Ep 219: The Real Effect of Hyperemesis And Strategies To Treat It with Kimber MacGibbon of Hyperemesis Education and Research Foundation

Dr. Nicole (00:00): In this episode, you're going to get excellent information and strategies to help with Hyperemesis gravidarum from Kimber MacGibbon of the Hyperemesis Foundation. Welcome to the All About Pregnancy and Birth podcast. I'm Dr. Nicole Callaway Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer drnicolerankins.com/disclaimer. Now, let's get to it.

Dr. Nicole (00:55): Well, hello there. Welcome to another episode of the podcast. This is episode number 219. Whether you are a new listener or a returning listener, I am so grateful that you're spending some of your time with me today. In today's episode of the podcast, we have Kimber McKibbon. She's a registered nurse who experienced hyperemesis gravidarum twice and struggled to receive proper treatment and cope with the long-term health issues. It caused the experience, fueled her determination to alleviate the suffering and losses faced by families dealing with HG. In 2000, she established hyperemesis.org, a comprehensive website on hg, which later evolved into the nonprofit charity, her foundation in 2003, with the assistance of Ann Marie and Jeremy King, the HER foundation has since taken the lead in advancing hyperemesis grab arm research, advocacy awareness, and education. And through collaborative research efforts, it has helped identify genetic factors which may contribute to HG and also dispel many misconceptions about the condition.

Dr. Nicole (02:06): We have a really informative conversation about how hyperemesis differs from morning sickness and exactly what hyperemesis gravidarum is, how long it can last, what are potential complications, what are strategies to approach treating it? What are some over the counter options? What are prescription options? What are some complimentary medicine options? Also, if you had it in a prior pregnancy, how likely is it to recur? Are there any research things being done for hyperemesis? Just tons of great information in this episode. If you've ever, ever struggled with hyperemesis or even nausea and vomiting in pregnancy, you will definitely find this information useful. Now, before we get into the episode, I want to tell you one of the things about hyperemesis or nausea and vomiting in pregnancy is that sometimes it can feel a little bit isolating, especially if it's severe, if it's hyperemesis, and one of the ways you can feel less isolated is by joining community.

Dr. Nicole (03:02): So I would love to have you join my virtual community all about pregnancy and birth Inner Circle community on Facebook. It's a free Facebook group. It's open to anyone who's trying to get pregnant, currently pregnant in that early postpartum phase. Also, if you work in pregnancy and birth, definitely feel free to come. It's a community of just supportive, encouraging folks. No hazing or craziness or nonsense. I don't tolerate that sort of stuff in my community. So check it out. Come join us. It's facebook.com/groups/drNicoleRankins, or just search for my name, Dr. Nicole Rankins, or search for all about pregnancy and birth inner circle, and you'll find it there. All right, let's get into the episode with Kimber from the Hyperemesis Foundation. Well, Kimber, thank you so much for agreeing to come onto the podcast. I'm really excited to chat with you about this important topic.

Kimber McGibbons (04:03): I am excited to be here, and thank you so much for having me on today.

Dr. Nicole (04:06): Yeah, so why don't you start off by telling us a bit about yourself and your work and your family, if you'd like. Okay.

Kimber McGibbons (04:12): Well, I'm a registered nurse and I'm the executive director of her foundation. I've been a nurse for over 30 years, and I have two children and a foster daughter, and yeah, it's wonderful. My first child was a honeymoon surprise, and so about four weeks after we got married, I began getting sick and I couldn't figure out what was going on. I thought, oh, I must have a stomach ulcer. It's been very stressful. I just started grad school and had just gotten married, and so it was a lot of stress. I'm like, just have a stomach ulcer, right? A little too much alcohol in the honeymoon. So I go to my doctor and go, Hey, can you give me something? I've got another stomach ulcer. She's like, you're pregnant. Like,

Dr. Nicole (04:57): And you're like, what? No,

Kimber McGibbons (04:59): But at that point I'd already been feeling really sick. So I ended up going to see a midwife, and by the time I got in with her, I had already started vomiting and really nauseous, not able to eat much, and my husband brought home a garlic pizza, and that pretty much set me off. Okay.

Dr. Nicole (05:18): You were like, why So

Kimber McGibbons (05:18): Yes. No. So I went to the doctor and the midwife was like, this is a unconscious rejection of your pregnancy. You were planning to wait two years to be pregnant, so you're trying to vomit up your pregnancy. That is why you're sick. I'm not joking. Oh, I'm not joking, my God. And I felt horrible because I was like, I'm rejecting my child. That is awful. And I'm thinking to myself later months down the road, after I felt horrible for months, I realized, I was like, but wait a minute. I went to the doctor thinking I had a stomach ulcer. Right? Pregnancy wasn't even on my mind. It was kind of a miraculous that he's here, but I couldn't believe he, it was just very strange. But unfortunately, that's what a lot of moms are told when they develop pregnancy sickness of some sort, psychological, it's something that you're causing yourself.

