The effect of menstruation on seizure frequency. The interaction between anticonvulsant drugs and oral contraceptives. The effects of anticonvulsant drugs on the fetus.

Some mothers report that their seizures become more frequent, others less frequent during pregnancy, and others have seizures which remain more or less unchanged in pregnancy. There seems no way of predicting what is going to happen in the first pregnancy, except that those with very frequent seizures are unfortunately, likely to get worse. By and large, subsequent pregnancies in any one mother follow much the same pattern. An unexpected and totally unexplained finding has been that those pregnant with a male baby are rather more likely to have more frequent seizures. Although epilepsy may start for the first time during pregnancy, this usually seems to be coincidental, and there is no good evidence that pregnancy itself is a

particularly potent event in inducing seizures. One possible reason for an increase in frequency of seizures during pregnancy is that the body processes anticonvulsant drugs differently. The interactions between pregnancy and drug metabolism may be complex.

Some anti-epileptic drugs pass through the placenta into the fetus. Phenobarbitone is perhaps the best-known example. After delivery the baby’s serum phenobarbitone falls, and during the early days after birth the baby may be much more fractious and irritable than most new-born babies.

Many mothers on anti-epileptic drugs wonder whether they can breast-feed their babies. Careful studies have been made on this point, and only small quantities of the drugs are secreted into milk, so it is quite safe to breast-feed.

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DLPA (DL-phenylalanine) is a very interesting substance that reduces pain quickly and effectively. It can help patients promptly gain a satisfying level of comfort while waiting for the long-lasting benefits of CMO to take effect. In the body endorphins are the natural substances produced to control the transmission of pain signals. Although they are non-narcotic, endorphins can be thought of as a sort of natural morphine.

DLPA prevents the normal hasty destruction of endorphins and thus inhibits the transmission of pain signals. It works by inhibiting the enzymes that break down endorphins, which results in extending their beneficial effects for a much longer time. In some people, DLPA sometimes acts as a mood enhancer as well.

L-phenylalanine and D-phenylalanine are natural amino acid substances commonly found in many protein foods. DL-phenylalanine is a combination of the two. Most people enjoy very prompt pain relief with DLPA and experience no negative side effects. It is safe and effective, gentle on the stomach, and not habit-forming. And it does not contribute through joint cartilage deterioration as do aspirin and other NSAIDS.

However take note that although not common, some people experience headaches or nausea from taking DLPA. People with high blood pressure, women who are pregnant or lactating, persons with psychoses, those suffering from malignant melanoma, those with phenylketonuria, or those with any sensitivity to phenylalanine should consult their physician before taking DLPA containing products. Taking DLPA with MAO or tricyclic antidepressants can lead to dangerously high blood pressure.

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Signs and symptoms

In severe cases of scoliosis the curvature of the spine can easily be seen when the child stands up. Even a slight curvature may be easy to recognize because the child stands in a hip-shot position, with one hip more prominent than the other. Scoliosis in almost any degree can be observed when the child bends forward at the waist with the knees straight. In this position scoliosis causes the chest to rotate, making one side of the back more prominent.

Home care

The important aspect of home treatment is to watch for the onset of the condition by observing your child’s posture periodically, particularly during periods of rapid growth.

Precaution

Any curvature of the spine is abnormal. Since scoliosis can become severe in a matter of months, your child should be checked as soon as you notice any abnormality. The child should then continue to see the doctor regularly.

Medical treatment

After confirming the presence of the condition, your doctor will often refer you to an orthopedist (bone specialist) who is skilled in treating scoliosis. The specialist will X ray the spine.

Idiopathic scoliosis occasionally corrects itself during growth. However, it must be checked several times a year. Correction of idiopathic scoliosis may require the use of a back brace or surgery of the spine. Differences in leg length will be treated by placing lifts in the child’s shoes or by surgery.

Exercise and physical therapy are not known to be helpful in treating any type of scoliosis.

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Elimination Diets

There are two kinds of elimination diets. The first one eliminates for a period of one week a single food item in order to observe the effect of that elimination. The second one eliminates for one week all the highly allergenic foods. During this period, the child is fed the following hypoallergenic diet which does not contain wheat, eggs, or milk. Bread should be banana rye, potato bread, or Ry-Krisp. The only beverage should be tea with sugar. Olive oil and lamb drippings should be used as fats. The only meat should be lamb. Beets, spinach, and sweet potatoes (all thoroughly cooked with no sauces added), and apricots, cherries, peaches, and prunes (all thoroughly cooked with nothing added except sugar) should be the only vegetables and fruits.

