#1st month of pregnancy symptoms

[womenandwellness]

PREGNANCY

Symptoms of the initial months of pregnancy are critical and crucial for women. At WomenWellness360.in, we aim to support you through this entire journey from pregnancy to childbirth. The Common 1st month of pregnancy symptoms are missed periods, experiencing nausea, fatigue, and random mood swings. A few women also experience tender breasts, frequent urination, and mild abdominal cramping as their body adjusts to the initial/early stages of pregnancy.

Knowing pregnancy symptoms in the first trimester is essential for maintaining your body and your baby’s well-being and health. It’s common to have these concerns during this time, and our platform, WomenWellness360.in, can help. We offer a community of like-minded people and informative content in videos, blogs, and articles, and we seek help with expert consultations to guide you through the early stages of pregnancy at no cost.

Remember, every pregnancy journey is unique, and knowing the symptoms of the first month can help you prepare for the journey ahead. Let WomenWellness360 be your trusted partner/buddy in this beautiful experience.

https://womenwellness360.in/category/pregnancy-and-childbirth/

[lucy90712]

Family Christmas- Pedri

A/n: Happy holidays guys. I have a surprise new mini series for new years so get ready

1st December 

The test stared back at me as it laid face down on the bathroom counter while Pedri stood behind me with his arms wrapped around my waist. We have been sort of trying for a baby but not taking it too seriously by tracking my ovulation or anything so I really wasn't expecting to miss my period only 3 months after coming off my birth control. My period was due 5 days ago and I've had no signs that it will be coming any time soon the only usual symptom I've had is a bit of nausea in the mornings and evenings but that's also a symptom of pregnancy. The thought that I could actually be pregnant has me excited and nervous being a mum is a big change in life a change I know I'm ready for I'm just nervous about doing things wrong. 

"Are you ready to find out?" Pedri asked 

"I'm ready" I replied 

"You don't need to be nervous it's it's not positive we'll just try again it doesn't matter ok" he said 

"I know I've just got my hopes up so if it's not positive I'll be a little disappointed" I said 

"And that's ok but let's not think about that right now" he said 

He kissed my cheek then put his hand on the test waiting for me to do the same so we could flip the test together. I took a deep breath and put my hand next to his then we counted down from three and turned the test over. Staring back at us was two distinct lines just as dark as each other so there's no question I'm definitely pregnant. Without me even noticing tears of joy poured from my eyes which Pedri wiped away before pulling me into the tightest hug. This is the best early Christmas present ever and now we can surprise the rest of our family throughout the holidays. 

~~~~~~~~~~

24th December 

Way before we found out I was pregnant we agreed to host Christmas with Pedri's family which at the time was a great idea but now I'm sort of regretting it. There is so much that goes into hosting so I've been exhausted all week because the first trimester is really taking it out of me so coupled with all the extra things I've been doing I can barely keep my eyes open by 9pm. Pedri has helped as much as he can but he's only been off for the last few days so now here we are finishing wrapping presents on Christmas Eve and I still have some food to prep. 

Usually I do most of the work when wrapping presents as if I don't it will look like a toddler wrapped them in the dark as Pedri doesn't exactly have the eye for wrapping. Under my instruction he did most of the work as then I could just sit there and hold the paper while closing my eyes for a few seconds to get some rest. The main thing we needed to wrap was the things we bought to surprise Pedri's family with the news as they don't know yet. We had our first ultrasound just a few days ago so we added some of the pictures to the little onesie we bought that we customised to have the baby's rough due date on. I can't wait to see their faces a when they find out because it's been so hard to keep it a secret from everyone especially when I've been feeling so awful and having to lie and say it's just a regular sickness. 

After we finished wrapping I went to prep some stuff ready to make dinner tomorrow as I don't want to spend all day in the kitchen and not enjoying the festivities. I tried my best to get on with the prep I wanted to do but the smell of the food was making me feel so nauseous I tried to breathe through my mouth or just ignore the smell but I couldn't. Eventually it became too much and I had to run to the bathroom where Pedri quickly joined me to help hold back my hair. To begin with my sickness wasn't too bad but over the last week or so it has definitely got worse there is certain foods that I just can't stomach anymore and the smell of most things makes me nauseous. Once I was feeling better I wanted to go back to the kitchen and finish what I started but Pedri wouldn’t let me he insisted on doing it so I gave him instructions and he did all of it for me. 

Pedri joined me back on the sofa and put on a show for us to watch or for him to watch while I fight to keep my eyes open. As predicted I must've fallen asleep as I was woken up by the squeaky step on the stairs as Pedri carried me up them. When he saw my eyes open he cursed the step before telling me to go back to sleep but I would only do that when he tucked me up in bed and gave me the goodnight kiss I missed out on before. 

~~~~~~~~~~

25th December 

My Christmas morning started out with the most delightful gift of having to run to the bathroom because I woke up feeling overwhelmingly sick. Luckily my hair was already up this time but Pedri still sat by my side and rubbed my back for nothing more than moral support but I appreciate it anyway. He got me a glass of water and helped me up so I could brush my teeth so that we can get on with the days plans. Like the amazing husband he is Pedri made me some toast for breakfast as he knows that’s one of the things I can eat when everything else makes me sick. He also had all my vitamins I'm supposed to take laid out and some water to go with them which so nearly made me cry as all my hormones have had me extra emotional but I managed to hold back. 

We agreed that we weren't going to open any presents until Pedri's family arrived but after we finished eating Pedri handed me a gift and told me to open it. Inside was a little photo album meant to capture every first of a baby's life I flicked through the book to see all the moments we can capture in here then I saw that Pedri has already put the first ultrasound picture in there. That was enough to make me cry I can't wait to fill this book with memories and cry again every time I look at it. 

