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K. Vatras. Bethel College, McKenzie, Tennessee.
Avoid contact group sports as well as exercise at high altitude discount 75mg anafranil with amex depression symptoms test, and do no scuba diving or downhill skiing whatsoever. Beginning in the second trimester, the official party line is that you must avoid exercises done on your back. The theory is that you can start to squish your vena cava with your uterus—the vena cava sends blood to your heart to get oxygenated. While this rule of no-more- lying-on-your-back isn’t conclusively proven, it’s wise to obey it until we know better. As you progress through your pregnancy, the best thing you can do is listen to your body. If anything feels painful, if you can’t perform at the same speed or level that you could before, or if you suspect you’re pushing yourself too hard. Shorten and simplify your workouts as your pregnancy progresses and your symptoms change. Stop exercising and visit your ob/gyn if you experience any of the following: • vaginal bleeding • dizziness • headache • chest pain • muscle weakness • calf pain or swelling • preterm labor • decreased fetal movement • amniotic fluid leakage. The Gottfried Protocol for Pregnant and Postpartum Women As you probably know, there is a much higher safety standard for what we’ll recommend for pregnant and postpartum women. It’s very expensive to perform the type of safety trials that are needed to put a supplement in the “safe” category for pregnant women. When it comes to The Gottfried Protocol while breast-feeding, I recommend omega-3s and to continue a high-potency multivitamin as you gradually increase your exercise. Pregnancy Once you’re pregnant, stick to the preconception diet I recommended earlier, and make sure you have plenty of nutrients, lean proteins, and healthy fats. When you’re pregnant, you want to make sure you get enough slow carbs such as sweet potatoes and quinoa. There are so many benefits for you and your baby, and the latest evidence shows that yoga even helps prevent high-risk complications such as high blood pressure (both pregnancy-induced hypertension and preeclampsia), gestational diabetes, and intrauterine growth restriction, which is a problem that can lead to your baby not growing as intended. Yoga has also been shown to be supportive in making a healthier baby, as measured in weight and 17 Apgar score. Sadly, most of the supplements, such as phosphatidylserine and rhodiola, have this warning: Insufficient reliable information available. I imagine you are frustrated to hear this, but the truth is that it’s just not black and white when it comes to safety in pregnancy and nursing. For women who are pregnant and have morning sickness, most doctors recommend Unisom. The American College of Obstetricians and Gynecologists states that the recommendation of “taking Vitamin B or Vitamin B plus 6 6 doxylamine is safe and effective and should be considered a first-line treatment,” which is based on consistent scientific evidence. In fact, 33 million women have taken it safely, yet the bottle advises against it. That’s just one example of how the standard is much higher for pregnant and postpartum women, and I cannot give blanket statements about whether one supplement is safe or not. Your best bet is to discuss any supplement, over-the-counter medication, and/or prescription with your clinician. I recommend you find a practitioner who shares your values and with whom you can speak openly. Then you can rely on her advice about what will be safest and what will work best for you individually. Postpartum When it comes to women’s hormonal health after pregnancy, postpartum is a menopausal state. You enter the birth experience with sky- high hormones, especially estrogen and progesterone, and when you deliver your placenta, your hormones drop to the floor. I recommend continuing most of the food and lifestyle changes you implemented before and during your pregnancy, but you can now push yourself harder with exercise once you pass your six-week checkup with your clinician. In fact, I work with a psychiatrist who prescribes an estrogen patch as a first line of therapy. The tricky part of being a new mom is the sleep deprivation—lack of sleep alone can tip the best of us toward the blues, even depression. Because supplementation is a bit of a minefield and the quality of safety data is sparse at best, I encourage new mothers to focus on food- based nutritional healing. We know that women under stress do best when they are with their girlfriends, so I suggest very strongly that new moms join a postpartum yoga class or baby boot camp. Additionally, I recommend essential oils for pregnant and nursing women, and all of the stress reduction techniques listed below.
