Question #6: What exercises can I participate in while pregnant?

Physical fitness is just as important during pregnancy as when not pregnant, maybe more so.  There are two main points to keep in mind.

The first is that any activity that could potentially injure you could injure the baby. The converse is also true, any action that is not going to injure you is not going to hurt the baby.  The fetus is in an extremely protected environment.  It is cushioned in a bag of water which is covered  by a thick muscle which is in turn covered by the mothers strong abdominal muscles and to varying degrees, a fat layer.  Exercises such as jogging, cycling, treadmills, ellipticals and climbers are great in pregnancy.  Swimming is a super way to exercise in pregnancy.  Light weights and weight machines are also safe and useful for pregnant women to stay in shape or get in shape.  Calisthenics such as stretching, sit ups and push ups, yoga, lunges, Pilate's are all ok.

I suggest people take care when snowmobiling, skiing, boarding, water skiing, boating, climbing, etc... as these activities carry an inherent risk of injury.  While it isn't likely one is going to get hurt in these activities care should be used, and keep in mind if it can hurt you it can hurt the baby.

The second point is related to maternal heart rate,  It turns there is an optimal heart rate that allows the heart to be the most efficient at pumping blood.  It has to do with filling time and the volume the heart is pumping per stroke.  This rate is at about 140 beats per minute.  So when doing cardio workouts please try and keep your heart rate at a maximum of 140 beats per minute.

One last comment about activities.   It is uncommon for a pregnant woman to be a scuba diver but for those of you who might be, take care.  The partial pressure of oxygen in the blood is affected by the pressures of diving and most authorities don't recommend scuba diving in pregnancy.  I have an avid and experienced diver who while pregnant has taken dives to 20 and 25 feet and has had absolutely no problems but I cautioned her to go no deeper.  Snorkeling is safe and very rewarding save the occasional shark attack..

Question #5: Is it normal to have bleeding when you are pregnant?

It is never normal to bleed when you are pregnant.  Having said that, it certainly doesn't mean that if you do bleed it means you will miscarry or even have any harm to the baby.  In fact it all depends when in the pregnancy, how much, and what the source of the bleeding is.

Early 1st trimester bleeding (within the first 12 weeks) is always concerning to me as it does increase the risk that the pregnancy may be non-viable or end in a miscarriage.  If the bleeding is light or moderate, lighter then a normal period, there is about a 50/50 chance it portends a loss.  That also says there is a 50% chance all will be normal.

Bleeding in pregnancy can come from 4 possible sources; the placenta, the cervix, the bladder or the bowels.  If its from the cervix it is often associated with intercourse and is usually light.  Bladder bleeding can appear and would be indicative of an infection.  The most common type of bowel bleeding is related to hemorrhoids and can usually easily be elucidated. So these are not usually dangerous to the pregnancy.  Bleeding from the placenta can be indicative that the pregnancy is not growing or already dead.  The heavier the bleeding and the more the cramping the more concern. It is a simple thing to find the answer and an ultrasound can almost always tell us the truth.

Bleeding during the 2nd and early third trimester is much rarer. If it's heavy even as much as a period it should be evaluated either by going to the hospital or your doctors office a.s.a.p.. Light bleeding that is not painful is likely coming from the cervix, especially if it is associated with intercourse. Your doctor should be informed but it is not an emergency.   Heavy bleeding at this stage of pregnancy can mean the placenta is separating and is an emergency.

Bleeding in the late 3rd trimester or near the last 3 or 4 weeks of pregnancy can either be associated with labor and cervical change or the placenta and possible placental separation.  Again it is important if it is heavy like a period or heavier and painful.  This type of bleeding would be more likely from a placental separation and is an emergency.  Light bleeding that is not painful or associated with contractions is not an emergency but may mean labor is starting and a hospital or doctors office visit would be advised.

Question #4: Can I use Tylenol while pregnant?

There are various causes of pain in our bodies.  The nervous system has multiple types of sensory nerves to interpret different "injuries" to our bodies.  There are stretch receptors, pressure receptors, thermal receptors, and if you crush or cut a nerve fiber or receptor end it will send impulses back to the brain.  Those impulses are interpreted to some extent by which fibers they are arriving on.  If a crush injury occurs on your leg, all of the sensory nerves; i.e. pressure, stretch and thermal,  are sending messages and the brain initially "reads" pain but it takes the eye, past experience and the minds computing of all of this input to understand what is really happening.

