Varicose Veins

WHAT ARE THEY?

Varicose-Vein

Varicose veins occur when the valves (that keep the blood flowing one way through the vessels) have become weak, which allow the blood to pool in the veins. This “pooling” causes the veins to become lax and distended.

CAUSES:

  • May be due to diet
  • Lack of exercise
  • Heredity
  • Hormone changes can cause the laxity of the valves
  • Pregnancy can be a predisposition for some women
    -Because there is a congestion of the blood in the lower extremities due to pressure from the uterus.
    -The return of blood from the legs to the pelvic area is reduced by the heavier uterus.

They are most common in the legs, ankles and feet. They can also show up in vulva (Vulvar variscosities) and anus (as Hemorrhoids). They become more pronounced as the pregnancy advances.

The vulvar variscosities usually are not noticible until birth. Some women notice the large ones during pregnancy. A gentle birth and hot compresses applied to the large distended veins will reduce damage or trauma to the veins. Occasionally bleeding or hematoma (internal pooling of blood) can occur and will require medical care.

Hemorrhoids become evident after birth, normally. So the use of gentle birthing will help with these as well. Constipation will aggravate hemorrhoids, and should be treated (although, following a good diet will reduce constipation due to the additional fiber from foods).

Usually the varicose veins will empty quite quickly after pregnancy. They are quite common during pregnancy, and usually repair is not considered during that time.

RECOMMENDATIONS

• Eat well, and drink lots of water
• Exercise! Exercise improves the circulation, and assists in both the prevention of and treatment for varicosities.
-Brisk walks for 30 minutes each day
-Or ride a stationary bike for the same length of time as walking
-Swim
-Yoga
-Belly dance moves such as pelvic rocks, and rolling/rocking the hips in a figure-eight.
-Dance!
• At least 20 minutes twice a day with feet elevated higher than the heart
• Do NOT sit in one place for too long. This would encourage insufficient pelvic and leg circulation.
• If you have severe varicose veins use support stockings (you can find them at a drug store.
• Use visualization to reduce the size and number of the varicose veins.
• You need to consider who / what is your support. You are not superwoman, and will need support during this very exciting time in your life!

CAUTION: Never massage the varicose veins! Massaging the veins can cause clots to dislodge and lead to an embolism. Embolisms are dangerous! If you see signs of phlebitis (swelling, heat, pain, infections around the veins) you should see the doctor or midwife right away.

DIETARY RECOMMENDATIONS

Follow the “baby wise” diet . Be especially careful to eat whole grains, high quality proteins, fresh vegetable and fruits as often as you can.

• Vitamin C with bioflavonoids is vital for assisting the walls of your veins to be strong.
• Foods with high vitamin C: citrus fruits, rose hips, dark green leafy vegetbles, cherries, alfalfa sprouts, strawberries, cantaloupe, broccoli, tomatioes, and green peppers.
• An additional 2,000 mg. of C with bioflavonoids can also help
• Vitamin E also is good for the vascular system. Take 200 to 600 IU a day. If you have heart or blood pressure problems begin with 50 IU and work up to 400 IU over a three month time-frame.
• B complex vitamins. Whole grains, nutritional yeast (I take mine in orange juice), and yogurt (its helps maintain intestinal integrity ).
• Green Vegetables…romaine (stop eating the low-vitamin Iceburg variety) lettuce, butter lettuce, turnip greens, kale, collards, mustard greens, dandelion greens, and turnip greens. Steam these, do not boil!

HERBALS

• Nettle leaf tea (One herb in the “Pregnancy Tea” blend I use) . Infuse by making 1 ounce of herb to 1 quart of water and allow to steep for 2 hours. Drink a cup to up to a quart a day depending on severity.
• Garlic, onions, oatstraw, calendula, motherwort, can also be consumed. Please consult an herbalist for guidance on their use.
• Kelp. Kelp can be added to soups or taken in a tea form.
• Deficiencies in essential fatty acids may make the varicose veins worse. Take 500 mg. of one of the following oils once each day: evening primrose, flaxseed oil, black currant oil, or borage oil.

REFERENCES:

Romm, Aviva Jill. The Natural Pregnancy Book: herbs, nutrition, and other holistic choices (2003) Celestial Arts

Lowdermilk, Dietra Leonard and Shannon E. Perry. Maternity and Women’s Health Care, 9th ed. (2007) Mosby.

Stress, Part 2

Stress

stress

Social and Family Stress

Social stress can be an actual threat or that what is perceived as a threat. These are within ones social environment. This could be relationships at work, conflicts at school, or interactions that occur within a person’s society.

Inside the family unit certain life events can affect the family directly or indirectly. Some of the stressors could be things that are deemed “normal” such as a birth in the family.

Stressors could be caused by ambiguous facts, such as an illness of unknown cause in which the doctor states the person will die at some time. Also, there are stressors that are caused by nonambiguous facts such as the onset of a severe storm and its aftermath.