Kimber McGibbons (06:10): So I went through that pregnancy and struggled a lot. I weighed less when I delivered than when I got pregnant, and I was normal weight normal, B M I, right, ideal body weight when I got pregnant. And then when I was four months pregnant, my goals for the day were to try and get 500 calories down to maybe sit up unassisted for 15 minutes. I mean, I was completely bedridden, and I weighed what I weighed when I was 12, and I, oh my God, I weighed about 116 pounds at four months pregnant, and my normal is around 135. So I was not in good condition. And I look at, think about Maslow's hierarchy of needs, just the basics. We didn't do any of those. So it was really, really traumatic and very scary. I thought I was going to die. I thought my baby was going to die for my entire pregnancy.

Kimber McGibbons (07:05): So it was very, very hard, and I couldn't believe that there was nothing that anybody would do. I'd get some IV fluids, no vitamins. I didn't have vitamins my entire pregnancy. There were at times during my pregnancy where I'd have a relief enough that I could eat for some period of time and gain enough weight. So I eventually gained 14 pounds, which was great, but I had a nine pound baby. And so basically I weighed less after I delivered, and my baby had a lot of neurodevelopmental delays and a lot of, so I had some health issues. So it was a very, very rough start. Definitely to a marriage and also just to, just to life in general. Yes. Yeah. Wow. So it was very, very hard. And unfortunately, this is not all that uncommon, so that was kind of my beginning. I was looking back over the years and thinking I was a healthy person who went to the gym. I ate organic, natural foods, was very, and then I'm looking at myself during my pregnancy going, I can't anything sip ice cream and white bread, sometimes fruit, and just terrible food. Oh my goodness. Yeah. So it was just really, really tough, and I couldn't figure out how anybody could possibly not have something to be able to manage something so horrible. Sure. But sure, it was very hard. And then I went on to have one more child, and then my doctor's like, yeah, don't do this again. Okay.

Dr. Nicole (08:39): So did you have trouble the second time as well?

Kimber McGibbons (08:42): Okay. Yes. Okay. All right. Yeah. So she said, Nope, you should not do this again. I have my two children and

Dr. Nicole (08:50): You have your two children. Okay.

Kimber McGibbons (08:52): And now I have children all over the world from other families that call me grandma now or mom or something. I'm like, you, let's not go for the grandma quite yet. I'm

Speaker 3 (09:01): Not quite ready for that.

Kimber McGibbons (09:03): So

Dr. Nicole (09:04): Then how did that experience lead you to the Hyperemesis Foundation?

Kimber McGibbons (09:09): Well, so when I went online looking for information, I'm a registered nurse. I didn't know anything about hyperemesis. I mean, I knew what the word meant, but I didn't know anything about it. So I looked in my textbooks from school, and then the information was very minimal. And so I said, well, I'm going to find out about this. There was one support group online, and there just wasn't much out there. And so I started doing reading, and I actually went all the way back to the 17 hundreds reading all the research. Wow. Really all the research. And I would pull up medical textbooks from different years, like Williams Obstetrics and things like that, all the way back to the 17 hundreds. It was fascinating to go actually go to and medical library and pull these special books. You have to wear gloves to touch them.

Kimber McGibbons (09:53): They're like enshrined. But to go back and look and see, and it used to be until the 19 hundreds, HG Hyperemesis Gem was what this condition has caused and it was considered a toxemia of some sort, that there was some kind of toxic problem in the body. But around 1900, when Freud became popular, anything that was not explainable, especially with women, then it became something that was psychological. So around 1900, they decided that HD must be a psychological condition. So that's when they started treating it as such, and locking women in psych wards and doing crazy stuff like that, giving them, binding their hands and feet and dunking them in hot water and putting them leeches on them to Right. I mean, these were the treatments in the 18 hundreds. Right. It was really, really bad. Oh my God. So anyway, but I mean, I'm looking around going, really, there's not much out there. And Zofran was just new to the market, so people weren't really excited about using that. But I did manage to score some of that because the ER doctor took pity on me, and his wife had hyperemesis, so he gave me Zofran. And so I almost named my daughter Zofran, because I'm like,

Kimber McGibbons (11:03): I tell her that still. I'm like, you could have been so frantic. Right. Because truly, that was the only way that she made it here. Okay. Yeah. When I couldn't find enough information, and I was taking information to my health professionals saying, this is what I need, and most of them were like, yeah, I don't feel comfortable doing that. So I had to just suffer. And I'm like, this has to stop. So I just said, I'm going to put this information, I'm going to research this and find out what we can do to help women and how we can support them. So when, back in 1999, after I had my son, I ran across Dr. Marlena Fazo, who was doing a survey on hyperemesis, working on some research. She had just lost her baby to hyperemesis, and she said, I'm going to determine a cause of this.

Kimber McGibbons (11:53): And I'm like, well, I'm going to figure out how we treat this. So we said, we're going, we're going to connect. So after I recovered, we connected. So we kind of joke around. We've known each other for 24 years. Right. But we met online. That's kind of our joke. Online is our 24th anniversary. But anyway, she's amazing. She's a Harvard trained scientist. And so we partnered to do research, and I do a lot of the recruiting and help with the writing and the trial design and things like that. But we've done a lot of research over the years together. And so we've just, over the years, I put online a website and began developing tools and offering support and doing consulting with families and health providers and training educa, doing training for providers. And then we also set up a referral network where people can submit their doctors, and then that allows them to find doctors that are more likely, because there is no specialty of hg.

