Morning sickness

I've had reason to review my knowledge of morning sickness recently. Most women get this to one degree or other in pregnancy in the early stages of pregnancy. Most don't require treatment and it usually settles around the three month mark.

Some don't settle however. I suspect those women probably don't enjoy being pregnant as much as they were hoping to.

A few unfortunate souls suffer hyperemesis gravidarum. That is more serious and sometimes requires hospital admission, especially if the mother becomes dehydrated. But there are degrees of hyperemesis. Someone close to me has it at the moment (in my completely unbiased and objective opinion). I thought she would require admission last week, but luckily we've avoided that.

The constant nausea and repeated vomiting brought on dehydration and an extreme malaise and lethargy. She is currently not working, which is just as well because I don't think she would be able to anyway. This week, she is coping a bit better. In part this is due to the phenergan she has been using on and off. The only trouble with that is it causes sedation and gives her a headache, which in turn makes her feel nauseated.

See the problem there?

There are other drugs which help some people: prochlorperazine, metoclopramise, cyclizine. None of these drugs are licensed for use in pregnancy related sickness. But numerous studies have been performed which have not shown any adverse effects on the baby. The Prodigy website was one which I have found helpful as a revision, though it hasn't helped Mrs Brown very much. She is trying accupuncture, having already (unsuccessfully) tried the accupressure bands you can buy in any pharmacy. Accupuncture has not been shown to be helpful in 2 randomised controlled trials. But if it helps her, I'm certainly not going to argue.

So in case you've come across my blog because you're suffering from pregnancy related sickness and you've googled it, here is my suggested managment plan:

1. Sip frequently, don't drink large volumes. The quicker you drink a large volume, the more likely you are to throw up. Try using a straw.
2. Drink and eat whatever you feel like. Don't worry about whether the baby is getting enough vitamins because your previosuly healthy diet has been reduced to mashed potato and baked beans. The improtant thing is that you avoid dehydration and manage to get food in to yourself. The baby will take what it needs from you, at your expense.
   
3. If you can't stop vomiting, seek help from the health professional of your choice. Midwives may have some sensible suggestions. GPs certainly will and can prescribe certain drugs (though be aware that many GPs will prefer to avoid them if they can).
4. Try having some sort of bland carbohydrate before you get up (crackers or toast).
5. Don't get hungry: nibble snacks throughout the day and see point 1.
6. Rest. You're not superwoman, and the world won't fall apart because you're knackered. If you have other things that need looking after (like other kids) enlist help from family and friends. Do not try and do it all yourself. You don't have to.
   
7. Despite the fact that most alternative therapies have not been shown to be of benefit, that doesn't mean they won't make you feel better. Any cynical GP (like me) who says anything other than "If you say it helps I won't argue" shouldn't be told (as long as it won't do any harm of course).
8. Ginger in various forms may help. Of course, it makes some people worse.
9. If you're prescribed medication, please use it. We don't prescribe for fun. You never know, it might help.
10. See points 1 and 6 again.
    

And here's Russell's management plan for husband's/boyfriends/whatever:

1. Be sympathetic. Its not nice. Jokes will not go down well and do not make your wife/partner/girlfriend/lover feel any better.
2. Cuddles are good, but don't squeeze. You will regret it.
3. Try and think ahead of yourself. Keep fresh water handy. Try flavoured electrolyte replacement or rehydration salts (such as dioralyte). Buy crackers.
4. If you're worried, seek help. That can be your Mum, her Mum, your doctor, her midwife, anyone you like. If you don't ask, you won't get.
5. Wash up before you go to bed. You won't have time in the morning.
6. Don't feel guilty. Its not (just) your fault. Two people had sex. At the same time however, accept any and all criticism with that stock phrase: "Yes, dear."
7. Don't forget to tell her you love her either. That will help, because the way she is feeling, she is unlikely to love herself at the moment.
8. Just because she isn't eating her broccoli doesn't mean you shouldn't.
9. Beer and whiskey smell. You should be aware that women with pregnancy relates sickness are often made worse by certain odours. Ask first.
   
10. Remember, things will get better. (Probably in about 18 years.)
    

Flea: When Daycare Calls - Part I

Flea: When Daycare Calls - Part I

Flea posted this recently. It seems they have GANFYD's in the States as well.

If you don't know what a GANFYD is, well, hopefully you'll never need one. All they do is create work for people like me.

The number of different notes people ask for never seeks to amaze me: examination board notes, holiday notes, simple "been to the doctor" notes and yes, "safe to return to nursery/school" notes.

Flea is absolutely right: no-one seems to use their common sense anymore. Perhaps more to the point, no-one is happy for anyone else to use their common sense anymore either!

Anyway, I'd better get back to work and stop reading blogs...

Dame Janet slams docs again

Ho hum.

Dame Janet Smith is perturbed by the lack of progress shown by the Government over her recommendations after Harold Shipman's crimes.

Talk about tarring everyone with the same brush...

She made this comment: "There are doctors who still think that everything is fine and that there is no need for change. There are still those who think Shipman was a one-off villain."

Well, wasn't he? Is there any evidence that there are more mega-serial killers in the current medical workforce? No?

Thought not.

I do think that some of the changes she has proposed in one of her many reports are sensible: the proposals about changing death certification and cremation administration; the need for a system to ensure doctors' skills remain up to date; her criticism of the GMC's procedures for monitoring doctors (although that led to the GMC embarking on disciplinary proceedings when perhaps it should not have).

But it seems to me and I suspect many of my colleagues that she would rather have us all shot. That would certainly prevent any more Shipman's.

But there are other things about her rampant anti-doctor attitude that concern me more. I can't help but wonder how many patients have been left in unnecessary pain because doctors have been concerned that adequate pain relief may result in an earlier demise than might otherwise have been the case and that that demise may then be subject to vexatious scrutiny. Certainly I've been aware of a lot more post-operative patients are being discharged by surgeons with simple, less powerful analgesics. Perhaps they don't need anything stronger. Palliative care also feels a lot more defensive in the last few years, or perhaps cautious would be a better word.

Perhaps this caution is for the best. Perhaps doctors do need more monitoring to ensure public safety. But I certainly came in to this career because I wanted to help people through their lives, from beginning to end. I suspect the same is true for most of my colleagues. Dame Janet's viciously negative attitude does nothing to help avoid another Shipman. It just makes doctors feel vulnerable and defensive and that cannot be good for patients.