How soon to get in home IV's

[purplespirit79]

Just wondering how soon I should get an in home IV or Picc line or NJ tube. Who would I even ask for it the ER if I went in to get hydrated or my OB when I go in for my first appointment. Should I get it before I start actually getting sick which is always at 6 weeks. Should I do it as soon as I find out i'm pregnant and schedule a drs appointment asap??? I've always had severe HG with every pregnancy to the point where i cant keep down anything not even water.. I've been on every type of antimedic out there and nothing works.....Tried zofran oral, suppository and the kind that dissolve on your tongue and still was sick. Tried the B6 and every other thing except in home iv's picc lines or nj tubes ... What would anyone suggest??? Please respond with any information that would help me or give me some more insight!!!!!! XO You can reach me on yahoo messenger at purplespirit79

[Kalanit]

first of all remember that doctors often dom't have immediate appointments. I made the 'mistake' of getting pregnant and starting to vomit non stop at the end of august. Every single OB in my area was on vacation for the last two weeks of august and then booked full for the next two. What you should do now is go OB shopping. Find a good OB in your area. Get the medications you want to try stocked up at home so that as soon as the vomitting starts you are prepared. As for home health, I'm not from your area, so things are different by me. But tell the OB exactly what you said here about home health. If he/ she seems reluctant, continue OB shopping. Best of luck, and remember, not every HG pregnancy is the same.

[purplespirit79]

I have heard every pregnancy is not the same but ive been pregnant 4 times and every one has been exactly the same from the time when i started to get sick to the symptoms before i got sick to the severity of the HG.. So it just leads me to believe that the next will be the same as well.. Who knows though maybe now that im over 30 yrs old it will be less severe. As far as having meds stocked up.. None of the meds that drs prescribed me during past pregnancies worked. That why i was talking about home iv's , picc lines and ng tubes........

[aaronsmommy]

The idea with having the medications on hand is that they work much better when you take them before you are very sick.
Do a search on preemptive therapy and read as much as you can about it. Even medications that you have tried before and didn't work are worth trying again this way, and the idea is to start at the first sign of the mildest nausea or even before and to increase the doses if you have even the littlest bit of breakthrough nausea.
Your OB would order home health, not the ER (and ideally it would keep you from needing to go to the ER, I never did have an ER visit with either pregnancy, but survived on IV hydration done at home). And Kalanit is right, you need to have an OB and a plan set up before you get pregnant in order to have this work well for you.

[teddi]

The medications are the things that will actually stop/prevent/ and/or help the nausea and vomiting. It doesn't really matter how many home IV's you have, or a PICC or NG tube. Those things CAN be a delivery vehicle for the medications and food and fluids, but they are treatments for the SYMPTOMS and side effects OF the HG and do not really treat the root cause itself.

I had infusion clinic orders (i.e. the same thing as a home health nurse coming out to administer IVs three days a week, except I went to the clinic Mon/Wed/Fri and did 2 liters for hydration and IV meds) and did that for a month. I then had a PICC line in for 6 months, the rest of my entire pregnancy (the PICC line came out post partum). I still had HG the entire time.

For sure, being dehydrated makes vomiting and nausea worse and it can help keep the cycle from spiraling downward, but you can still be quite sick and just as nauseated and still vomit a lot even if you are hydrated.

NG tubes aren't really very useful, if the food goes to your stomach, it can still be vomited back up, so in HG women it's mostly NJ tubes that are used that go further past the stomach to the jejunum where the contents can't come back up. NJ tubes, I think, in the women who have used them on the boards are only tolerated about probably 50% of the time. The insertion can be a quite an ordeal and sometimes needs to be done under sedation. The tube itself it relatively safe, but there can be complications but many women can't tolerate it because it hurts/irritates the throat and can trigger the gag reflex incessantly.

PICC lines are not an easy answer. Back when I had mine, I thought it was great. It still was a good option since I was never able to maintain my own hydration for more than a week and needed the veinous access. However, having been around the boards for the past 7 years, I now don't recommend them at a first course of action. They DO get infected. And that means sepsis- and that can mean a very very very sick mom and baby. It can mean a dead mom or baby is the symptoms are missed for a long enough time.