So, all pain medicines work to either block the pain messages from going down the fibers, or to alter the brains interpretation of the message.  We sometimes separate these different modalities of pain relief as centrally acting or peripherally acting.  Injectable medicines such as xylocaine work peripherally to block nerve impulses, while codiene works within the brain to alter the brains interpretation of the impulse.  Pain medicines are also categorized into opioid and non-opioid analgesics. Tylenol or acetamenophine is a non-opioid while morphine is an opioid.  Both are centrally acting..

One important process in our bodies that involves healing and defense is called inflammation.  Inflammation is the mechanism whereby the body tries to kill, seal off and limit damage from insults whether they be infectious or traumatic.  Inflammation is swelling, redness, production of heat, and is modulated by the immune system and immunochemicals.  This process is started by a chemical reaction originating from a molecule called cyclooxygenase.  It causes pain. Many of the commonly used pain relievers block this chemical reaction.

Steroids such as prednisone and hydrocortisone have long been known to block inflammation.  They inhibit this inflammatory process in multiple ways sometimes to the bodies long term detriment.  Drugs were developed that didn't have such broad suppression of the immune system but limited inflammation.  These are called Non-steroidal antiinflammatory drugs or NSAIDS.  Ibuprofen, good old aspirin and Naprosyn are examples of common NSAIDS. Tylenol is not an NSAID which is important.

There is a part of the fetal circulation that allows blood to flow thru the heart and bypass the lungs. In the fetus the lungs play no real role in keeping it alive so not much blood is needed there while the baby is developing in the uterus.  Science found that NSAIDS cause that bypass mechanism to close and the concern with using NSAIDS during pregnancy is that it will close.  It is called the ductus arteriosis.  It is really only theoretical and has never been confirmed to happen even in women who have uses NSAIDS during pregnancy. In fact, there is a type of NSAID called Indomethicine that was used for some time to help prevent preterm labor.  No cases of premature closure of the ductus were ever found. Never the less, we don't recommend using these drugs during pregnancy. On the other hand there is no known dangers to using acetimeniphine or opioids during pregnancy in recommended amounts. No adverse effects have ever been shown to the fetus and thousands of women have used these drugs in large amounts.

In fact, treating a fever (which Tylenol is effective at reducing) and eliminating the pain of a headache is probably beneficial in pregnancy allowing the mothers normal bodily functions to proceed unhampered.  Tylenol is safe to take during pregnancy.

Question #3: Can I get in a hot tub while pregnant?

The discussion in question 2 regarding the thermo regulatory center of our body and the baby being isolated from the external environment is the basis for our concerns about hot tubs.  Body biochemical reactions are quite temperature sensitive and only work well between about 96 degrees and 102 degrees. Our bodies are very efficient at keeping our temps about 98.6 degrees Fahrenheit.  The babies core temp in utero runs about 99.5 to 100 as it's only temp regulation is related to the blood flow from baby thru the placenta.

As you would expect, the baby could get over heated if the mothers body temp is elevated and she is unable to cool herself such as in a hot tub.  The normal body temp being close to 99 allows bath or hot tub water to be safe around 100 degrees.  This would feel very warm to the touch and very comfortable and one could spend as much time as one wished at this temp.  I recommend in water from 101 to 105 to limit time submersed to 10 minutes.  This water would feel hot and would turn the skin red.  At 104 -105 it would be hard to get into.  Anything above 104 or so I recommend staying out of.

Question #2: Is it ok to tan when pregnant?

The body has an amazing temperature regulation system. It is part of the autonomic nervous system and is located centrally within the brain.  It is the thermoregulatory system. It controls our body temperature by shunting blood to the peripheral skin surfaces, dilating these vessels, and causing sweating which cools the skin by evaporation.  It sometimes malfunctions such as when we get an infection and associated fever.  The main way we keep our bodies the right temperature is by our interface with the outside world.

A fetus is cocooned within the uterus which is surrounded by fluid and by the maternal body.  These coverings isolate the fetal body from interaction with the outside world environment thus eliminating in large measure its ability to regulate its own temperature.

So,  how does this all relate to tanning?  The light rays used in a tanning booth are either UVA or UVB on the electromagnetic spectrum.  These are relatively short wavelength and have very limited capacity to penetrate solid structures including the human body.  The penetrance of these light waves is only millimeters into the epidermis/dermis of the skin and in no way could reach the fetus so well covered within the uterus.  The only possible issue could be the over heating of the mothers body which is very unlikely in a tanning booth.  Thus, it is totally safe for your pregnancy to tan in a tanning booth.  It may not be the best idea when it comes to causing skin cancers and you increase your risks of developing skin cancers by exposing you skin to these damaging light rays.  Melanoma is the most common type of skin cancer associated with sun damage.

