Post-Partum Blow-out!

Hello!!! MOM! Isn’t it time for the February Quiz?

Well, Shana, for your information, if I had a little help around here, like with cooking? And doing the laundry? Maybe I’d have more time for the ezine and solving cases!

Well, Mom, as you can see, I’m busy!

Busy??? You call that busy??? Isn’t that you on facebook?

I’m not ON facebook, Mom; I’m getting on facebook, there’s a difference; and shouldn’t you be starting dinner?

Shana, if you don’t get up and start helping right now, I’m going to put you up for adoption. (Needed: Good home for 19-year-old; must have internet, cable and pizza….)

Alright, I’ll get up! Do we have a case for this month?

Yes, can you come up with a fictitious name?

Um…OK, “Lehigh”.

Isn’t that the name of your dorm?

It was the best I could do.

(sigh!) OK, so this is the case of “Lehigh” (pronounced Lee-High) and Lehigh has just given birth about a week ago. She’s been under a lot of stress with relatives visiting the new baby, friends dropping by, not getting enough sleep, the baby, it seems, can’t get enough milk, nursing is painful, there’s pains from the delivery still and not surprisingly, Lehigh has a great big HEADACHE! Her husband filled out the questionnaire because Lehigh has gone to bed. Here it goes:

Questionnaire

1. Describe the complaint

“Lehigh” is having a constant and deep headache. She suffers from migraines once in a while (maybe 3-4 times a year). She is having migraine type headaches for the last 2-3 days.

She is also constipated. She has an anal fissure that got reactivated during delivery. So, when she does pass stool it hurts really bad.

She has joint pains.

She has sore nipples when the baby feeds. One of her breasts also bled two days ago.

2. Etiology–this means the CAUSE

“Lehigh” delivered a baby boy 10 days ago. It was a long labor (almost 48 hours) and it was vaginal delivery. It was long because she was having the labor pains but her cervix had not dilated. We went to the hospital thrice because of the contractions but were sent back home twice because there was no dilation at all. The third time they took pity on her and admitted her to the hospital because the pains were severe. Then they gave her Fentanyl because the pains were severe and the cervix was not dilated. While Fentanyl took the edge of the pain she could still feel it. Within 45 minutes of giving Fentanyl her cervix went from 0cm to 9cm dilatation. Then they gave her an urgent epidural. The baby was delivered 3 hours later.

She developed an anal fissure during her first pregnancy that got reactivated during this pregnancy. She also had 2^nd degree tears due to vaginal delivery.

Because it was hurting soon after delivery I gave her Arnica 200C, followed by Arnica 1M. It did not help with the pain. Then I gave Staphysagria 200C (again not much help). She was also taking Motrin for her pain. But her tears healed more or less.

In her first pregnancy she was severely constipated. So this time she made sure to drink a lot of water and also ate fiber rich food. She was not constipated for the first few days after delivery. But constipation started 3-4 days ago.

3. Sensation–

Headache is deep (migraine). All her joints hurt.

4. Appearance– anything remarkable? Red skin, droopy eyes, etc.?

N/A

5. Location

Head, back and anal fissure (hemorrhoid).

6. Modalities

When she has the headaches she feels like sleeping and all sounds and lights are turned off.

7. Concomitants

She has a neck sprain that she developed yesterday.

8. Discharges

None

9. Generals

When she has a headache, she wants to be left alone. It seems like eating chicken has increased her headache, but she can’t say for sure.

10. The Mentals

She is making an attempt to keep her spirits high even with the pain, because she fears that it might impact her ability to lactate. As it is, the breast milk she is producing is not sufficient for this baby. So we are having to supplement the baby with formula (i.e., topping off the breast milk with formula, if baby is still crying for milk). Avoid formula if the baby is not crying for more.

11. What have you been saying?

She wants to drink cold water.

12. What are you doing?

Don’t know how to answer this question.

13. Describe your thirst and appetite.

She is drinking plenty of water to keep herself hydrated. She prefers cold water.

14. Fever?

No

15. Sweating?

No

16. Odors? Are odors an issue, such as bad breath, foul or unusual odors of any sort? Any identifiable odors–like sulphur, onions, fish, etc.?

No

17. What is most striking, peculiar or identifying about your condition?

Headache and joint aches.

18. Is there a diagnosis?

No

19. Describe your energy

Frustrated because of the constant headache.

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Well, gang, what do you think it could be? If you know the remedy, write to me at [email protected] and let me know! See you back here in March for the answer.