Both of these factors are associated with a worse prognosis than less advanced lesions and estrogen-receptor- positive tumors buy generic anafranil 25mg on-line depression chemical imbalance. Delays in diagnosis of 3–6 months significantly diminish the chances of survival in both pregnant and nonpregnant patients. As part of family history collected, any genetic relative of the patient who has had breast cancer should trigger a simple screening for breast carncinoma. Treatment strategy depends upon (1) stage of the carcinoma and (2) gestational age of the pregnancy. If the procedure is done close to term, risk to the fetus can be eliminated if the infant is delivered first (Bloss and Miller, 1995). The usual accepted surgical technique for breast carcinoma in the pregnant patient is modified radical mastectomy with axillary node dissection (Marchant, 1994). Moreover, radiotherapy may present a significant risk to the fetus (Petrek, 1994). These guidelines are consistent with the recommendations made in 2005 (Pentheroudakis and Pavlidis, 2006). Chemotherapy is frequently recommended for either adjunctive therapy or treatment in advanced cases. Women with axillary lymph node metastases appear to be the best candidates for adjunctive chemotherapy (Barnavon and Wallack, 1990). As detailed pre- viously in this chapter, chemotherapy with currently available antineoplastic agents car- ries an increased risk of congenital anomalies with first-trimester exposure, and fetal growth retardation is the major risk in the latter two-thirds of pregnancy, although long- term effects are unknown. Special considerations 143 The efficacy of breast carcinoma treatment during pregnancy appears to be enhanced little, if at all, by therapeutic abortion and prophylactic oophorectomy (Donegan, 1986). Therapeutic abortion might be a consideration if radiotherapy is deemed neces- sary or if chemotherapy is necessary during the first trimester. However, with proper shielding and focused radiotherapy above the maternal diaphram, it may be possible to minimize the adverse effects of radiation on the fetus (Pentheroudakis and Pavlidis, 2006). Leukemia Acute leukemia is extremely rare during pregnancy, occurring in approximately one in 100 000 pregnancies. However, it is among the most common neoplasms in young women (Caliguri and Mayer, 1989; Catanzarite and Ferguson, 1984; Koren et al. Review of 72 cases of leukemia during pregnancy (13 separate reports), 64 (89 percent) women had acute leukemia and eight (11 percent) had chronic or other forms of leukemia (Caliguri and Mayer, 1989). The survival rate was approximately 75 percent in one report of 45 pregnant women with acute leukemia (Reynoso et al. Antineoplastic drugs most commonly used to treat chronic leukemia include antimetabolites (methotrexate, thioguanine, mercaptopurine, and cytarabine), anthracy- cline antibiotics (daunorubicin and doxorubicin), and plant alkaloids (vincristine). Therefore, all antineoplastics have a very high potential for production of birth defects during embryogenesis because this period is character- ized by the highest rate of cell division (hyperplasia) in a human’s life. The prognosis for survival in the untreated woman is extremely poor, with life expectancy of less than 3 months (Catanzarite and Ferguson, 1984; Hou and Song, Table 7. Therefore, chemotherapy should be initiated immediately (even during the first trimester) once the diagnosis of acute leukemia is made. Among a series of 58 infants born to pregnant women who had either acute myelo- cytic or lymphoblastic leukemia, there were 31 (53 percent) premature births (including five stillbirths), and 23 (43 percent) full-term infants (two of whom were of low birth weight) (Caliguri and Mayer, 1989). No studies have been published of congenital anomalies among the infants born to women with leukemia during pregnancy. No con- genital anomalies have been reported among the 13 fetuses exposed to chemotherapy for leukemia during the first trimester (Caliguri and Mayer, 1989). Lymphomas and Hodgkin’s disease An estimated 40 percent of malignant lymphomas are of the Hodgkin’s variety and are the most commonly encountered lymphoma among pregnant women, and occur among approximately one in 6000 pregnancies. As with breast carcinoma, pregnancy does not seem to affect the prognosis for Hodgkin’s disease (Lishner et al. Both leukemias and lymphomas are known to metastasize to the placenta, but the empirical risk is unknown. Treatment of Hodgkin’s lymphoma, like that of most other malignancies, depends on the stage of the disease and the gestational age at which the disease is diagnosed.
