Gynecomastia (enlarged breasts in men)

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Gynecomastia is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Newborns, boys going through puberty and older men often develop gynecomastia as a result of normal changes in hormone levels. There are other causes as well. Generally, gynecomastia isn't a serious problem, but it can be tough to cope with. Men and boys with gynecomastia sometimes have pain in their breasts and may feel embarrassed.
Gynecomastia may go away on its own. Gynecomastia can also be treated with medications that help balance hormone levels. In some cases, surgery to remove breast tissue also may be an option.

Symptoms

Signs and symptoms of gynecomastia include:
• Swollen breast gland tissue
• Breast tenderness

When to see a doctor: If you have swelling, pain, tenderness or nipple discharge in one or both breasts, see your doctor.

Causes

Gynecomastia is triggered by a decrease in the amount of the hormone testosterone compared with estrogen. The cause of this decrease can be conditions that block the effects of or reduce testosterone or by a condition that increases your estrogen level. Several things can upset the hormone balance, including:
• Natural hormone changes
• Medications
• Certain health conditions
In about 25 percent of cases, the cause of gynecomastia is never found.

The testosterone-estrogen balance
The hormones testosterone and estrogen control the development and maintenance of sex characteristics in both men and women. Testosterone controls male traits such as muscle mass and body hair; estrogen controls female traits including the growth of breasts.

Most people think of estrogen as an exclusively female hormone, but men also produce it — though normally in small quantities. Estrogen helps regulate bone density, sperm production and mood. But male estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.

Gynecomastia in infants
More than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen. Generally the swollen breast tissue goes away within two to three weeks after birth.

Gynecomastia during puberty
Gynecomastia caused by hormone changes during puberty is common. In most cases, the swollen breast tissue will go away without treatment within six months to two or three years.

Gynecomastia in men
The prevalence of gynecomastia peaks again between the ages of 50 and 80. At least one-quarter of men are affected during this time.

Medications
A number of medications can cause gynecomastia. These include certain:
• Anti-androgens used to treat prostate enlargement or cancer and some other conditions. Examples include cyproterone, flutamide, finasteride and spironolactone.
• AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz is more commonly associated with gynecomastia than are other HIV medications.
• Anti-anxiety medications, such as diazepam (Valium).
• Tricyclic antidepressants.
• Antibiotics.
• Ulcer medications, such as cimetidine.
• Cancer treatment (chemotherapy).
• Heart medications, such as digitalis and calcium channel blockers.

Street drugs and alcohol
Substances that can cause gynecomastia include:
• Anabolic steroids and androgens
• Alcohol
• Amphetamines
• Marijuana
• Heroin

Health conditions
Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:
• Hypogonadism. Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia.
• Aging. Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.
• Tumors. Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
• Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine.
• Kidney failure.
• Liver failure and cirrhosis.
• Malnutrition and starvation.

Herbal products
Plant oils, such as tea tree or lavender, used in shampoos, soaps or lotions, have been associated with gynecomastia. This is probably due to their weak estrogenic activity.

Risk factors

Risk factors for gynecomastia include:
• Adolescence
• Older age
• Use of anabolic steroids or androgens to enhance athletic performance
• Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome

Complications

Although there are few physical complications associated with gynecomastia, having this condition can cause psychological or emotional trouble caused by appearance.

Tests and diagnosis

Your doctor will ask you questions about your medical history, what medications you're taking and what health conditions run in your family. The doctor will also do a physical examination that may include careful evaluation of your breast tissue, abdomen and genitals.

Your doctor will want to be sure your breast swelling is actually gynecomastia and not another condition. Other conditions that can cause similar symptoms include:
• Fatty breast tissue. Some men and boys have chest fat that resembles gynecomastia. This is called pseudogynecomastia or false gynecomastia, and it isn't the same as gynecomastia.
• Breast cancer. This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
• A breast abscess (mastitis).

Initial tests to determine the cause of your gynecomastia may include:
• Blood tests
• Mammograms

You may need further testing depending on your initial test results, including:
• Chest X-rays
• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Testicular ultrasounds
• Tissue biopsies

Treatments and drugs

Most cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you're taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.