Kimber McGibbons (12:49): Sure. More likely to treat hg. So that's what we have done. And so I put that online. And then a few years after I had been doing this, a couple named annemarie and Jeremy King came along and said, Annemarie was literally dying in Texas because she couldn't get the care she needed an, she was having adverse reactions. And so her husband reached out and they decided they wanted to help me make what I had done, an actual nonprofit. So they came in and made a nonprofit, and they kind of helped me get all the paperwork done and helped me get the foundational stuff done. So that's been really great. And it's just been building our team with different people. We have an advisory council now. We have a board. Oh, good. Yeah, it's been really great. I love it. So we've been doing that for since 2000. Okay. So it's been 23 years.

Dr. Nicole (13:34): So let's get into hyperemesis or hg, and let's talk about it a bit. So what is the difference between that and morning sickness?

Kimber McGibbons (13:41): So hyperemesis, so nausea and vomiting in pregnancy is a spectrum. So you have on the mild end of it, you have mothers that have morning sickness, which is more like you can rest and maybe avoid using the subway and take a car instead and eat more frequently and lay down and take breaks. And you can manage miserable, but you can manage, get through life. You might have to take a couple weeks off from work during the worst of it, but for the most part, you can handle it. Usually you can get your prenatal vitamins down, things like that. But then, and you can eat a decent diet, maybe select foods. But with hyperemesis, it's more that you can't eat and drink very much at all, if at all. You may go weeks to months without eating much. If anything, you may eat a hundred calories to 500 calories a day for a long period of time. Food can be very aversive. You lack appetite. You lose all your muscle mass because you can't function. So you spend a lot of time in bed and you don't have any social life, and you feel very weak and you just feel sick pretty much 24/7 for months. A lot about half of women have symptoms beyond the first trim trimester.

Dr. Nicole (14:55): Okay. Yeah, that's what I was going to ask. How long does it last?

Kimber McGibbons (14:57): So most people have symptoms beyond 13 weeks. Usually between 14 and 20 weeks, about half of women have their symptoms subside, and then the other half gradually do towards the end of pregnancy or some of us, for me, it was all nine months. I had a couple of days in the middle where I was like, wow, I feel amazing. And I was very excited. And then it came back again. Yeah. So

Dr. Nicole (15:22): Yeah, about half, we'll get better halfway through pregnancy, but then the other half, it could last longer, unfortunately. Yeah.

Kimber McGibbons (15:29): Yeah. I mean, the numbers vary between 20 and 40%, but somewhere around mid-pregnancy, about half of women are pretty good to go.

Dr. Nicole (15:38): Okay. Yeah. Okay. And you mentioned some of the potential complications. You said losing muscle mass. What are some other potential issues that can happen? Well,

Kimber McGibbons (15:45): The complications are largely preventable. I want to say that with good care. And so it's really important, but you can have just, almost everyone's going to have some level of depression and things like that. You might have acid erosion of your throat and stomach ulcers from the acid, but then you can go into more severe things, like you could have your esophagus rupture. You could have moms that commit suicide. You have and have moms that develop preeclampsia. And we have many fetal losses. We have a number of terminations. They've gone down a lot since we've come along to help offer support. But there's still quite a few unwanted terminations, tons of dental issues. We have women that have five, 10 root canals. We've had women come along who have that require dentures and things like that because they've took their teeth or completely eroded. We have a lot of electrolyte issues and kidney damage, kidney failure, heart issues. We even have women, the very commonly we have women with severe thiamine deficiency, and that can manifest as heart issues, like tachycardia, all and arrhythmias and things like that. Or even brain damage from the swelling of the brain from lack of thiamine. And so we try to have all moms be on vitamin B one before they're pregnant and postpartum, just live on it for a while. Gotcha. Yeah. Okay. So it

Dr. Nicole (17:11): Can be very serious. Obviously,

Kimber McGibbons (17:13): We see it. We find about at least one mom every year dies somewhere in the global north. As far as the developed countries, we usually hear of at least one death. We've had some years where three or four mothers have died. And I would say that pretty many, pretty much all of them are preventable. Okay. Okay. Yeah.

Dr. Nicole (17:32): So what are some strategies, like just two or three strategies to approach treating hg?

Kimber McGibbons (17:39): So really the first thing that every family needs is to have a responsive doctor who thinks outside the box and having a plan in place. That's really important. But because with, you can make any medication plan you want, but unless you have a doctor on board who's willing to prescribe it, it doesn't help you. So we have all kinds of resources on our website to help them make a plan. But when they get down to making their plan, hydration is really critical. Without hydration, then your medications just don't work as well. But then once you have some hydration in place, getting a cocktail of medications that you take on a strict schedule is just very, very important. And so many moms are prescribed Zofran twice a day when it has to be scheduled four times a day, and on a very strict schedule. And I can see moms go to the ER every couple of days for weeks and weeks and weeks because they're given Zofran twice a day. And I just think of all the medical care and the hassle and the stress and the cost to the family that could be prevented just by giving medications on a schedule, strictly on a schedule, get up in the middle of the night to take them and taking them at a higher dose that they need. So

Dr. Nicole (18:48): Yeah, I have been frustrated at times that I've seen physicians describe it on a prn, so as needed basis. And it's like it really needs to be scheduled or else people get behind and then it gets really terrible. And I think another thing, what are your thoughts on stacking medi medications? Absolutely. Or a multimodal approach?

