Miscarriage

by Pallavi Joshi, Candidate for Doctor of Osteopathic Medicine 2016

What is a miscarriage?  A miscarriage is the loss of a pregnancy before the 20th week. The medical term for a miscarriage is spontaneous abortion, but because of the stigma and discomfort associated with the colloquial definition of the term “abortion”, most practitioners refer to pregnancy loss as a miscarriage.
What causes miscarriage? There can be many causes of a miscarriage, and most of the time the cause cannot be identified. The most common cause of miscarriage in the first trimester is chromosomal abnormalities in the baby. Most chromosomal abnormalities happen by chance and are not related to the mother or father’s health.
ENVIRONMENTAL CAUSES
PREVENTABLE CAUSES
OTHER CAUSES
Radiation or toxic agent exposure
Smoking during pregnancy
Infection

Excessive alcohol during pregnancy
Hormonal problems

Use of illicit drugs
Uterine abnormalities

Certain prescription medications (e.g., Accutane)
Incompetent cervix

Severe malnutrition
Immune system disorders (e.g. lupus)


Severe kidney disease


Congenital heart disease


Poorly-controlled diabetes


Thyroid disease
How do I know if I have a miscarriage?  Symptoms of a miscarriage include bleeding which progresses from light to heavy, severe cramps, abdominal pain, fever, weakness, and back pain.  If you experience the above symptoms, contact your health care professional.
What can I expect when I see a doctor?  Your health care provider will perform a pelvic exam and an ultrasound test to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required.  Blood work may also be performed.
How is a miscarriage treated?  Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is often performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medications can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.
What if I have multiple miscarriages?  Multiple miscarriage is defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive. Miscarriages can be very traumatic and leave you with a deep feeling of sorrow. Allow yourself to grieve the loss of your baby and your pregnancy instead of suppressing these feelings. Talk to your spouse and confront your feelings together.
There are some tests you can ask for to understand the cause of multiple miscarriages.
Miscarriage Common Causes
Related Tests
Hormonal factors
Test for prolactin, thyroid and progesterone levels
Structural factors
A hysterosalpingogram evaluate the shape and size of your uterus and looks for factors like scarring, polyps, fibroids and septal wall, all of which could affect implantation
Immunologic causes
Blood tests to check for immunologic causes of pregnancy loss include antithyroid antibodies, lupus anticoagulant, and anticardiolipin antibodies.

CONNECT WITH YOUR REPRODUCTIVE SYSTEM

What is the reproductive system? The female reproductive system consists of an internal part and an external part. The internal system consists of two parts: the uterus, which hosts the fetus, produces secretions and passes the male’s sperm through to the fallopian tube; and the ovaries, which produce the female’s egg cells. The internal system meets the external parts at the vulva, which includes the labia, clitoris and urethra. The ovaries release an ovum, or egg, at regular intervals. If the egg meets a sperm cell in the right conditions, the sperm cell penetrates and merges with the egg cell, fertilizing it.
How can I prevent miscarriages?  Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.

HARMONIZE WITH YOUR BODY

What are some lifestyle advice? You and your spouse can do the following in order to provide a healthy environment for conception:

  • Exercise regularly
  • Eat healthy
  • Manage stress
  • Keep weight within healthy limits
  • Do not smoke

Additionally, you should take prenatal vitamins daily even when you are trying to conceive.
Once you find out that you are pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:

  • Keep your abdomen safe
  • Do not smoke or be around smoke
  • Do not drink alcohol
  • Check with your doctor before taking any over-the-counter medications
  • Limit or eliminate caffeine
  • Avoid environmental hazards such as radiation, infectious disease and x-rays
  • Avoid contact sports or activities that have risk of injury

What are some nutritional advice?  Eat a variety of foods to make sure you get the nutrition you need while you’re conceiving and after you get pregnant. You should consume 300 more calories per day when you get pregnant.  Choose high-fiber foods, such as whole grain breads, cereals, pasta and brown rice. Eat or drink at least 4 servings of dairy products to ensure you’re getting 1000-1300 mg of calcium. Eat at least 3 servings of iron-rich foods such as leafy vegetables, lean meat and beans. Eat Vitamin C rich fresh fruit like citrus fruits, strawberries, tomatoes, honeydew and papaya. Eat Vitamin A rich vegetables like carrots, pumpkin, sweet potatoes, green vegetables and cantaloupe.
Take 400 mcg of folic acid and a prenatal vitamin daily.   Avoid caffeine, alcohol and tobacco.
What are some exercise advice?  There is no evidence that moderate exercise increases the risk of miscarriage. You can safely continue a moderate exercise regimen as long as you avoid contact sports and activities that can cause trauma to the abdomen.

INTEGRATE COMPLIMENTARY ALTERNATIVE MEDICINE

What can be expected during an osteopathic manipulative treatment? Osteopathic manipulative treatment is a gentle hands-on therapy directed at releasing restrictions in the body.  Following a miscarriage, the pelvic region and lower abdomen may have pain or discomfort that can be alleviated with release of fascial strains.
What can be expected from homeopathic medicine?  Depending on the stage of the miscarriage and the symptoms, homeopathic medicine can be directed at alleviating the symptoms and encourage the body's return to health.

