An entity known as hyperemesis gravidarum (HG) occurs in about one in 300 pregnancies. In this condition, nausea and vomiting are severe and intractable, requiring hospitalization and IV fluids to prevent or treat dehydration. HG usually begins in the first trimester, and usually disappears by the end of the second trimester. It occurs most commonly in older women during their first pregnancy and is also associated with obesity. The cause is unknown.

Gastroparesis is also a relatively common cause of nausea and vomiting during pregnancy. In this condition, the stomach fails to contract and empty properly after a meal. Again, high levels of hormones may be implicated. Other less common conditions that can lead to nausea and vomiting in pregnancy include hyperthyroidism (an overactive thyroid gland), pancreatitis (inflammation in the pancreas) and hepatitis (inflammation of the liver).

I would expect that in your friend’s case, given that her symptoms have been present for almost the entire pregnancy, a proper workup was done to find the cause. If not, she should discuss this with her doctor. Often no cause is found, and these cases are usually attributed to HG. The key is to rule out other causes, such as gallstones, for which a therapy is available.

In case you are having trouble getting pregnant, find ways to boost odds of having a child and discovering facts about when to have intercourse, ovulation, menstrual cycles and also signs of pregnancy.

Jamie

A.Gallstones are very common in our society. It’s estimated that up to 30 percent of women over age 50 have gallstones. Stones cause problems by temporarily blocking the cystic duct leading out of the gallbladder, resulting in abdominal pain, nausea, vomiting and fever. These episodes, called biliary colic, often lead doctors to recommend removal of the gallbladder.

A. During pregnancy, a couple of factors increase a woman’s propensity to form gallstones. First, the hormonal milieu, with high levels of estrogen, leads to higher levels of cholesterol in bile. Bile is made by the liver and stored in the gallbladder between meals. The higher concentration of cholesterol leads to formation of microcrystals, which slowly grow to form larger stones in the gallbladder. Secondly, the gallbladder enlarges during pregnancy, becoming more flaccid and losing its ability to empty after meals. Again, hormonal changes (probably increased progesterone levels) are responsible for this. This decreased gallbladder activity leads to stagnation of bile and greater propensity to form stones in the gallbladder. Overall, about 30 percent of pregnant women develop gallbladder sludge — thick bile with small crystals, which can cause pain (biliary colic). Two percent of pregnant women develop actual gallstones, which are even more likely to cause pain. In most cases, the gallbladder can be removed after the pregnancy to prevent future episodes.

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Lamers and other pioneers in the hospice field set traditional thinking on its head. Everything changed. “We found it was beneficial for staff to attend the funeral of a patient that had died,” Lamers said. “We invited survivors in for support, for weeks, often years after the death.”

This caring had an unintended benefit for the patient. “We let patients know that their families will be taken care of and this gives patients an opportunity to talk about their own concerns that they might not have otherwise expressed,” Lamers said. “It gave everyone a new level of relatedness.”

These lessons about ritual and memorializing apply equally to professional and family caregivers. “People need to understand that their loved one is dead, but not gone as in forgotten,” he said.

Facing the Grief
Rhoda Eagan, project leader for the Volunteer Hospice Network, representing approximately 200 all-volunteer hospices in the United States, agrees that attention to the grieving process is critically important to caregivers. The national emphasis on acute medical care takes away from the human interaction. “Nothing goes to the frontlines,” Eagan said.

Lamers often sees the most serious burnout in couples trying to go it alone through the dying process. “It comes from husbands and wives trying to ‘protect’ themselves from strangers,” he said. At a minimum, he recommends some kind of regular “respite care,” in which the primary caregiver gets a break from the physical demands, psychological pressures and business decisions that come with the territory.

“Caregivers need to recognize that it is a job and that putting your own health at risk just won’t work,” Mintz added. Lamers, who began his practice in psychiatry, says that advances in drug-based pain management have allowed caregivers to focus on more quality-of-life issues, especially preparing for the grieving process. ” In my early practice I saw a lot of problems with unresolved grief; now we are dealing more with it at the appropriate time,” he said.

Foster says that a key to surviving caregiving for the terminally ill is facing the inevitability of death early in the process. “We live in the age of ‘if you can do, you should do it’,” she said. “We don’t have the social ethos to support decisions to limit anything.” Lamers concurs that too often, caregivers are struggling not to prolong life, but to extend death.