"Thank you this is the best gift" I said 

"You've already given me the best gift so I had to try and get you something that represents that and I know you love a photo album" he said 

"It's perfect I can't wait to keep adding to it" I said 

We continued to talk about what our lives will look like over the next year and then for the rest of our lives until Pedri's family arrived and I had to hide the photo album quickly. He ran and let them in and helped them with the bags of presents they'd brought with them while I greeted them all as it's been a while since we were all last together as life has been hectic. Rosy complimented my outfit and told me I looked beautiful which really put a smile on my face as I've not felt good about myself since my pregnancy symptoms took over. We all chatted for a little while catching up before I could see Pedri getting impatient and wanting to tell his family already so I suggested we open presents.��

Pedri quickly took over and gave his mum the gift we wrapped yesterday and says it was for all of them so they all gathered round to look at what it was. Seeing the look on their faces as it sunk in made my day. I knew they would all be excited as Pedri's family are all really close but I wasn't expecting the immediate group hug we were both pulled into. I've never heard the word congratulations so many times but it made me happy to know they were so excited as I know our baby will have the best grandparents and uncle. 

"congratulations how far along are you y/n?" Rosy asked 

"I'm just over 8 weeks so not far along but we couldn’t wait to start telling people" I said 

"How have you been feeling?" Fernando asked 

"I've been better but I'm doing ok" I answered 

"She's been quite sick recently and very tired but she's been a trooper and still living like nothings going on" Pedri said 

"The first few few months are tough but it does get better and it's all worth it in the end" Rosy said 

"We can take over everything for today you should be resting and taking care of yourself" Fer offered 

"Oh no I can't have you do that you're supposed to be guests I'm fine really" I said 

"Don't be silly at least let us take over dinner I remember when I was pregnant with the boys the smell of food always set me off" Rosy said 

"Ok but I will make up for it at a later date we will invite you over for dinner and I'll cook for you" I said 

"That sounds lovely" Fernando said 

We opened the rest of the presents we had got for each other but nothing was really able to top the pregnancy surprise we started with. Pedri did get me a little heartbeat reading machine so once the baby is more developed we will be able to listen to their heartbeat at home which I enjoyed. He said he thought about getting this really cute baby onesie he saw but he held back so that we can get the first things together but he did promise to use one of his days off to go baby shopping with me in the new year which at this time in my life is my version of a great day. We also had to joke about the fact that Fer had bought be a nice bottle of wine which of course he wasn't to know was bad timing but it made everyone laugh especially when Pedri said we could pack it in my hospital bag for right after the baby is born. 

Then it was time to start on dinner but I wasn't allowed to lift a finger in fact I wasn't even allowed to get myself a drink of water someone else aways did it for me. I was also periodically fed snacks by Pedri who wanted to make sure I'm getting enough nutrients even when I'm not feeling well. At some point I must've fallen asleep as it was light when I last remember being awake but then it was dark out and very dark out. It was a good nap though as I actually felt refreshed and like I had some energy for once. As I slept for apparently most the afternoon dinner was almost ready so I got up to freshen up as I know I look ridiculous when I've just woken up. I fixed my hair and even put on a bit of makeup which made me look and feel more human which is the most I can ask for at the moment. 

By the time I was ready the table was being set so I tried to help as I've done nothing all day but Pedri steered me away from the kitchen to the table where he pulled out a chair for me and told me to sit down. I wanted to help but he told me that his parents have it all covered so my job is to just sit and look pretty which he said I'm doing a great job of. He gave me a quick kiss before running back to the kitchen to help. It didn't take long before there was a plate of food put in front of me which looked amazing although I had to try not to smell it as it will make me nauseous. The food was lovely much better than anything I could've made but I guess thats what happens when you get chefs to make your Christmas dinner. I ate as much as I could before I started to feel sick which Pedri could definitely tell as he squeezed my hand under the table to check that I was ok. 

The original plan was for everyone to stay and watch a movie after dinner but Pedri's family insisted on leaving us be after cleaning up which again I tried to say wasn't necessary but they insisted on helping out. The house ended up cleaner than it started out so I won't have to clean for a few days which will be nice. 

"Thank you for taking over dinner and cleaning I really appreciate all your help" I said as they were all leaving 

"There's no need to thank us you've done all the hard work preparing for today" Fernando said 

"And if you need anything don't hesitate to reach out even if it's just something small we are all happy to help out" Rosy added 

"Thank you guys we really appreciate all your help" Pedri said 

"Make sure you take care of her bro and you've got to learn to cook now your a father" Fer said 

"I've been trying haven't I love" Pedri said 

"He has and he's definitely getting better I don't have to supervise all the time anymore" I said 

They congratulated us one more time before leaving so it was just me and Pedri. It wasn't late but we decided to just go to bed as it's been a long day. Pedri definitely wasn't tired but I was so he got me to rest my head on his chest as he played with my hair as he knows that always sends me to sleep.

“Good night mi amor I love you and our little baby so much already” Pedri whispered as I was falling asleep

“We both love you too” I whispered back 

[thinkingofausername]

Alright, so there's been discussion about Anya's pregnancy. I've got a theory that she wouldn't have given birth on the ship, but I'm still piecing things together. Here's what I've got:

The ship was crashed 147/365 days of the trip. The same day Anya told Jimmy about the pregnancy. Let's assume she confirmed the pregnancy not long before that.

There were 218 days (7.2 months) left after the crash. Going with the logic that the birth would've happened after the trip, aka the 9 month mark was achieved after the trip, that would leave 1.8 months before the crash, during which she had time to confirm the pregnancy.

If she had a urine test, IF, according to the sources I've checked she could've confirmed the pregnancy after ten days (earliest). If there was no "official" way to confirm, if she had to go off symptoms, she would be looking at missing bleeding (14 days minimum), sore breasts (1-2 weeks earliest), nausea (4th week earliest).