In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than three years. However, treatment may be necessary if gynecomastia doesn't improve on its own, or if it causes significant pain, tenderness or embarrassment.

Medications
Medications used to treat breast cancer and other conditions, such as tamoxifen and raloxifene, may be helpful for some men with gynecomastia. Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for this use.

Surgery to remove excess breast tissue
If you still have significant bothersome breast enlargement despite initial treatment or observation, your doctor may advise surgery. Two types of surgery are used to treat gynecomastia:
• Liposuction. This surgery removes breast fat, but not the breast gland tissue itself.
• Mastectomy. This type of surgery removes the breast gland tissue. The surgery is done on an endoscopic basis, meaning only small incisions are used. This less invasive type of surgery involves less recovery time.

Coping and support

For a man, enlarged breasts can be stressful and embarrassing. Gynecomastia can be difficult to hide and a challenge to romantic relationships. During puberty, gynecomastia can make boys a target for teasing from peers. It can make activities like swimming or changing for gym class traumatic.

Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself. These feelings are normal, but there are a few things you can do to help you cope:
• Get counseling. Talk therapy can help you avoid anxiety and depression caused by gynecomastia. It can also help you communicate with your partner or family members so that they understand what you're going through.
• Reach out to your family and friends. You may feel embarrassed to talk about gynecomastia with the people you care about. But explaining your situation and asking for help will likely strengthen your relationships and reduce stress.
• Connect with others who have gynecomastia. Talking with men who have had a similar experience can help you cope. Web sites such as Gynecomastia.org provide a forum for connecting with others who have the condition.

Prevention

There are a few factors you can control that may reduce the risk of gynecomastia, including:
• Don't use illicit drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
• Avoid alcohol. Don't drink, or drink very little.
• Review your medications. If you're taking medication known to cause gynecomastia, ask your doctor if there are other choices.


Mayoclinic

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Diabetic Nephropathy

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Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.
What causes diabetic nephropathy?

The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure.

For reasons doctors don't yet understand, only some people with diabetes get kidney damage. Out of 100 people with diabetes, as many as 40 will get kidney damage.1

Certain things make you more likely to get diabetic nephropathy. If you also have high blood pressure or high cholesterol, or if you smoke, your risk is higher. Also, Native Americans, African Americans, and Hispanics (especially Mexican Americans) have a higher risk.2

What are the symptoms?

There are no symptoms in the early stages. So it’s important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed.

The first sign of kidney damage is a small amount of protein in the urine, which is found by a simple urine test.

As damage to the kidneys gets worse, your blood pressure rises. Your cholesterol and triglyceride levels rise too. As your kidneys are less able to do their job, you may notice swelling in your body, at first in your feet and legs.

How is diabetic nephropathy diagnosed?

The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine does not usually contain protein. But in the early stages of kidney damage-before you have any symptoms-some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should.

Finding kidney damage early can keep it from getting worse. So it’s important for people with diabetes to have regular testing.
• If you have type 1 diabetes, get a urine test every year after you have had diabetes for 5 years.
• If your child has diabetes, yearly testing should begin at puberty.
• If you have type 2 diabetes, start yearly testing at the time you are diagnosed with diabetes.

How is it treated?

The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. These medicines include:
• Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
• Angiotensin II receptor blockers, also called ARBs.

You may need to take more than one medicine, especially if you also have high blood pressure.

And there are other steps you can take. For example:
• Work with your doctor to keep your blood pressure down, usually below 130/80.
• Work with your doctor to keep your cholesterol level as close to normal as you can. You may need to take medicines for this.
• Keep your heart healthy by eating a low-fat diet and exercising regularly. Preventing heart disease is important, because people with diabetes are 2 to 4 times more likely to die of heart and blood vessel diseases. And people with kidney disease are at an even higher risk for heart disease.
• Watch how much protein you eat. Eating too much is hard on your kidneys. Most doctors recommend that protein make up no more than 10% of your daily calories.
• Watch how much salt you eat. Eating less salt helps keep high blood pressure from getting worse.
• Don't smoke or use other tobacco products.

How can diabetic nephropathy be prevented?

The best way to prevent kidney damage is to keep your blood sugar under tight control. You do this by staying at a healthy weight, exercising regularly, and taking your medicines as directed.