“You don’t want to hurry death or retard death,” Foster said, ” but we have so many medical tools for doing either.”

New technologies have pushed doctors even further from giving definitive “terminal” diagnoses, a situation that disrupts a patient and caregiver from facing quests beyond the extension of physical life: peacefulness, a sense of completion, spiritual examination.

The challenges of caregiving for the terminally ill can be daunting. The issues are complex and emotionally taxing. But professionals agree that self-care — and societal support — for caregivers is crucial to society as it navigates these uncharted waters. “Choose to take charge of your life, and don’t let your loved one’s illness or disability always take center stage,” advises the National Family Caregivers Association in its “10 Tips for Family Caregivers.”

“You can’t help someone if you are gasping for air,” Mintz said, continuing the image and encapsulating the wisdom of professional and amateur caregivers across the country.

This advice is especially true for someone caring for a loved one with a terminal illness, a situation that has become increasingly common in recent years.

A Recent Phenomenon
A dramatic demographic shift in the past century has resulted in the growth of “caregiving” as a social phenomenon. William M. Lamers, M.D., whose Hospice of Marin was, in 1974, only the second such caregiving institution in the country, explains this phenomenon. “In and around 1900, most deaths occurred in children under the age of 15,” he said. “By 1970, two-thirds of recorded deaths were among people over 75.” People now not only live longer, but also take longer to die. The country’s healthcare system — in fact all its institutions — have failed to keep pace with the change.

As a result, there are an estimated 25 million family caregivers in America, according to “The Economic Value of Informal Caregiving” published in the March 1999 edition of Health Affairs, the journal of Project HOPE, a nonprofit organization dedicated to promoting health around the world.

As many as 75 percent of caregivers are “going it alone,” according to “Caregiving Across the Life Cycle,” a 1998 joint study of the National Family Caregivers Association and Fortis Long-Term Care. Of “intense” family caregivers (those providing at least 21 hours of care a week), 61 percent have suffered from depression, according to the same study.

When the End Is in Sight

Statistics do not distinguish between those caregivers providing long-term care and those caring for the terminally ill. There are similarities between the needs of the two groups, and important differences as well.

“In the case of the terminally ill person, there is a clear end in sight and a single, clear purpose — make the person comfortable,” said Lisa Giannasi Foster, an independent consultant in clinical social work and systems and social policy development. A “terminally ill” diagnosis means that, in all probability, the patient has less than six months to live.

The idea of “an end in sight” is a mixed blessing for caregivers, however, Foster says. Unlike long-term care, where the open-ended relentlessness and physical demands can lead to burnout and depression, care at the end of life has a kind of clarity and redemptive value.

“It is very possible for most people to be heroic in the short-term,” she said. “The psychological toll comes in having to make the adjustment up front that you are walking down the last hallway with a loved one.”

This can show up as spotting between menstrual periods, longer and heavier periods, bleeding after menopause or bleeding after sexual intercourse, douching or a pelvic exam.

Pelvic pain can occur, but it is not common. Only a doctor can tell if cervical cancer or another health problem is causing these symptoms.

In addition to great advice from facility operators, highlights of McGough’s article are tips from two leading manufacturers for trade show success, as well as advice from a trade show consultant. Douglas MacLean, president of MacLean Marketing, outlines four steps to profit from your trade show experience: Making a written plan, executing the plan, being open to new information and managing your time. Be sure to make a list for yourself that includes which seminars/workshops you plan to attend, which suppliers you plan to see, which new products and suppliers you’re interested in, and which colleagues/peers you want to see. Then, after the show, evaluate your results. Ask yourself: 1) Did I meet my goals? 2) How, specifically, was the show valuable? 3) Did I obtain the desired information? 4) If I didn’t meet my goals, why not? Was the show lacking, or was it my plan? Use these results when planning for your next show.