If we go with the option that it took her a month to confirm, she told Jimmy soon after, he crashed the ship the same day, there are 7.2 months left of the trip (let's imagine they'll be home when they were supposed to be), by the end of it all she's about 8.2 months pregnant. The scenario of her giving birth on the ship would be very narrowly escaped, but still.

It's important to mention that there's no certain answer, this is just a fun little attempt at analyzing, it's interesting to think about.

There are many possibilities and factors (stress, miscarriage, early birth, late symptoms, individual experience, etc), this is just an attempt to get the general or basic idea of how things could've gone.

Constructive and polite criticism is always welcomed, encouraged even. I'd really like to piece this together.

I'm tagging some folks who have inspired me to start this topic: @kodyfae-the-1st @theodd8ball @kettle-black @ayyyyysexual

[seerkin]

HER SEER ABILITY:

Considering with all the new species in the tvdu, i have that ali has the ability of being a seer.

You can read more about it, by clicking the keep reading below.

HISTORY:

Ali’s sightseeing inheritance goes back to the 1st Century, Greece, the same timeline as Silas, Amara and Qetisyah, and the first ever seer is Alexandra (known as Cassandra) and the first born daughter can only inherit the gift.

Regardless if the firstborn daughter is a supernatural creature or a human, the bloodline must continue on. The first supernatural and Ali’s ancestor is Lucia, who became a vampire in 1114, and has continued to watch over her family, including Ali, Dominic and Vera, to the present.

ABILITIES:

Human - can only see the future. But as a supernatural - is greatly enhanced, and can see past, present and future.

Can see anything in general, but Physical contact will have a stronger connection.

Visions can come in advance or at random.

Has the ability of carrying a child, but with only a strong, deep connection to the male lover.

Fast pregnancy. (not a standard 9 months pregnancy like humans, but 6 months)

The children will have some vampire traits - healing and fast aging, till they reached a certain age. 18, and then aged slowly.

Seers are supernaturals, thus, they can be on the other side and interact with other supernatural species.

Naturally charismatic.

cant be compelled.

WEAKNESSES:

If the female is a vampire - will have the same weakness as a vampire.

Werewolf Venom - if she has been bitten by a werewolf, she won’t die, but will have the symptoms of it, but will survived without having Klaus’s or Hope’s blood after 24 hours, like the common cold.

Hunter’s Curse - will suffer some symptoms but will overcome it. This is due of Lucia being present during the beginning, and was able to protect her bloodline, due to her relationship to the witch.

The Cure - like most, if the female is a vampire, and has taken the cure, she will go back to being human/seer.

If the female is a witch - will have the same weakness as a witch.

If the female is a werewolf - will have the same weakness as a werewolf.

RELATIONSHIPS TO OTHER SUPERNATURALS

HUMANS - seeing as seers are regarded as humans, they have the best relationship with them.

WITCHES - Seers, also, have the best relationship with witches, as witches will always rely on seers (even if they are vampires), especially witches who have the rare gift of sightseeing.

VAMPIRES - Seers tend to keep their ability a secret, not wanting to be exploited, so Seers are cautious revealing themselves to vampires. That is why both Lucia and Ali kept their ability a secret for so long, only revealing it to a handful of people they trust.

WEREWOLVES - Like vampires, Seers also kept their ability a secret, as they know that the werewolves would want to use Seers against vampires.

RELATED SPECIES TO: Humans , Witches, Vampires , Werewolves, Siphoner, Psychic, Seers

KNOWN SEERS

Alexandra (1st century) - human / seer -  deceased

Lucia  - vampire / seer - undead

Joanne Maxwell (ali’s grandmother) - human / seer - deceased

Louise Martin (ali’s mother) - human / seer - deceased

Ali Salvatore - vampire / seer - undead

Lois Martin (daughter of ali & kol) - vampire / seer - undead

Alexa Martin (ali’s granddaughter / lois’s daughter) - human / seer - alive

[mcatmemoranda]

Stuff from OB:

At 38 weeks, induce moms who have GDM so baby doesn't get too big.

Edinburgh Postnatal Depression Scale (EPDS) = depression scale for postpartum pts.

Giving Tdap vaccine at 28 weeks is optimal to give the baby time to absorb the antibodies and not have it wane too much prior to birth.

Between 18-22 weeks, you should be able to feel the baby kick. It takes longer for the mom to feel it if the placenta is more anterior because the placenta can act as a cushion, preventing mom from feeling the kicks.

Hypertensive Moms Love Nifedipine = Hydralazine, Methyldopa, Labetalol, Nifedipine can be used for gestational hypertension. Labetalol and nifedipine are the best.

At 20 weeks the fundal height is at the level of the umbilicus, and then it grows 1 cm per week. If it's greater than or less than 2 cm of expected height, get ultrasound.

Vitamin B6 can help with migraines. Riboflavin and magnesium help with migraines in pregnancy. At 20 weeks, you may start feeling the baby kick. The goal is 20 kicks per hour. If less than 20 kicks/hour, you can not eat or drink something cold, lie down to try to get the baby to move.

Doxylamine (Unisom) and pyridoxine (vitamin B6) can help with nausea after taking every day. Phenergan (Reglan) is first-line for hyperemesis gravidarum. There is a theoretical risk of fetal death in utero with use of Zofran, which has been seen in animals, but not in humans. Zofran a second-line for hyperemesis gravidarum.

Zoloft and Lexapro seem to be best for depression in pregnant women.

If a pt has Nexplanon in and is bleeding for an extended period, you can try an OCP or depot contraceptive for 2 months rather than just taking out Nexplanon.

GDM A1 = diet controlled gestational DM

GDM A2 = insulin controlled gestational DM

Gestational diabetes increases the risk of preeclampsia. Gestational hypertension develops at 20 weeks GA and increases the risk for preeclampsia. An increased BMI and lupus can increase the risk for preeclampsia. Previous history of preeclampsia also increases the risk of preeclampsia. There was a patient who had gestational diabetes which increases her risk of preeclampsia, so is not baseline labs including CMP, urine protein to Cr ratio, started her on aspirin.