Because the speed of depolarization determines how quickly adjacent cells depolarize(and therefore af- fects the speed of conduction of the electrical impulse) anafranil 25 mg on-line depression without meds, Class I drugs decrease the conduction velocity of cardiac tissue. In so doing, these drugs change the shapeof the cardiac actionpotential, and thus change the three basic electro- physiologic properties of cardiac tissue:conduction velocity, refrac- toriness, and automaticity. Effect on cardiac arrhythmias Tachyarrhythmias are mediated by changes in the cardiac actionpo- tential, whether the mechanismisautomaticity, reentry, or a chan- nelopathy. It is not difficult to imagine, then,howdrugs that change the shape of the actionpotential might be useful in treating cardiac tachyarrhythmias. Inpractice, the drugs commonly referred to as antiarrhythmic are relatively ineffective in treating automatic arrhythmias or chan- nelopathies. Instead, the potential benefit of these drugs isalmost exclusive to the treatment of reentrant arrhythmias, whichaccount for most cardiac arrhythmias. Nonetheless, drugs that change the shape of the actionpotential canpotentially affect all three mecha- nisms of arrhythmias. Automatic arrhythmias Abnormal automaticity, whether atrial or ventricular, is generally seeninpatients who are acutely ill and as a result have signifi- cant metabolic abnormalities. The metabolic abnormalities appear to change the characteristicsofphase 4 of the cardiac actionpo- tential. The changes that most likely account for enhanced abnor- mal automaticity are an increased slopeofphase 4depolarization or a reducedmaximum diastolic potential (i. Ei- ther typeofchange cancause the rapid,spontaneous generation of actionpotentials and thus precipitate inappropriate tachycardia (Figure 2. An antiarrhythmic drug that might be effective against automatic tachyarrhythmias islikely to reduceone or both effects. Unfortu- nately, no drug has been shown to reliably improve abnormal au- tomaticity in cardiac tissue. Therefore, the mainstay of therapy isto treat the underlying illness and reverse the metabolic abnormalities causing abnormal automaticity. A logical treatment, therefore, istoadminis- ter a drug that reduces the duration of the actionpotential. Treating the arrhythmias most ofteninvolves discontinuing digitalisand administering beta blockers. Brugada syndrome Thissyndrome is caused by abnormalities in the rapid sodium chan- nel. Antiarrhythmic drugs that further block the sodium channel (Class I drugs) seem to potentiate the abnormalities associatedwith Brugadasyndromeand should be avoided. Other drugs, including 40 Chapter 2 beta blockers and amiodarone, have at best provenineffective in treating thissyndrome. Reentrant arrhythmias Incontrast to the limitedusefulness of antiarrhythmic drugs in treat- ing automatic arrhythmias and channelopathies, these drugs, at least in theory, directly address the mechanism responsible for reentrant arrhythmias. Afunctioning reentrant circuit requires a series of prerequisites— an anatomic or functional circuit must be present, onelimbofthe circuit must display slowconduction,and asecond limb must display a prolonged refractory period (to produce unidirectional block). One can immediately grasp the potential benefit of a drug that, by chang- ing the shape of the cardiac actionpotential, alters the conductivity and refractoriness of the tissues forming the reentrant circuit. A drug that increases the duration of the cardiac actionpotential (thereby increasing refractory periods) fur- ther lengthens the alreadylong refractory period of one pathway, and thus may convert unidirectional blocktobidirectional block, which chemically amputates oneofthepathways of the reentrant circuit. Alternatively, a drug that has the opposite effecton refrac- tory periods—one that reduces the duration of the actionpotential and shortens refractory periods—may shorten the refractory period of one pathway so that the refractory periods of both pathways are relatively equal. Withoutadifference between the refractory periods of the twolimbs of the circuit, reentry cannot be initiated. The key point in understanding howdrugs affect reentrantar- rhythmias is that reentry requires a critical relationship between the refractory periodsand the conduction velocities of the twolimbs of the reentrant circuit. Because antiarrhythmic drugs canchange these refractory periodsand conduction velocities, the drugs can make reentrant arrhythmias less likely to occur. Proarrhythmia The manner in whichantiarrhythmic drugs work against reentrant arrhythmias has an obvious negative implication. For example, if a patient with a previous myocardial infarction and asymptomatic, nonsustained ventricular tachycardiahad an occult reentrant cir- cuit whose electrophysiologic properties were not able to support a reentrant arrhythmia, such as the circuit shown in Figure 2. With suchadrug, the refractory period of pathway B may be sufficiently prolonged to prevent reentry from being initiated.