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Having attended at least two national industry conferences each year for the past 10 years, I can tell you from experience that it’s not always necessary to attend a show. Much of the information that is imparted at trade shows can be obtained in the comfort of your office chair via industry periodicals, trade organization resources, and supplier directories and websites. However, sometimes you can only get the information you need by experiencing it firsthand, be it personally trying outaproduct, or by making contacts with those you would otherwise not have the opportunity to meet. It simply dependson what you aim to gain. The only way you can ensure that you get more from a trade show than you do from one of the many other, cheaper sources, is to know specifically what your purpose is for attending. Therefore, the key for you, as fitness facility owner or manager, is to closely examine the reasons for attending a conference, and to plan appropriately to ensure your money is spent wisely.

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The guys have a champion in old St. Nick. Who do we gals have — the prehistoric Goddess of Willendorf? When we see Santa we think: Time for fun. When we see the goddess we think: Time for liposuction. I call this acceptance of fat men “The Santa Factor”; it is a holiday double standard for the double-chinned.

Holidays are a tough time for the Willendorf women. All eyes turn toward big-boned folks when they belly up to the buffet during seasonal soirees; but it is usually the women — not the men — who receive disapproving stares from other guests when they reach for high-calorie collateral.

If the guy’s waist measurement adds up to more inches than his height, we shrug it off because that’s just the way he’s built. The Santa-factor phenomenon occurs because even the biggest of big guys appears to radiate confidence. Confidence is something many big women sadly lack. In this society we prey on the weak and helpless no matter what their size. Thus, big girls are easy, slow-moving targets for our disdain.

I don’t begrudge our big boys their approval rating. What does pinch my inch, though, is how they denounce the fat sisterhood. The large lads are some of the worst when it comes to lobbing pejoratives in the direction of fleshy femmes. There’s nothing worse than a fat fatist.

This holiday season remember to treat yourself the way you want others to treat you. You have as much right to be at the party — and to have a plateful or two of hors d’oeuvres — as any of the smaller people in the room.

If you walk up to the buffet with confidence and take what you want and not what you think others want you to choose, you will probably end up consuming less of what’s on your plate, and be more satisfied and happier for it.

Update: I haven’t lost or gained any weight since last week, but I have attended several holiday parties.

If parents choose to share personal information or worries about especially challenging situations, members of the group should maintain confidentiality. Adopting a respectful and non-critical attitude is important. It is vital to create a sense of comfort and safety for participants.

Sometimes it can be useful to raise issues anonymously. Parents can write down the situations they have confronted or might soon face on paper or index cards. The cards can be shuffled and handed out. People can take turns reading them, sharing ideas and responses. They can discuss the pros and cons of each response, as well as their possible short- and long-term consequences.

Parents can “role play” and rehearse different situations and responses, and potential outcomes so they can “try on” different ways of acting.

Another possibility is to invite groups of children to serve as consultants or teachers. For example, in my local elementary school, the guidance counselors have been teaching conflict resolution skills to several grades. At the next meeting of the kindergarten through third grade parents circle, children demonstrated the skills they learned, teaching us and guiding us in role-playing activities.

By growing embryonic stem cells in solutions containing special growth factors, scientists “coaxed” them to develop into glial cells — nerve cells that produce myelin, a coating required by other nerve cells for normal communication — according to Dr. Oliver Brustle from the University of Bonn Medical Center in Germany, and co-workers from the National Institutes of Health in Bethesda, Maryland, and the University of Wisconsin-Madison.

Glial cells — called oligodendrocytes and astrocytes — normally help to maintain the health of brain and other nerve cells. They also produce the myelin coating that is critical for the normal transmission of signals between nerves and brain cells. Among the human diseases caused by a lack of myelin are multiple sclerosis and a rare genetic disorder called Pelizaeus-Merzbacher disease.

When these specialized glial cells were transplanted into the spinal cords of newborn rats bred to lack myelin (as a model of Pelizaeus-Merzbacher disease), the cells not only grew and spread for several millimeters from the transplant site, but they also produced myelin that surrounded the rat nerve cells, according to a report in the July 30th issue of Science.

Similarly, when the cells were transplanted into the brains of rat embryos, the cells migrated into multiple brain regions, where they produced normal myelin.

The research team believes that their approach may ultimately be applied to human neurological disorders. “The availability of human embryonic stem cells… provide(s) exciting perspectives for the treatment of human diseases…. Self-renewing (able to differentiate into any cell type)… embryonic stem cells may provide a virtually unlimited donor source for transplantation,” the authors conclude.

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