Kimber McGibbons (19:13): So the cocktail we find works the best, and this is 23 years and living through two twice. But the cocktail we find that usually works for a large percentage of women are mixing an antihistamine of some sort with Phenergan or Raglan, and a serotonin drug like Zofran or Ondansetron or Centron Rel, oh, one of those two, or even Mirtazapine, some people will do, will not respond to Zofran or Adaron, but they will respond to Remar on Mirtazapine. So really you have to just keep trying all these different options and different combinations. But also to that regimen, we would add an acid reducer and vitamin B one and vitamin B six B one is something that most people don't know about, but vitamin B one only lasts two weeks. And when you're deficient in it, then you develop basically hyperemesis. You have nausea, vomiting, weight loss, abdominal pain, headaches, like all of that.

Kimber McGibbons (20:16): And so when we have our moms come in and we get them started on B one at the start of their pregnancies, they tend to do better. Because if you think about it, if you've got a B one deficiency that's causing nausea and vomiting, and you give them Zofran, they're not going to fully respond. You haven't treated the B one deficiency. So if you treat both of them, that makes sense, then you have a better response to medication. So if you give 'em fluids, vitamins, and Zofran, they're going to do so much better, but you would not believe how difficult it is to get Vitamin B one. I joke with people that it's a controlled substance because getting it, I mean, I have moms that are 16, 18, 20 weeks who haven't eaten in months, and they're told that the baby's going to get what it needs, and then the baby dies at 21 weeks because 22 weeks somewhere in there, or they have a preterm birth because they're so vitamin deficient. So it's always, I guess it's still doesn't shock me, but it just, it's very hard to watch that happen over and over and over again. Yeah. So

Dr. Nicole (21:13): You mentioned some of the prescription options. Are there any over the counter options that can be added in

Kimber McGibbons (21:21): Well over the counter? Definitely. I mean, the acid reducers are great. They're not a treatment for hg, but they definitely, for me personally, when I took PPIs, the proton pump inhibitors, which are the medications like Prevacid and Protonix, those made the difference between whether I could and couldn't eat, and I still needed my Zofran. But those helped keep the acid down. Those are great. Antihistamines are over the counter. Those are great. And then some of the side effects from Zofran and the serotonin meds are constipation. And if you don't treat that, then you worsen the nausea and vomiting. And so those are over the counter, the citrate and the colac and things like that. Those are really helpful. And then of course, the B one and B six, we do recommend it's more absorbable than some of the other types of thiamine, but getting moms to take a thiamine every single day that they can.

Kimber McGibbons (22:11): And if they puke it up as nontoxic, just keep taking it. And if some moms can only do things like drink coke, they can't drink water, they can drink coke. And I'm like, okay, well, you're, when you eat a lot of sugar, which most of us with nausea and vomiting like carbohydrates. And so when you have a lot of carbohydrates, you use up your thiamine very rapidly. And so we encourage moms, the more carbs you eat, the more thiamine you take. But all that over the counter stuff really does help. Not a treatment, but it does help.

Dr. Nicole (22:39): Gotcha. Gotcha. What about any complimentary, what are considered complementary medicine options? Like acupuncture or things like that?

Kimber McGibbons (22:47): Well, I personally was very into holistic medicine, even though my traditionally trained nurse when I got pregnant. So I went through herbs, acupuncture, acupressure, Bowen therapy, all kinds of stuff and homeopathics. And most of it did little, or if it did help, it was just like maybe took the edge off for part of the day, but nothing really took the edge off. And so what we find is on a rare occasion, acupuncture will be significantly helpful. Hypnotherapy has also been tried. There are a few studies with a few herbs, but not a whole lot. The smell of those can be extremely difficult, so they're not really something that we can use a lot. So in general, I'm a huge fan of alternative medicine, but it just is not something that we focus on for hyperemesis A Wish, because I would love for that. But there are a lot of studies out there, but just none of them aren't showing any, can find anything that really works for sure. Gotcha. Gotcha.

Dr. Nicole (23:47): Yeah. So when people are on medicines, one thing I find, how do you make the decision to back down on your medicine and see how you're doing without the medicine? What are your recommendations around that?

