Hyperemesis + Pancreatitis = No Fun

This is a pretty long post. If you don't want all of the details I have put a summary at the end, so you can skip to that if you want.

Some of you know by now that Christy is in the hospital. If you didn't know, then now you do. So here's the story on what has happened this past weekend.

She started out with Hyperemesis Gravidarum, which is basically just an excessive form of morning sickness. That began to get a little better a few weeks ago, and then about a week and a half ago things got worse again.

As you know from the previous blog post, she went in to the doctor's office on Tuesday, and ended up having an IV treatment. They did 1 liter of fluids there, and a dose of Zofran (anti-nausea). The plan was to do more treatments as needed either at the doctor's office, or at the hospital or Instacare. She didn't really start feeling better after the first treatment, so she decided she wanted to go in the next day to do more. She went to the Instacare, and had 3 more liters. Again this didn't really help her feel much better.

Friday, she had her mom take her in to the Instacare again to do another, and they started her on a liter of fluid. Before even finishing this, the Instacare doctor came in and told her that he didn't think she was very dehydrated. They had taken some blood to run some tests, and he wanted to take another sample to verify some of the results. After the second test results were in, he came back to her and told her that she probably had some malnutrition, and low potassium, and that her blood was acidic and starting to digest her body. He reccommended that she go to the emergency room and have things checked out there.

Her mom took her to the emergency room, and I left work early to meet them there. When I got there they hadn't really done much except take some blood to do more tests. A little while later they took her down to do an ultrasound. We assumed this was to look at the baby, and make sure that was all ok. When we got in there they started looking at her liver, and her pancreas, and intestines, and all of her other organs. I figured they working thier way down to the baby. A little while later, after spending a lot of time looking at organs the lady finally said, "Well, the doctor didn't actually order and ultrasound on the baby, so I'm not supposed to show you, but there is the baby, and there is the heartbeat." (as she showed it to us briefly in the screen. She said she wanted to show us just for our peace of mind.)

As we were walking back to her room she said the doctor would probably come see us in a few minutes. About an hour later he finally popped his head in for 5 seconds just to tell us that he was trying to get a hold of the on-call doctor for the OB/GYN. About another hour later the nurse came in and said "Well, it looks like she has pancreatitis, so the doctor is working on getting her admitted to the hospital."

A little while later the nurse came in and told us that she was admitted to the women's center, and started to take her up. When we got up there, the new nurse said "It looks like you are a little dehydrated," (obvious from the IV bag) "so we will see if we can't get some more fluids in you." I said, "the nurse downstairs told us she had pancreatitis, so what do you need to do about that?" The nurse replied (in a very irritated tone) that it wasn't on her charts yet, and she would have to wait to see if that got sent up. She also said that if it only came from the nurse down there we shouldn't believe it, because the nurses aren't authorized to give that kind of diagnosis, and as far she was concerned she didn't have pancreatitis because it didn't come from the doctor (remember we had only seen the doctor for 5 seconds). We were a little irritated by this point, because everyone was slow, and didn't seem to know what was going on.

We eventually decided to sleep, and the nurse came in and gave her an injection of another anti-nausea drug called Phenergan that was supposed to also make her sleepy. Unfortunately this only made her legs restless. They gave her a sleeping pill, but nothing seemed to work. She tossed and turned all night (and so did I from the uncomfortable couch I was on). In the morning they again gave her more of the same drug, and it again had the same effect. She decided at that point that she didn't want to try that one anymore. They ran some blood tests again, and discovered that her potassium level had dropped even more overnight, so they upped the dose.

Saturday afternoon I decided to go home for a while and shower and take care of the dogs. My mom stayed with her to keep her company, and take care of anything that happened. That's when all the excitement began. A nutritionist came in and decided to start a feeding tube. Since it was the weekend, they don't do the procedure as often. A short while later an opening came up, and they took her down to insert the tube. My mom went down with her to keep her company. That procedure didn't go so well. As the tube got into her stomach her stomach started going into spasms, and they weren't able to get the tube to go past the pylorus (the opening out to the intestines). Since she is pregnant, and they had to use x-rays to see where they were placing it, they decided to stop, and try again the next day. They left the tube in because there was a chance that it would work its way through on its own.


