Acupressure - Pressure on the NeiGuan Pressure Point (P6)
Apply direct pressure to this point either with your fingers or with the use of wristbands. This spot is about 2 inches below the wrist crease that divides the underside of your wrist from your hand, between the two tendons. Since organized medicine usually doesn't study holistic approaches until it's realized that someone, somewhere, is making billions from it, you won't yet find a lot of legitimate material on this and other similar methods. But so far the studies there are disagree as to whether acupressure helps with hyperemesis or not. It probably works for some women. One commercial product is a wristband, powered by a battery, which gives continuous electrical stimulation to P6. Other cited pressure points are the "liver" and "spleen" points. I myself haven't had much luck with acupressure, and your chances of finding a doctor, midwife, or anyone in cities like Duluth knowing about it is slim to none. Patients who try it and don't improve will probably suspect it's voodoo, and they'll be pretty upset when their insurance doesn't cover it under the voodoo rider of their policy. The truth is that it isn't voodoo. There really is something to pressure points. Unfortunately, many who champion a particular procedure do so as an end-all; heightened expectations, when unfulfilled, lead to scorn by organized medicine and patients alike.
The problems with this are that it's a long therapy during which time the nausea of pregnancy may abate on its own. There are no studies to support or refute it. Certainly, though, if nausea is perceived in the brain, relaxation training and behavior modification may provide help to some. Once again, this could be construed as voodoo.
Ginger has been used for centuries for nausea. But high doses may affect the testosterone-receptor binding and sex steroid differentiation in the fetal brain. But this theoretical possibility seems to be doserelated, and since it's never been observed or proven, these warnings are vague at best. A cup of ginger tea is much less (1/10 to 1/50) than the amounts that would worry those knowledgeable about traditional Chinese medicine and who worry about effects on the fetal brain.
Tincture of time
Since morning sickness and its wicked stepmother, hyperemesis, are usually self-resolving, time-related conditions, the passage of time may prove the most beneficial treatment when all else fails. When the hCG levels plateau at around 10-12 weeks, hyperemesis usually resolves as mysteriously as it developed. But when nausea continues well into the second trimester, this should prompt investigations into unusual causes of nausea because this is probably no ordinary morning sickness gone awry.
Management of Hyperemesis Gravidarum, in Chronological Order
- Thyroid function tests to rule out hyperthyroidism; hCG determination to rule out hydatidiform mole-like conditions; gall bladder ultrasound to rule out gall bladder disease or gall stones; other studies to rule out liver disease and pancreatitis.
- Avoid foods known to worsen the situation, like dairy products or fatty foods.
- Emetrol, home-made Bendectin (pyridoxine + Unisom), herbal ginger tea.
- Prescribe Compazine, Phenergan, Tigan, or Reglan.
- Prescribe Zofran.
- Parenteral hydration. "Parenteral" is a word used to mean administering by intravenous route - by an I.V. infusion. The dehydration of nausea and vomiting can make the nausea worse - a vicious cycle which spirals down, and fluids by an IV can break this chain. Usually one overnight stay in the hospital with a liter or two of merely physiologic solution through an IV can cure a severe hyperemesis episode. After parenteral hydration, re-introduce your diet with what is called a "wet-n-dry" diet, that is, dry unsalted crackers and water. Then, if that's tolerated, slowly advance your diet with other bland items.
- Zofran pump - a continuously delivered dose of Zofran, managed by a home health company, like Matria. This is expensive, and some managed care companies won't pay for it, being the thieving bastards that they are.
- Psychiatric evaluation - yes, some patients just may have a psychosis or neurosis, but it's interesting to note that this cause is considered very unlikely as compared to a generation ago when this would have topped the list of causes.
- Parenteral nutrition - IV infused nutrition. If this is necessary, then something's been missed, because there's something else besides pregnancy going on. Parenteral nutrition is a much bigger deal than 6, above, because administering fluids involves very simple formulations, most of which is water. Nutrition given IV, as opposed to just fluids, is like the difference between arithmetic and calculus. The body doesn't do well getting its calories from places other than the mouth. IV nutrition bypasses the wise screening of the stomach lining, intestinal lining, and liver "hall monitor". Parenteral nutrition is a delicate balance of feeding and poisoning. . (P-Factor - If you're like every pregnant woman I've ever cared for in my practice, this will never happen to you. It's more likely that you'll win the Powerball.)
Although it's tempting to see nausea, even hyperemesis, as a sign of a healthy pregnancy, still it's not pleasant. It's not "cute," even though it's the running joke of identification with the otherwise joyous condition of pregnancy. Throwing up is a massive physical upheaval that can trap you in a body you're powerless to help. I know. I've been to college fraternity parties - I've called Ralph on the big porcelain phone myself. But whether it's teleological or merely the unfortunate chemical struggle between two persons occupying the same body, it can have serious consequences if unremitting for any period of time. All of our treatments are Band-Aids at best. But what I've presented is what we have - So far.