Monthly Cycle Getting You Down

By E. W. Spence, DO & C. Cheng, DO

What is PMDD? Premenstrual dysphoric disorder (PMDD) has many of the same symptoms as PMS, but it is more severe. If you have PMDD, you may struggle to do your job or get along with family and friends the week before your period. You may feel very depressed, angry, or irritable during this time.

Do I have PMS or PMDD? You may have some of the symptoms described above. If these symptoms happen before your period most months and are severe enough to bother you, tell your doctor.  There are many causes of PMDD including genetics, environment, and hormonal differences. PMS and PMDD can adversely affect one's daily life and can lead to mental disorders or even suicide. Understanding the signs of PMDD can help with early identification and treatment.

CONNECT WITH YOUR CYCLE

What causes PMS or PMDD?  The cause of PMS and PMDD is still not fully understood.  It is thought to be triggered by fluctuations in female hormones resulting in an abnormal response including a steroid-induced change in the opioid system.  Other causes of PMDD that are currently being investigated are vitamin deficiencies including vitamin E, vitamin B6,  vitamin A, and magnesium. The changes in opioid response and vitamin deficiency can affect the way body works and feels.

HARMONIZE WITH YOUR BODY 

What exercises can be useful for PMS or PMDD?  Since pathogenesis of the disease is still unknown, treatment principles focus on lifestyle measures.  For mild symptoms, lifestyle changes such as nutritional support and increase aerobic exercise and relaxation techniques can be effective in reducing symptoms.   For moderate to severe symptoms, traditionally a pharmacological approach with selective serotonin reuptake inhibitors (SSRIs) is considered. If SSRIs are not successful, oral contraceptives and alprazolam may be effective.  In highly severe cases that are refractory to treatment, surgery to remove the ovaries and uterus is often given as an option.
INTEGRATIVE APPROACHES TO PMDD
Osteopathic Manipulative Therapy (OMT) can be a very effective in treating the musculoskeletal dysfunctions that occur with PMDD.  Physical symptoms of dysmenorrhea and abdominal bloating can be relieved with several techniques focused on relieving pelvic and lymphatic congestion. OMT may be helpful in treating affective symptoms such as depression and mood swings as well.

If you are experiencing some of the symptoms of PMDD, take measures to focus on exercise and relaxation techniques.  Find a method you enjoy, and try to add it into your daily life.  If symptoms of PMDD are affecting your daily life, seek help from a healthcare provider.  OMT and other integrative healthcare modalities can provide you with symptom relief, and may help treat PMDD.

Gastroenteritis: Stomach Flu

By Dr. Courtney Cheng, D.O., M.S.H.S. & Jessie Dhaliwal, O.M.S., Candidate for Doctorate of Osteopathic Medicine in 2016


What is the stomach flu?  The stomach flu is an infection of the gut. The scientific name for the stomach flu, gastroenteritis, describes the exact parts of the human body that are affected by the stomach flu as well as the process by which it happens. It is the inflammation (-itis) of the stomach (gastro-) and small intestine (entero)- due to thebody’s defense mechanism reacting to the virus invader.
What causes the stomach flu?  Germs like viruses, parasites and less commonly, bacteria can cause the stomach flu. The rotavirus is the most common culprit of the stomach flu in infants, while an adult case of the stomach flu can be caused by the calicivirus (norovirus), rotavirus, astrovirus, or adenovirus.  The stomach flu can be caught from someone else who has it, especially through inadequate hand washing after a bowel movement. The infection can also be caught through the ingestion of foods that contain these harmful germs. Germs can find their way into food while it is being grown, processed, or prepared. Ill-prepared, or undercooked foods are a common source of harmful microbes that cause the stomach flu.
How do I know if I have the stomach flu?  Someone with the stomach flu may present with abdominal cramps, nausea, vomiting, diarrhea and low grade fever.  Many will present with runny nose or other cold symptoms.
What can I expect when I see a doctor?  Your doctor will likely inquire about possible triggers and timing of your problem.  Lab tests are generally not indicated for gastroenteritis. If bacterial infection is suspected, one can identify the toxins in the stool. Giardia lamblia can be detected by identifyingtrophozoites or cysts in the stool. Stool antigen enzyme-linked immunosorbent assays are also a viable option and have a high sensitivity and specifity rate. Viral epidemiologies rely on a careful physical and history examination with the elimination of other possible pathologies. However, rotavirus can be identified using rapid antigen testing of the stool. Enzyme immunoassays for calicivirus infections have recently been developed, but are expensive to run.
How is the stomach flu treated? The mainstay treatment for the stomach flu is bed rest and PLENTY OF FLUIDS. Dehydration is the biggest risk from the stomach flu as the body is prone to losing more fluid than it takes in during this state due to diarrhea and/or vomiting.  Consult your physcian if you sufferr from dehydration a evidenced by dry mouth or wrinkled skin, or urination is reduced or stops in an eight-hour period.  Keeping one’s body hydrated during this illness is the most important treatment. Water is a good fluid of choice for hydration; however, in many circumstances water may not contain enough electrolytes that were lost through vomiting and diarrhea. Oral rehydration salts can be bought over the counter and mixed into water to replace the electrolytes and salts that were lost during the infection.
What if my symptoms get worse?  If you suffer from stomach flu and rehydration is not enough, seek advice from a medical professional about other possible therapies.  We can look at some of the common reasons for stomach flu and provide techniques for decreasing the symptoms; however they do not replace the role of a qualified health professional.  Consult your health care provider if your diarrhea lasts for more than two days, there is blood in the stool, your stool looks like back tar, you have a fever above 101 degree farenheit.  If you try any of these techniques and experience worsening symptoms, you should immediately stop and consult a health care professional.

