Week 5- pica through end of minor complaints

Question 1

what is pica? etiology?

Answer 1

eating inedible objects

generally physiological signal of protein or Ca2+ deficiency or glucose intolerance

Question 2

2 possible ways to tx pica naturally

Answer 2

improve diet
homeopathy (stomach craves strange things during PG= chel, mag carb, lyssin; stomach desires lime/slate/pencils/earth/chalk= nit ac)

Question 3

tx for diarrhea in PG?

Answer 3

increase bulk/fiber, raspberry tea (esp root), if dt infxn then 4 caps charcoal q 1-3 h PRN, only short term

Question 4

a PG mom presents w/abd pain, what do you need to r/o? what other less serious things could it be dt?

Answer 4

serious: placenta abruption, UT infxn, ectopic PG, appendicitis, constipation, KD infxn, premature labor, ruptured ovarian cyst
less serious: round lig pain, braxton-hicks, baby kicking or punching, pain in groin is normal when getting close to delivery

Question 5

etiology of SOB in PG?

Answer 5

anemia
mechanical P of uterus against diaphragm late in PG
r/o heart or respiratory problems
adjustment to changes of PG

Question 6

etiology of palpitations in PG? management? tx?

Answer 6

increased blood vol= increased P and workload on heart aggravated by wt gain
functional arrhythimas
in sternal area mb dt P of uterus on diaphragm
anemia
r/o thyroid problems esp hyperthyroid
management: if regular consider EKG/consult w/cardiologist
if irregularly irregular consider consult
tx: mg/ca, cactus grandiflorus, homeopathy (arg-n, con, laur, lilium-tig, nat mur, sepia)

Question 7

etiology of breast tenderness in PG? tx?

Answer 7

increased size dt prep for lactation

tx: well-fitting bra (no underwire, blocks ducts), heat, cimicifuga

Question 8

what are the 4 circulatory problems that can occur in PG?

Answer 8

hemorrhoids, varicose veins, edema and nose bleeds/bleeding gums

Question 9

etiology of hemorrhoids (varicose veins too)? tx options?

Answer 9

laxity of veins (prog caused); increased uterine size increases back P on pelvic venous system and lymphatics, straining w/constipation and increased P
tx options: tx constipation, botanicals (hammamelis virginiana, collinsonia canadensis, symphytum off, potato wedge suppository), sitz bath, exercise (including kegels), homeopathy (aesc, am-m, cap-s, coll, ach, lye, nat-m, nux-v, sulph); keesey tx w/local anesthetic, BHI cream

Question 10

with a PG mom with varicose veins what do you need to monitor for? prevention? tx?

Answer 10

thrombophlebitis (homan’s test for deep varicosity)

prevention: elevate legs above heart q4h for 15 min, rx support hose or ace bandage, decrease standing, be aware of FHx
tx: botanicals (ahmmamelis, collinsonia), vigorous massage, supplement with Vit E, Bioflavs, lecithin, pycnogenol, alt hot and cold, slant board, homeopathy (calc fluor cel salt, carb veg, ferrum, fl acid, puls, arnica, ars, caust, mill, nux-v, zincum, hamm, lyc, ly-cps, graph if lower leg; mer, podo if vulvar)

Question 11

etiology of nosebleeds/bleeding gums? tx?

Answer 11

increased vascularity, Ca2+ deficiency, check that bleeding w/cuts/bruises stops normally
tx: medicago sativa, bioflav, Vit C, Ca2+, homeopathy (repertorize but ferrum phos, phos can be good options)

Question 12

etiology of edema? tx?

Answer 12

increased uterine size= slow venous return, increased permeability and increased blood vol pushes fluid into interstitial space
tx: 15-30 min rest q4hr w/legs above heart (lie on side in 2nd 1/2 of PG), nutrition (adequate protein, fluid and salt), taraxicum, acupuncture, exercise, homeopathy (merc-c, zinc)

Question 13

etiology of MS pain? prevention? tx?

Answer 13

relaxin softens SI jts which pulls on lumbar musculature and can cause P on nerves + hypermobility on SI and pubic symphysis, change in body wt can change posture, increased size of UT causes pull on ligs (lumbar lordosis)

prevention: sensible shoes, proper lifting (avoid heavy wts) PN exercises
tx: SI manipulation, SI blocking, exercises, rest q4h (esp if standing a lot), firm mattress, props, SI belt or truss, Ca2+ (1500-2000 mg/d), botanicals (symphytum and hypericum), homeopathy (arnia, calc fluor)

Question 14

etiology of leg cramps? tx?

