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?