Dr T Takes a Cruise
Friday, February 22, 2008
Kenneth F. Trofatter, Jr., MD, PhD
Incidentally, I checked my email today and saw absolutely NO comments. I KNOW that some of you have written comments/questions/concerns over the past week (since they seem to be expanding exponentially), and that only means the ‘comment fairy’ at Healthline hasn’t prescreened the ones you have submitted and posted them on the website. Don’t worry, when I finally receive them, I will answer as quickly as possible, so please don’t resubmit one if you already have and it hasn’t yet appeared on the site.
Anyway, to purposely avoid all things medical for at least another day, let me tell you about some aspects of the cruise. First, I have a whole new appreciation for DIMENHYDRINATE (marketed as Dramamine, Gravol, and Vertirosan). As I am sure many of you know, this is a medication used to treat ‘motion sickness’ (and it is very safe to take during pregnancy – oops, I already haven’t avoided ‘all things medical’!). Chemically, it is very similar to the antihistamine diphenhydramine (Benadryl) and it is actually a salt of both diphenhydramine and 8-chlorotheophylline (related to the stimulants caffeine and theobromine – CHOCOLATE), although the antihistamine effect predominates.
Motion sickness is the body’s natural response to conflicting reports from your senses (particularly your eyes and inner ears) to your brain regarding motion and women are about twice as susceptible to it as men for reasons I do not understand. Anyway, half the ship woke up seasick after the first night on the cruise and if it hadn’t been for the Dramamine, I don’t think I would have had much fun. Thank goodness it works FAST! Enough of that digression!
It was a short 5-day cruise. The first stop was in the Cayman Islands and while there I visited “Hell” (and returned safely). For those of you unfamiliar with “Hell”, it is a wetlands field that has jagged limestone rock structures covered with black algae that gives it a truly ‘out-of –this –world’ and hellish appearance. If I figure out how to post a picture on this page (I am technically challenged), I will do so in the future. Anyway, we went from “Hell” to 'heaven’ where we sampled many varieties of Tortuga rum cakes – VERY yummy! It would not have been hard to have spent the rest of the trip there! The rum samples (especially the ‘spice rum’) weren’t too bad either! Although the sea was not necessarily my best friend by that point, I did enjoy the beautiful water and the ambience of the people. No scuba diving for me yet because the left shoulder still has not healed. Before I left, I had to stop at the local Harley-Davidson dealership and get a Grand Cayman T-shirt with a pirate on it, of course – ARRRGGH!
The next stop was Calica, Mexico on the Yucatan peninsula. From there we went to see the Mayan ruins at Tulum. Our guide was Mayan, indeed that was his ‘first language’, and his family still lives in an open-sided thatch-roofed hut without running water and electricity in the middle of the country. Gilberto gave us a perspective on the history, culture, philosophy, and religion of the Mayan people that I am sure many of the other touristas didn’t appreciate by simply wandering the ruins on their own. When he found out that I was a physician, he related several tales of the ‘herbal’ cures passed down through the centuries and still used by his people today. He even educated me on the Mayan midwives’ method of predicting the number and gender of children a woman would have by ‘interpreting’ the number, spacing, and appearance of ‘knots’ in the umbilical cord of the first born child – will have to give that one a try! Gilberto was so good, he even made the ritual of ‘human sacrifice’ sound like it was something both understandable and acceptable. I was afraid to ask if his family had yet abandoned that practice, but if I ever go back to visit him again, we will be sure to clarify that point before heading into the mountains to say hello to his Mom and Dad!
Well, today, I won’t bore you with other more banal details of the cruise. In brief, I am currently withdrawing from both overeating and Dramamine (but not too much sun or alcohol). I already miss the vacation and the wonderful people (crew and passengers) we spent time with during the week. If you want to be spoiled, take a cruise! Tomorrow, I will tell you about one of the ‘activities’ on board that was not only entertaining, but gave me some insight into a technique that could be applied to improve relationships with significant others. So for now, and out of respect for the ship’s captain who was Italian,…Ciao!
