An unexpected dr’s visit and the realities of prescription drugs in Singapore

Before I freak anyone out–I’m fine, the baby is fine.

For the squeamish–I’m about to talk about throwing up.  You’ve been warned.

Nausea and vomiting during pregnancy are sadly nothing new to me.  I spent the majority of Elanor’s pregnancy (7 weeks straight through the actual delivery) throwing up.  However, I didn’t have severe nausea with her after the first trimester.

With the current pregnancy, I’ve suffered from an overactive nose (EVERYTHING smells bad) and extreme nausea since the stick turned pink.  I’ve been vomiting regularly since about 10-12 weeks….you know, when all the books talk about how you’re feeling better and all the first trimester symptoms are disappearing.  Not that I’m bitter or anything (I will, however, confess to cursing out several tomes and flinging several against the wall for that very passage).  Honestly, in a lot of ways, I’m finding the persistent nausea and oversensitive nose far more debilitating than just the vomiting with E.

During Elanor’s pregnancy, my OB put me on two drugs that kept things to a minimum (ie, I was only throwing up a few times a week, as opposed to a few times a day)…reglan and zofran.

When I got a positive pregnancy test, I didn’t wait for the nausea/vomiting to begin…I just asked the OB I was seeing at the time for the local equivalents proactively, so they would be on hand.

Which is when I ran up against one of the realities of life in Singapore versus the US.  Not all drugs are available here.  Not all drugs are available in the same dosages (for example, Ravi has to take 2-4 times the number of medications he used to in the US to recreate his blood pressure regimen).  Worst of all, there is a sad lack of generic drug options in Singapore.

Overall, I would argue that most name brand drugs are cheaper in Singapore than in the US.  However, there are exceptions.  Zofran is one of them.  Twenty of these precious miracle pills set me back $1000SGD ($810USD). For comparison, when I was in the US, I got sixty pills of the generic zofran for $200 USD.  That is quite a difference, especially as my insurance has a cap for pregnancy related expenses and I’d like to not use it all on anti-nausea medication (obviously we can afford additional expenses, but why pay more per pill when I can get a generic cheaper in the US?).

However, the other issue I’ve run up against in recent weeks is that my old regimen of zofran and reglan haven’t been doing their jobs.  The last 10 days have seen my symptoms get significantly worse (instead of better as all the books say…liars).

The reason I missed posting yesterday was that I was unable to keep anything beyond a glass of water down for 24 hours and was dehydrated, sick, and very weak.

My local OB gave me two options-the first was to be admitted for 24 hours to the hospital.  I’m really not a fan of hospitals, so I declined (although in retrospect, it probably would have been the better decision).  My second option was to come to her office and get fluids and a dose of a different anti-nausea drug that had been recommended to me by several friends/readers-Phenergan.  I elected this option.

I went in and got the IV plus anti-nausea, which worked better than anything else I’ve encountered during this pregnancy for my nausea.  (By the way–Dawn and Sandy–THANK YOU).

When Ravi tried to fill the prescription, we were unable to get a pill form of phenergan.  Again, the realities of drugs in Singapore sometimes mean that you have to be more flexible.  So I got the syrup version instead, which is vile tasting (worse than cough syrup) but more importantly, works!  I’ve kept down 4 whole meals straight, which is a record at this point.

After my IV was through, my OB and I agreed that she should do a quick ultrasound just to confirm that the baby was looking okay, given that I’d been having a lot of pain and cramping (most likely a combination of normal 2nd trimester stuff and irritation from all the vomiting, which takes a toll on your stomach muscles as well).  The baby was fine, and measuring on schedule.

As I was still a bit woozy (phenergan, at least at first is a very soporific drug), they waved off payment, saying I could just take care of it next time.  They also wheeled me down and put me in a cab so that B could meet me and help me upstairs at home.  Looking back, had I understood how tired the phenergan would make me (after getting home I slept another 5 hours after sleeping for most of the 2 hours it took to get the IV fluids) I probably would’ve elected the hospital stay, regardless that I really hate hospitals.

I have to admit, I have my doubts about medical care in Singapore.  I’ve had doubts about giving birth here.

Yesterday my OB’s office really helped me out, and the help was much more personalized than I would have gotten in the US.  In the US, I would’ve called my OB’s office and they would have sent me to the labor and delivery triage floor of the hospital.  I would’ve gotten the IV there, and possibly a resident or the supervising doctor would have done an ultrasound.  But other than a report, my OB wouldn’t have been able to be involved in my care as individual offices just aren’t set up for that sort of thing.

This, along with the long email my OB wrote explaining things I had questions about earlier this week, is the sort of thing that has me giving strong consideration to staying in Singapore for the birth.  Obviously I’m in very good hands here.

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12 Responses to An unexpected dr’s visit and the realities of prescription drugs in Singapore

  1. Dawn says:

    I’m glad the phenergan’s working for you, though very surprised it’s not available in pill form. I don’t find it makes me that sleepy – even the first time I took it – but I suffer from GAD/insomnia, so very little knocks me out. (Surprisingly, benadryl is able to knock me out but leave me exhausted *and* anxious, which is the worst feeling ever).