I have found my circumstance was an exception far more than the rule- to have a single PICC line in for so long. And I did have complications. The line clogged twice, and I also ended up with an air embolism due to user error (also potentially life threatening).

My point in all this- is that those invasive treatments come with risks that always have to be weighed with the benefits. And none of those things actually cure or treat the underlying HG. If those things can be avoided, you want to avoid them (well except for home or in clinic IV's- those are pretty safe and you DO want fluids of course when they are needed).

Medications and finding the best combo that works for you is key. Preemptive treatment is also key- it may not stop the HG, but I just spent a month doing preemptive treatment (Zofran) and it was amazing to me how well the Zofran DID work for mild nausea (compared to how little it did once the HG was in full force in my previous pregnancies).

You need to find an OB ahead of time, and you need to know and find out ahead of time what you hope and expect and what a Dr is willing to try. Some OBs *will not* do PICC lines. Some OBs (probably not many) may also not be willing to do preemptive meds w/out reviewing your medical records too, so you want to make sure you and the Dr are on the same page.

And ER will not order a or place a PICC line. Or Home health or an NJ tube. That would be ordered only if you are under the care of a regular and ongoing physician or for the short term if you were hospitalized. Those types of things need ongoing orders- for instance a PICC line has to have a dressing change weekly and it has to be inspected by a nurse or Dr for signs of infection/etc- there are medical supplies that go along with those that can only be ordered by a Dr.

You didn't mention all the medications you used before, but many women do combinations of various medications. Sometimes mixing anti-emetics works much better than taking one by itself. You also probably did not try steroid therapy, which is definitely worth trying (and works great for some women too).

With my twins pregnancy, I unfortunately wasn't given access to Zofran before I was dealing with full blown HG, BUT I did take a couple other meds and even that helped delay the onset/downward spiral into HG by about 10 days. So it's really always worth to go the preventative route first.

[katypate]

A good, understanding doctor should be your first course of action! Many doctors just don't understand HG. Make sure you have a good doctor before you get pregnant. A lot of doctors don't like to schedule you for your first appointment until after 8 or 9 weeks--HG'ers need to get in before that.
What all medicines have you tried? There is a great list of meds on this site that you can review. The only med that worked for me last time was Remeron. Unfortunately we didn't figure that out until I was 17 weeks and 90 pounds! Once I started the Remeron it was like a night and day difference.
I also had a PICC line and an NJ tube. The NJ was horrible for me. The PICC did not do anything for the nausea or vomiting, but it did help me stay hydrated. I would not hesitate to do a PICC again. This is something I plan to discuss with my doctor before getting pregnant.
Good luck! I hope you find a great doctor and the perfect combination of medicines and interventions to pull you through.

[purplespirit79]

Can I get an ob/gyn even before I become pregnant??? What do I tell them that I ve had HG w/ 4 other pregnancies and that I'm trying to conceive.

[aaronsmommy]

Yes, you can get an ob/gyn before you get pregnant!!!

You want to make an appointment for a "pre-conception" visit. You tell them you have had hg and want to be prepared for early/preemptive treatment when you do get pregnant. Do it NOW (and think about waiting to try until you have someone and a plan).

[MichellevsHG]

purplespirit79 - have you been getting yearly pap smears/exams with an Ob/Gyn?????

[purplespirit79]

Yes I get yearly paps . I dont get medical insurance through my work till August so waiting till then to find a ob/gyn. Waiting to ttc till November at the earliest..

[sweetpea]

Definitely do a pre-conception visit and discuss your previous pg's. With mine, I brought in a page long protocol of what I wanted to try. He's a really good OB and said it all looked good and that's what we did. That was for my 2nd pg. This pg I still see him and he's been good about calling in meds ahead of time or when I need them. And he's having me check my ketones so when they get past a small amount I'll start going in for fluids and will eventually get a PICC and home health. Last time my PICC got infected, so I'm really not looking forward to getting one!