Hepatitis C cannot be treated during pregnancy. You can treat the patient postpartum and you test the baby at 3 months. If the viral load is heavy, pt has symptoms, send to peds hepatologist.

The 1st trimester ultrasound is accurate to +/-1 week and in the 2nd week it is accurate 2+/- 2 weeks.

It is safe to treat a yeast infection in a pregnant woman with fluconazole 100 mg once.

You want to obtain the GBS swab at 34-36 weeks. It expires 5 weeks after it is done. Penicillin should be given 2 hours before delivery in patients who are GBS positive.

1st trimester screening includes sexually transmitted infections, Pap only if they need a Pap, CBC, type and screen, Rh factor. Any time you have vaginal bleeding or abortion in a pregnant woman you should give RhoGAM. RhoGAM at 28 weeks and after delivery. Rubella and varicella titers, ultrasound.

if the patient has an increased BMI or glucosuria usually get an early oral glucose tolerance test.

Pregnant women can eat deli meat if they cook it up to 165°, which will kill listeria.

Spotting is normal during the 1st 7-9 weeks of pregnancy.

GDM blood glucose goals: fasting should be less than 95 mg/dL; post-prandial should be 90-140 mg/dL. You should do a 2-hour oral glucose tolerance test 6 weeks after delivery for moms who had GDM (you can also just check a HgbA1c).

Things to know for tests: identifying preeclampsia, gestational vs chronic HTN, risk factors for GDM, management of postpartum hemorrhage, management of hypoglycemia in newborns, management of transient tachypnea of the newborn

[izroulia]

Izroulia bonus chapter

This is a little bonus backstory that I couldn’t really fit into the actual book. It goes a little deeper into Aries’ parents and Momo.

July 1st 1990

“Lana shut the fuck up, are you kidding?”

“Nope! I’m pregnant, MOMO I’M HAVING A BABY!”

Screaming in joy, the best friends leapt into each other’s arms and squeezed each other in a tight hug. Lana wasn’t exactly actively trying for a baby, but she and Cynthus had decided that if it happened, then it happened and they’d roll with it. But something about it actually happening made it seem so much more exiting and joyful. It was much too early to tell the sex of the baby, but Lana didn’t care what her kid was. She just wanted a healthy and happy child.

“I better get to be the cool god mother” Momo said.

“Duh, that’s why I’m here. To tell you you’re going to be the godmother. If for some reason me and Cynth are out of action you’re the next of kin” Lana replied.

“That I can do. Holy shit Lana you’re having a freaking KID!”

“I KNOW!”

The siren was already thinking of names, nursery ideas, looking for patterns to make baby clothes. And her fiancé was already out getting wood to make a custom crib with. They were thinking a sailor themed nursery, perfect fit for a siren. So a crib shaped like a little boat? That’s be the cutest thing ever.

“Did Cynthus have a heart attack?” Momo snickered.

“In a good way yes, you should have seen that absolute baby. Literally sobbing he was so exited” Lana replied.

“Seems like deep down he really did want that baby”

“I think he did, hey got his wish. 10 weeks in”

Momo still wasn’t in a relationship, and she didn’t really feel the need for one right now. Not when she was going to be on full time baby helping for her two best friends soon anyway. She was overjoyed for them, she’d known Lana since highschool and Cynthus joined the group only about a year later. They’d all be so close, Momo didn’t mind being the third wheel because they all got along so well and were genuinely such deep friends.

“Any names or too early?” Momo asked.

“A few. Rhiannon, Tessa, Lux for a girl. Maybe Lucian or Atantic for a boy. But honestly I have a soft spot for gender neutral names” Lana explained.

“You know how they say mothers can tell the gender before the baby is born? Maybe that’s why. Maybe they’ll end up both” Momo joked.

Oh how ironic that joke would end up in the years to come…

“Haha, maybe. I don’t really have any guy feelings but then again, it’s early. But for androgynous names there’s Fawn… or maybe Aries” Lana said.

“Ooh Aries is good” Momo replied.

“Cynthus did the math, they’ll be born in Aries season so he thought it’d be a good candidate”

“It is, I say Aries. Or maybe Rhiannon if it’s a girl”

There was so much to do. Get all the supplies, tell the family, pick a name, go to all the check ups, build the nursery… but even with all the work and pregnancy symptoms to deal with. Lana was still practically jumping out of her skin. She was going to be a mother, and the father was the love of her life. And the godmother? Her best friend. She felt like absolutely nothing could stop her, being her down or wipe away her smile.

July 1st 1991

“Everything is in the crib, we didn’t have much time so it’s a bit if a mess. But it’s all there… everything you need to raise a baby” Cynthus said, a numbness in his voice.

“Cynth there has to be someth-“ Momo said.

“There isn’t… it’s too dangerous to take a newborn through a portal. Let alone an unstable one. If things work we will be back… promise”

Momo looks over at Lana, clutching the sleeping baby to her chest, sobbing her eyes out. It’d only been 4 months. 4 months with her baby, and now she has no choice but to say goodbye. She knew Momo would take care of her child, but she’d gone through 9 months of pregnancy and excitement waiting for the day she got to meet her baby. And after all that… only 4 months together.

But she had no choice. At the rate Merfolk wee being killed, it was either run or die. And a newborn just can’t go through an unstable portal… it’d kill them instantly.

Cynthus turned to his fiancé, tears in his eyes as he pulled her and his baby into a hug. He wanted to scream, but he tried to keep it together for Lanas sake. He placed a kiss on the babies cheek, threatening to break down.

“Daddy will be back ok? I promise…” he said.

