Doc: Strategies for dealing with morning sickness
Dear Dr. Roach: My friend has severe morning sickness. She just found out that she is pregnant with her first child, and can’t keep anything down. Do you have any advice?
Dear J.B.F.: Nausea and vomiting are very common in pregnancy, and symptoms can range from mild to severe, requiring hospitalization with intravenous fluids and medications. If your friend is having severe symptoms, it can be dangerous for her and her baby; she should get immediate help from her obstetrician.
If her symptoms are mild, the first thing to do is to change her diet to smaller, more frequent meals, avoiding strong flavors and odors. For some women, frequent naps and a shorter work day help; sadly, that isn’t always easy to do.
The acupressure wrist bands help some women (but should be removed at night). Ginger (often taken as ginger tea or as 25 mg capsules, four times daily) helps more with nausea than with vomiting.
Another thing that helps is taking 25 mg of vitamin B-6 (pyridoxine) three or four times daily.
If none of these works, it’s time to think about more powerful medicines, such as diphenhydramine, meclizine or ondansetron. Those certainly need the OK by her OB. Many women worry about the effect of medications on the developing child; however, not getting nutrients isn’t good, either.
Dear Dr. Roach: My wife recently died from “graft versus host disease” after a very successful liver transplant. I can’t find much about the disease as it’s so rare. Her transplant center has seen only four cases in 21 years and 1,500 or so transplants. It was not a pretty sight to see her slowly waste away, and they couldn’t do anything to stop it. What can you tell me about it?
Dear D.A.: I am very sorry to hear about your wife.
Graft versus host disease is a very common problem in people after a bone marrow transplant; however, it is rare after a liver transplant. As its name states, the immune cells in the transplanted organ attack the healthy cells of the person who received the transplant. Since a bone marrow transplant is essentially a new immune system (from the donor), unless the recipient is an exact match, the new cells will attack the recipient’s liver and skin most commonly.
In the case of a liver transplant, sometimes there are many lymphocytes (an important part of the immune system) contained within the transplanted liver. In GVHD from liver transplant, it’s the skin that most commonly is affected, and treatment consists of powerful drugs to suppress the transplanted immune cells. Unfortunately, that also suppresses the recipient’s immune system, predisposing one to infection (which may already be likely due to skin disease, which in turn makes it easier for bacteria and fungi to attack the body). For this reason, the mortality rate in GVHD following liver transplant is reported to be 80 to 100 percent. Attempts are sometimes made to use the recipient’s own stem cells as a bone marrow transplant, or to use a very closely matched person for a bone marrow transplant, but this often is impossible to do.
Email questions to ToYourGoodHealth@med.cornell.edu.