At the first sign of protein in your urine, you can take high blood pressure medicines to keep kidney damage from getting worse.

webmd
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Movie: The Duchess

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Available at Blitz Megaplex Jakarta Indonesia: 11 February 2009
Casts: Kiera Knightley, Ralph Fiennes, Dominic Cooper, Hayley Atwell, Charlotte Rampling
Director: Saul Dibb
Writers: Jeffry Hatcher, Anders Thomas Jensen
Genre: Drama, History

The movie explores the marriage, relationships, and passions of 18th century aristocrat Georgiana, Duchess of Devonshire. 17-year-old Georgiana (Kierra Knightly) is delighted to have excited the notice of the much older Duke of Devonshire (Ralph Fiennes), and marries him amid high personal and family expectations. Unfortunately for Georgiana, the Duke is an undemonstrative and tight-lipped man who is far more interested in his dogs than in getting to know his new wife. He does nothing to alleviate her wedding night fears, and does his husbandly duty with few words and a noticable lack of tenderness. He makes it clear at the outset to both Georgiana and her mother, Lady Spencer (Charlotte Rampling), that it is Georgiana's duty to bear him a male heir in short order.

Georgiana becomes the center of a glittering social circle, attended not only by the British noble elite but also by the political figures of the time. She uses her beauty, wit, charm, and social connections to advance the Whig party -- especially the policies and ambitions of a young nobleman, Charles Grey (Dominic Cooper), with whom she socialized, and to whom she was attracted, before her marriage. She indulges her love of parties and gambling, to the apparent delight of her peers, who joke that Georgiana is adored by all of England, except her husband.

Shortly after Georgiana marries the Duke, he has a young girl brought to live with him and Georgiana. Initially shocked by his admission that the child is his illigitimate daughter, Georgiana soon takes on the role of the child's mother. In the meantime, Georgiana gives birth to two daughters, but fails to provide the Duke with the expected male heir. The Duke continues to have affairs with other women.

While "taking the cure" at Bath in the hopes of being able to conceive a boy, Georgiana befriends Bess Foster (Hayley Atwell), whose husband, Georgiana is apalled to learn, beats and even tortures Bess. Because Bess has left the marital home, the husband refuses to allow her to see their three young boys. At Georgiana's suggestion, the Duke invites Bess to live with the Duke and Duchess in Devonshire. Some time later, Georgiana discovers that the Duke and Bess have begun sleeping together. When Georgiana confronts Bess, Bess begs Georgiana to understand that she is in the affair only in order to have the Duke pressure her husband to release her sons to her. When Georgiana demands that the Duke remove Bess from the house, he refuses. Bess remains in the house, and her sons come to live with them. While Georgiana adores her children and is obviously a devoted and loving mother, she chaffs at the presence of the Duke's lover and her sons. She explores her attraction to Charles Grey, and finds that the attraction is mutual. She brings the situation to a head by proposing a "deal" to the Duke: she will not object to his continuing to have Bess live with them, if he will not object to her engaging in an affair with Grey. The Duke, not surprisingly, rejects the proposal, pointing out that he does not make "deals," and that all of the power in the situation belongs to him. He upbraids Georgiana for failing in the two things that he demands of her: bearing him a male heir, and remaining loyal to him. She is outraged by his attitude and refusal to break off his affair, and flees from him. He chases her down and rapes her.

After the rape, Georgiana appears at her social gatherings in a fog -- alcohol induced? -- until it is learned that she is pregnant. She delivers a boy. Having done her "duty," Georgiana goes to Bath, where she finally consumates her passion for Grey. They live blissfully in Bath until the Duke arrives unexpectedly. He accuses of her of being indiscrete and demands that she drop Grey and return with him to Devonshire. He warns her that, if she does not, both she and Grey will be cut off entirely from their wealth and positions in society, Grey will lose his political position, and she will never see her children again. After the Duke leaves, Georgiana races back to Devonshire, realizing that she cannot live without her children.

