Ok. Steroids have made me 1000% better in less than 3 weeks.

A place to discuss all things treatment-related. Medications, IVs, midlines, PICC lines, NG tubes, sub-q pumps, home health care, etc. Also includes alternative and homeopathic remedies including NAET, vitamins, liver detoxing, and more for active HG and TTC preparation.

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Ok. Steroids have made me 1000% better in less than 3 weeks.

Postby BlueEeyore » Oct 09, 2004 6:53 pm

I am 21 weeks pregnant. Three weeks ago, I was not eating or drinking and was 24 lbs under my pre-pregnancy weight. I was hyper-salivating, throwing up a minimum of twice a day, nauseated 24/7, and just plain miserable. I had a PICC line in for months and was taking nightly TPN treatment.

I was prescribed steroids for an allergic reaction and within 3 hours, I started feeling significantly better.

Now, I have had my PICC line removed. No more TPN. All meds are orally taken. I am hungry and thirsty and can eat and drink like a champ. I am only 12 lbs under my pre-pregnancy weight now.

I was hyperemetic for the ENTIRE time last time I was pregnant. I was headed down that path this time, too. The steroids have made all the difference in the world. Best part is - the steroids are largely thought to be safe.

I have done research and found that the steroid I'm on - methylprednisolone - is a preferred steroid for pregnant women because it crosses the placenta poorly. A low dose is something under 80 mg a day. A mere 20 mg a day keeps me feeling MUCH better. My doc has approved long term daily maintenance doses after speaking to a high risk OB specialist.

This has been my savior. Those ladies out there who are convinced nothing will work for them - this is worth a try. Reglan didn't work for me. Neither did B6 and unisom, phenergan, or zofran (well, zofran helped a little).

I am thrilled. :D
Last edited by BlueEeyore on Oct 10, 2004 12:36 pm, edited 1 time in total.
Survivor of 18 months of HG - through 2 long pregnancies.
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Postby MamaLily » Oct 10, 2004 1:09 am

BlueEeyore -

:D Hurray! I'm so happy to hear that steroids have worked so well for you. I wholeheartedly agree with you...they are worth a try when nothing else is helping. I was the same way - nothing really helped me until I tried the steroids. And I was on the methylprednisolinone as well - for over 2 months (my 2 year old has always been perfectly healthy, by the way).

So glad you're feeling better...

- Anna
"The little reed, bending to the force of the wind, soon stood upright again when the storm had passed over." - Aesop
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Postby emily » Oct 10, 2004 5:07 am

I am so glad these worked for you! I was prescribed these very early in my HG pregnancy and they didn't work at all for me. But, I hope to try them with better success later on in my next pregnancy. I really am glad they have worked for you, that is really just so wonderful that you are doing so well. It is exciting to hear stories like this!

Emily
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Postby Gail » Oct 10, 2004 2:55 pm

I love to here stories like this. It give me hope for when we are ttc again. This is a treatment that I will definately be trying. I figure it couldn't make feel any worse , right?! I am so happy that you are feeling great again!!
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Lauren (10-13-99)
Lost Angel (2-9-04)

Strange how people who suffer together have stronger connections than people who are most content---Bob Dylan
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Sorry

Postby ejoann » Oct 12, 2004 4:09 pm

I'm so glad that your feeling better and I'm totally with you on using the steriods for short periods of time, especially since you were feeling so bad.
However, prednisone use directly caused the death of my first son. So please be careful with longterm use, especially if you have GBS. It is a serious medication and should be treated that way.
(I took 10mg/day for about 10 weeks, way to long)
~i~Baby Julianna cord accident 8-10-07

~i~Rebecca (1-21-05) @24weeks IC, mild HG
~i~Quinton (5/7/2003-6/8/2003) @26weeks IC, heavy HG
~i~Elliotte (1/9/04) @17weeks SB, regular HG
42yrs old
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Postby alisonc8 » Oct 13, 2004 7:58 pm

I am one of the HG survivors who couldn't sing the praises of steroids highly enough... until Monday when I was diagnosed with Avascular Necrosis, also called Osteonecrosis, in my hip. I took methylprednisilone for about 6 months for HG.
The steroid use is very highly correlated to the incidence of AVN. AVN is when the blood supply to the ends of bones (like the femur) is compromised. This causes bones to "die", and they don't regenerate very well because of the poor blood supply. There are not many ways to treat AVN, the most common treatment is a total hip replacement.
AVN is painful, all the time. My mobility is severly impacted.
I look at my precious baby and I wouldn't change a thing. But I do recommend, if you can do without the steroid, please learn from what has happened to me. Try to wean off the steroid as soon as you can.
Alison
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Erin 3/17/04
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Postby emily » Oct 13, 2004 10:04 pm

I will throw in my two cents on this... I was very VERY surprised to see extended use of steroids on this message board. My peri did a two week taper and said he "sometimes" though rarely does a repeat of it. I would be very wary of doing an extended course. Maybe someone has some links so we can all find out more info?