Kimber McGibbons (24:02): I created this thing called the Rule of Twos. And so what we say is that once a bomb is in her second trimester or later, and she's had two good weeks where she's eating well, her symptoms are really minimal, and she's doing well, then we wean one medication at a time over two weeks. So that's my rule of twos. And so when people follow that, it's extremely helpful because bomb stop drugs, cold Turkey. And if they've been on Phenergan for eight months, then they can have really nasty side effects. Even acid reducers can have rebound acid from that. And the other thing is if you doctors say, oh, you're 20 weeks, you shouldn't need Zofran anymore. So they just stop it and they don't give them another prescription. Then they go home and then they relapse, and then you, it's harder and harder to get it under control. So that's why. But when they wean it over two weeks, when they get to a dose that they begin to relapse, they go, oh, stop and go back up to one level, and then they can stay on that level for a little while and see how they do. And then when they do it that way, they don't tend to have as many complications and relapses, and they just generally do much

Dr. Nicole (25:09): Better. I love that. I have never heard that in 20 years of being a physician. That's a great,

Kimber McGibbons (25:13): No way

Dr. Nicole (25:14): To think about it. Yeah, we don't, we just don't get a lot of training about hyperemesis. So it is just one of those things that we don't get a lot of training about. Like I said, I see a lot of folks do the whole P R N. We just don't do good about it. So I'm glad that folks are getting this information from

Kimber McGibbons (25:35): You. And we're developing an educational program we hope to roll out for physicians and health providers. Oh, nice. Next year.

Dr. Nicole (25:41): Okay. So if you had HG in one pregnancy, how likely is it to recur in the next pregnancy?

Kimber McGibbons (25:51): Our research has consistently found over 75% of the time. Okay. 75, 80 plus percent of the time there. Occasionally, it'll skip a pregnancy, and we think that's due to genetics. The challenge is some research looks at only hospitalization rates, and a lot of moms get home care. They figure out how to manage their medications better so they don't go to the hospital. So a lot of the ones that find lower recurrence rates just look at hospitalization, but only half of women are hospitalized. So that doesn't really help. Sure,

Dr. Nicole (26:23): Sure.

Kimber McGibbons (26:24): Okay. Give an accurate picture of the whole.

Dr. Nicole (26:26): Gotcha. So it's almost certain that you're going to get it, I mean, not almost certain, but there's a very high likelihood that it's going to occur very high. Okay. Yes. So if that's the case, then how do you prepare for it the next time around?

Kimber McGibbons (26:40): Well, preparing is really, really important. Having a financial plan, planning your family, so you don't have a surprise pregnancy.

Dr. Nicole (26:47): Oh, financial plan. I didn't even think about that. Yeah.

Kimber McGibbons (26:49): Yeah. Okay. And a social plan you need to have, I didn't have family nearby, and I didn't have a lot of friends. My friends worked, and because I had just gotten married, I moved to the other side of town. So I basically didn't have any support except in the evenings, that little bit of time between work and bed. So I was largely on my own. And when you can't drive for much of your pregnancy, you can't prepare food for yourself. We had to do things like put a cooler beside the sofa with snacks and drinks for me for the day. I couldn't go in the kitchen because of the smells, so, so having a social plan, being financially ready, checking out your insurance, knowing if it will cover home care, having a doctor in place, I'm a big fan too, of labeling all your foods, cleaning out all your cabinets before you're pregnant, because people are known to accidentally eat things that are not good by, and they have a moment where they feel good and they grab something and they just eat it. Like, I have a minute that I can eat, and then they get food poisoning. I had that happen when I was pregnant, and not a pleasant thing to have food poisoning and hyperemesis simultaneously, not at all.

Kimber McGibbons (27:54): So I'm a big proponent of really being, just cleaning out everything, stocking up on everything, and being prepared. So we have a whole lot of prep information on our website on doing that and being really, oh, and then another thing is really being as healthy as possible, clean. And some people detox and do hormonal balancing and some of the alternative and natural medicine ways of preparing their bodies. I'm a fan of all that. I did all that stuff the second time around, and it did help. It didn't cure my hg, but it definitely helped. So

Dr. Nicole (28:24): One thing I forgot to ask, you talked about home care options. What are some of the home care things that can help keep people out of the hospital with hg?

Kimber McGibbons (28:33): Well, getting fluids. So you can have either just a regular IV at home, or you can have what's called a midline or a PICC line. The midline PICC line, have a little bit more risk to them, but have getting daily fluids where you can, A lot of women do better if they get their fluids infused slowly. So if they can get them at home, or they can just infuse a bag over, say, six hours as opposed to 45 minutes that you get in the er. A lot of women with HG don't tolerate that. It makes them sicker. So having daily fluids allows them to not have to sit and gag down fluid all day. Because one of the things with HD that people don't understand, this is a very different way of looking at it than traditional. So when you have food poisoning, once you vomit, you feel relief, and your stomach begins to settle and you feel better.

Kimber McGibbons (29:19): It's not like that with hg. The impulse is continuous, and so when you start to vomit, you can't stop. And that can go on for an hour. And so doctors don't really fully understand that. And so they say, well, just try a bite. But all of us with HG know that one bite is going to send you into a vomiting episode that's probably going to last for an hour. And so every time you take a sip of water, you start to gag. And the more you drink, because it doesn't process very quickly, a lot of times it sits in your stomach, and then you just sit there and you gag and retch. And then, everything you do triggers nausea, nausea and vomiting, looking at the tv, reading a book, hearing noisy children, changing a diaper. So you're constantly on the edge of vomiting. So every time you put something in your mouth, it makes you want to vomit, which actually ends up causing some sexual issues within couples as well.