CONNECT WITH YOUR IMMUNE SYSTEM

What is the immune system?  The immune system is a highly complex defense mechanism that helps us fight infections.
What are the viruses causing the stomach flu?  The rotavirus is the most common culprit of the stomach flu in infants, while an adult case of the stomach flu can be caused by the calicivirus (norovirus), rotavirus, astrovirus, or adenovirus.  The rotavirus is the number one cause of acute onset diarrhea. It produces a protein that disrupts reabsorption of water.  Lactase deficiency is a common symptom of rotavirus infection and can last for weeks. Adult cases of the stomach flu can be caused by the calicivirus (norovirus), rotavirus, astrovirus, or adenovirus.  In adults, the Norwalk virus from the is another common culprit of gastroenteritis.   Unlike bacterial infections, viruses can not be eliminated by antibiotics.
How does the body work as a unit?  The digestive track is necessary for the absorption of nutrients and vitamins needed to support the immune system.  If the body is not taking in the appropriate amount of nutrients and vitamins, the immune system cannot function effectively.  If the body is not absorbing the nutrients and vitamins due to problems with digestion, this can also effect the immune system.

HARMONIZE WITH BODY

What are some lifestyle advise?   Proper hand hygiene is important.  The stomach flu can be caught from someone else who has it, especially through inadequate hand washing after a bowel movement.
    Make sure to handle raw foods with care and properly cook all meats.  The infection can also be caught through the ingestion of foods that contain these harmful germs. Germs can find their way into food while it is being grown, processed, or prepared. Ill-prepared, or undercooked foods are a common source of harmful microbes that cause the stomach flu.
    Cleaning objects touched by the affected individual with chlorine-based disinfectants or using a dishwasher can help to eliminate the virus.  The Norwalk virus and Rotavirus are not susceptible to alcohols and detergents. Sufficient heating, autoclaving, or the use of chlorine-based disinfectants are effective ways to eliminate the viruses from surfaces and objects.
What are some nutritional advise?  Limiting food is another good precaution that should be taken early in the course of the infection as people with the stomach flu may have trouble tolerating large meals.  Foods that are easy to digest such as cereal, bananas, rice, noodles, soup, and toast can be introduced gradually as the person’s condition improves.  Rice helps to form stools and supply the body with B vitamins.

Helpful Nutrients
Dosage
Reason
Essential fatty acid complex

Aids in forming stools
Kelp
1000 mg daily
To replace minerals lost through diarrhea
Garlic (Kyolic from Wakunaga)
2 capsules twice daily with meals
Destroys harmful bacteria in the colon
Vitamin C with bioflavonoids 
500 mg 3 times daily
Has a cleansing and healing effect. Helps immunity.
Acidophilus

Aids in normal bowel function.  Allows survival and rapid passage of "friendly" bacteria through the stomach into the small intestine.
Multienzyme complex with pancreatin

Aids digestion
Zinc
50 mg daily
Aids in repair of damaged tissue of the digestive tract and enhances immune response.
Wild oregano oil

Contains antibacterial, antifungal, antiparasitic, and antiviral agents


However, remember to refrain from drinking milk as it can make the symptoms of the stomach flu much, much worse due to the temporary loss of the enzyme needed to digest lactose.  Avoid high-fiber foods, which may stress the digestive system. Limit intake of fats and foods containing gluten, including barley, oats, rye, weat.  Avoid alcohol, caffeine, and spicy foods.
What are some exercise advise?  Bed rest is advised for quicker recovery.  Avoid strenuous exercise while suffering from the stomach flu.

INTEGRATE COMPLIMENTARY ALTERNATIVE MEDICINE

What can be expected during osteopathic manipulative treatment? Chapman reflex points are defined as a system of reflex points on the outside of the human body that reflect dysfunctions in the various organ systems that comprise the body. Chapman reflex points located on the persons sternum and ribs can be tender in the face of a stomach infection and when treated by a trained osteopathic physician can provide symptomatic relief.
What can be expected from homeopathic medicines?  Homeopathic medicines can be used to significantly reduce the diarrhea symptoms.  Arsenicum album can be used for burning diarrea that is troublesome at night.  Podophyllum can be used for watery stools.  Sulfur is excellent for diarrhea that comes on suddenly.