Friday, October 24, 2014

HG Treatment Post 1: The Meds -- Zofran and Reglan

This is the first post in my HG series on Infusion Pumps.  To see the intro post, which will list all other posts in the series and link you to them, please go here.  If you are here because you are about to start a Zofran/Reglan Infusion Pump, don't worry!  For all the garbage that may come with them, it is by far better than the crippling illness that HG is.  

So here, we go, right?  The meds.  While this may not be the first post in the series that you clicked on if you are set to start a pump -- because let's be honest you wanted to understand the pump and the poking-yourself part, amIright? -- it is in no way unimportant.  In fact, I slapped it as the first of this series because I would happily argue that the meds are the most important component you need to understand if you are walking on your own (or supporting someone through) hyperemesis gravidarium journey.

Initially I started on oral Zofran.  The pills were actually the generic Zofran, Ondansetron, which some people react to differently than the name brand stuff.  It certainly helped me a little, I felt better but it wasn't enough.  After 2 weeks I called my doctor's office miserable and dehydrated because I couldn't keep hardly anything down.  I wound up having a ketones level of 4+ which is the worst on that scale.

I was also miserably constipated.

A quick word about Zofran and Ondansetron ... the constipation you most likely will experience will be extreme.  Pills OR infusion pump.  Seriously, I made my nurse choke one day when I checked in over the phone by describing it as "pooping glass shards, assuming I am lucky enough to actually poop."  I joked here about how desperate the constipation got.  While I joked, eventually I was genuinely worried I was going to cause some kind of permanent damage to my body, even with colace three times a day.

It only got worse on the Zofran pump, mainly because the amount of meds I had increased.  I tell you this not to scare you, because you may not be as bad as I was.  I tell you to prepare you.  A friend who had HG and was on Zofran joked with me that she wished she could have taken the pills with a milk of magnesia chaser.  Seriously.

Example of the redness around a catheter
site.  Not the bet picture but it gives
you an idea.
So when the pills failed, I went to the Ondansetron/Zofran pump.  Then it got really miserable (for ME, don't panic if you are reading his and about to start Zofran).  Aside from the constipation, I also was having a nasty reaction at my infusion sites, where the catheter goes into my abdomen.  I address the Orbits and infusion sites in post three of this series and I will talk about this there too.  But for the purposes of this post, Zofran is an irritant to your skin.  the sites became very sore and I had to change them about every 10 hours due to the severity of my own sensitivity (I am a freakishly sensitive person though so you may not be as bad).  They would swell and turn hard, get red and warm to the touch.  And they hurt.  Sometimes a lot.  I did use a product called Skin Prep (more in post three) and that helped my reaction to the adhesive on the Orbit.

If you DO have a reaction at the infusion sites (which I have never heard of anyone having no reaction) just know that heat and/or cold will help.  I used ice packs and a rice sock thing I have and alternating between the two helped me, some people have better luck with one over the other.  But, you want to treat them ASAP because it will help!  Additionally, you can technically go two days without changing your sites, but if you are really uncomfortable they will urge you to change more frequently.  The longest I could handle was 12 hours.  Some people may actually get better after a week, so my nurse told me, like their bodies get used to the Zofran.  I was not one of those people.

Between the sites, the constipation, and the headache -- all known symptoms of Zofran for peeps who do not respond well to it, we decided to change to Reglan after 2 weeks on the pump with the Zofran.

The Zofran is the orange syringe. The yellow one is Reglan/Metoclopramide, different medication with different focus but same intent.  Zofran slows the gut, thus in many people reducing vomiting and nausea.  Reglan forces the stomach to empty faster, so the same final hope but different means of getting it.

The biggest issues people have with Reglan are anxiety, depression, and heart palpitations.  For some people this can be crippling and even dangerous.  I was nervous to try Reglan for these reasons, I have a history of anxiety if nothing else.  But I am SO glad I switched.  The infusion sites are nothing comparatively, the headache is gone, and I can *ahem* go to the bathroom with some degree of normalcy again.  My nausea is also much more controlled though it is not gone.  I occasionally feel my heart race a little, but I will happily take that over all the other garbage Zofran did to me.

Bottom line, *I* did not respond well to Zofran, but *I* am responding much better to Reglan.  You may not be the same as me.

I also have the oral Zofran pills to take when I need them, and I take Phenergan at night.  Phenergan knocks me out so it is not a valuable option for me during the day, helps me sleep fabulously though at night.  Additionally, I alluded to Colace before.  I take Colace three times a day, and occasionally I am allowed to swap out Colcae for Peri-Colace.  Colace is a stool softener, Peri-colace is that plus a laxative.  I have also tried suppositories but found that it was a lot of misery for no real result and
diligently sticking to my Colace and trying to get hydrated (mostly buy IV which I will address later) got me past that constipation until I switched meds.  Last but not least, acid production is an issue for HG sufferers and mine is mostly controlled with regular Pepcid AC at present.  

Regardless of what meds you take, speak very frankly with your healthcare provider regarding symptoms and your needs.  There are other oral medications you can take, and some of these may come in infusion pump form.  I have not had a need to move on from Reglan at present.

Looking forward to the next post in the seires regarding the pump, it does not matter which medication you are on.  My pump machinery itself did not change at all.  Just the syringe I stuck in it.  What *I* do to change things does not change between the two.  So if you are reading this and about to start one or the other the info all applies to you unless I state otherwise.

The next post in this series is about the pump itself.

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