Category: Pre- and Post-Natal

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An Incredible Introduction

Meeting Adam for the Very First Time
Meeting Adam for the Very First Time
 

For the first time ever, I recently experienced something wonderful and poignant which I would like to share with you.  Several weeks ago, I met an adorable baby named Adam*.  Adam is the first baby I have met who was born in part due to my services as a pelvic floor physical therapist.  When I first met Adam’s parents, Sarah* and Jonathan*, they had been married for approximately one year without ever having consummated their marriage.  Despite multiple attempts, Jonathan and Sarah were not able to participate in intercourse due to Sarah’s pelvic floor muscle tightness which resulted in sexual dysfunction.  They tried various approaches, such as acupuncture and relaxation approaches, however nothing succeeded at reducing Sarah’s pain.  Even though Sarah knew that this was not her fault, she could not help but feel embarrassed and shameful about her symptoms.  She began to wonder if she would ever be able to participate in intercourse with her spouse, and this led her to question whether or not she would be able to have children.  The couple decided to raise the issue with Sarah’s doctor, for the potential benefit outweighed the discomfort and awkwardness associated with the conversation.

Fortunately, Sarah’s gynecologist was familiar with the benefits of pelvic floor physical therapy, and she quickly realized that Sarah was describing musculoskeletal related pelvic floor dysfunction.  Sarah left the office that day with a prescription in hand for pelvic floor physical therapy.

I am grateful that I was granted the wonderful opportunity to guide Sarah along her healing journey.  I initiated a downtraining program for Sarah in order to help stretch and relax her tight pelvic floor muscles.  Her downtraining program included external and internal manual therapy, myofascial release, trigger point work, pudendal nerve glides, diaphragmatic breathing exercises, and hip and low back stretches.  In addition, I taught Sarah how to use both dilators and the Therawand, tools which enabled her to perform vaginal desensitization training at home between sessions.

Sarah responded well to pelvic floor physical therapy.  I remember the day several months into therapy when she excitedly arrived at her session and shared the wonderful news that she and Jonathan successfully consummated their marriage.  Sarah continued her therapy for several more months, and she informed me that she and Jonathan had begun family planning conversations.  She was at a point in her therapy where she was independent in a thorough home exercise program, and she had all the tools at her disposal to maintain a healthy pelvic floor.  Sarah was discharged from physical therapy, and we have remained in touch since then.

Do you know how you remember very specific details about monumental, life changing moments?  Well, fast-forward to December 2014, and please picture this scene: I was about to embark upon a vacation, and I was standing in line at the JFK airport check in catching up on last minute emails and text messages.  I had not heard from Sarah in several weeks, and I noticed that I had received a message from her.  I opened the message which informed me that she and Jonathan were expecting a baby.  My eyes welled with tears of joy and happiness, and to this day I still feel chills when I think about that moment.  I was overjoyed, but I was all alone at the airport with no one to share the moment!  (For half a second, I debated giving a hug to the woman who checked in my luggage; I used my better judgement and decided against that.)  After the many months of hard work, dedication, and commitment, Sarah and Jonathan had finally arrived at their ultimate goal.  What an honor and privilege it was to be God’s messenger in that process and to be the conduit through which this incredible couple’s dream would shortly come true.

Fortunately for me, I often meet wonderful people through my work.  I am constantly inspired by my patient’s and their significant others.  Sarah and Jonathan are the paradigmatic example of such a couple.  Jonathan was incredibly supportive throughout the therapy, and his loving patience facilitated Sarah’s journey.  According to Sarah, “Riva’s excellent and compassionate care helped my husband and I be able to have physical intimacy in our marriage that was previously impossible.  Her work with me also enabled us to have our sweet son.  We are so grateful!”  After Adam was born, Sarah and I met for coffee so that I could meet their precious little miracle.  It was a moving and emotional experience for me, and it reminded me how blessed I am to be a pelvic floor physical therapist who has the opportunity to help people with such intimate and personal aspects of their lives.  I hope to have the opportunity to continue doing so for many years to come.

*Names and minor details have been changed out of respect to involved parties

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Bothersome Bile

Common Symptom of Cholestasis of Pregnancy: Itchy Palms of Hands and Feet
 

Many of us are familiar with gestational diabetes, a form of temporary diabetes that occurs during pregnancy, but very few of us have probably ever heard of cholestasis of pregnancy.  I am not ashamed to admit that I myself had not heard of the concept until last week, when a patient brought it to my attention as part of her medical history, despite my specialization and continuing education classes.  Therefore, I did what any health care provider would do.  I decided to research it and discuss it in my latest blog in order to educate and enlighten you!

Cholestasis of pregnancy (aka obstetric cholestasis and intrahepatic cholestasis of pregnancy) is an uncomfortable phenomenon characterized by severe itching, most often on both palms of the hands and soles of the feet.  It involves impaired flow of liver bile, a dark fluid involved with lipid digestion in the small intestine.  Itchiness may occur on other parts of the body as well.  Itching is often worst at night, and it often interrupts one’s ability to sleep.  Other less common symptoms of cholestasis include jaundice (yellowing of the skin and whites of the eyes), loss of appetite, and nausea.

The exact cause of cholestasis of pregnancy is unclear, yet researchers believe there is a strong genetic factor that contributes to its development due to the commonly observed familial pattern of the disease.  Furthermore, certain pregnancy hormones which circulate in greater concentrations, especially during the third trimester, may contribute to its development.  It is believed that pregnancy hormones decrease the flow rate of bile from the liver, and the buildup of bile in the liver causes bile acids to seep into the bloodstream.  Once the acids have entered the circulatory system, they can be transported anywhere in the body, including the hands and feet, where they often tend to accumulate and create itchiness.

Risk factors for developing cholestasis of pregnancy include a family history of the condition, a previous history of liver disease, and a twin pregnancy.  A previous personal history of cholestasis of pregnancy is also highly correlated with development of the condition in subsequent pregnancies.  In fact, approximately 50-66% of women will experience a recurrence of cholestasis of pregnancy.  While onset of cholestasis of pregnancy often occurs during the third trimester and worsens prior to one’s due date, it may develop earlier in the pregnancy as well.  It can be diagnosed via blood sample tests which measure liver function and blood bile levels.

Treatment of cholestasis of pregnancy is aimed at alleviating maternal discomfort and prevention of complications.  Ursodiol (Urso or Actigall) are medications commonly prescribed to decrease the amount of bile in the bloodstream and to relieve itching.  Antihistamines are contraindicated and may be harmful to the fetus.  Lukewarm water baths are also recommended to decrease itchiness.  Doctors often recommend early induced delivery at approximately the 37th week of pregnancy due to the fact that it may have harmful effects on the fetus.  Cholestasis of pregnancy is associated with preterm birth and meconium contamination of amniotic fluid, which may lead to fetal breathing complications.  Once the baby has been delivered, the intense itchiness resolves within several days.

If you or someone you know are pregnant and can relate to these symptoms, please discuss them with your general practitioner or obstetrician.  Accurate diagnosis can lead to proper treatment, which will help both you and your fetus.  For other pregnancy changes and challenges, Revitalize Physical Therapy can help with your musculoskeletal related pregnancy needs.  Please contact us with any questions you may have about how our services can help you.