Preparing for doctor appointment

[bibliojo]

Hi guys,

I have an appointment with my doctor on Monday to discuss how I'd like to have my HG treated once I get pregnant again. What should I have prepared for this appointment? What should I ask about? I'm a bit nervous about this as I'm not a very outgoing and demanding person but I do really want to have a better experience of being pregnant, HG or not (I only wish that this time there won't be any HG but we all know the statistics...!) Last time, I felt that I was just left to struggle on my own because they said they couldn't do anymore for me. And I think the lack of support that I received contributed to my PPD afterwards because the depression really began those months that I was sick. Should I bring this up too?

Thanks in advance for any input you guys can give me! You all have all been such an encouragement to me.

Joanna

[nomore]

Joanna,

I brought in a protocol I created after doing a lot of research. I used the protocol to begin discussion topics and I printed out a copy to have him put in my folder. It was helpful, as I nearly always "forget" certain points and it let me know exactly where he and I differed or agreed. He did ask me my reasons for certain things, but was agreeable to everything I recommend excpet he did not want to try steroids until I was 13 weeks, not 12. I thought that was reasonable.

This Dr is a Peri and I saw him for part of my pregnancy last time. 13 weeks until about 18 weeks. This time he agreed to see me excuslivley and it really made me feel more comfortable!

Let me know and I will post my protocl if you want. Not saying its right for everyone, but I hope its the right plan for me!

[bibliojo]

Hi Robin,

If you would be willing to post your protocol that would be great! It would give me some sort of idea what to include, where to start etc. I'm just kind of at a loss right now. There's been lots of information that I have gleaned from this site but I don't know how to organize it all or what to include.

Thanks!

Joanna

[nomore]

Here it is:

Protocol for HG Treatment:



Prior to TTC:

• B6- 50 mgs daily
• Folic Acid- RX dose aprrox 3200 mgs in addition to prenatal
• Rainbow Light Just Once Daily prenatal vitamins
• Exercise 3 to 5 times weekly
• Stay hydrated. Make sure 75% of liquid daily is water
• Milk Thistle liver detoxification for 1 to 1 ½ months. Stop 2 months prior to TTC
• Remove gallbladder
• 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. Come in 25 mg tabs. May break into ¼ to ½ tabs to reduce drowsiness affect. Pair with B6 for best effectiveness.

As Nausea increases:

• Zofran (start will pill, then try ODT if pills wont stay down)- 24 mgs daily. Try: 8 mgs every 8 hours. If not as effective as wanted, try 4 mgs every 4 hrs. Get 8 mg tabs and split in half. Zofran works best if you are HYDRATED.

Consider the following:

• Ginger Root:- capsules up to 1000 mgs daily.
• Phenergan- suppositories (25 mgs). Cut in half lengthwise to use as necessary. Try combo with zofran at worst of HG.
• 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.
• Add Sea Bands for motion sickness to see if they offer any relief.



If Dehydration Occurs:
• Preferable: Home IV Therapy. Not just straight saline, add glucose to ease some of the nausea. Optimally try for hydration at night when Madison is sleeping instead of 24 hour hydration.
• 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

[bibliojo]

WOW! Thanks Robin! I had no idea that it would be so much work for you to type it all out! You obviously put a lot of thought and research into this! I'm going to have to spend some time going over it deciding what will work for me and what won't.

But...enough of all that. We have much more important things to talk about! CONGRATULATIONS!!! I'm so excited for you! How are you feeling physically? Are you feeling prepared mentally for the HG? I do hope all goes well with this pregnancy. I will keep you in my thoughts and prayers!

Joanna

[nomore]

Joanna,

It wasnt really a big deal, I didnt retype it, I copied and pasted it from a saved document I already had. I hope it helps.

And, yes- I did put a lot of time in to it! I started gathering info back in 2003 right after my duaghter was born and finally compiled what I hope is right for back in eartly Septmeber of this year. It took a lot of thinking about what I wanted, now that I probably know way more about HG than my DRs.

Hope it helps! And, thank you!!!! I am very excited still! Still feeling great today. FOODMENT: Have some heartburn, but I ate a sandwich that had tomatoes and onions on it for lunch and they normally bother me. Popped a zantac and letting it do its job.

Robin

[Natalie]

I just remembered - don't forget (if you are able to read) there is a book called 'What to do if your miracle makes you miserable'. It sounds really good and funny to me and is recommended in another forum (can't remember which one). You can prob. find it through Amazon.