Question #1: Is it safe to use hair dye when pregnant?

Is it safe to use hair dye when pregnant?

The dyes used to color hair are varied and depend on the color of the underlying hair pigment and the color planned on.  They include peroxides and ammonia which cause no problems in pregnancy. P-phenylene diamine, 1,4, diaminobenzene and 2,5, diaminotoluene are other common dyes.

These can be toxic to humans and would potentially harm a pregnancy only if ingested into the systemic circulation.  Little if any of these chemicals are able to penetrate the skin and with the caps used to protect the scalp it is even less of a problem.  Inhalation of the fumes has not been shown to be a problem but I would always recommend a well ventilated area and even a fan to dissipate the fumes.

Over all it is safe to use hair colors during pregnancy and has never been shown to be a danger to the fetus.  Don't drink the stuff however! :)

Tori's Struggle with Drug Addiction (Part 3)

The day I saw Dr. Dewey was a Friday. I had taken pills that morning about 9am. My appointment was at 11am. So by the time I got home I was already feeling sick. On my way home I had so many emotions going through me. I was scared to death to go through detox but I was done taking pills. I knew as soon as I got home I had to flush all the pills I had, because I knew when it got bad and when I got super sick I needed to have no options but go through the detox. I also contacted my friend that day and told her the gig was up. She was cold to me, but I knew that it was a necessary step.

What I experienced for the next seven days was something that is hard to express in words. By that evening I felt completely weak and very nauseated. By the time it had been 24 hours I just wanted to die. Looking back it was a good thing that I got rid of all my pills, because without a doubt being as sick as I was, I would have taken anything to not feel the way I felt. Although my husband felt like I needed to be in rehab, I knew in my heart that I could do it myself; which was a lot harder than I expected. I can’t tell you the countless prayers that I said during that week. And I know at times that prayer was the only reason I was able to continue.

Dr. Dewey has been a listening ear for me and I see him every couple weeks to check in. The reason for sharing my story is because I want women that are going through my same struggles to know that it is possible to take back control of your life. Never give up hope! The 4-7 days of hell that you’ll go through doesn’t compare to how good you’ll fell knowing you’ve got your life back. It will always be something that I struggle with. It’s been just over two months now, so it’s something I think about every day. I’m no longer in a fog. I can think clearly. I’ve lost weight – about twenty pounds! My relationships will take some time to mend completely, and I’m far from perfect, but I’m grateful I’m where I am at today.

This may sound silly, which people without addiction might not understand, but I still have refills on some of the pain pills. I have chosen to leave it that way because it empowers me to know that I that they are within an arm’s reach but I chose every day for myself that I don’t want them in my life. Choosing to stop on my own is so much better than someone else choosing for me. – Tori, age 34

I believe Tori will make it! She is unusual in that she came to a self-realization early and was able to sop “cold turkey”. We often will taper someone and use other meds to damper the effect so the withdrawal but her method worked for her.

She emphasized an important point I alluded to earlier; most people can’t be forced to change their behavior. The change has to come from inside. Locking someone away from the problem only solves the problem temporarily and superficially. Tori felt empowered to change her life and having a prescription around added to that source of empowerment, but I wouldn’t recommend it for most. Stay as far away from it as possible, it’s not a good idea for an alcoholic to spend a lot of time in a bar.

                Is Tori at risk to start using again? I believe she is and I’ve talked to her carefully about his. The physical and psychological aspects of her life have not completely changed. She will still have a high level of risk because of these needs to justify, and return to her drug use. Her awareness of this will help.

How do all of you see this? Any comments or questions?

Alice - Where do I fit in?

Alice: Hey, I have a somewhat personal question for you. Well, it’s personal for me, not you. How do you feel about that on Facebook? I’m not planning on coming for a doctor’s appointment until February and am curious about your thoughts about his particular subject.

Dr. Dewey: I am happy to entertain personal questions in this venue, as I believe it is private. Shoot!

Alice: I figured as much, but wanted to check first. I’m thinking about having an intimate piercing. Have you have experience with them? I think it will be beneficial for me, but am wondering if you think it will cause me problems down the road. Keep in mind I’m only 31…I need my parts happy for a long time.

Dr. Dewey: From a physiological basis there would be no benefit. It would not add anatomic benefit to achieve orgasms. It may, however, psychologically add much. Our sexual function is in a large way tied to the psyche. I don’t think it would be harmful to your anatomy if done sterile and professional.  I wonder how it will affect your view on the world and of yourself. I have personally been opposed to body piercing except the traditional ear lobe.