To this diet, one suspected food item can be added each week, and the effect of that addition observed. If the diagnosis is still not conclusive, then the child’s food intake for the next week should be limited to water, sugar, and allergy-free proteins. (Allergy-free proteins are called Amigen by Baxter, Nutramigen by Mead Johnson, Amino Acids by Stuart. Their purpose is to provide healthy nutrition on a restricted diet.) To this restricted allergy-free diet, one suspected food item can be added every two to three days, and the parent can observe how that addition is tolerated.

Provocative Diet

This consists of adding a large quantity of a suspected food item to the regular diet to observe the effect of that addition.

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Toxoplasmosis

Toxoplasmosis is an infection of the parasite Toxoplasma gondii which is found in most animals but the only reproductive host is the cat, which acquires the cysts by eating infected birds and mice. It can be transmitted to humans by contact with cat litter, eating raw or partially cooked meat, drinking contaminated water and in unpasteurized dairy products.

If a woman acquires toxoplasmosis during pregnancy, the baby is usually infected in 45 per cent of cases and it is a very serious disease for the foetus. The risk to the baby is greater in the first trimester (first 12 weeks) of pregnancy, when an infection of toxoplasma can cause hydrocephalus (accumulation of fluid on the brain), eye problems, convulsions, blindness and brain damage. Toxoplasmosis can also increase the risk of an early or late miscarriage.

In France pregnant women are routinely tested for toxoplasmosis, sometimes as often as once a month. If a pregnant woman becomes infected then, depending on the stage of pregnancy, advice is given as to the course of action. In this country, the Royal College of Obstetricians and Gynecologists have concluded that routine screening of toxoplasmosis for pregnant women is not ‘appropriate’, perhaps due to financial constraints. Once infected with toxoplasmosis, the person acquires life-long immunity.

Prevention is the best approach and that means that, up to four months before pregnancy and during pregnancy, the woman must not handle cat litter. If this is impossible then disposable gloves should be worn. Gloves should also be worn while gardening and hands should be washed thoroughly after changing cat litter, gardening and handling raw meat. If you eat meat only eat it when it is well cooked, wash all fruit and vegetables thoroughly to remove soil, avoid unpasteurised dairy foods such as milk and cheese, and wash your hands before eating.

Genital Herpes

This virus is sexually transmitted. Once acquired, it can come and go, with attacks varying from slight red bumps to blisters. If a woman gets herpes for the first time during the early part of pregnancy it can increase the risk of miscarriage by up to 25 per cent. If herpes is active when the woman gets to term then she is usually offered a Caesarean. This is because, if delivered vaginally, the baby could contract herpes during the delivery and there is a possibility of brain damage, blindness or death.

Gardnerella

This vaginal infection, gardnerella vaginalis, needs to be cleared up before conception. It can cause a burning sensation and also a grey or yellow discharge with a fishy smell.

Group  Haemolytic Streptococci

This is a very common bacteria, but it has links with premature rupture of the membranes and premature birth. If this infection is present during birth the mother needs to have antibiotics to prevent the infection spreading to her baby.

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• As soon as you think you want to start a baby it is good sense to make sure that all the conditions are right for your baby to get off to a good start. First, start eating properly. Make sure that you eat enough, especially if you are thin. If you are underweight your baby may grow slowly. Ensure that your diet is rich in protein, vitamins and minerals and complex carbohydrates. These latter should be in the form of high-fibre, unrefined carbohydrates. These also have the advantage of ensuring that you don’t get constipated during pregnancy-a common problem.

Drink plenty of fluids-keep off or cut down on tea, coffee, cocoa and cola drinks. Drink more water or dilute pure fruit juices (not squash). Aim to gain between 17 and 25 lbs in weight over the whole pregnancy. Any more could be disadvantageous. Come off the contraceptive pill at least three months before you plan to conceive. Use a barrier or other method until your body resumes its natural cycle and then try to conceive. Remember that it takes an average of 5.3 months for a normal, healthy couple to conceive if they are having unlimited sex. After taking the Pill a small percentage of women take many months to conceive but eventually almost all of them do so. If you have a coil doesn’t remove it until you actually want to conceive. Come off all drugs but don’t stop any prescribed drugs or medications until you have discussed it with your doctor. Stop or seriously cut down on your smoking and alcohol intake. Both can be hazardous in pregnancy and their effects on the health of eggs and sperms are not yet fully understood. Play safe.

