My New Protocol

Discuss ways to prepare yourself, your family, and your protocol for HG.

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My New Protocol

Postby nomore » Mar 31, 2005 9:20 pm

Well, here it is, my new and improved protocol!!! Please add any imput you feel is helpful, as Im always looking for suggestions. Also, I didnt add stuff about preparing my house, food for fmaily when pregnant, but have a game plan here, just not actually typed!!! We met with my Peri earlier in the week and he is on board with our plan so far!

Here it is:

Protocol for HG Treatment:


Prior to TTC:

• B6- 100 mgs daily
• Folic Acid- 800mgs
• Rainbow Light Just Once Daily prenatal vitamins
• Exercise 3 to 5 times weekly
• Stay hydrated.- brink a minimum of 40 oz of non-caffeinated liquid daily
• Acupuncture Treatments to promote good health
• NAET allergy elimination treatments
• Chinese Herbs as directed by DR for Body Detox and overall improved health
• Ensure you are mentally and physically healthy
• Aciphex 20mgs daily (40 mgs if needed)

Upon Positive Pregnancy Test:

• Increase B6 intake. Take in 25 or 50 mgs doses. Increase up to 150 mgs. At worst nausea may take up to 200 mgs- not to exceed this dose for more than 1 month, as it may cause nerve damage over a prolonged period of time. If oral pills are not tolerated, use sublingual.
• Add Unisom, up 75 mgs a day. Comes in 25 mg tabs. May break into ¼ to ½ tabs to reduce drowsiness affect. Pair with B6 for best effectiveness.
• Ginger Root:- capsules up to 1000 mgs daily.
• Stop taking Chinese herbs.
• Start taking (500 to 1000 mgs) Dandelion Root and/or Milk Thistle (1000 mgs) for increased liver function.
• Call Mom and make flight arrangements for her trip.

As Nausea increases:

• Zofran (start will pill, then try ODT if pills wont stay down)- up to 32 mgs daily. Try: 8 mgs every 6 hours. Do NOT delay taking this if the previous meds are not addressing the nausea and vomiting.
• Increase Acupuncture treatments to help reduce nausea.

Consider the following:
• Phenergan- suppositories (25 mgs). Cut in half lengthwise to use as necessary, OR oral
• Consider Vistaril- up to 25 mgs every 6 to 8 hours (this may additionally help with anxiety). – not sure if this can be taken with other antihistamines (Unisom, Dramamine, meclizine).
• Switch from Unisom to one of the following: Meclizine- up to 75 mgs daily. Pills may be split as well. Benedryl- 200 mgs daily in 25 mgs increments. Ambien- 5 mg tabs, may be split into smaller doses to reduce drowsiness. Dramamine- 50 mgs every 4 hours.
• Add Sea Bands for motion sickness to see if they offer any relief.
-Address any anxiety/depression issues as they occur. See what options for medication/therapy can be put into place.

If not feeling relief TRY alternate drugs approved by Dr or try different combinations of drugs to see if any relief can be found.

If Dehydration Occurs:
• Preferable: Home IV Therapy. Lactated ringers or glucose with saline. Instead of 24 hour hydration try for 1 bag over a 1 to 2 hour period, with a 6 hour break. I felt BETTER when the hydration went in faster vs slower.
• Consider using a PICC line for hydration, as the smaller IVs cause phlebitis easily for me and need to be changed more frequently.

If Dehydration is NOT a continuous issue, and ODT Zofran is not working as effectively, try a Zofran Pump. (This is portable and can be worn easily in taking care of Madison and going to work.)

If Nausea and Vomiting Continue excessively after 12 weeks:

• Steroid Treatments: Prednisone with a low taper rate of 5 mgs. This is a Cat B steroid. Other steroids used are decadron and Solu-medrol. Opt for the “safestâ€ÂÂ
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Postby *** » Mar 31, 2005 9:53 pm

Robin
That protocol sounds great!!!!
I have been wondering about PICC lines and taking care of Cecilya with one in(how is that going to work???)
My peri suggested a reglan or zofran pump if I need it and said it is eaisly "hidden" so I wouldn't have to worry about that with Cecilya. He also suggested a sub-clavian line instead of a PICC b/c she won't see it. (They tried a Sub-clavian when I was pg with Cecilya and couldn't get it in...The surgeon said I was too dehydrated DUH!!!!)
Unfortunatly I can't take phenergan (makes me feel like I'm going (more) crazy and my vision got all messed up.
Anyway I just wanted to say the plan looks good and thankyou for putting in how to care for a little one with lines in. That is one of my biggest fears and I guess I have been too chicken to admit it to anyone so....THANKYOU
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Postby aaronsmommy » Mar 31, 2005 10:47 pm

Robin, just curious, why only low doses of pepcid/zantac? I'm sure you have a good reason, but I know my heartburn was worse the second time, and the steroids only made it worse, so I wanted to make sure you had some other ideas in there. Have you ever had a proton pump inhibitor (protonix, aciphex, and others)? May be worth jotting down so you know you have some options if you get that burn.

Erika - why the concerns about seeing/doing stuff with a picc line? If you get it put in the upper arm it is really easy to keep hidden/active (to the extent the hg lets you). I didn't have a toddler then, but I worked for over a month with one in and no-one knew unless I told them, as long as I wore at least 3/4 length sleeves. There are some other advantages to certain subclavian lines, but the insertion has more risk (and it would certainly be visible with any kind of a scoop neck too)
Aimee

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Postby bibliojo » Apr 01, 2005 12:01 am

Robin,

I don't have anything to add since I think you've covered everything I could possibly think about suggesting and then some. Looks great! I REALLY REALLY hope this plan of action works for you this time. I'll be there be to help you out as best as I can with support!