Lana took a breath, she look one more look at her baby and kissed their forehead.

“Be good for mama Momo ok? I love you guppy, I’ll come back one day. I promise” she sniffled.

With tears in her eyes, Momo took the sleeping child, and pleaded with her gaze at her best friends to stay. She knew they couldn’t, but she wanted them to stay so bad. If Agnemetra didn’t cease the throne… this never would have happened.

“Momo, I love you. Take care of my baby” Lana said.

“I will… I promise” Momo replied.

The group hugged one last time, and hardly able to keep it together Lana and Cynthus got into their car and pulled out of the driveway to the portal centre. Hoping that if they were lucky, they could get out with their lives.

Momo took the baby inside, on the table was a basket of supplies. Bottles, clothes, formula, pacifiers. Next to the table the handmade crib with the rest of the supplies. She needed to set up, she had a baby to care for now.

She wrapped the child up in a sling, so she could keep them close and move stuff around at the same time. She packed all the supplies into her cupboards, and pushed the crib into her room next to her bed. She set up the mobile of sea creates she gifted to the parents at the baby shower, put the blankets with little fish and anchors on it over the mattress. And she placed the sleeping baby in their crib.

They had Lana’s black hair, Cynthus pale skin and blue eyes. A true mix of their parents. All warm and cosy in a knitted onesie, something Lana made while she was in the late stages of pregnancy and couldn’t move around as easy. Hanging off the railing of the crib was a necklace chain that held the family signet ring for the child to wear when they were older.

The boat shaped crib was pained red and navy, had a little life raft and sail on it. Where the name of the boat would be, was the name of the child.

Aries Nautica.

Momo sat on her bed, looking down at the baby who was completely unaware the danger they were in and how painful this was for their parents. Momo had a sinking feeling she may never see her best friends again, and now she had to take care of their child.

Aries would always be Lana and Cynthus’ child. But right now… Aries was her child too.

Aries was the only thing she’d have left of Lana and Cynthus… and every day they were alive in Izroulia, their life was in danger because they were born to two sirens.

Momo sighed, and everything just broke.

All she could do was cry.

[kehaze]

Eleven weeks

April 15th was the last day of my last period. It's July 1st, I'm 11 weeks pregnant now. We've told absolutely everybody, because I figure two things:

If I'm superstitious and don't tell anyone, no one will be around to console me if something does go wrong.

If I give in to the superstition, the superstition wins. I want to share, I want to connect, I'm a classic oversharer.

I haven't had too many rough symptoms. I was low-key nauseated for weeks, but not to the point of throwing up. I had bad acid reflux week 9, but have been eating smaller meals and have a bottle of Gaviscon around, so have been ok since. I may have developed allergies, and have some annoying post-nasal drip that's keeping me coughing. I went about a week with no sleep but that was week 9-10, I seem to be sleeping great now as of a few days ago.

Fatigue has been the big one. The second month (weeks 4-8) was the most tiring, knock on wood but I feel pretty ok now.

I'm overweight, and know that I'm going to experience more severe back pain than I already do just by nature of being a bit overweight. Breathing will get uncomfortable as the baby takes up more space, I'm not looking forward to that.

2 days after I found out I was pregnant (2 days after my missed period), I had a doctor's appointment scheduled for something else, and told my GP I was pregnant. Thus kicked off the free maternity visits. I've had 2 so far, the initial one with my GP where he printed off loads of paperwork for me and sent off my information to CUMH, the maternity hospital here. I had my first scan June 18th, where they changed my EDD. Based on my last period, I'd be due January 20th, 2025. They changed the due date to January 26th, 2025. Not too big a jump, but they said the baby was small and wrote "IUGR" on one of my scan photos - something I know can be overdiagnosed, and hope I'm not suffering from. I should warn them I was born 5 and a half pounds, fully baked.

Looking forward to the rest of this pregnancy :)

[kaurharleen]

Navigating the Miracle: A Comprehensive Guide to Pregnancy Stages

Pregnancy is an extraordinary voyage brimming with delight, eager anticipation, and boundless wonder. From the magical moment of conception to the exhilarating climax of birth, expectant mothers embark on a profound journey, traversing through a series of pivotal stages that sculpt the profound experience of ushering new life into the world. In this comprehensive guide, we embark on an enlightening exploration of the multifaceted journey of pregnancy, unraveling the mysteries and marvels of each stage, from the subtle stirrings of life in the initial signs of the first month to the profound metamorphoses of the transformative first trimester.

Along this captivating odyssey, expectant mothers are enveloped in a tapestry of emotions, from the tender joy of discovering new life within to the exhilarating anticipation of meeting their precious bundle of joy for the first time. Each stage of pregnancy is imbued with its own unique wonders and challenges, shaping the expectant mother's experience and deepening her connection to the miraculous journey of bringing new life into the world. Join us as we embark on this extraordinary expedition through the pregnancy stages, celebrating the awe-inspiring journey of motherhood and the boundless miracles it brings forth.

1. The First Month: Early Signs and Symptoms

Embarking on the Journey: The 1st month pregnancy Symptoms marks the beginning of a miraculous journey, an awe-inspiring transition from conception to the dawn of new life. While conception may have just occurred, the body quietly whispers its transformation, undergoing subtle changes that signal the onset of pregnancy. These changes manifest in various forms—fatigue settles in like a gentle tide, a sense of tenderness pervades the body, and heightened sensitivity to smells delicately emerges. Though these symptoms may appear subtle, they serve as poignant early indicators of the remarkable journey ahead, a journey filled with anticipation, wonder, and boundless love.