    It’s possible a lot of how tired you were after getting out of the hospital was less due to the drug than due to the fact that you were less nauseous and therefore your body was producing less adrenaline, and you’d been sleep-deprived so your body took the opportunity to urge you to catch up. I bet you felt better after you slept? (Sleep is really a wonder-drug; the difference between 3 hours and 8 hours can mean nauseous all day versus not nauseous at all for me.)

    • Crystal says:

      Honestly, there’s a weird disconnect between which drugs are available here and in what form. For example, there’s no compounding pharmacy for children’s meds. I’m really glad E was ready to wean off her anti-reflux meds as all they wanted me to do was crush a pill and mix it with water…would never have worked with E versus a small liquid compounded dose.

      • Dawn says:

        Speaking of that and sorry to change the subject…do you have any strategies for getting a toddler to take meds that they don’t want to take? F had a bad reaction to amoxicillin (which we had finally gotten her to take willingly) so we had to switch up her antibiotic, and the new one she absolutely refused, to the point that she was screaming so much while it was being forced into her that she threw it all up immediately. We got a prescription for a *third* antibiotic which we’re going to attempt to give her tonight, and asked for a special alternate flavoring (apparently she doesn’t like cherry, which is the default and was the flavor for the last one), but I’m dreading the fight tonight.

      • Crystal says:

        Honestly, we tried mixing it with applesauce, etc.

        With E, we still generally have to told her down and syringe it into the back of her throat, forcing her to swallow by rubbing her throat. However, after her first two doses of amoxicillin, we realized that she was old enough to bribe. Stickers worked for us. (with minimal spitting out/drooling out).

        Best of luck…I dread few things like I dread giving E medicine.

  2. Sandy says:

    I have had a couple 3 year olds who refused to take any meds. Bribes sometimes work – take the meds get M & M’s. I have had docs suggest mixing with mint chocolate ice cream, usually something they like, and the mint will cover the smell and taste of the meds. My husband didn’t take anything as a kid that wasn’t mixed with a spoon full of jelly. I know lots of people say not to mix with anything, due to the stronger likelihood that they won’t get the full dose, but if the choice is between no meds and a partial dose, I say go for it.

    • Crystal says:

      I think you’re totally right that it’s best to get some of the drug than none of it. It’s also far less unpleasant than being puked on after the kid gets themselves worked up.

      Never worked with E, though. She figured us out and spat it back in our faces. Sigh.

      Kids and medication is never fun.

  3. KJ says:

    In Australia, Phernegan is the parents drug of choice for knocking out their kids – often used during long haul travel, so I’m not surprised you;re tired!

    I was advised jsut the other day that should I require any prescription medication I should pop over to Johor Bahru. Which isn’t a great dealof help as the last thing you would want to do at the moment is travel anywhere, but just thought I’d mention it anyway.

    Hope the treatment works and you hvae m full sympathy as I am also not someone who revels in pregnancy. A week after having my 4 year old I weighed 6 kilos less than when I fell pregnant. x

    • Crystal says:

      Yikes. Like you, I ended E’s pregnancy weighing a decent chunk LESS than a weighed at the start. I sat in my mommy and me classes and kept my mouth shut when the other moms were complaining that they couldn’t fit into their normal clothes and I’d had to go shopping for a smaller than my normal size. Sadly the weight came right back once I wasn’t puking anymore. Of course.

      I don’t know if I’d trust JB for prescription drugs. I imagine it’s far less regulated than Singapore. But it’s probably still worth keeping in mind 🙂

      You’re the second Aussie I know to tell me Phenergan is the knock out drug! I’ll have to try it out on E next long haul flight because benadryl never worked for that purpose for us.

      • KJ says:

        Just be careful with Phenergan it has the OPPOSITE effect on some kiddies, so you better do a trial run before a plane trip!

        Hope you feel better soon. x

      • Crystal says:

        Good point. That seems to be the case with E and Benadryl. Doesn’t make her sleepy AT ALL.

  4. prongs says:

    Hi I’m an anonymous Singaporean reader who’s been following your blog.
    For your nausea, why not give some TCM (traditional chinese medicine) a try. Nothing too scary. Just boil some ginger and a bit of rock sugar to make ginger tea and drink it whenever the nausea hits.

    • Crystal says:

      Thanks for commenting and your suggestion.

      With my first pregnancy (and to some extent with this one) I did try herbal options first. I’m not a tea person (never have been) but I’ve tried ginger candy, ginger ale, “preggie pops” (herbal based sour candies from the US for nausea), and a wealth of other options. Unfortunately I’m one of those women for whom the hormonal changes are so overwhelming that without medical intervention, I’d spend my pregnancy in the hospital being forcibly re-hydrated on a constant basis. Hyperemesis…it’s not a pretty or fun condition.

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