Love,
Joanna
2 HG pregnancies
Lukas - February 2003
Katya - October 2006

Image
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Postby Natalie » Apr 01, 2005 7:13 am

Hi Robin

I wish I could also come up with something but I can't think of anything right away.

I just wanted to let you know that I will also be supporting you and cheering you on through the difficult journey ahead.

You are a very brave woman.

(((Hugs)))))

Love Natalie, xx
2003 - DD
2006 - DS
2010 - DS
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Postby *** » Apr 01, 2005 8:46 am

Aimee
I guess I'm concerned because last time I had the PICC it was running TPN 24 hours a day. I had to stay in bed or on the sofa, and if I moved I threw up. Unfortunatly my HG doesn't get better it gets worse as time goes on. So I'm scared about being that sick and trying to take care of my VERY active two year old.
I think I'm afraid she'll accidentally pull on it. (Even though I know it's taped down pretty securely) and I'm afraid it will scare her.
Thanks
Erika
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Postby nomore » Apr 01, 2005 9:37 am

Hi Ladies,

Thanks for all of the replies!!! This protocol has been a work in progress, and Im sure it will somewhat change as pregnancy occurs (figuring out what works right).

Aimee- I seem to react badly to RX doses of antiacids (even when not pregnant), they make me nausated. I DO NOT understand it! I also took Pepcid again this last time and would feel OK when about 1/2 of the dose was IV pushed, but then would feel crummier when it was all in. So, thats why I think smaller doses work better for me. Also, I currently am taking aciphex (20 mgs). It works GREAT!!!! However, if next time is anything like the past, I wont be able to keep oral meds down. Do you know if any of these types of drugs come in a sublinqual or IV version?? Aciphex has been a miracle drug for me since my pregnancy with Madison.

Ericka- Having a baby already was the hardest part of my 2nd pregnancy. With that being said, thats why we have my Mom coming up to move in with us to take care of both us. In regards to the PICC, I had one in both prevoius pregnancies. I didnt find them to be too horrible. If I wore long sleeves (of course if I wasnt hooked up, whch wasnt often), you would of never known. This last fall, when Madison was 19/20 months, she was pretty Ok with the IVs. She didnt pull them or take to much interest in them. They also gave me a little IV "backpack", which was ALOT easier than a stupid IV pole with her,a nd trying to get around my house). I know how much TPN sucks. My 1st pregnancy, I was on it for 12 weeks. I kept my PICC with my pregnancy with Madison from week 12 until 2 days post partum (and I delivered at 39 weeks 3 days). Even at the end of that pregnancy I couldnt keep oral meds down and still had the occasional bag of fluids at home. I am also not opposed to the sub-q pumps, but have a HUGE issue with dehydration, still throwing massive keytones on hydration, so if I have to have the hydration, Id rather just get my meds in the PICC too, kwim? :)

To all the ladies: Thanks for your support on this. This isnt an easy road to walk down again. I need all the suport I can get :)

Robin
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Postby aaronsmommy » Apr 01, 2005 9:45 am

Erika - Once I started TPN, I was on it 24 hrs a day until delivery, and I have a toddler the same age, so I TOTALLY understand those concerns. I just don't think they would be different with a PICC line vs a subclavian. If you are lying around in a nightshirt attached to an IV pump, there is plenty for her to see either way, and the clothes that will be comfortable and easier to get on and off when hooked up are likely going to show the subclavian even more! Besides, toddlers are so curious, you can't hide much from them anyway! TPN can be run for just a few hours every day, I never liked the way I felt coming off of it, so I didn't, but I think most people do it that way, and it doesn't matter what kind of line you have in to do it.

If you got a tunnelled catheter, or a mediport (both subclavian) those are basically impossible to pull out, but also mean a trip to the OR to place AND remove. I don't remember anyone having a picc pulled out by their kids, I could be mistaken though.

I just think you should pick the line for the medical indications, that's all.

I know I am personally biased against subclavian lines because of the risk of nicking the lungs with placement (I also really didn't like the idea of someone pocking around in my chest with a drape over my face to place it). That risk is low though, but a big fear of mine.

I just think you should pick the line for the medical indications, that's all.
Aimee

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Postby aaronsmommy » Apr 01, 2005 9:53 am

Protonix comes IV, and it sounds like you will need it if you are already on it before pregnancy!
Have you ever tried adding the pepcid to the fluids, or TPN and run it in slowly that way?
Aimee

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Postby nomore » Apr 01, 2005 10:01 am

Aimee,

Thanks for the info! I will mention the protonix to my DR. Also, when the pepcid was mixed with the IV bags, it did do better! ( I think they put it in my TPN, I cant remember if it was inthe hydration). Do you know what drug category the protonix is? I know aciphex is a B.

Thanks!

Robin
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Postby aaronsmommy » Apr 01, 2005 10:11 am

Protonix is a category B, that's the one I took.
I don't get nauseous with pepcid, but it sure WORKED better when added to the TPN. You could easily add it to a bag of fluids, even if you run the bag over only a couple of hours. Might help!
Aimee

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aciphex funny

Postby *** » Apr 01, 2005 10:44 am

Just a little aside to try and put some humor into the planning...My friend is a 'drug rep' and one of her drugs is aciphex. Her selling point to docs..."Aciphex has less a** effects." Meaning it doesn't cause all the diarrhea that some of the other anti-ulcer/gastric acid-pump inhibitors. So talking to her the other day she wasa joking that maybe I would want some of the a** effects because zofran can be so constipating.
Hope that brings a smile to you all. :wink:
It made me smile :P
Erika
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