Understanding 1st Month Pregnancy Symptoms: During the first month, expectant mothers embark on a voyage of self-discovery, as their bodies gracefully adapt to nurture new life. Many women experience a symphony of symptoms during this delicate time—fatigue whispers softly in the background, nausea may gently ebb and flow, and the tender embrace of breast tenderness becomes familiar. These symptoms, like gentle whispers of change, are often attributed to the symphony of hormonal fluctuations orchestrating the body's transformation. As the body begins its intricate dance of preparation for the growth and development of the baby, these symptoms serve as gentle reminders of the awe-inspiring journey unfolding within. While the nuances of these symptoms may vary from woman to woman, they are all an integral and natural part of the early stages of pregnancy, a testament to the miracle of life burgeoning within.

2. The First Trimester: Understanding Early Pregnancy Symptoms

Introduction to the First Trimester: The first trimester pregnancy symptoms is a period of profound change and growth. From conception to the end of the twelfth week, expectant mothers experience a range of physical and emotional changes as their bodies adapt to support the growing baby. Understanding these changes is essential for navigating this transformative stage with confidence and ease.

Exploring First Trimester Pregnancy Symptoms: The first trimester pregnancy is often characterized by a variety of symptoms, including morning sickness, fatigue, and mood swings. These symptoms can vary in intensity from woman to woman and may come and go throughout the trimester. While these symptoms can be challenging, they are a normal part of the pregnancy experience and often subside as the pregnancy progresses.

3. Coping Strategies and Support: Navigating the early pregnancy stages can be overwhelming, but there are strategies and support systems available to help expectant mothers cope. From seeking guidance from healthcare providers to leaning on the support of friends and family, finding ways to manage symptoms and emotions is essential. Additionally, joining online communities or support groups can provide valuable insights and camaraderie with other expectant mothers going through similar experiences.

4. Nutritional Needs During Pregnancy: Proper nutrition is crucial during pregnancy to support the health and development of both the mother and the baby. The first trimester is a critical time for fetal development, and ensuring adequate intake of essential nutrients is essential. Expectant mothers should focus on a balanced diet rich in fruits, vegetables, lean proteins, whole grains, and dairy products. Additionally, taking prenatal vitamins prescribed by healthcare providers can help fill any nutritional gaps and support the healthy growth of the baby.

5. Physical Changes During Pregnancy: The first trimester brings about various physical changes in the expectant mother's body as it adapts to support the growing baby. These changes can include breast tenderness, frequent urination, and fatigue. Additionally, hormonal fluctuations may cause mood swings and changes in skin pigmentation. Understanding these physical changes can help expectant mothers prepare for the journey ahead and alleviate any concerns they may have about their changing bodies.

Conclusion: Understanding the stages of pregnancy is essential for expectant mothers as they embark on this remarkable journey. From the early signs in the first month to the transformative changes of the first trimester, each stage brings its own joys and challenges. By embracing these stages with knowledge and confidence, expectant mothers can navigate pregnancy with grace and excitement, eagerly anticipating the arrival of their new little one. With proper support and care, the journey through pregnancy becomes not only a physical transformation but also a deeply enriching and empowering experience for mothers-to-be.

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Cold

Symptoms – sore throat, sneezing, runny/blocked nose, cough, mild fever, pressure in ears, headache, myalgia (pain in muscles)

Duration – 1-2 weeks, symptoms peak 2-3 days, incubation period 10-12 hrs

Referral criteria – suspected flu, earache not responding to analgesia, sinus pain not responding to decongestants, no improvement after 10-14 days self-medication

Complications - immunocompromised, who smoke, and with comorbidities such as diabetes mellitus, congestive heart failure, asthma, chronic obstructive pulmonary disease, cystic fibrosis, and sickle-cell disease

Sinusitis – prolonged nasal congestion and facial pain

LRTI - acute bronchitis, acute exacerbation of asthma or chronic obstructive pulmonary disease (COPD), and community-acquired pneumonia

Acute otitis media – common in younger patients

Differential diagnosis

Meningitis – high fever, drowsiness, blank expression, vomiting, loss of appetite, high pitched screaming, non-blanching rash, photophobia, severe headache, malaise

Upper airway obstruction – noisy breathing, drooling, inability to swallow.

Nasal foreign body – persistent discharge from 1 nose with no other symptoms

Management – paracetamol or ibuprofen for headache, muscle pain or fever – only continue use if distressed, change to other agent if not alleviated, don’t give both together

Paracetamol contraindicated in – liver/kidney problems, epileptic

Ibuprofen contraindicated in – pregnancy, perforated stomach, increased bleeding, severe HF, kidney or liver problems, high BP, asthma, hay fever

Intranasal decongestants – improve breathing and promote sleep and has fewer S/E than oral decongestants. Ephedrine HCL 0.5% nasal drops for 12 and older p 1-2 drops 4x daily for 1 week – contraindicated – diabetes, hypertension, hyper thyroidism, CVD, high BP, MAOI in last 2 weeks

Oral decongestants – relieve nasal congestion (phenylephrine) – max 1 week

Antitussive (cough) – dextromethorphan

Expectorants (guaifenesin)

Chlorphenamine or Beecham’s (contains phenylephrine and paracetamol) (Sedating antihistamine – dries up secretions)

Counselling points

Go to GP if

fever for more than 3 days

symptoms worsening after 5 days

symptoms not better after 10 days

follow up meeting

risk and complicated patients within the week

young children – 1 week

Headaches

Types of headaches

Primary – not associated with other conditions – migraines, tension types, cluster

Secondary – associated with other conditions – trauma/injury, vascular disorders, hyper-tension, withdrawal such as opioids, analgesics, or alcohol. Bacterial or viral infection.

Features of serious headache – referral

New severe or unexpected headache – sudden onset reaching max intensity 5 mins and new onset in over 50s

Progressive or persistent headaches that changed dramatically

Associated features – fever, impaired consciousness, seizure, stiffness, photophobia, neurological deficit, cognitive dysfunction, atypical aura (greater than 1 hour) or aura 1st time in patients using combined oral contraceptives.

