she didn't know how to effectively treat me. With this next pregnancy I am planning I have been refered to an OB/GYN that has experience treating HG. I have met with him for a pre-conception appt and have learned that Ondansetron (Zofran) can be made available to women with HG. However, I don't imagine that your regular family doctor would be prescribing this drug as Ondansetron is not routinely offered to Canadian women with HG. I've found that Canadian doctors tend to be quite conservative in their treatment of HG in comparison to some of their American counterparts.
What I have written about so far is what I have learned from my personal experience with HG, that of a friend's, and also the experiences of Canadians who have visited this site. I am not very knowledgable about treatment beyond this, but I do know for those extreme cases of HG, TPN and PICC lines are offered. They are usually last resorts in keeping the baby and mother alive though. If I hear of anybody receiving these and/or other types of treatment, I will post about them. In the meantime, I hope that all this information helps someone!
Joanna