Natalie

[MamaLily]

Joanna -

I have a few other ideas, in addition to the excellent ones that Robin has given you.

Here are some pages from this site that I personally found very helpful when preparing a protocol.

This lists all of the meds commonly used by HGers. I printed out this page and took it with me when I met w/my new doctor before TTC. I use this page all the time because of the great info it has about these medicines (dosage, category, risks, how it helps with HG, etc.):
http://helpher.org/mothers/treatments/medications.php

Here is a list of questions to ask a new doctor to find out his/her philosophies about HG treatments:
http://helpher.org/mothers/referral-net ... doctor.php

This page lists all of the commonly used treatments for HG:
http://helpher.org/mothers/treatments/index.php

The following article contains a WONDERFUL visual representation of the different steps of HG treatment options. I really like this algorithm because you/your doctor can look at it and say, "Okay, I am dehydrated so the next step is ___. And if that doesn't work, then I can move to ___." I think every HGer preparing for another pregnancy ought to read it. Just click on this link, and then scroll down through the article until you find, "Click here to view a management algorithm for NVP." I found this when reading on perinatology.com. I think this would be great to print out and show your doctor.
http://www.obgmanagement.com/content/ob ... _00025.xml

Good luck to you and please let us know how your appointment goes!

- Anna

[bibliojo]

So I had my doctor appointment tonight and I'm feeling quite at peace with what transpired. This doctor has been my family physician for over 15 years and was the one that took care of me when I was pregnant with Lukas, but looking back I feel that the HG was not properly managed. However, I really like her, we have the same philosophies about pregnacy and childbirth and I knew that she tried her very best with me when I was so sick. But it turns out that she is giving up the maternity part of her practice as of the end of this year and so I would have no other choice but to find another doctor for my next pregnancy. I have started a binder of all the information I can find on HG and its treatments and many of the ideas I presented to her, she was unaware of or didn't know about, such as Zofran during pregnancy or even taking extra Vitamin B6 before TTC! And when she happened to mention that I was the sickest person that she had treated for NVP (and she's been practicing at least 30 years, I'm guessing) I knew that having to find a new doctor was the best thing for me. She agreed that I should see an OBGYN and she's going to try and find one for me that has had considerable experience with HG. However, I think I'm still going to do a post in the Trying to Find a Physician forum to see if anybody has heard of a good doctor in my area (which may or may not get any results as I think I'm the only one from Vancouver around here, but it's worth a try!)

So, thanks, guys for your input. You have all been very helpful. I haven't completed my protocol, but I have a lot of things gathered together and have some ideas as to what I'd like in terms of treatment. However, a lot of my questions remain unanswered as my doctor just didn't know so I'll have to wait until I find my new physician before determining exactly what I would like to have done. Will keep you posted!

Joanna

[bibliojo]

So I got my referral for my new OBGYN this morning from my family doctor. Apparently this doctor is supposed to have considerable experience with HG. However, my consultation appointment isn't until February 8!!! What's with that?? It's a good thing that I started planning early! This will still fit in with our timetable for TTC (we're not planning to TTC until next May) but I would like to decide on what we're going to do when the HG hits again. I feel as if I'm in limbo. I just want to have everything decided so I don't have to think about it! Also, this doctor is a man which I'm a bit disappointed about. I'm always more comfortable with a woman doctor and especially in relation to pregnancy since having a female doctor who has had children truly knows what is like and can sympathize. I'm trying to think positive and am hoping that this doctor will work out just fine. But in the back of my head, I'm worried that if I don't like this doctor or his philosophies on HG or labour and delivery that I will have to find a doctor that I like and that could take another 3-4 months and that would take us up to the time when we will be TTC. I don't want to have HG and be looking for somebody to treat me! Sorry for whining...I'm just frustrated that it's taking this long to get answers to the questions I have!

Joanna

[nomore]

Hi Joanna,

I jsut wanted to comment that my DR is a male. He is great. I saw a midwife for part of my last pregnancy and she was just AWFUL! I think I cried after every appoitnement with her. She is NOT understanding at all. Whereas, my Male DR is much more understanding. Go Figure! My regualr OB/GYN is a female who practices with the Male Dr I am seeing now. THe male Dr is the PEri (high risk DR).

Anwyays, Im so sorry you have to wait so long for your apppointment. It took me about 6 weeks from when I called to get mine.

