PREGNANCY & DELIVERY:
1. Do you agree with the following concerning treatment of FM flares (pain, fatigue, stiffness) while pregnant (& do you give any other advice?)?
A -- pregnant women need to be careful to avoid hot tubs and hot baths (and likely hot packs in the area of the fetus) as the increased body temperature is associated with an increased risk of birth defects. Taking calcium and magnesium at night can help sleep. In addition, a taking 5 – HTP 200-300 mg/night can help both sleep and pain, although it takes six weeks to work. As long as the PT is done gently it can be helpful, as can stretching and massage therapy. Most importantly, by giving appropriate treatment before pregnancy, flares can usually be avoided during pregnancy.
2. What can a woman do if she experiences a flare of: depression, migraine or irritable bowel while pregnant?
A -- migraine attacks can often be knocked out by giving magnesium 2 g IV over a ten minute period. In addition, avoiding chocolate and sugar, which are common triggers for migraines, is helpful. Taking magnesium orally (and this is already present in the vitamin powder) decreases migraine attacks as well. Taking the fish oil and the nutrients in the vitamin powder and B-complex (plus 5- HTP) decreases the tendency to depression considerably. Our study and clinical experience show that most people will find that their irritable bowel syndrome resolves when the underlying opportunistic bowel infections have been treated (e.g. -- Clostridium, SIBO, fungal infections, and parasites). These do however need to be treated before the patient becomes pregnant. If the patient is constipated, taking magnesium is very helpful. Adjusting the thyroid dose for those who are hypothyroid is also critical, and constipation can be a marker for this. The iron and calcium dose can be adjusted to help with diarrhea.
3. Anecdotaly, women with FM report improvement of symptoms with pregnancy. The few studies and surveys generally report the opposite. What is your experience? Are there particular trimesters when an improvement or exacerbation is likely to occur? What would be the reason for improvement (immune system turned off, particular hormones, or other reason?)
A - in my experience with treating thousands of patients, once the patient has gotten past the morning sickness, they usually feel much better during pregnancy. Morning sickness can often be avoided by taking adequate vitamin C (500 milligrams a day) and vitamin B6 (100 -- 200 milligrams a day). The improvement that occurs during pregnancy can occur for many reasons (increased CRH, blood volume, estradiol levels which improve immune function, relaxin levels, etc.). Overall, people do great during pregnancy (if given proper nutritional and thyroid hormone support) but may crash after. Even the crash after pregnancy can often be avoided with proper therapy.
4. Are there any particular complications of pregnancy or delivery related to FM or CFIDS (ectopic pregnancies, miscarriages, symphysis pubis disruption, breech presentation, for example)? Do women with FM lack muscle strength or tone for pushing? Do you advocate warm water birthing to ease the muscle pain of FM?
A -- as long as the woman is on adequate magnesium to decrease to risk of eclampsia, they tend to do just fine with their delivery. Warm water birthing would be reasonable for anybody.
5. Does an epidural help to conserve energy during birth and speed recovery afterwards?
A - I think that an epidural is quite reasonable, but leave this to the preference of the mother as in any other delivery.
6. Does FM affect length of stay in the hospital for mom or baby?
A -- not in my experience