Bess and her children are still at Devonshire. Georgiana informs Bess and the Duke that she is pregnant with Grey's child. At the Duke's command, she moves to the countryside to await the birth. She delivers another girl, Eliza, and immediately is forced to give the baby up to Grey's family. Heartbroken, she returns to Devonshire, where she continues her social circle, but with none of the vivacity and verve for which she was known before. She remains at Devonshire with the Duke and Bess and their children, until her death. After her death, the viewer is told, the Duke marries Bess.

imdb.com
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Varicocele

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A varicocele is the enlargement of the network of veins that drain the testicle in males. Blood flows from the scrotum and testicles through a complex of veins rather than a single vessel. These veins are prone to becoming enlarged or dilated. This frequently happens when the valves in the veins that keep the blood flowing in the direction of the heart become weakened. A varicocele is more common on the left because of the specific pattern of blood flow on that side. Varicoceles are linked to infertility in males 20 to 40% of the time. This is because the increased blood flow through the enlarged veins raises the temperature of the testicles and affects the development of sperm.
What are the causes and risks of the condition?

Approximately 15% of adult men have a small to moderate size left varicocele. Right-sided varicoceles are uncommon. Typically, the presence of a varicocele does not signal any type of serious disease. However, a large varicocele on the right side that appears suddenly may indicate a mass such as an enlarged lymph node or testicular cancer.

What are the signs and symptoms of the condition?

Most varicoceles do not have symptoms. They are found by accident during a routine exam or an infertility evaluation. Very large varicoceles may produce a heavy or dragging feeling in the testicles. They rarely are painful.

How is the condition diagnosed?

A varicocele is usually diagnosed with a physical exam. It appears as a full but soft mass above the testicle. The mass disappears completely when the man is lying down. The varicocele's appearance has been described as a "bag of worms." Ultrasound is sometimes used to confirm the diagnosis. This is more common during an evaluation for male infertility.

What can be done to prevent the condition?

There is no known way to prevent developing a varicocele. Routine testicular self examination may alert the man to any new masses, which should be evaluated by the healthcare provider.

What are the long-term effects of the condition?

Varicoceles can be linked to male infertility. If abnormalities show up in a semen analysis, removing the varicocele may improve sperm quality.

What are the risks to others?

There are no risks to others, as a varicocele is not contagious.

What are the treatments for the condition?

A varicocele is usually managed conservatively. A scrotal support may be worn to relieve the heavy sensation in the scrotum. However, if the pain continues or if infertility results from a backup of blood in the veins, surgery may be needed.

Removal of the varicocele is called varicocelectomy. This operation can be accomplished with a variety of incisions. The most common is a small cut in the groin or just below it. Several of the veins draining the contents of the scrotum can be tied off through this opening. An alternative procedure is to make a small incision higher up in the flank. Also, the enlarged veins can be blocked with material injected into them through a catheter, or narrow tube.

What are the side effects of the treatments?

Side effects may include bleeding, infection or the accumulation of fluid along the spermatic cord, known as a hydrocele.

What happens after treatment for the condition?

The man will feel some discomfort and a sense of congestion in the testicle for a few weeks following the procedure.

How is the condition monitored?

If the varicocele makes the scrotum feel uncomfortably full, or impairs fertility, the male should follow up with a healthcare provider. Any new or worsening symptoms should be reported to the healthcare provider.

Author:Stuart Wolf, MD
Date Written:
Editor:Slon, Stephanie, BA
Edit Date:05/09/00
Reviewer:Gail Hendrickson, RN, BS
Date Reviewed:06/01/01
Sources
The Merck Manual of Medical Information, Home edition, 1997
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

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Sexual Dysfunction in Women

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When you have problems with sex, doctors call it “sexual dysfunction.” Both men and women can have it. There are 4 kinds of sexual problems in women.
• Desire disorders ¬- When you are not interested in having sex or have less desire for sex than you used to.
• Arousal disorders ¬- When you don't feel a sexual response in your body or you cannot stay sexually aroused.
• Orgasmic disorders ¬- When you can't have an orgasm or you have pain during orgasm.
• Sexual pain disorders ¬- When you have pain during or after sex.

What causes sexual dysfunction?

Many things can cause problems in your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past abuse) can also cause sexual dysfunction.

You may have less sexual desire during pregnancy, right after childbirth or when you are breastfeeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex due to a decrease in estrogen (a hormone in the body).