Kimber McGibbons (30:07): So it's a big trauma trigger in so many ways. So doctors just keep sipping, keep trying, and Yeah, you have to, but you also have to respect that for some women, drinking is going to make them vomit more than if you just give them a bag of fluids and let them not have to torture themselves all day long. Yeah. Yeah. So it's a really great option, but they can also get IV nutrition at home, or they can also get feeding tubes at home. Okay. Feeding tubes can be kind of hard to tolerate, but for some women, they do work. Okay.

Dr. Nicole (30:37): I've also seen more people using Zofran pumps at home. I don't know if you

Kimber McGibbons (30:42): Yeah. So my personal opinion is they can be very helpful, but I'd love for people to try to max out all medications. And when I have moms skidding Zofran twice a day, and then going to a Zofran pump, you Yeah. And you're going to love this one. But one of our big things that we've done for many, many years, like 17 years, will be moms that are getting oral dissolving tablets, we'll use them vaginally instead of orally. Really? Yeah, I know it all. The obese love that, and it works. I've never

Dr. Nicole (31:13): Heard of

Kimber McGibbons (31:13): That. Yeah, you can't do that with Prevacid or something. Right. But you can do it with Zofran. Yeah. God, I

Dr. Nicole (31:19): Learn something new every

Kimber McGibbons (31:21): Day, and it's really, it's very effective. And that the strawberry taste of the Zofran ODTs is horrible. And I know I just didn't tolerate them very well, the taste of them. But then when I had a kidney stone, they gave me one in the ER, and it just sat in my mouth because I was so dehydrated. And I was like, how do HD moms even get these to dissolve? Because there's, my mouth was so dry, I literally puked it up and you could still see the markings on it. You know what I mean? And I'm like, I'm sure you got some of it. I'm like, I can see it right here. I did, yes. They're like, well, we can't give you more. I'm like, it's not a controlled substance. Right. That's a four milligram tablet. I know that. But anyway. Yeah. But using Zofran or DTSs vaginally, it can be a very effective way because moms will gag at the taste of it and sometimes vomit before it fully exhausts or just not want to take it. It makes them a gag. So that works great. Some of our moms call it hooch in it, and they just love it, and it works really

Dr. Nicole (32:20): Great. Right. I love it. Love it. So is there any promising research being done to figure out what's causing this or better treatment options? Is there anything on the horizon?

Kimber McGibbons (32:32): Yeah, there are some treatment options. There's stuff I can't talk about,

Dr. Nicole (32:37): But there

Kimber McGibbons (32:38): Are hardly, hardly anyone. There are only a few teams in the world that are doing any research on HG because there's no funding. We get almost zero funding for our research, even though we've been doing this, and we're the only team in the United States that focuses on hg. Right. And if you haven't seen our research, are you familiar with the GDF 15 that we have in our research? No, Uhuh. Okay. So we just went to a medical conference and talking with an M F M who trains people about hg, and we said, do you know what the cause of HG is? And he goes, I wish we knew. Right? And I'm like, wow, you are doing training on this. And we do know one of the causes, one of the predominant causes of HG was found by our research team, Dr. Fazo. I mentioned early on, and there is a gene called GDF15.

Kimber McGibbons (33:29): And when the body has any kind of organ trauma stressor or a tumor, or the placenta is growing because of a baby, then the body pumps out a hormone called G DF 15. And so that hormone causes nausea and vomiting and weight loss and lack of appetite. And one of the major things that causes is massive taste aversions. So food that normally would taste good to you. For me, whole wheat bread tasted great when I wasn't pregnant, but when I was pregnant, it tasted dirt and grass wrapped in, I don't know, it was simply wrapped more dirt. It was like, no, it just tasted disgusting. And anything that tasted disgusting before, some fast food that I would never eat tasted like heaven when I was pregnant. Okay. Can't explain it. But that G DF 15 hormone, we now know changes all your taste. And so women have bizarre taste knees.

Kimber McGibbons (34:24): I needed my cheese cut in a certain way, and the top part and the bottom part cut off the cheese because I could taste all the stuff in the refrigerator. So it influences all of those sensory perceptions like that. So we're learning more and more over time as to how it is. But my theory has long been that the worse the HG gets, the harder it is to control what I see. But now we think that because the more severe you get, the women that are hospitalized have higher levels of G DF 15. And so I think that women that get more severe have higher levels of this, and therefore have worse taste versions, more anorexia, more lack of appetite, and more nausea, abdominal pain, all of those kinds of things. Their guts moves slowly, things like that. So all that begins to be an issue, but we're working on a multi-ethnicity gwas or genome-wide association study to look at the variants across different ethnicities.

Kimber McGibbons (35:18): And we have, I'm, I don't know where the last count is. Dr. Faso is the head of all that, but more, I think it's like eight groups or something, like different countries around the world. Sure. Trying to see if the variants are the same from one ethnicity to the other. And so we don't have the results yet, but we also have some other studies looking at hospitalization and other predictors of severity and other things that will determine if a woman will have HG more severely, longer need hospitalization, things like that. So ultimately we can get testing and predictive, predictive testing, things like that.

