DEAR DOC: I have diabetes. Can I  get pregnant safely?

Approximately 10 per cent of pregnancies will have complications, but the vast majority are expected to be normal. It is terrible when a mother, whose only desire is to have a baby, ends up in the intensive care unit for weeks on end or spends the rest of her life in a vegetative state because of conditions like eclampsia, in which high blood pressure causes a pregnant woman to have seizures and can be fatal. PHOTO | FILE

Dear Bhavini,

Diabetes can affect you and your growing baby during pregnancy, if blood sugar is not well controlled. It can lead to birth defects, premature delivery, overweight baby, baby with breathing problems, blood sugar problems in the baby, miscarriage or stillbirth. In the mother, high blood sugar during pregnancy can lead to eye problems, kidney problems or pre-eclampsia.

Thyroid disease can lead to difficulty getting pregnant, though once the thyroid hormone levels normalise, it should be possible to get pregnant. Once you get pregnant, thyroid disease can lead to premature birth, low birth weight, miscarriage, pre-eclampsia, heart failure or thyroid storm (sudden elevation of thyroid hormones with severe symptoms).

For this reason, it is important to have your blood sugar and thyroid hormones well controlled before and during pregnancy. Take your medication as directed, manage your diet, exercise and aim for a healthy weight. Before getting pregnant, have a checkup for blood pressure, thyroid hormone levels, the heart, the eyes, the kidneys and the nerves. The doctor may also change your medication. You will also be put on folic acid.

You will probably have more frequent doctor visits during the pregnancy, frequent blood sugar and thyroid hormone level checks and more frequent ultrasounds and monitoring of the baby.

A safe pregnancy and delivery will take team effort with the endocrinologist, an obstetrician, a nutritionist, and you as the most important team member.

 

Dr Flo, I am 25 years old. The left side of my body aches and sometimes I can’t hold anything with my left hand. The pain is in my head, neck, arm, hip and leg. What is ailing me and how can I treat it? Winfred Khatabasi

 

Dear Khatabasi,

The pain may be a result of a problem with the bones, the discs or the ligaments at the neck. The bones of the spinal vertebral column are held together by ligaments, which are bands of fibrous tissue. The bones have inter-vertebral discs between one bone and the next, which act as cushions. The spinal cord that passes through these bones is made up of many nerves, and at every level, some nerves come out between the bones heading to different parts of the body. At the neck, the spinal cord is carrying the nerves that go to the neck, the arms, the chest and back, and the lower part of the body.

You may have wear and tear of the bones, leading to formation of bony projections called spurs or uneven edges of the bones which can press on the spinal cord itself or some nerves. The discs can also shrink due to wear and tear, or they can slip or bulge on one side, pressing on some nerves. The ligaments can also become stiff, making it difficult to move the neck. This can happen if you have ever had a neck injury, or if your job involves moving your neck a lot or holding it in a particular position, or due to advanced age.

This leads to pain, stiff neck, numbness, tingling and weakness of limbs, lack of coordination when walking or loss of bladder or bowel control. You need to see a neurologist (nerve specialist) and an orthopaedist (bone) specialist, for a thorough physical evaluation. Thereafter, you will be sent for X-ray, CT scan or MRI scan. You may also be sent for blood tests or nerve tests to check for other illnesses like multiple sclerosis.

Regular exercise, hot or cold packs for the areas in pain or painkillers can help ease the symptoms. You would also benefit from physiotherapy and use of a soft neck brace for short periods. The doctor may recommend steroids or anti-convulsants to help manage the pain.

 

Dr Flo, my wife feels pain in her heel especially if she walks a long distance or does some exercise. Which is is the best medicine to treat this? Stan

Dear Stan,

Your wife has inflammation of the fascia on the bottom of the foot. This is a sheet of fibrous tissue that connects the heel to the front of the foot, where the toes start. It supports the foot, helping us walk by acting as a shock absorber. It can easily get injured or torn due to too much pressure on the feet. When this happens, there is pain, usually after starting to walk after sitting or lying down for long, or after being on your feet for long. It is more common in those who are overweight or obese, those whose jobs require them to stand or walk for long durations of time, and long distance runners. It can also occur during late pregnancy, and in those with flat feet or a high foot arch. Wearing shoes with poor arch support also contributes to the problem.

To manage it, reduce the pressure on her feet by reducing the walking and standing. Stretch and massage the feet before getting out of bed in the morning and after standing or walking for long. She should wear shoes with a cushioning sole e.g. thick rubber sole or sneakers and shoes with good arch support. She can also get heel cushions from the hospital, a pharmacy or even the supermarket. Painkillers also help to reduce the pain and inflammation. A physiotherapist can help with exercises for the feet and legs. In case she has tried all this, and she’s still in a lot of pain, she may require a steroid injection to the damaged area, which should be done by an orthopaedic specialist. Other treatments that the orthopaedist may recommend include using splints, plantar iontophoresis (using an electric current to get an applied drug into the foot), extracorporeal shock wave therapy and surgery.

 

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