The stresses of everyday life can also affect your ability to have sex. Being tired from a busy job or caring for young children may affect your sexual desire. You may also be bored by a long-standing sexual routine.

How do I know if I have a problem?

Up to 70% of couples have a problem with sex at some time in their relationship. Most women will have sex that doesn't feel good at some point in her life. This doesn't necessarily mean you have a sexual problem.

If you don't want to have sex or it never feels good, you might have a sexual problem. Discuss your concerns with your doctor. Remember that anything you tell your doctor is private and that your doctor can help you find a reason and possible treatment for your sexual dysfunction.

What can I do?

If desire is the problem, try changing your usual routine. Try having sex at different times of the day, or try a different sexual position.

Arousal disorders can often be helped if you use a vaginal cream or sexual lubricant for dryness. If you have gone through menopause, talk to your doctor about taking estrogen or using an estrogen cream.
If you have a problem having an orgasm, you may not be getting enough foreplay or stimulation before actual intercourse begins. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful. You might need rubbing or stimulation for up to an hour before having sex. Many women don't have an orgasm during intercourse. If you want an orgasm with intercourse, you or your partner may want to gently stroke your clitoris. Masturbation may also be helpful, as it can help you learn what techniques work best for you.

If you're having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Emptying your bladder before you have sex, using extra lubrication or taking a warm bath before sex all may help. If you still have pain during sex, talk to your doctor. There are a variety of causes of pain during sex, so talk with your doctor. He or she can help you find the cause of your pain and decide what treatment is best for you.

Can medicine help?

If you have gone through menopause or have had your uterus and/or ovaries removed, taking the hormone estrogen may help with sexual problems. If you're not already taking estrogen, ask your doctor if this is an option for you.

You may have heard that taking sildenafil (Viagra) or the male hormone testosterone can help women with sexual problems. There have not been many studies on the effects of Viagra or testosterone on women, so doctors do not know whether these things can help or not. Both Viagra and testosterone can have serious side effects, so using them is probably not worth the risk.

What else can I do?

Learn more about your body and how it works. Ask your doctor about how medicines, illnesses, surgery, age, pregnancy or menopause can affect sex.

Practice "sensate focus" exercises where one partner gives a massage, while the other partner says what feels good and requests changes (example: "lighter," "faster," etc.). Fantasizing may increase your desire. Squeezing the muscles of your vagina tightly (called Kegel exercises) and then relaxing them may also increase your arousal. Try sexual activity other than intercourse, such as massage, oral sex or masturbation.

What about my partner?

Talk with your partner about what each of you like and dislike, or what you might want to try. Ask for your partner's help. Remember that your partner may not want to do some things you want to try, and you may not want to try what your partner wants. You should respect each other's comforts and discomforts. This helps you and your partner have a good sexual relationship. If you feel you can't talk to your partner, your doctor or a counselor may be able to help you. If you feel like your partner is abusing you, tell your doctor.

How can my doctor help?

Your doctor can suggest ways to treat your sexual problems or can refer you to a sex therapist or counselor if needed.

Nazz/familydoctor.org
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Surviving Bedrest

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Until this point in your pregnancy, you've probably been going about your normal activities of work, chores at home, spending time with family and friends, and exercise. But one day, suddenly or perhaps planned in advance, your doctor tells you that for your health and the health of your baby, you'll be restricted to bed rest.

Even though your friends and family may envy you for what they see as a mini-vacation, don't be fooled - bed rest during pregnancy is no walk in the park. Fortunately, though, there are plenty of ways to make your time in bed more enjoyable and productive, so keep reading and find out how to make the best of bed rest.

There are several situations that might cause your doctor to recommend bed rest for some portion of your pregnancy. If your medical history, including previous pregnancies, contains information that might point to a medical complication, your doctor might recommend bed rest. Or, you might experience symptoms, such as bleeding or contractions, that require you to go on bed rest.

Even if your medical history is clear and you experience no symptoms, your doctor may require bed rest if the results of a test or procedure indicate a medical complication or if your baby's growth is determined to be poor.

So what are some common pregnancy complications that often result in bed rest? A few include: high blood pressure (including pregnancy-induced hypertension, preeclampsia, and eclampsia), vaginal bleeding (including placenta previa), premature labor, and cervical changes (such as incompetent cervix and cervical effacement).