With a tube hanging out of her nose, doing no good except irritating her throat and gagging her, she was a bit discouraged, and not at all thrilled about the procedure. Every time she vomited a little would come out the tube and get all over her gown (though we couldn't figure out at first how she kept getting it on her). They ran some more test, and found that her potassium was back up close to normal levels. She went to bed that night without any sleep aid, and slept a little better.

In the morning they ran the blood tests again, and found that the potassium was low again, but the pancreatic enzyme levels had improved. A doctor cam in a while later, and informed us that they were going to go ahead and place a PICC line (long term IV). They had previously decided not to place the PICC line because it has a higher risk of infection, and complications with pregnancy. We were a little confused by this change in plans, because we were under the impression that the feeding tube would be used in place of the PICC line completely. After discussing it more with the doctor, and the PICC line team, we decided to cancel the PICC line, and continue with the feeding tube. We later discovered that the order to go ahead and do the PICC line was actually given before consulting with the Nutritionist, and really they shouldn't have ordered it at all.

A short while later they had an opening come up in radiology to finish placing the tube, so we loaded her back up in a wheelchair and took her downstairs. They laid her on the x-ray table, protecting the baby with some lead shields, and started the procedure. I watched from the other room on an x-ray monitor. They spent about ten minutes working on it, and at one point told Christy that they were trying to be fast not gentle (in order to limit the baby's exposure to the x-rays). Eventually they got the tube to go past the pylorus, and into the intestine. They got it all the way to some ligament that it has to go around, and couldn't go any further. They decided it was far enough, and stopped the procedure in order to protect the baby. They said it should be far enough to do its job. I snapped a picture of the x-ray screen to show to everyone:


The dark "cloud" on the right is a contrast fluid they injected to help see things better. They said that the fact that it is going the direction it is going is a good thing because it means the fluid from the tube is going the right direction, and is not likely to come back into the stomach. They also pointed out that the path it takes is short enough that the pancreas must not be very inflamed (meaning only a mild case of pancreatitis).

She went back up to the room, and a few hours later they came and hooked up the tube to the feeding fluid. At this point, with the tube placement fairly successful, we decided for sure to keep the tube, and skip the PICC line. She still felt pretty horrible at this point, and continued to vomit a few times that evening. They started the feeding slow, and worked the rate up until the next morning it was at the target rate. They continued to give her fluids and potassium through her IV, because her potassium level had dropped again.



By morning her potassium was back up to normal levels, and the feeding was going well. She still felt pretty nauseated, but hadn't vomited yet. They didn't run the pancreatic enzyme levels that time, but Sunday they had slightly improved, so we were hopeful that they had continued to improve.

Early in the afternoon she finally started feeling quite a bit better, and even asked if she could go out for a walk around inside the building. We walked around for a bit, and when she got back she even felt like taking a quick shower. We were all feeling much better about how she was doing, and she even started talking and joking more. My mom came to visit, and we decided to go down to the cafeteria for some dinner. We loaded Christy up in a wheelchair, and wheeled her down, feeding bag and all.


After smelling all of the food surrounding her in the cafeteria, she decided she wanted some potatoes and gravy. Unfortunately she is not able to eat any real food yet because of the pancreatitis. After learning that she can at least use lip-balm she wondered if she could maybe find some gravy flavored chapsitck. It is a good sign that she is starting to get an appetite, and her sense of humor is coming back.

Anyway, the good news is that she has improved enough that they are probably going to send her home tomorrow (Tuesday). She will still need to be on the feeding tube at home for a while, and will not be able to do too much, or leave the house too often, but at least she will be at her own home. She is obviously feeling a little more optimistic at this point too.


Summary (for those of you with A.D.D.):
Christy has had a hard pregnancy so far with Hyperemesis (excessive sickness). She started to get better, and then got worse again. She ended up in the hospital where they discovered she also had Pancreatitis. She ended up with a feeding tube that she will need to keep in for a while until she gets better enough to do without it. She is now feeling much better, and will probably be going home tomorrow, which we are all excited about. She has now almost gone 24 hours without vomiting, which makes only the second time that has happened since the beginning of this pregnancy.

We are grateful for everyone's concern, and prayers, and support. We will keep updating you as things progress.