Dr. Nicole (35:52): Gotcha. I love it. That's really, really fascinating. I had never heard of that. Yeah. I forgot to ask for treatment. What are your thoughts on steroids to helping and helping treat hg? Well,

Kimber McGibbons (36:04): I have both a very scientific opinion and a non-scientific, so my slightly unscientific opinion is when I look at steroids, I find that they kind of have a shotgun approach on people. They affect so many systems that they can be very unpredictable in their side effects. So I tend to want to exhaust all the serotonin drugs, the Phenergan, things like that before I try steroids. And of course, we know that there's this very small risk of cleft palate and things like that if you take them early in pregnancy. So we try and wait until nine, 10 weeks before we try those. But I like to see, one of the other things I have, my rule two is I haven't found a way to put this in a rule yet, but one of the things that we have found over the years is you have to try different routes of medications, different schedules, different doses, all kinds of different options.

Kimber McGibbons (36:55): And that can take weeks to do that, but you evolve that very rapidly. It's not like, let's try this and wait two weeks, but you're constantly changing things one at a time to see what works. And once you've kind of exhausted all those different combinations of things, then if mom's still not doing well, steroids can be helpful. I would probably give it a 50 50 shot on whether it makes a huge difference. But for those, it helps. It can be very dramatic. And sometimes you can actually stay on a really low dose for an extended period of time, just a few milligrams. But we also are finding some success with gabapentin. Okay.

Dr. Nicole (37:29): I've heard that. Yeah. Yeah, yeah.

Kimber McGibbons (37:31): I've seen some kind of hormonal things happen with that. So I'm a little in the middle on that. And I know there's, there's a potential for addiction. There's also a potential for safety issues because the higher the dose, the more it makes you feel high. And so there's a lot of challenges with it. But in lower doses, probably relatively safe. Sure. All the safety data so far has been pretty positive. But for those moms that are considering termination or really at the end of the rope, yeah, I really encourage that.

Dr. Nicole (38:02): Yeah. Yeah. Okay. All right. So as we wrap up, what is the most frustrating part of this work that you do?

Kimber McGibbons (38:08): Well, 23 years, thousands of patients working with them all across the world. I talked to moms in Zimbabwe, Japan, Estonia, like, you name it, I probably talked to somebody in that country. And the issues are the same. They can't eat, they can't drink. They have malnutrition. They're developing preventable complications. They can't get the treatment they need. And that's the most frustrating thing over and over and over. I talk to these women and I know what they need, and I know what we can do to them most of the time that every once in a while we get moms that are really refractory to all treatment, but not being able to get them the care that they need and not getting their doctors that we hand them resources specifically made for doctors, and their doctors won't look at them and won't try things. And I think I know, and I can watch this preventable pattern. It's like, okay, I know by 24 weeks, you're probably going to have either lost your baby or you're going to preeclampsia preterm birth or something if you're not eating by 16 weeks. It's very predictive for the majority of cases. And we have moms that lose a third of their body weight over 60 pounds. I've had probably in the last six to nine months, I've had at least a half a dozen women lose 30, 40, 50, 60 plus pounds from hg. So it's really unfortunate. Yeah.

Dr. Nicole (39:27): That's heart. That's heartbreaking. Yeah. Yeah. So then on the flip side, what's the most rewarding part of the work?

Kimber McGibbons (39:33): Well, I mean, looking back and realizing that we've helped the termination rate go down by about 10% and seeing women seeing thousands and thousands of babies that we've gotten to walk through their pregnancies and moms coming back multiple pregnancies and coming back to help and seeing that by them helping us, they help heal their trauma. And just being able to support, I mean, our website has reached two and a half million people across the globe, right? 95% of the countries of the world. And seeing years of this as we're seeing the tide begin to turn, and just seeing moms not have to suffer as much as those of us who in years past that didn't get care that we needed, seeing them not have to suffer as much trauma. And we really haven't talked about the neurodevelopmental issues, but the children, there's a high rate of neurodevelopmental issues, behavioral and emotional issues, long-term psychiatric issues, possibly long-term cardiometabolic issues.

Kimber McGibbons (40:32): But these are pretty for the families. Our family was, I mean, I won't get into the details, but our family was, no, all other families did all kinds of things that we never did. We had special education, we had homeschooling, we had special programs, we had every kind of therapy you can imagine. And it was like, I mean, it completely consumed our family and it was extraordinarily difficult. So being able to help these moms know what treatments to look for their children, how to navigate that, there's just so much that comes from so many years of doing this and being able to watch fewer families have to suffer and have the trauma and the challenges that we did is just the best thing in the world. And then moms for years will send me pictures of their children watching them grow up, and that is my joy. I have a little families all over the world, and it just gives me, so I've got some babies in Kenya that call me grandma, and just like they, oh, she's made me teary eye. It just makes me so happy. I love to see that. Yeah,

Dr. Nicole (41:30): I love it. Love it, love it. Yeah. So then, what is your favorite piece of advice that you would give to someone who is struggling with hg?

Kimber McGibbons (41:37): I really think that really preparing for the worst of it and being very, very prepared and then hoping for the best, and just really having a lot of support and structure in place so that you don't have to suffer. I mean, having doctors and family and friends and enough financial support, all that, because the less of that you have, the more trauma you're going to have. Sure. The more stress you're going to have. And that affects not only mom, but baby and even the entire family for sure. So I think that just being prepared, it's just this immensely important.