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Postby BlueEeyore » Oct 13, 2004 11:08 pm

I thank you for your cautionary tales.

My OB at first would not entertain the idea of steroids. We have consulted a high risk specialist, 2 pharmacists, and 2 other doctors. They all agreed that steroid use - particularly methylprednisolone at the small dosage I'm taking - is safe. Safe is a relative term. There are always risks when taking steroids, I'm sure. There is also a large number of women who have to take steroids - pregnant or not - for issues like asthma and lupus that go for years with out serious complication.

I suspect we will be doing regular ultrasounds to make sure that the growth of the baby is not being affected by the steroid, as I have heard that there is a slim chance of causing hypoadrenalism - although this is much more likely on a higher dosage.

I will, however, bring up these topics that you have mentioned to my doctor the next time I see him, which is in a week.

Ejoann, I'm so sorry about the loss of your son. How devastating. :(

Alison, I'm also sorry to hear of your troubles. May I ask what dosage you were on?

As for doing without the steroid, I probably could. But it would mean going back on the TPN and PICC line, having debilitating nausea, destroying my mouth and esophagus with the constant vomiting of acid and bile, and losing all ability to eat and drink - which poses a threat to my entire GI system. Having a non-functioning GI tract can be dangerous. It's hard to balance the pros and cons. The pros here are very positive. The cons may not be as bad as the alternative. It's a hard call.

Thanks again.
Survivor of 18 months of HG - through 2 long pregnancies.
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Postby aaronsmommy » Oct 16, 2004 12:00 am

It is so nice to hear about people doing well, and so sad to hear about those that have had problems. Sometimes I wonder If I should stop hanging around for a while, but occasionally I find myself with something to say.

Here we go, ramblings of a crazy woman . . .

I really think it is interesting that we have had several people with severe complications from steroid use here. Typically I tend to think that is because it is the people with the worst complications that tend to seek out a support group like ours, but many were here well before the complications occurred. Aside from the two people who have already posted the other I know about is someone (with hg, but on steroids for a different reason) who had a preterm delivery (from ruptured membranes - a known association with long term steroid use) and then a debilitating chronic parvovirus infection for a year after delivery. Seems like a lot considering so few are on steroids long term.

Short term use of steroids is not particularly controversial, but I think the goals of long term use need more evaluation. It would be nice of someone would do the studies, but I don't think that will happen. Avoiding TPN is probably a good reason to accept the risks, but is avoiding all IV use? Is the right goal to make you feel good enough to eat and gain weight, or is the goal to make you feel good? How much is too much? and how long is too long? I don't think that even the "experts" would agree, and I wouldn't consider just any perinatologist an expert on this.

Nobody has ever considered the psychological complications of hg when evaluating risk. Should you? How would you?

For me, it was a difficult decision. We decided after over a month of steroids that the benefit was not enough to justify staying on them and I have always wondered about that. I feel much more comfortable with it now. Steroids were the thing that made the most noticeable difference for a short while, but even on the higher doses (32-48mg) I was only eating about 300-500 calories in a day and so I still needed to stay on TPN. We figured that TPN and steroids made for a bad combination and so eventually after several unsuccessful attempts to get below these doses without spiraling out of control I went off of them and spent the rest of the pg in bed, on TPN, and miserable.

Everyone's situation will be different, but I think the obvious lesson is that you should continue to reassess the dose and the need to continue steroids.

As for what those "experts" do recommend. Most of what is written about steroids and hg recommends a dose of 10-12 mgs or less, for a maximum of 6-10 weeks.

This stuff is a bit technical, but I'm going to put it out here for those who are interested.

First, the recommendation from ACOG in the educational bulletin on hg for doctors that came out a couple of months ago:
-----------------------------------
Corticosteroids may be considered as a last resort in patients who will require enteral or parenteral nutrition because of weight loss. The most commonly described regimen is methylprednisolone, 48 mg daily for 3 days, given orally or intravenously. Patients who do not respond within 3 days are not likely to respond, and treatment should be stopped. For those who do respond, the dose may be tapered over a period of 2 weeks. For recurrent vomiting, the tapered dose may be stopped and the patient continued on the effective dose for up to 6 weeks. To limit serious maternal side effects, corticosteroids should not be continued beyond this period for the treatment of hyperemesis gravidarum
----------------------------------------------