• Keep away from infections, including childhood infections, ‘flu and so on. By doing all these things for 3-6 months prior to conceiving you will stand a better chance of conceiving a healthy, normal baby.

Obviously you can’t choose your parents and there may well be diseases or conditions that run through your family or that of your partner. If you are worried about anything like this tell the doctor. He or she can arrange for you to attend a specialist, if necessary, to put your mind at rest or to establish whether or not the risk of a particular condition occurring is worth taking.

During pregnancy eat well and don’t put on too much weight. The ideal to aim for is 17-25 lb, but if you are very skinny at the outset you could add a little more. Eat as outlined above. Don’t take any food to excess because it is now thought that large slugs of certain foods can sensitize a baby in the mother’s womb. Be moderate in all you eat. Be sure to have plenty of dietary fibre and lots of fruit and vegetables eaten raw or very lightly cooked to preserve the minerals and vitamins.

There is a good case to be made for taking additional vitamin and mineral supplements during pregnancy, especially as so many foods are so poor in these valuable nutrients today. Do not drink pints of milk a day. This can sensitise your baby in utero to cows’ milk protein. Also milk is very fattening and rich in fat. If you really want to drink milk make sure it is skimmed milk. Carry on drinking plenty of bland fluids and avoiding tea, coffee, cocoa and cola drinks, as before conception.

• Don’t take any drugs at all and see your doctor to ask if you can come off any of the prescribed drugs you are on. This should already have been discussed before conception but now he or she may be prepared to reconsider the whole subject with more urgency. Almost all drugs cross the placenta and affect the unborn baby somehow, so you are better off without them unless they are life-saving. Morning sickness, constipation and other minor ailments, should be coped with by using dietary and natural remedies rather than drugs and medications. A high-fibre diet will prevent constipation, and dry toast and biscuits are good if you feel sick. Moderate doses of antacids for heartburn are probably safe.

Keep away from X-ray machines and other X-ray hazards. If a child has to be X-rayed get someone else to hold him or her if there is even a remote chance that you are pregnant.

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What are the main symptoms

There are 101 different symptoms you can put under the endometriosis umbrella. Most common is pain.

Some women complain of pain and feeling bad, usually for the two weeks preceding menstruation. Other common symptoms include fatigue, bloating, irregular and abnormal bleeding, rectal bleeding, pain in cycle, pain in bowel, pain in bladder, a general feeling of pressure within the pelvic cavity, painful intercourse, infertility, depression, lethargy, insomnia, diarrhea – sometimes alternating between constipation and diarrhea – and a general feeling of being ‘nervy’.

Other symptoms include blood pressure changes, leg cramps,

palpitations, changes in body temperature, mood swings, changes in weight – most often an increase although some people seem to lose a lot of weight – skin rashes, flushing, loss of libido and sugar cravings.

Other associated symptoms include some tendency towards showing a hormone imbalance.

What happens at the first visit

An hour is allowed for each consultation – possibly longer for the first. A detailed list of symptoms is taken, together with answers to relevant questions defying such things as sleep patterns, moods, traumas etc. This can take some time as the woman has the opportunity to ‘divulge all’, and there is usually quite a deal of bottled-up anguish in endometriosis cases.

A medical history is taken – past illnesses, operations, traumas, etc. A list is made of past and current medications and a family medical history is taken. An inspection is made of the woman’s hands, nails, hair, tongue, palpation over liver/stomach/ spleen/ovaries/kidney area, examination of any rashes, moles, lumps, etc.

After I arrive at any treatment programme, I discuss this with the woman, explaining the method and significance of the remedies and the anticipated healing path ahead.

What is your treatment regime

Bach flower essences: For the mental/emotional sphere – to help emotional blocks and negative beliefs.

Diet: Non-chemical foods. An emphasis on low fat, high fibre, low sugar foods. No processed or refined foods. Ideally, organically grown fruit, vegetables, cereals and grains, filtered water. Avoid coffee, tea and alcohol. If candida is present, a special anti-candida diet will be prescribed.

