HG treatment in Canada

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HG treatment in Canada

Postby bibliojo » May 01, 2005 5:49 pm

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
2 HG pregnancies
Lukas - February 2003
Katya - October 2006

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Postby carla » Sep 24, 2005 3:38 pm

This is a great overview Joanna!! Very well written!
Severe HG with DD (Gracee) 30/03/2006
Severe HG with DD (Amara) 01/04/2008
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Postby JourneyOfHope » Mar 19, 2007 5:31 pm

That sounds about right:) Great way to put it all together. Thank you.
We can roll over and feel unlucky, or we can put on our runners!
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Postby Gracie » Mar 19, 2007 6:50 pm

Joanna,

May I just add that in Quebec, there are CLSC's (local healthcare depts.) who can be quite helpful and free of charge... it pays to contact your local CLSC when faced with any pregnancy complication from HG to bedrest.

1- They have perinatal homecare nurses who can do home IV or IV at the CLSC (gets you in and out in the time it takes to run a litre or two.

2- You can arrange for a homecare assistant for housework, childcare, etc...

3- They can do home blood tests and urine tests and such

4- There are psychologists and social workers if you need to talk or help with other children or your spouse

5- Extra pampering and homecare visits once you deliver if you want them... home weight checks for the baby, vaccines, etc... so you can rest and recover.

:hugs:
Gracie
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Postby bibliojo » Mar 19, 2007 7:07 pm

Wow, Gracie! Sounds like they really take care of you in Quebec!

I just reread what I wrote and I think I could probably do some updating to it. Plus I'd love Erin (Atsie) to add to this thread her experience with a PICC. Erin??? :)
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Katya - October 2006

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Postby Gracie » Mar 19, 2007 8:05 pm

Every province and even every city is different... if we could perhaps list some of the resources (Erin for Ottawa, Kris in Edmonton, etc...) that were particularly helpful to us or that were recommended to us, it may help others who are browsing the site...

When I was pg last time, I didn't know about half of these resources, it was when the peri/postnatal team at my CLSC got the notice that I was home with a preemie that they called to tell me what was available (for every hospital birth here, there is a notice sent to the patients CLSC with details about the pg, delivery and the baby so that they can at least offer the homecare and do a phone contact to reach out in case of PPD and such). They offered childcare (although my other 2 were in school so we didn't need it) and someone for housework so that I could spend more time at the hospital with Jack if needed... They also have volunteer drivers to pick up prescriptions, or stuff at the pharmacy or to give you a lift to appts if needed. I was shocked by all that was available.

There is also a "meals on wheels" program... although not advised for HG, but if I had been purely on bedrest, it would have been great.
Gracie
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Postby irisgirl » Jun 11, 2007 2:52 pm

I know this is an old topic, but I am a new member, and I live in Nova Scotia. I felt I had to speak for Yarmouth/Halifax. What Joanna wrote is just about right with happened to me. Only I had a bad OB, and wasn't given the choice of a different one. He was reluctant to try meds on me, and kept insisting it was a metal problem, not physical. Why they have men like this working with women, I'll never know. When he got tired of trying things, he shipped me off to Halifax. Because I was stabilized, they wouldn't give me anything very strong. But as soon as I left the hospital, and was off the IV, it was back to square one again. After 6 months of this, I think they got tired of me, and just gave me the Zofran. :D It worked! Anyway, I just met with my new family doctor today and we discussed a plan of action when the time comes toTTC. She is wonderful and very supportive and understanding! Interesting though what you said about them being reluctant to give Zofran. I'll have to keep that in mind, as it is the only thing that worked for me last time. The docs just tend to keep trying the same meds over and over even if you tell them it won't work!
This forum is great to inform us of what's available to us. The docs won't tell you, so you have to research it yourself. Thanks SO much for the info for us in Canada!
Leah
Wife to Jonathan and Mom to Caleb Joel and Charity Esther
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Postby taomom » Sep 25, 2007 9:04 pm

This topic (and this website) really helped me get treatment and be taken seriously in my last PG and I'm totally grateful.

What Joanna wrote was pretty much my experience--the only thing I would add is that in my experience Dr.s/OBs have a tendency to want to move you very slowly up the drug algorithm that motherisk prescribes--eg. start with Diclectin, add more Diclectin, then Gravol, etc. If you're really desperate it can take too long to get to what really works..the Zofran/Ondansetron. When I was admitted for dehydration they wanted to stop at the Gravol (which actually helped, but made me really loopy and sleepy which isn't much help once you go home and have to function like a normal human being and go to work everyday). So I lied and said it wasn't working, and said unless they could get me a prescription for Ondansetron I was going to terminate the pregnancy. I left the hospital with a prescription for a drug cocktail of Diclectin, Maxaran, Zantac and Ondansetron that carried me through the pregnancy (with only a few bad days where nothing seemed to work). Of course, the drugs, especially the Ondansetron, are super expensive but some Blue Cross plans cover it 100%.
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Postby bibliojo » Sep 25, 2007 10:59 pm

Welcome Taomom! I'm glad that this topic has helped you! Yes, it is true - some doctors will be overly cautious and move quite slowly through the Motherisk algorithm. It's usually doctors who don't have alot of experience giving medications to women in pregnancy and/or who haven't seen how bad HG can get and how quickly things can go from bad to worse. If you ever plan for another pregnancy, it's good to sit down with your doctor beforehand and decide at what points other medications and treatments will be added. Also, I wanted to add that my insurance provider Manulife also covered the Ondansetron 100% (thank goodness!) but the Medical Services Plan in BC does not cover it. There is a special form that can be filled out by your doctor to apply to have it covered but having not gone that route nor heard of anyone else doing it either, I don't know if one would be successful in getting full coverage through MSP.
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Katya - October 2006

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Re: HG treatment in Canada

Postby ferder » Nov 09, 2012 1:33 am

I wish I knew about this site... In 2006 I had mild HG with my son. Was on diclectin but that did nothing. Somehow made it. Got pregnant with my daughter 11 months after my son was born and although I was constantly in touch with mother risk, I was never offered zofran. The HGI was much worse and I was on an IV every 10 days for the first 4 months. This is my third and last pregnancy and now that we knew what to expect my dr. Put me on zofran right away when my HG symptoms started at 5 1/2 weeks but it didn't help. Nothing did and by 7 weeks I was on daily IV and then was put on a picc line to get 2l of fluid every night. I'm on week 16 and still on the IV.... I think that has really saved me because otherwise the dehydration would have destroyed me. Slowly... Slowly... We are finding out more and getting more support. It seems we need to be our own advocates. This is the perfect place to learn more in order to help each other. Good luck to you and hope you have an understanding dr.! That makes life withHG a bit bearable!
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