This second piece is quoted from the article by Goodwin who is the person who has written the most about steroid use in hg, on this website http://www.nvp-volumes.org/ which is a summary of reasearch presents at a conference on hg. He is also one of the authors of the first article I quoted and seems to suggest the possibility of using them longer here. This was written in 2000 and I don't know if there is any reason for the stricter restictions in the more recent one.
----------------------------------------------
After the first weeks of therapy we have limited the use of corticosteroids to low dosages (12 mg methylprednisolone per day or less) for no more than six weeks of total treatment. Others have used lower doses from the start with reported efficacy. Some have continued the corticosteroids for as long as 10 weeks. It is our view that usage of this duration begins to pose a significant risk of maternal complications and should be strictly limited. Since the vast majority of hyperemesis, even if refractory to antiemetic therapy, can be managed with supportive care, a reasonable risk-benefit ratio demands a high degree of confidence regarding the safety of the regimen.
Even chronic steroid use has not been shown to pose significant foetal risk. Although it is still debated whether corticosteroids could have any teratogenic effect in humans, therapy can usually be delayed until at least 10 weeks' gestation. Recently, an increased risk of preterm birth and preterm premature rupture of membranes has been attributed to corticosteroids; this effect has been described only with use throughout pregnancy, however.
Serious maternal morbidity has not been reported with exposure comparable to that which our patients received. Reported complications from steroid therapy for hyperemesis are clearly related to prolonged treatment at very high dosages. This emphasizes the need to taper the medication and limit the duration of usage. In our experience, corticosteroids for the treatment of hyperemesis are safe and effective and can significantly reduce the need for hospitalization.
-----------------------------------------
Aimee

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Steriods also worked for me

Postby TErickson » Oct 27, 2004 12:55 pm

I was in the same position... I was extremely ill from week 8 - 18 when after trying Reglan, B6, Unisom, Phenergan, and zofran I was still miserable.. nothing was working.

Once trying methylprednisolone I was doing dramatically better from that point on and didn't vomit again for over a month. After losing 25 lbs from my pre-preg weight I was so thankful to be able to finally drink water and eat some food.

I was on the medication for 3 weeks and ti-trated off and thankfully was able to continue on with no medication. I did feel nauseaus from time to time.. but at least kept all food and drink down. I say that I was going through normal morning sickness then, and I could deal with the uneasy stomach, as long as I could eat and keep it down.

At 29 weeks I am doing very well compared to before and have gained back almost all of the weight and baby is doing well. I have to admit that in the beginning since this was my first pregnancy I thought I would never do this again.. but I am already starting to slowly forget how awful it was. I am sure this baby will be worth it, and I may try for number 2 a few years in the future. Even with all the lingering bad stuff like financial stress and losing my job because of HG... I have high spirits and am thankful my baby looks to be healthy and strong.

Good luck to all!
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Postby MamaLily » Nov 04, 2004 12:52 am

Aimee -

I just wanted to say thanks for posting your thoughts (and the articles) about steroids.

I think a lot about when steroids should be used, and for how long. I was put on steroids at 11wks and although I tried to wean repeatedly, I stayed on a low dose for a little over 2 months. Steroids definitely didn't make me feel great and didn't let me eat more than a couple hundred calories a day - but they stopped the weight loss and reduced the vomiting when nothing else did. I didn't worry about not being able to eat (even with the steroids) because I had the NG tube. And I honestly don't know what I would have done without steroids. They definitely helped to stabilize me. At least in my case, the true goal of using steroids was stabilization - and not "curing" my HG. I was still very miserable on steroids but they saved me!

With a future pregnancy, I have trouble deciding when I would start taking steroids, if necessary. I think...if I have an NG tube early, then maybe I could avoid a substantial weight loss and therefore escape the need for steroids. But then, without steroids I don't know if my vomiting would be under control enough to have the NG tube. If I could find another way of controlling the vomiting, that would be good. I'll definitely have fluids at home before trying steroids, but my biggest goal is to avoid a PICC. And steroids might be necessary to avoid that. Wouldn't it be nice to know exactly what is going to happen in advance?

I was wondering...is it typical to have a problem with the combo of steroids & TPN? Why is that a bad combination?

Sorry to ramble so much! I guess I have a lot of thoughts about steroid use with HG...weighing the risks vs. benefits is a hard one for me. And I think your questions about mental/emotional risks are good ones. Again, I'm glad you posted your thoughts.

- Anna
"The little reed, bending to the force of the wind, soon stood upright again when the storm had passed over." - Aesop
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Postby BlueEeyore » Nov 06, 2004 8:31 pm

Well, I tried weaning off the steroids and immediately found myself going from being able to eat to losing all ability to eat and drink again. I became extremely fatigued and nauseated all over again. My doc has agreed to allow me to take the steroids for longer. He is consulting another perinatologist. One doctor said that the biggest risk is to ME AFTER I get off the drug. Very little crosses the placenta and the risk to me is virtually nil while I'm on the drug. But once I get off, my adrenal glands may not make corticosteroids - which is the risk. So one has to wean off it slowly over several weeks.
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Postby aaronsmommy » Nov 22, 2004 11:05 pm

Anna -
The problem with steroids and TPN is the risk of infection. Steroids suppress the immune system, so when you add in the risk of infection with TPN, well it sounded pretty bad.
A picc line for fluids and meds has a lower risk of infection, when you put in the TPN that risk goes way up.
I didn't try the NG tube until after I was off of the steroids, so maybe that combo could have worked. I guess I'll never know.
I won't ever get pg again, but if I did I would do a g-tube. I wish I could know if it would make me feel better to be getting some food in that way without actually getting pregnant.
Aimee

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