HuGS,

Robin

[MamaLily]

Joanna -

I'm sorry that you have to wait. When I was preparing my protocol and finding a doctor, I became so impatient. I just wanted to have everything planned out - and I wanted it planned right then! So I understand about wanting to have your answers well before you are pregnant & sick.

Could you call every now and then to see if this new OBGYN has a cancellation? Or could your family doctor give you a few other referrals, so that by the time February 8th rolls around you will already know how other doctors would treat your HG? Sometimes it's nice to interview/consult with more than one doctor before making your decision.

Also, as I have been preparing for round 2 of HG, I have read everything I can find about HG. I made a list of everything that other women had tried, and that really helped me narrow things down for my own protocol. I really knew what I wanted, and then when I saw my doctor I didn't even need to pull out the protocol - because my new doctor had the same philosophy about treating HG. So, if you get everything ready on your end before February, then hopefully your doctor's visit will go smoothly and things will be perfectly in place! I hope that is the case for you!

Good luck and please keep us posted! It's so exciting to see HG survivors preparing themselves for another little one!

- Anna

[bibliojo]

Thanks Robin and Anna.

I'm going to phone this OBGYN to see if he has a cancellation list that my name can be added to and hopefully I can get a sooner appointment. I've done some further research on him and I've found out that he makes $660, 000 a year which is a lot of money for a Canadian doctor to be making - even if he is a specialist. And his office is only open 4 days a week! So he's squeezing a lot of appointments into his days which I'm not too excited about. Also, I've found out that he supports abortion which for me, as a Christian, I can't agree with. My fear is that if I'm really sick he might suggest it or pressure me towards that option and I don't want that. BUT I must keep an open mind and see what happens when I actually meet him. In the meantime, I'm looking into midwives. A friend of mine had a midwife with her pregnancy (but she didn't have any complications) and she has raved about having a midwife non-stop since then! I really like the idea of having 30-60 minute appointments with them so they can really assess how you are doing. And these midwives apparently will refer you an OBGYN if they can't help you so it would be ideal if I could find a midwife that has some experience with HG but that can refer me to an OBGYN that has even more knowledge and experience. I think I can try and find a midwife at the same time as waiting for my appointment with the OBGYN but I don't think that I can make a bunch of appointments with other OBGYNs when I already have the one referral -- a least I think that is how our health system works up here in Canada. In the meantime, I'm putting together a binder of all the information I can find on HG treatment and then from that information I'm making notes of which treatments sound appealing to me but that I would like to talk to the specialist about them first before deciding on them. I showed my family doctor what I had complied so far and she seemed quite impressed. And oh yes, I also thought of calling Motherisk and asking them if they know of any doctors in Vancouver that treat HG since they are Canadian. They might know and then I would have someplace to start if the appointment with Dr. Rosengarten doesn't go well or the midwife thing doesn't happen either. So I think I am prepared as one could be...I just have to wait!

So, Anna, when are you going to TTC? What have you decided on for your protocol (if you don't mind sharing)?

Thanks for listening!

Joanna

[tanishaj]

Hello,

I am seeking a referral for a physician in the GVRD who treats HG. MY sister-in-law is suffering, but has found success with Zofran. The last doctor she saw was reluctant to prescribe it and told her he wouldn't do it again. I notice that several of you have had good experiences with your doctors. Are you able to pass along names and contact info? She is desperate and I'd like to help her.

[acorn26]

Hi, Joanna,
There are good midwives out there who understand HG. Having said that,
I was first sent to a midwife, but she was horrible. She kept "crackering" me and actually told me that most women experience nausea and that I'll be ok. If thoughts could punch.

My doc was a male (and retiring this year, so on the older side), but I truly think he got me through the pregancy with his total compassion.

If you seek a mid-wife, make sure she truly understands HG to the fullest. Make sure she understands that zofran is ok.

Were you able to get another appointment earlier?
Thinking about you.
Amy

[bibliojo]

Tanisha, I have pm you with the contact info for my OB. It is so very sweet of you to want to help out. Your sil is a very lucky lady.

Amy, this is an old post! But I haven't ruled out seeing midwives after I'm over the worst of the HG. It just sounds so much nicer to be able to talk with someone who understands pregnancy rather than be rushed in and out of a doctor's office. I've decided though that I'll decide later on. Right now just thinking of getting pregnant! Thank you for asking though...

Joanna