Pain management: If needed, acupuncture and visualization may be considered.

Stress management: Meditation, yoga, massage.

Exercise: Gentle, regular exercise such as walking, cycling, swimming. No jarring exercise such as jogging.

Usual length of a treatment cycle

Two to 18 months, most around the six to eight month span with intermittent visits over the longer period. It is sometimes hard to tell due to lack of compliance to treatment – after the pain has gone, the motivation to complete the healing programme can disappear.

Women being treated usually require a visit once every four weeks.

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The incidence of kidney stones has gone up considerably this century. It used to be mainly an adult disease but now it occurs in children too. The occurrence rate is between 3 and 13 per cent in westernized countries, with the rate in the USA about 12 per cent, yet kidney stones are rare in people living in poor or primitive conditions.

What could have caused such a change? The greatest difference between the poor and the affluent countries of today is their diets. In the richer countries, the fat and animal protein content of the diet is five times greater than in the typical diet of the poorer countries. Most kidney stones are made of calcium and it is known that both protein and glucose can increase the amount of calcium the body puts out in the urine. One researcher has found that the glucose effect is exaggerated in stone-formers. Sugar can be shown to increase the amount of calcium put out by the kidneys in normal people and to produce damage to the tubular cells of the kidneys of animals.

It has been found that people who repeatedly form kidney stones eat more animal protein than do other people. The stone-formers in one study consumed more meat, fish and poultry and less grain and starch than did non-stone-formers. A high-fibre diet might well be of value in this condition in so far as it reduces blood-glucose swings-which are known to be critical in producing a urine rich in calcium, which then crystallizes out to form kidney stones. Lastly, there is evidence that a western diet reduces the production of normal stone-inhibiting substances in the urine.

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The people involved in establishing the in-patient pain management unit in Melbourne have all worked with chronic pain patients for several years. They have learned that the management of pain must involve a ‘multi-disciplinary’ approach to the patient with chronic pain.

In setting up such a clinic, the specialists had become convinced from experience that an in-patient facility was important in the assessment and management of chronic pain patients. They also believed that such a unit would operate best on a ‘behaviourial model’ based on principles of behaviour modification as set out by Dr W. Fordyce of Seattle.

This involves changing the behaviour of chronic pain patients and encouraging them to return to normal behaviour. In other words, patients must start managing or coping with their pain, and not allowing it to completely control their lives.

The programme’s aim is to improve the quality of life of patients with chronic pain. Accordingly, a programme of pain management was organised to minimise the length of stay in hospital.

The unit is staffed by:

• A clinical director who is a consultant psychiatrist, with experience in managing chronic pain patients.

• A full-time charge nurse and two other nurses.

• A clinical psychologist who acts as programme director.

• A part-time occupational therapist.

• A part-time physiotherapist.

• A part-time dietician.

• A unit physician.

• A social worker.

The programme usually runs for about four weeks. Under most circumstances, patients are initially admitted for a five-day assessment period which runs from Monday to Friday.

At the end of this time, the patient’s major areas of difficulty, both physical and psychological, are discussed and a contractual period of admission is agreed upon, with the specific aims being clearly defined.

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Surgical treatment of cancer pain

When all else fails, pain management calls for the specialised skills of the neurosurgeon . Surgical procedures interrupt the pain pathways by making incisions into various levels of the nervous system. Thus, cordotomy (in which the pain pathways in the spinal cord are interrupted), removal or destruction of the pituitary gland and the destruction of various collections of nerves known as ganglia may be carried out.

All or any of these treatments may be used in the one person at the same or different stages of the disease.

Physical treatments of cancer pain

The physical methods of treatment as discussed in other chapters of this book are also helpful for the pain caused by the cancer itself and also that caused by non-cancerous conditions which may add to the sufffering. Treatments include acupuncture, TENS and conservative physiotherapy methods.

Psychological management

In some cases, psychological methods using imagery, relaxation and hypnosis can give cancer sufferers relief, as can physical therapy and measures such as sympathetic understanding of their thoughts about pain and its effects on them. This can dramatically help put the pain into perspective.

Carl and Stephanie Simonton describe these techniques in their books ‘Getting Well Again’ and ‘The Healing Family’.

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