Labels: dramamine, motion sickness
4 Comments:
At Fri Feb 22, 08:30:00 PM 2008,
Anonymous said…
Dear Dr. T,
I am a 34-year-old healthy woman who has been able to carry one child to full term without any complications (he was born 11-29-05). Unfortunately, I have suffered two miscarriages in the past six months and am currently seven weeks pregnant (third time). After the second miscarriage my OBGYN conducted several genetics tests and found that I am heterogeneous for Factor V Leiden (i.e., one gene mutation, not two). With this current pregnancy I have been on baby aspirin since ovulation and started Lovenox daily (40 mg) from the day I found out I was pregnant. At six weeks, we saw a healthy ultrasound and heartbeat. Up until yesterday, I have had no complications. However, yesterday, I spotted some pink blood during one urination, causing concern and having me seen by my OB today. Upon today's ultrasound, the baby is growing as predicted, the yolk sac was intact, and the heartbeat beating strong....however, he noticed a "fairly large" (he didn't tell me any more specifically) hematoma. Upon calling my perinatal specialist w/ this news, he took me off the baby aspirin but is keeping me on the Lovenox. While my OBGYN has me concerned about this development, the perinatal specialist says this is fairly common and that most often the hematoma subside and a healthy pregnancy can ensue. Obviously, all of this leaves me utterly frustrated and confused.
I have had no more spotting since the one incident.
What exactly is the risk of me losing this pregnancy? How common is hematoma in women on Lovenox? Is taking me off the baby aspirin the right thing? Is there anything I can do to safegaurd this pregnancy? What does all this mean towards me having a successful pregnancy - either this time - or ever??
I just thought we finally figured it out (i.e., Factor V Leiden diagnosis) and that by taking Lovenox all would be well....and now I am more frustrated than ever. Your thoughtful response is more than appreciated!
At Sat Feb 23, 05:56:00 AM 2008,
Anonymous said…
Hi,
I love reading your blog and have found it v. informative throughout my preg. Glad you had a chance to get away for a short time. My husband and I spent some time in Tulum and the surrounding area a few years ago. Tulum really is fabulous, as is all of the Puuc Route (Chichen Itza and all the rest of the ruins in the area)--our favorite was Uxmal.
I don't know if this is the appropriate place for this question, so please feel free to ignore it if necessary (I will also speak with my ob/gyn, but, unfortunately, she is at a conference for several days and I don't have an appointment for another week).
Here goes: I just received the results of my GBS test and they are positive. I also have had a v. high white blood count (last number was 17.5 or so) starting in trimester 2. I haven't had a fever or any other signs of chorioamnionitis, but am concerned that the high WBC count, combined with the GBS results, might indicate an infection somewhere (and, of course, the uterus is the area I am most concerned about right now). I am currently 36w6d and am scheduled for a repeat C-section at 39w2d (my GBS strep trest was neg. last time).
Is there anything I can do to minimize the chance of GBS infection in my child (other than taking antibiotics during delivery if my water breaks)? Are antibiotics during the preg. sometimes useful? Should I not permit any manual vaginal exams for the rest of my preg. (I've heard that can push the bacteria up into the uterus)? Am I at increased risk of stillbirth?
I would greatly appreciate any information you can provide about GBS/high white blood cell count/chorioamnionitis etc.
Best,
Andrea
At Thu Feb 28, 04:53:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Andrea Feb 23: Thanks for the kind comments and the torism information! I would only treat you at this point if you had an asymptomatic GBS urinary tract infection. Pregnant women often run a slightly higher WBC later in pregnancy for reasons that are not clear to me. It may be related to the rise in corticosteroid levels later in pregnancy in prepaation for labor and delivery. Carriage of GBS does slightly increase your risk for fetal complications, but the standard of care is NOT to treat at this point because so many women carry it and relatively few have problems. Thanks for eading and best of luck for the remainder of your pregnancy. Let us know how things turn out! Dr T
At Thu Feb 28, 04:58:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Feb 22: I probably would have recommenede what the MFM specialist recommended - stopping the ASA and continuing the relatively low dose of the Lovenox. Unfortunately, there is no "right way' to handle these situations at this time. In your case there is probably a very delicate balance between risks of losing the pregnancy, or having a complication related to Factor V Leiden, and sucessfully carrying the baby. Best of luck to you and let us know what happens. Dr T
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