If you're having multiples, your pregnancy may be termed high risk and will require close monitoring by your doctor. If you develop any problems, your doctor might place you on bed rest. Bed rest might also be recommended if you've had previous pregnancies that ended in miscarriage, stillbirth, or a premature birth.

Just as every pregnancy is different, every woman's experience with bed rest is different. Some women may know early on that because of their medical histories, they will have to go on bed rest at some point in their pregnancies. Other women may be surprised to hear their doctors announce, after a routine appointment, that they'll be on bed rest for a few weeks.

Some women are on bed rest early in their pregnancies and then released, whereas others spend their entire pregnancies confined to their beds. Your doctor can give you specific information about the duration of your bed rest.

What Can - and Can't - You Do on Bed Rest?

Sometimes, doctors recommend modified bed rest or "house arrest," which generally allows women to stay on the couch, bed, or in a sitting position, but restricts them from sexual intercourse, exercise, or lifting. Other women may be told to remain in bed, only sitting up for meals or standing to take quick showers. Some women have to remain in bed in the hospital because their pregnancies require closer monitoring by a trained hospital staff.

Whatever kind of bed rest your doctor recommends, if it's long-term, you'll need to remember to exercise your legs to keep the blood circulating and prevent clots. Because every woman who experiences bed rest is different, be sure to get answers to the following questions from your doctor:
• Can I get up to use the bathroom?
• Can I get up to prepare quick meals or to do light chores?
• Can I take a bath or shower?
• What position should I be in while I'm resting?
• Can I go to work or work from home?
• Is driving OK?
• How much walking is safe?
• How much and what kind of sexual activity is OK?
• What activities can I do to increase blood circulation safely?

Tips for Surviving Bed Rest

Fortunately, there are plenty of ways to make your bed rest enjoyable without becoming addicted to daytime TV. Try these tips:
• Stick to a schedule. Even if you have to stay in bed all day, you'll feel better if you take care of yourself. After you wake up, change into comfortable clothes and plan what to do for the day. Having a plan will make you feel as if you're accomplishing something and will give you something to look forward to.
• Catch up while you can. Let's face it, after the baby arrives, you'll be too busy to think about catching up on correspondence or reading your favorite author's latest novel.
• Stock up. Just because you're on your back doesn't mean you have to be unprepared. You can fully stock your baby's nursery and layette by phone or the Internet. Order all the items you think you'll need for the first 3 months - including diapers! In addition to baby stores and centers, online drugstores often carry a wide variety of baby care items that they'll deliver right to your door.
• Don't be afraid to ask visitors for assistance. Your friends and family would probably love to help you with household chores, errands, or meal preparation. Create a task list so that when someone offers help, you can assign him or her a task. Visits from your friends and family can boost your spirits - just make sure you ask them to come at a time that's convenient and comfortable for you.
• Become a parenting expert. Plenty of parenting books and websites can help to answer many of your parenting and children's health questions. If you feel uncomfortable reading about high-risk pregnancy issues, learn about breastfeeding or how to encourage your child's development instead. You could also get subscriptions to local and national parenting magazines and start clipping out useful articles and tips. File your clippings in folders (i.e., new baby care, feeding, crying, sleeping, safety, development, etc.) for future reference when the baby comes. Also file away any articles you print out from the Internet.
• Seek out a support system. The Internet is a great place to find support from other moms on bed rest. Check out bed rest message boards and chat rooms, where you can share tips and get advice.
• Support your support person. You're probably relying heavily on your spouse or partner to tend to household chores, child care, and errands during your bed rest. Make sure you take the time to show your appreciation - you can always order a nice gift by phone or online!
• Let people help. It may be hard to ask for or accept help from friends and family, but you have no choice. Enlist those around you in your cause - whether it's going shopping at the grocery store or picking up shirts at the dry cleaners. Consider setting up a schedule so that your household continues to run.

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Episiotomy

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An episiotomy is a cut made to widen the opening of the vagina. It is done toward the end of labor to keep the vaginal tissues from tearing as the baby is born. Sometimes an episiotomy can also help the doctor to deliver the baby quickly if the baby is in distress.
Who is a candidate for the procedure?