Volitional stressors are things such as divorce, things that members of the family may cause or control the end result. Chronic stressors are events that occur over an extended time, such as a handicapped family member. Acute Stressors are temporary, such the hospitalization of woman giving birth. An isolated stressor is a singular event, such as the arrest of a family member.

Family stressors can proceed a crisis within the family but not all family stress leads to a crisis. Here are four indicators that a family is in a crisis:

• Members within the family are no longer able to function with their family roles
• Family members cannot make decisions and solve problems
• They are unable to give care to each other in a way usually seen
• A shift from family to individual survival

Sexually Transmitted Infections – Part 3

Syphilis

Transmission “is thought to be by entry in the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse (Lowdermilk & Perry, 182)”. It also can be transmitted through kissing, biting, and oral-genital sex.

The rate of transmission declined from 1995-2004. Syphilis continues to be at a high rate in the southern states.

Primary syphilis appears 5-90 days after as a lesion or chancre, usually painless. Then it erodes into an ulcer appearing sore.

Secondary syphilis occurs 6 weeks to 6 months after transmission. Its appearance is a widespread, symmetric rash on the palms and soles of the feet; with affected lymph nodes. Some individuals also have a fever, headache, and generalized malaise (under-the-weather sensation).

In the vulva, perineum, or anal area Condylomata lata may develop. If left untreated the female may enter a latent phase. If still left untreated, tertiary syphilis will develop, in approximently 1/3 of these women. In this third stage, neurologic, cardiovascular, musculoskeletal, or multi-organ system complications can develop.

Screening and Diagnosis

All women who are diagnosed with another STI or with HIV should have a screen form syphilis. All pregnant women should be screened at the first prenatal visit.

Diagnosis is dependent upon the microscopic exam of primary and/or secondary lesion tissues during the latent or late infection. Serologic tests of antibodies may not be reactive, in early tests.

There may be false-positives with VDRL or RPR screenings. This is not unusual for several reasons, such as: drug addiction or acute infection. To confirm the positive results the use of treponemal tests, fluorescent treponemal antibody absorbed (FTA-ABS) and microheagglutination assays of antibody to T. palidum (MHA-TP) are used to confirm positive results.

Testing should be repeated at 1 to 2 months when genital lesions exist. This is due to early exposure not showing results until 6 to 8 weeks after exposure.

Other STI tests should be done at this juncture, for chlamydia, gonorrhea, et al. HIV should be also offered as a test if indicated.

Management

Penicillin is the preferred drug for treatment. Doxycycline, tetracycline, and erythromycin are alternative treatments. Tetracycline and Doxycycline are contraindicated in pregnancy.

Some pregnant women may get what is known as “Jarisch Herxheimer ” reaction, that may be accompanied with headaches, myalgias, and arthalgias . If the treatment occurs at the second half of pregnancy, it may cause early labor and birth. Their doctor should be contacted if fetal movement stops or if contractions occur.

Women should abstain from sexual activity during treatment and all evidence of primary or secondary syphilis is gone. She should also tell all partners that have been exposed, and that this disease is to be reported.

Sexually Transmitted Infections – Part 2

Gonorrhea

Gonorrhea is exclusively transmitted sexually, genital-to-genital contact; but can also be transmitted oral-to-genital or anal-to-genital. In females the disease can spread from the genitals to the rectal area. It can be spread to the newborn in the form of ophthalmia neonatorum through vaginal birth.

AGE is the most important factor. Statistically, sexually active teens, young adults, and African Americans are at the highest risk. The majority of those who have contracted this disease are under the age of 20.

Girls who are prepubescent the two most common symptoms is vaginitis and vulvitis. There may be signs of infection, or vaginal discharge, dysuria and swollen, reddened labia.

The factor of concern, most adolescent females show no signs or symptoms. When they DO have symptoms they are less pronounced than those of men. In women there may be some cervical discharge, but usually it is minimal of lacking altogether. Irregularity of the menses may be the presenting symptom or complaints of pain within the pelvis.

In rectal gonorrhea, the symptoms may not be asymptomatic or the opposite with severe discharge, pain and blood in the stool. There may be rectal itching, fullness, pressure, and pain…as well as diarrhea.

Since Gonorrhea is a highly transmittable disease all recent partners (30-days prior) should be reported, cultured, and examined. Most treatment failures occur due to reinfection.

Screening and Diagnosis

All pregnant women should be screened at the first appointment. Those women with risky behaviors indicated, should be re-screened at 36 weeks. The screening is done through “cultures”.

Management

45% of those women who are found to have Gonorrhea also have Chlamydia. For both pregnant and non-pregnant women, the treatment should be cefixime in a single dose.

All women with co-existing syphilis infections should be treated as for syphilis. Penicillin is the preferred drug for treatment. The alternative (especially for those allergic to penicillin) is Doxycycline, Tetracycline, and erythromycin. Tetracycline and Doxycycline are contraindicated in pregnant.