Answer 14

lactic acid build up, Ca2+ deficiency, decreased circ in legs
tx: Ca2+/Mg+ (1500-2000 mg Ca/1000 mg Mg qd + PN vit), exercises (stretching, don’t point toes), massage during cramp, viburnum opulus, alt hot/cold baths, homeopathy (calc phos, gels, viburn, sepia), avoid diary, check for adequate salt intake

Question 15

etiology of pubic bone pain? sxs? tx?

Answer 15

etiology: mb dt relaxin or hypertonicity of psoas musc causing tendon to click over the pubic tubercle
ssxs: bad pain on lifting legs, pain rolling over in bed, pain walking
tx: pubic bone adjustment, trigger pt massage of psoas, pillow b/w knees, get up slowly

Question 16

etiology of carpal tunnel? tx?

Answer 16

etio: edema, compression of carpal tunnel (median nerve distribution of sxs)
tx: B6 100-200 mg BID, cervical and thoracic manipulation, look at scalenes (possibly TOS), decrease meat in diet (AA increases PGs= inflammation), homeopathy (rhus tox, ruta, causticum), bromelain, wrist braces, wrist manipulation

Question 17

h/a etiology? tx?

Answer 17

etio: all the non-PG etiologies, increased BHcg, blood vol changes, anemia, hypoglycemia, calcium deficiency, PIH
tx: avoid aspirin or tylenol (dec plts), calcium plus rainbowlite, homeopathy, hot foot bath w/cold compress on neck

Question 18

syncope and dizziness etiology? tx?

Answer 18

etio: increased vaginal response to position change, inc demand on heart, anemia, inc blood vol, hypoglycemia
tx: tx for anemia, hypoglycemia, sepia

Question 19

what 4 skin sxs can be assoc w/PG?

Answer 19

stretch marks, mask of PG (cholasma), rashes, pruritis

Question 20

what % of stretch marks are genetic? what % of women will get them? what % go away postpartum?

Answer 20

50% for all

Question 21

tx of stretch marks?

Answer 21

tx: vit C, E, Zn in prenantal vits, exercise to improve musc tone and decrease skin sag, wheat germ oil or vit E cream/oil topically

Question 22

etiology of mask of PG? tx?

Answer 22

inc pigmentation dt hormone changes, MC in women w/poor diet; liver not processing hormones well
tx: ddx AI (lupus), caulophyum thalictroides, homeopathy( sepia, phos)

Question 23

etiology of rashes? tx?

Answer 23

inc metabolism, sweating, inc intertrigenous spaces (more skin to skin)
tx: cold compresses or soaks, homeopathy (cantharis, ars, sulphur), oatmeal bath

Question 24

what is hydrorrhea graviderium? is it normal? what does it present as? what can it be confused as?

Answer 24

normal profuse watery d/c
white or clear, non-pruritic
normal mucus is protective, keeps out infxn
increases at end of PG
can be confused as water breaking (won’t be alkaline like amniotic fluid will be)

Question 25

etiology of yeast infxns? 3 prevention techniques? tx?

Answer 25

predisposed dt inc in estrogen, change in pH

prevetion: cotton underwear, good hygiene, low sugar
tx: vinegar retention douche, acidophilus capsule vaginally qd, boric acid capsules vaginally, UV light w/calendula succus, nystatin suppositories if severe, monistat 7 if nothing else works

Question 26

what 3 vaginal infections do we need to worry about in PG?

Answer 26

yeast infxn, trich, BV

Question 27

when would you treat a PG mom w/trich?

Answer 27

not until postpartum unless symptomatic or can use homeopathy or vaginal packs

Question 28

tx for BV in PG? what do you need to remember w/BV (presentation)?

Answer 28

cleocin vaginally

BV may be asx so do a wet prep early on

Question 29

if PG mom presents w/vulvar itching what is your work-up? 2 txs?

Answer 29

swab w/hydrogen peroxide followed by UV light, need to determine cause (gardnerella, yeast, etc)
tx: urtica tincture, rescue remedy cream