Alice: I’m having a difficult time determining where I fit in the world. There’s this whole lifestyle that is so appealing to me and yet so different from how I have been taught to be. I feel like I’m standing on the edge of something big. I want to jump in with both feet, but I’m not sure I’d ever come up for air. I’m frustrated with how I function during sex. I get turned on, but usually have to turn to masturbating to orgasm. I’m sure it’s the typical “mom “syndrome where I’m so chaotic all day that by the end it’s difficult to view myself or my husband sexually. I want to have him enjoy our sex life very much. And I want to as well. I just feel drawn by the attraction I feel towards that “thrill of the chase”. I keep thinking if I do this or that, it will help. I’m just frustrated!! Both sexually and mentally. I think you are right that it’s psychological. So do I change my psyche? How? How do I change?

Dr. Dewey: Alice, you ask the question of the ages. Some of us, or maybe all of us, at one time or another find ourselves dissatisfied. It might be anything from our sexuality to our role as parents to our professional career. You are standing on the edge! I believe you need to examine carefully where you want to jump, but that you do need to jump. Our religion and culture do play a significant role and are primarily there to protect us from “jumping” in the wrong direction, but our religion and culture don’t necessarily tell us not to jump. I will suggest you channel these feeling towards exciting and new dimensions in your life. It seems to me and from my own experience it is an opportunity for learning and growth. It often ends up causing some pain and anguish and that can facilitate knowledge and understanding, compassion and empathy, tolerance and forgiveness. I would like to think about his for a while. Really ponder these issues as I know many feel the same. I certainly know I don’t have all the answers, but maybe some.

 

Dr. Dewey: I have started thinking and pondering. Here is a quote that keeps coming into my head, “most men lead lives of quiet desperation and go to the grave with the song still in them”. Maybe we can learn much from those that have felt much and written much. That was a quote from Thorou, Henry David.

Alice: Thank you for your response. It doesn’t really help me know what to do though…me and my wild streak.

What do you mean by this statement? “I believe you need to examine carefully where you want to jump but that you do need to jump.” I agree that I need to channel these feelings, and I’m trying to do so in a way that isn’t going to damage me…too bad. I think you are totally right that through some pain and anguish we can learn and grow. I’m fine with my own pain…to a certain extent, but I’m trying to keep in mind that I have a husband, children and extended family that will be hurt if I act too rashly. Let me give you a little idea of what I’m talking about. We are considering opening our marriage a little. I think that Kevin has been thinking about it for a while. It’s fun and exciting. He and I are of the same mind that it is so intriguing and sexually stimulating, but we are wary that it might ruin us both. We’ve talked a lot about what we want and need. I’m having a hard time separating the two things. Do I really need to have attention from other men to feel good and sexy about myself…or do I just want it? He and I have always had a bit more loose lifestyle, but do I dare take it to the next level? I feel like I am becoming a shallow existence of the person I once was. I love being social and making people laugh. Now I find myself alone nearly every day tending to children and the duties of a stay at home mom. This isn’t a bad thing, necessarily, but I feel like I am being lost in it. It is very difficult for me to get turned on at the end of a hectic day. I know this is the case for a lot of mothers, and busy women. I am not one of those women that turn my husband away, and we have a quite active sex life. I’m trying to find a happy medium where I am happy with who I am, and I feel sexually satisfied.

Dr. Dewey: I am still thinking about where I would suggest you jump. Not an easy answer. As I think about your considering an “open marriage” it would be exciting but I believe very strongly casual sex is empty and leaves one feeling used and alone. The emotional connection needed to make physical intimacy meaningful would tend to lead to feelings of jealousy and possessiveness. It would hurt some or all at some point in time.

Alice: My husband is of the mind that a lot of things are okay as long as they are casual. He doesn’t want me to get emotionally involved with someone else. We’ve spent a lot of time discussing this…but still aren’t sure where we stand. Last night we were thinking we would bag the whole thing. Today…I was face-timing with a guy I met through a couples dating site. Obviously, we flop easily. We are going very slow. We don’t want to get caught up in the lust of it and do something rash.

Dr. Dewey: Alice, I have been thinking about your situation a great deal. You seem to feel there is more out there, that life is passing you by and there should be more meaning to your existence. You are bored with the way things are in many aspects and want a change.

In any event, looking for more in life is a common issue and I think a good thing. It is just important where you expect to find it. As exciting as it might sound, casual sex in a meaningless relationship, is not going to do it. It will do just the opposite and leave you empty and feeling used. You for sure need to find something “meaningful”.