Dizziness, visual disturbance, vomiting. Head trauma up to 3 months prior, triggered by coughing, sneeze, or physical exertion. Worsened by standing or lying down.

Compromised immunity

Diagnosis

Migraine without aura – at least 5 attacks lasting 4-72 hrs with unilateral location (half the face), pulsating, moderate to severe pain and aggravated by or causing avoidance of routine physical activity. Attack comes with nausea and/or vomiting, photophobia and phonophobia

Migraine with aura – 2 attacks with visual aura (zigzag lines or blind spots), pins and needles, speech/language symptoms, motor weakness, vertigo.

One aura spreading gradually for 5 mins and 2 or more occurring after

Each aura lasts for 5-60mins which is unilateral

Management – stop combined oral anticontraception – contraindicated

Ibuprofen 400mg, paracetamol 1g, advise med to be taken at start of attack – follow up 2 weeks

Tension type – recurrent episodes lasting 30 mins – 7 days with NO nausea or vomiting. May have phot/phono phobia

Bilateral (across head landscape), pressing or tight (not pulsating), mild to moderate pain, not aggravated by physical activity

Management – simple analgesia – paracetamol or NSAID

Identify comorbidities such as stress, mood disorders, chronic pain, sleep disorders to manage

Cluster headache – 5 attacks of severe/very severe unilateral orbital (around ONE eye), forehead or temporal pain lasting 15 mins to 3 hrs with nasal congestion, runny nose, eyelid oedema, sweating, facial slushing, fullness in ear or restlessness

Attacks occur between one every other day and 8 per day for more than half the time the disorder is active

Management – REFER

Advise to avoid triggers and risk of medication overuse, identify and manage comorbidities – insomnia, depression, and anxiety

Medication – occurs 15 days per month and have a pre-existing headache disorder. Regular overuse of drugs for 3 months

Management – withdrawal from medication and advice around this

Sinusitis

Sinusitis usually follows a cold and lasts less than 12 weeks

If over 12 weeks becomes chronic – risk groups are allergic rhinitis, asthma, immunosuppression

Symptoms

Adults

Nasal blockage (obstruction/congestion), nasal discharge, facial pain/pressure, frontal headache, loss, or reduction of smell, altered speech indicating nose blocked. Tenderness, swelling. Redness over cheekbone, cough, headache worse when bending or lying down. Toothache.

Children

Nose block, discoloured nasal discharge, facial pain, pressure and or cough at day or night-time

Bacterial sinusitis

More than 10 days, discoloured, pussy discharge (from 1 nose), severe local pain (1 side), fever over 38 degrees, deterioration after milder sickness

Refer to hospital immediately

If they have symptoms of acute sinusitis and;

Severe systemic infection

Intraorbital or periorbital complications, including periorbital oedema or cellulitis, displaced eyeball, double vision, or new reduced vision

Intracranial complications, including swelling over frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs

Refer to GP

Severe symptoms, painkillers don’t work, symptoms worsen, symptoms don’t improve after 1-week, recurrent infection, sudden worsening, antibiotic failure, unusual or resistant bacteria, recurrent episodes, immunocompromised, allergic cause

Treatment

Acute with symptoms less than 10 days

DON’T OFFER ANTIBIOTIC, assure that it usually self resolves without bacterial complications. Symptoms managed

Paracetamol or ibuprofen for pain, headache, and fever

Use nasal saline spray or decongestants spray

Clean nose with saltwater solution (boil 1 pint of water and add 1 teaspoon of salt and bicarbonate soda. Wash hands, stand over sink, cup the palm of 1 hand and pour small amount of solution into it. Sniff water into 1 nostril at a time, breath through mouth and allow water to pour into sink, don’t let it go into your throat. Do 3x daily)

Acute for 10 days or more with no improvement

High dose nasal corticosteroid for 2 weeks for over 12s (mometasone 200mcg 2x daily)

Counsel that It may improve symptoms but won’t make the infection any shorter, could have systemic effects, may be difficult to use correctly.

Symptoms should get better 3-5 days of treatment – REFER if not

1st line antibiotic for adult

If not life threatening - phenoxymethylpenicillin 500 mg four times a day for 5 days.

Is systemically unwell, symptoms of more serious illness or high risk of complications - co-amoxiclav 500/125 mg three times a day for 5 days.

Allergic or intolerant to penicillin - clarithromycin 500 mg twice a day for 5 days.

Pregnant or intolerant to penicillin - erythromycin 250 mg to 500 mg four times a day or

Children 1st line

Phenoxymethylpenicillin

1 to 11 months, 62.5 mg four times a day for 5 days. 

1 to 5 years, 125 mg four times a day for 5 days. 

6 to 11 years, 250 mg four times a day for 5 days. 

12 to 17 years, 500 mg four times a day for 5 days.

If very unwell - co-amoxiclav

1 to 11 months, 0.25 mL/kg of 125/31 suspension three times a day for 5 days. 

1 to 5 years, 5 mL of 125/31 suspension three times a day or 0.25 mL/ kg of 125/31 suspension three times a day for 5 days

6 to 11 years, 5 mL of 250/62 suspension three times a day or 0.15 mL/kg of 250/62 suspension three times a day for 5 days. 

12 to 17 years, 250/125 mg three times a day or 500/125 mg three times a day for 5 days.

If allergic or intolerant to penicillin – clarithromycin

Under 8 kg, 7.5 mg/kg twice a day for 5 days. 

8 to 11 kg, 62.5 mg twice a day for 5 days. 

12 to 19 kg, 125 mg twice a day for 5 days. 

20 to 29 kg, 187.5 mg twice a day for 5 days. 

30 to 40 kg, 250 mg twice a day for 5 days. 

12 to 17 years, 250 mg twice a day or 500 mg twice a day for 5 days.