Dr. Nicole (42:07): Yeah. So please tell us what is your website? I looked at the website. There's so many great resources there. So what is the website?

Kimber McGibbons (42:14): So we actually have three URLs you can find us at. So depending on who you are, you can remember one of them. So help her, H E L P H e r.org is kind of our mom, U r l, and then hyperemesis.org, and then also her foundation.org. You can find out us all three of those. And Okay. We have a section for mothers, for health professionals, and for families also, all of our research studies are on there in full text. And then we have a tools page that talks all about our resources that we have for families, for health professionals. And they're all written with our team of clinical experts on HG that we have a obs M F M. We have a whole team of people. And so everything is very scientific and based on two decades of working with families. So very, very helpful. And information you won't necessarily find very anywhere else.

Dr. Nicole (43:04): Yeah, please. And it really is great information. I'm certainly going to share it with folks that I know because a really great resource. Good. Good. Yeah. All right. Well thank you so much Kimra for agreeing to come onto the podcast. Absolutely. Thank you for having me. This is really helpful. Awesome. Yes, it's really helpful information and I know it's going to help somebody not suffer so much with hyperemesis.

Kimber McGibbons (43:24): Great. Thank you so much. I truly appreciate it.

Dr. Nicole (43:33): Wasn't that a great episode? Just tons of really informative and useful information for those who have hyperemesis. I really appreciate having Kimra. Come on. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. And here are my Dr. Nicole's notes from my conversation with Kimber. Number one, it is really fascinating to me how pregnancy changes you. I think pregnancy really changes us in ways that we don't fully understand. I find it really fascinating that once you become pregnant, you can certainly have, have rather food aversions that you never had before. Suddenly smells can be really different. Even textures and things can feel different, and those things typically go away after pregnancy. So I just find it really interesting and fascinating. We have to be open to all of the possible things that can occur during pregnancy and the changes that can happen.

Dr. Nicole (44:33): Don't let anyone dismiss or belittle or minimize what you're saying about how you feel during your pregnancy, because I really think that we just don't understand all of the ways that pregnancy changes our bodies, even changes our mental state potentially as well. All right. Second thing is that obs, we don't really get a whole ton of training about hyperemesis specifically. We get some information about treating nausea and vomiting in pregnancy, but not necessarily a ton on treating hyperemesis specifically and diagnosing hyperemesis in pregnancy. I have not infrequently seen doctors who approach treating this the wrong way. For example, one of the important things is doing medications, as we talked about in the conversation on a scheduled basis. You know, want to stay ahead of getting things, stay ahead of the nausea and vomiting so it doesn't get bad and not infrequently. I see doctors who don't understand that and prescribe medicine on an as needed basis.

Dr. Nicole (45:39): Sometimes that's emergency room doctors because sometimes folks with hyperemesis will end up in the emergency room and it's emergency room doctors who aren't prescribing the medications correctly, or sometimes it's OB doctors as well. So you definitely have to be proactive about your treatment and the options, which leads into the next point is that doctors don't often looking at resources, they don't often like to be pointed out or made aware that, hey, this other thing exists. Some doctors are open to things, but not all doctors are. You may have to say, Hey, can we try X, Y, and Z? You may not necessarily say that you read it or maybe you do. You may say like, Hey, I found this website and this information. Would you be willing to try this particular approach to treating this and see if we can do things a little bit different?

Dr. Nicole (46:32): Actually, that's kind of a good test to see if you have a doctor who's open to learn new things change and evolve and we should all be open to learn new things and improve our practice and improve the way we approach medicine in order to take the best care of our patients. So if you approach your doctor with resources and they're like, well, that's not how we do things, or that's not how it's been done, that's actually a sign that maybe you need to find someone who's going to be a bit more open to things. And I say all this to say that you should definitely go check out the resources that they have at their website, hyperemesis.org. It is tons of useful stuff like treatment protocols, very easy to understand information that you can then take back with your doctor and start a conversation about developing a treatment plan that's going to work best for you.

Dr. Nicole (47:23): Hyperemesis is can be a really miserable condition and you and I know it sucks because in the midst of not feeling great, you have to do all this, that, and the other with of looking for information. But this is what I love so much about their website, is that they really put it in a format that is easy for you to use, easier for you to print out, easier for you to take back to your doctor and have that conversation so you can get the absolute best care that you need. And then also, remember, as I said, community can also be an important part, just having supportive folks around you. And that can include virtual community too. So I would love to have you inside my Facebook group the all about pregnancy and birth Inner circle community. It's facebook.com/groups/dr Nicole Rankins. I would love to see you there.

Dr. Nicole (48:14): Alright, so there you have it. Do me a solid share. This podcast with a friend sharing is caring. It helps me to reach and serve more pregnant folks. Also, be sure to subscribe to the podcast wherever you're listening to me right now. Leave an Honest Review in Apple Podcast. It helps other women to find the show or shoot me a dm, a DMM on Instagram at Dr. Nicole Rankins. I love to hear what you think about the show. Love if you have new show ideas as well. And also, I post tons of great information and content on Instagram too. That's again, Dr. Nicole Rankins where I'm there. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.