Here is part of a poem I found, “A critical point of this life, it surely seems to me, is to create and not destroy, it is without question a key. Whether it be a building, a painting, or a piece of pottery; these temporal things can add immensely to who we are, and who we come to be. As I sit here and ponder this idea of creation, (a garden of peas, an orchard of trees, the fresh mown grass as it blows in the breeze), all add to the joy that builds within our being, and yes it’s true that it does seem to please.”

Exponentially greater then these examples I’ve shared, is the meaning that comes forth when two people are paired. Two souls in the cosmos as we travel along can sometimes come together from the midst of the throng…

What this is suggesting is creation is the key. It may be temporal things that you do that will lead you to peace. These are certainly safer then creating new human relationships, but I believe it is also true that it is the human relationships that bring the most meaning. When two people build a deep emotional connection it is “creating” but in the wrong circumstance or when it is based on superficial selfishness it will be destroying.

I am interested in how you feel about the current dissatisfaction in your life and what it will take to satisfy. Do you know yet? I sense it has to do with creating and needs to have substance. What are you thinking regarding this? Maybe you should build a library?

Alice: I feel like a very unsuccessful person right about now. I should be totally satisfied. I have everything anyone could ever want in life. Right? I’ve been thinking about the creating thing. I just don’t know what I would create. What do you mean build a library?

Dr. Dewey: Building a library was sort of a joke, but would satisfy a desire to create temporally (the building) and intellectually (the books or the intellect contained within the books). You are creating now, look at the children you are continuing to shape and mold, look at your body that you are continuing to improve.

My suggestion is you continue in those wonderful and fulfilling endeavors and then add a serious intellectual pursuit. Get a degree in English literature, become an RN, study religions of the Far East. Start an in depth study of Mormonism and its history.

Set a goal to become a president of a clothing company or an on line gourmet food store.

What interests you? Getting to know another man would be exciting and fulfilling only if you could really get connected mentally but that would lead to frustration because of the other issues such as time restraints, money, sex, kids, etc. Life is so interesting and exciting and challenging and there for the taking. All we need to do is reach out, put forth the effort and gather it in. Easier said than done. Most of us have had our share of relationship challenges and know firsthand all of the frustrations that come from unfulfilled emotions and jealousy and time constraints, etc… I know for me  patience has been a huge source of peace and now for me, peace is a far more preferred emotion then happiness. The more patient I am, the more peace I have found in my life.

Alice: I think that I have been very self-absorbed. Unfortunately all the worrying about me has just added more chaos and turmoil to my household. The main job I have in life right now is to be a wife and mother…neither of which am I doing very well currently. I feel like things have spiraled out of control .I thought that other relationships, especially sexually charged ones, would make me feel good about me. I was wrong. Years ago when I was a younger mother I started reading about an organizational guru name Marla Ciley. She is better known as the Flylady. She is all about routines. While I found the majority of what she says to be cheesy and ridiculous, I liked the routines. It made me feel in control, and successful. Running also does this for me, it has made me learn to control my body. I feel like I’m losing the life that I have worked years to set up. I’m ashamed. I eat more. I sleep less, and the anxiety is getting bigger. I think that you are right. I need to find something else to help me feel fulfilled. I’ve always valued the relationships I have with my friends, but am often disappointed when I “love” them more than they “love” me. I realize that sounds quite melodramatic, but no one wants to be in a relationship where they are always the pursuer. I have quite a few friends that confide in me and want me to help them through issues they have. But then when the roles are reversed, I feel like I don’t have a lot of confidants in return. This week I’m focusing on getting my family organized and having our home flow better. I think that’s a good start for me. I started my focused training for my first marathon in May. After I feel like I’m not running in circles trying to clear the haze I’ve created in my mind, I’m going to find something to do that’s just for me. There isn’t a lot that doesn’t interest me…so it should be easy to find a serious intellectual pursuit. I hope I can learn to be more patient and find peace that way.

Dr. Dewey: I agree with what you are saying about some routine and our understanding what our primary responsibilities are at any given time in our lives. Yours is to be a wife and mother first.  Mine is to be a husband, father, grandfather, provider and to improve those relationships. Another major “job” for me right now is to come to know God more intimately. That sounds corny but it is how I feel. I am not always doing all the church asks of me but I am accepting my weakness and transgressions and honest feelings and still seeking that closeness to Heavenly Father I feel is there.

Balance is elusive and personal fulfillment should include a healthy physical self and all the running and working out that entails. It is also about intellectual improvement and spiritual improvement. My relationships with others are for the most part fulfilling, but I often want to be closer.