The ecstasy and the agony

Advice for an expecting mother and an unsatisfied patient.

November 19, 2015 10:09
Pregnant woman

Pregnant woman (illustrative) . (photo credit: INGIMAGE)

My daughter is 27 and pregnant for the first time, at five weeks. Instead of suffering from the usual morning sickness, she complains that she is nauseous almost all the time, day and night. She vomits only a bit, but describes feeling as if her stomach were turned upside down, except when she sleeps. She has almost no appetite, eating mostly fruit and a bit of dry cereal. She refuses to eat meat or poultry or cooked food of any kind. Her obstetrician/gynecologist has checked her, and said everything is normal. She was prescribed the drug Pramin (metoclopramide hydrochloride), which didn’t help, and now Diclectin (dolylamine), which is not in the basket and for which she had to pay NIS 300 for 100 pills.

What drugs are safe and effective against morning sickness in early pregnancy? Are there any “tricks” one can try, such as deep breathing or anything else to reduce nausea? V.P., Kiryat Shmona

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Veteran gynecologist and fertility expert Dr. Chana Katan replies: Nausea and vomiting – called “morning sickness” even though it does not occur only during the earlier hours of the day – affects some 80 percent of pregnant women, usually during the first trimester, some a lot and some much less. It is caused by the rush of female hormones that prepare the embryo/fetus for gestation and delivery.

In severe cases, it can result in dehydration and even hospitalization. Many women report that they become very sensitive to the smells of cooking and even of washing powder.

The 3 percent of women who suffer from severe side effects – hyperemesis gravidarum – can vomit dozens of times a day, causing damage to the esophagus, teeth and gums because of the gastric acid. In some women, it leads to depression. In most cases it ends after three months, but some women suffer from it throughout the pregnancy.

To ease mild nausea, one can eat ginger in various forms, even cooking it into a soup. However, it won’t help in serious cases. There are also various vitamins, such as from the B family, that can help if women have vitamin deficiencies. They can be taken as a rectal suppository, whose contents are easily absorbed, if the woman vomits.

Other kinds of drugs helpful for reducing symptoms come in the form of a gel absorbed through the skin.

The woman should drink a lot of water – at least three liters a day – so that if she vomits she will not become dehydrated and her kidneys won’t be harmed. Dehydration can cause contractions of the uterus, which is dangerous to the fetus.

Some claim that morning sickness has an emotional element, perhaps even including opposition to the pregnancy.

It’s hard to generalize about whether there is such a connection, but some gynecologists prescribe antidepressants to pregnant women who suffer from it. One must strengthen women emotionally during pregnancy, especially if they have a family history of depression or if diagnosed with hyperemesis gravidarum in the past.

I am always moved by women who go through this condition pregnancy after pregnancy and still manage to go on and bring new life to the world.

As for medications for morning sickness, besides ginger (which is also available in capsules in health food stores), pregnant women can safely take doxylamine and pyridoxine to reduce nausea. It may make them sleepy, so best to take before going to bed.

In severe cases, one can get Zofran by injection and paramine suppositories. As a second line of treatment, there is promethazome gel for the skin; it is individually made up by Superpharm pharmacists.

I want to know whether there is a board in Israel that accepts complaints about a psychotherapist’s unprofessional behavior. During a two-month period, my husband and I went to a marriage counselor in a nearby town. We found him on the Internet, and he seemed well-qualified. Instead, we found his behavior bizarre and unethical. He often seemed highly unfocused and had difficulty remembering our names and major pertinent details about our lives. At times we suspected he was high, as he had told us he was a proponent of marijuana use.

We were unable to bring up problems we have with our respective in-laws, which was our main reason for seeking therapy. When we tried to discuss it, the therapist yelled at us and told us he wished he could have a relationship with his mother-inlaw, but he can’t because she speaks a foreign language. This therapist also engaged in other unethical behaviors, such as calling my husband while he was abroad to ask him bring back electronic devices, and calling me nasty names when he disliked things I said about certain relatives. He also repeatedly tried to bring religious concepts into the therapy, although we clearly told him we didn’t want the therapy to have a religious focus. We feel we were duped out of a large sum of money before we came to our senses and parted ways with him. It’s too late for us, but where can we report him to a board of ethics and save other people from a similar experience? J.M., Modi’in

Yemima Goldberg, the Health Ministry’s chief psychologist, answers: In accordance with the 1977 Psychologists’ Law, you can file a complaint with my office in Jerusalem against a registered psychologist who violated the law or committed an ethical violation. This includes behavior that is in contravention of the profession, misrepresentation of a license or permit, showing lack of ability, responsibility or serious negligence as a psychologist or being convicted of a violation that shows that he or she lacks the responsibility necessary for his profession.

The complaints committee consists of three people – two psychologists and a lawyer.

If they find a basis for the complaint, it will go to a disciplinary committee, which has the power to warn, reprimand or suspend the license to work as a psychologist.

I have the ability to get involved only if he is a licensed and registered psychologist.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.

Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to [email protected], giving your initials, age and place of residence.

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