Dear Dr. Roach: My friend has severe morning sickness. She just found out that she is pregnant with her first child, and can鈥檛 keep anything down. Do you have any advice?
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 flavours and odours. For some women, frequent naps and a shorter work day help; sadly, that isn鈥檛 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鈥檚 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鈥檛 good, either.
Dear Dr. Roach: My wife recently died from 鈥済raft versus host disease鈥� after a very successful liver transplant. I can鈥檛 find much about the disease as it鈥檚 so rare. Her transplant centre 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鈥檛 do anything to stop it. What can you tell me about it?
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鈥檚 liver and skin most commonly. 聽
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鈥檚 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鈥檚 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 per cent. Attempts are sometimes made to use the recipient鈥檚 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.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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