23 July 2009

HG 101: A Boring Discourse on Why I Feel Like Death...All The Time

As promised in a Listless Monday post almost two weeks ago now, I have a post all about HG. A little disclaimer here, it will be interesting to no one, but hey, that is the fun in blogging. Read on if you will…

For those not “in the know” HG stands for hyperemesis gravidarum which is, in short, persistent and/or severe nausea and vomiting associated with pregnancy. Here are the highlights, or HG 101:

No one knows the real cause of HG. In fact, the exact cause of morning sickness in general has yet to be definitely determined. Lots of great theories are circulating, but only correlations have been established, For the epidemiologically uninitiated, correlations do not equal definitive causation. It seems to be quite a mystery as to why some women never so much as feel queasy, while others are living in the bathroom, taking time off from work and generally being miserable for roughly 40 weeks.

As a follow-up to the lack of definitive cause, there is also a lack of understanding as to just what constitutes HG versus NVP (nausea and vomiting of pregnancy, or normal morning sickness, an enigma in and of itself). In a nutshell so-called “morning sickness” runs a gamut of severity with HG sitting at the more extreme end. Within the HG area there is a sub-gamut, if you will, of severity. Just figuring out where you sit on the spectrum can bog down health-care providers to no end. If your illness keeps you bed-bound for your first trimester then clears up, it may still have been HG. If you are sick all day every day for 40 weeks, it may not qualify as HG depending oh how the rest of your health is doing.

The lack of understanding of what causes this disease, and how to even classify cases, leads to a lack of diagnostic criteria. The diagnosis of HG is pretty subjective with criteria ranging from mere duration of illness to necessity of hospitalization. Some resources site percentages of weight loss as a viable diagnostic tool, while other state that until you are on bed-rest with a PICC line and liver failure, you may just be a bit over dramatic. This places patients and their health care providers in a bit of a pickle when it comes to making diagnosis and treatment decisions.

The icing on the cake is that the all the above factors make having a standard treatment protocol somewhat impossible. Since getting a diagnosis of HG is rigmarole of complete subjectivity, so it treatment, should your health-care provider even figure you need some. Treatments include everything imaginable including dietary changes, medications to ease the nausea and vomiting, homeopathic treatments, and of course, in extreme cases, re-hydration and feeding via hospitalization. Since the western practice of medicine is based on an “if X then Y” pedagogy, this lack of direct “diagnosis to treatment” pathway can be very problematic for sufferers.

Having put all this out there, I will say that I fall on the mild end of the spectrum. My so-called diagnosis is based on duration and severity of conditions coupled with what may be considered extreme weight-loss (10% of pre-pregnancy weight). In my first pregnancy I probably had this condition, though it was much milder than this time around and I was able to manage it through copious use of red Gatorade and rest. Thankfully my job at the time was pretty low-key, and with not even my DH around thanks to hectic shipyard schedules and constant “under-ways” on a submarine, life was pretty conducive to taking it very easy. This time around, it is really doing me in. While I have, thankfully, avoided serious complications, it has clearly been more severe as illustrated by losing twice as much weight despite medication (bless that Zofran, if you can choke down the “cab-driver feet” flavored tablets, man that stuff works) and my general level of awfulness. Additionally my job now has no flexibility to accommodate my illness as tyrant bosses, I mean toddlers, don’t have a great sense of sympathy when they want snack. Now. Thankfully shore-duty means my DH can be home to take over by dinner-time, but still, it is kicking my ass.

I consider myself so lucky to have just dabbled in this as opposed to many who really get put through the ringer. None the less, it has been frustrating and I do feel like more research should be poured into this area. My thoughts on that, however, veer into a much longer feminist rant about inequality of resource distribution in medical research, but that is a post for another day…..

*Final disclaimer: I am not a doctor. My health-care training is purely in the field of epidemiology which in no way qualifies what I have written here are any kind of authoritative resource on the subject of HG. My only real skill is gathering data and rounding up the meta-analysis, something that is rarely useful in any way.


Jana said...

On the (maybe) plus side, I once read, on the highly trustworthy internet, that not having any vomiting during pregnancy increased chances that something is wrong with the baby, so you should have a super healthy baby in there! :)

Alexis said...

Good point. Many have said that "the greener the mommy the healthier the baby." Not sure if it is actually true, but I like to think it is.