He gives this for premature labor pains in doses of from ten to flfteen drops buy anafranil 75 mg mastercard mood disorder quotes, and in other conditions where both remedies are indicated, he gives from ten to twenty drops, as in severe persistent lumbago, sometimes with immediate results. Other agents which act harmoniously with it to a greater or less extent are passiflora incarnata, the bromides, and chloral hydrate, conium maculatum, physostigma, veratrum, and Jamaica dogwood. Antagonists—This agent is antagonized by alcohol, by strychnine, nux vomica, digitalis, ammonia and, to a certain extent, by caffeine and belladonna. Antidotes—In overdoses, heat applied, with electricity, and alcoholic stimulants, friction, artificial respiration, and hypodermics of atropine or strychnine should be administered. Physiological Action—Tonic in large doses, irritant, causing nausea, vomiting and diarrhea. Therapy—This is a popular stomachic tonic in cases where enfeeblement has occurred as the result of protracted disease. It has long been given in combination with other tonics or in wine, as an agent in the dyspepsia of the aged, or of gouty patients, and in the gastric inefficiency of infants and children, and to a good advantage in catarrhal diarrhoea. As a tonic to the stomach, and the other organs of digestion and appropriation, in those cases where the system is greatly debilitated by protracted disease, it is one of the best remedies, especially by exhausting fevers of malarial origin. It is of much value in malarial conditions generally and has been used to a great extent instead of quinine. When the periodicity has been overcome by quinine this is a rapid restorative to the system. The tincture of gentian is given freely in conjunction with other tonics and with alteratives. It is given with the tincture of iron in the treatment of anemia complicating malarial disease. It is given in conjunction with the iodide of potassium where a tonic and alterative is demanded, and given alternately with hydrocyanic or hydrochloric acid, it is sometimes of great value in the vomiting of pregnancy. It can be depended Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 235 upon as a bitter tonic and constant use will establish a confidence in it. It influences the mucous structures, directly improving their tone and function, overcoming relaxation and debility with a marked improvement of the capillary circulation. From long experience, I have learned to esteem geranium more highly than any other vegetable astringent, where a simple tonic astringent action is needed. It is palatable, prompt, efficient, and invariable in its effects, and entirely devoid of unpleasant influences. Specific Symptomatology—Where there are relaxed, atonic or enfeebled mucous membranes, in the absence of inflammatory action; debilitated conditions remaining after inflammation has subsided; excessive discharges of mucus, serum or blood with these conditions, this agent is indicated. Therapy—In sub-acute diarrhoea, geranium exercises an immediate influence, a single full dose producing a marked impression and improving the tone of the entire gastro-intestinal tract from the first. In chronic diarrhea, no matter how stubborn, it may be given with confidence if the specific conditions are present. In doses of ten drops every two hours, diarrheas of the above described character will promptly subside. It is the remedy for the general relaxation of the gastro-intestinal tract in childhood, with protracted diarrhea. In catarrhal gastritis, where there is profuse secretion with a tendency to ulceration, with, perhaps a mild hemorrhage, this agent is Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 236 very useful. It has been claimed that incipient gastric cancer has been cured with geranium, and there is no doubt that it takes precedence over many other remedies, when a diagnosis between severe gastric ulcer and incipient cancer cannot be made without exploratory operation. Its range seems much wider than that of a simple astringent, as it controls pain and rapidly improves the general condition. It has an influence over passive hemorrhage unlike that of other agents, but in violent cases of recent origin it is not the best remedy. The author treated a case of haematuria for nearly two years with absolutely no permanent impression upon the condition. Tubercular bacilli were found in abundance in the blood, which was usually arterial in character and steady in quantity.