Usually, the doctor or midwife attending the birth decides whether to do an episiotomy. An episiotomy may be done when:
• the vagina cannot stretch enough to allow the baby to pass through
• a baby is thought to be large, for example, more than 9 pounds
• a forceps or vacuum must be used to help in the birth
• monitors show that the baby is in distress or not getting enough oxygen and needs to be born quickly
• the vaginal opening starts to tear as the baby's head appears
• the baby's shoulder is blocking the birth canal


How is the procedure performed?

As the crown of the baby's head pushes through the vaginal opening, an anesthetic is injected in the mother's perineum to numb it. The perineum is the skin area between the vagina and anus. A cut 2 to 3 inches long is made there. After the baby is born and the placenta is delivered, the cut is stitched up.

What happens right after the procedure?

Most episiotomies are done to prevent large vaginal tears during childbirth. These tears heal slowly, often with poor results. Widening and tearing of the vagina may cause unneeded stretching. This may later lead to problems such as:
• urinary incontinence, which is being unable to hold urine in the bladder
• a prolapsed bladder, in which the bladder sags down into the wall of the vagina
• a prolapsed rectum, in which the rectum sags down into or through the vagina
An episiotomy may help to prevent these problems.

What happens later at home?

Keeping the area clean is the key to preventing infection and to helping speed healing. The stitches will dissolve after a period of time and do not need to be removed.
To help heal an episiotomy, a woman should:
• take sitz baths or sit in a tub of warm water a few times a day. Wash the area gently with a stream of water after using the bathroom.
• relieve pain and swelling with Tucks pads and ice packs. Sitting on an inflatable donut helps, too.
• avoid constipation to keep this tender tissue from stretching too much. Take stool softeners, such as docusate, and drink 8 to 10 glasses of fluids each day.
• use over-the-counter pain relievers, such as acetaminophen or ibuprofen, as needed.
• avoid sexual intercourse for 6 weeks after the birth.
A woman should see her doctor for follow-up visits to check on how the episiotomy is healing.

What are the potential complications after the procedure?

Very rarely, an episiotomy may extend into the rectum. More stitches than usual would be required to repair the cut. The increased risks of this problem are:
• infection
• bruising
• the forming of a hole between the vagina and rectum that is called a fistula

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:07/09/02
Reviewer:Kathleen A. MacNaughton, RN, BSN
Date Reviewed:10/28/02
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Postpartum Depression (Baby Blues)

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Postpartum depression is a form of depression that occurs in some women within the first 6 weeks after childbirth. Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own.


What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.
Pregnancy and childbirth are accompanied by hormonal changes that can affect emotions. The round-the-clock job of caring for a new baby can seem overwhelming at times. Too little rest usually accompanies these physical and emotional stresses.

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of the following:
• certain illnesses
• certain medications, including antibiotics and medicines used to treat acne
• changes in brain chemicals
• heredity
• hormonal changes
• lack of sunlight
• major stresses
• negative thinking patterns

Risk factors for depression in general include:
• alcohol abuse
• drug abuse and addiction
• job strain
• personal history of a suicide attempt
• personal or family history of depression
• stress

The hormonal changes of pregnancy and childbirth contribute to a woman's risk for postpartum depression. Caring for a newborn can be overwhelming. Physical exhaustion, lack of sleep, unrealistic role expectations, and social isolation can all play a role in postpartum depression.

The following increase the risk for developing postpartum depression:
• early hospital discharge after childbirth
• history of severe premenstrual syndrome
• lack of support system
• marital problems
• previous history of depression
• traumatic birth experience

What are the signs and symptoms of the condition?
In general, symptoms of depression include:
• appetite problems
• decreased energy
• difficulty paying attention or making decisions
• feeling very sensitive emotionally
• feelings of irritability
• feelings of sadness, despair, and emptiness
• inability to feel pleasure
• loss of motivation and withdrawal from others
• low self-esteem
• pessimism and negativity
• sleeping problems
• thoughts about suicide and death

A woman with postpartum depression may also experience the following symptoms:
• excessive concern over the baby
• excessive, severe mood swings
• fear of harming the baby
• feelings of guilt
• frequent headaches and other physical discomforts
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