2nd line – if symptoms are still worsening after 1st line treatment for 2-3 days

Adults – co-amoxiclav 500/125mg TD x 5 days

Children – specialist advice

ANTIHISTAMINES can be prescribed for allergic triggered sinusitis

Diabetes type 1

Body stops making insulin and the blood sugar (glucose) level goes extremely high - persistent hyperglycaemia (random plasma glucose of 11mmol/l or more). We must control glucose level with insulin injections, healthy diet and reduce the risk of other health complications. Typically occurs in children and young adults.

Symptoms of T1D- Frequently thirsty, pass a lot of urine, tiredness, weight loss and feeling generally unwell. Develops quite quickly, over days or weeks, as the pancreas stops making insulin.

Pathophysiology of T1D- Autoimmune disease (environmental & genetic factors). Antibodies attach to the beta cells in the pancreas destroying the cells that make insulin (pancreatic islet cells).

Diagnosing T1D- Simple dipstick test to detect glucose in a sample of urine BUT only way to confirm the diagnosis is to have a blood test to look at the level of glucose in your blood (level of 11.1 mmol/L or more in the blood sample indicates that you have diabetes) PLUS a fasting blood glucose level is taken (level of 7.0 mmol/L or more indicates that you have diabetes).

Management- Should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice. Twice-daily insulin detemir should be offered as the long-acting basal insulin therapy. Once-daily insulin glargine may be prescribed if insulin detemir is not tolerated, or if a twice-daily regimen is not acceptable to the patient. Insulin detemir may also be offered as an alternative once-daily regimen. There are multiple types of insulin…

Rapid Acting- Insulin Aspart (Novorapid®), Lispro (Humalog®) and Glulisine (Apidra®)

Short Acting- Soluble insulin (Actrapid®)

Intermediate Acting- Isophane (Insulatard® or Humulin I®) & NPH - neutral protamine Hagedorn

Long Acting- Insulin glargine (Lantus®), detemir (Levemir®)

Combination insulins (biphasic)- e.g., Novomix 30®, Humalog Mix 25®, Humalog Mix 50®, Humulin M3® and Insuman Comb 50®

Diet & Lifestyle- Diet low in fat, salt, and sugar and high in fibre and with plenty of fruit and vegetables. If you are overweight try to lose weight, increase your physical activity even if it’s only going for a walk (community groups)

Other Health Complications- Get regular checks with your GP, podiatrist, and optometrist. Also get the flu jab every year.

Complications – microvascular, macrovascular (MI, stroke), metabolic (diabetic ketoacidosis) and hypoglycaemia (blood glucose less than 3.5mmol/l)

Psychological complications – anxiety, depression, and eating disorders and those at increased risk of developing autoimmune diseases

Suspect DKA in diabetics – greater than 11mmol/L

Increased thirst and urine frequency, inability to tolerate fluids, persistent vomiting, diarrhoea, visual disturbance, lethargy, fruity smell on breath, deep sighing when breathing and dehydrated

Management

HbA1c levels target of 48mmol/mol or lower - Measure 3-6 months but more often if not controlled

Self-monitoring – need glucose monitor, lancet, finger pricking device and testing strips

Taught at diagnosis and review technique 1 yearly.

Before breakfast, 2 hours after meals, during illness, before driving, if they feel hypo – at least 4 times a day including before and after meals and before bed.

More frequency required (up to 10x daily) if

Target HbA1c not achieved, frequency of hypo increases, during illness, before, during and after sports, planning, during and while breastfeeding.

Target glucose readings

Fasting plasma glucose level of 5–7 mmol/L on waking.

Plasma glucose level of 4–7 mmol/L before meals at other times of the day.

For adults who choose to test after meals, plasma glucose level of 5–9 mmol/L at least 90 minutes after eating.

Agree bedtime target plasma glucose levels with the person. This should:

Consider the timing of the last meal and its related insulin dose.

Be consistent with the recommended fasting level on waking.

Provide information of effects of food and drinks – carbohydrate training (match carb quantities to insulin doses)

Educate to be careful of body weight and diets, feasting and fasting, fibre and protein intake, diabetic foods and sweeteners, alcohol intake, matching carbs with insulin and physical activity

Advice on alcohol – avoid drinking on empty stomach, eat carb snack before and after drinking (extra insulin not required). Measure glucose more regularly and maintain it with carb intake. Alcohol can exacerbate or prolong hypoglycaemic effect.

Exercise – lower glucose levels and reduces CVD risk and can help weight

Sick day rules – never stop or skip insulin – dose may need altering seek advice. Check blood more frequently – 1-2 hours including in the night. Check blood or urine ketone levels – 3-4 hours including night and if 2+ or 3mmol/l or higher then contact GP immediately.

Maintain normal meal pattern where possible if not then replace meals with carb rich drinks, milk, fruit juices and sugary drinks. Aim to drink at least 3L of fluid to prevent dehydration.

Offer multiple daily injection basal-bolus insulin regimens as the first-line choice to all adults with type 1 diabetes.

Offer twice-daily insulin detemir as the long-acting basal insulin therapy

Offer a rapid-acting insulin analogue injected before meals for mealtime insulin replacement

If a multiple daily injection basal–bolus insulin regimen is not possible and a twice-daily mixed insulin regimen is preferred

Insulin pump therapy is recommended as a treatment option for adults with type 1 diabetes mellitus if condition isn’t controlled by treatment

Diabetes type 2

The body still makes insulin however, you do not make enough insulin for your body's needs OR the cells in your body do not use insulin properly (insulin resistance means you need more insulin than normal make to keep glucose levels down. Occurs mainly in people aged > 40 but inc diagnosed in younger people, commonly associated with obesity, physical inactivity, raised blood pressure, dyslipidaemia, and a tendency to develop thrombosis (CV risk).

Symptoms of T2D- Gradual (weeks-months) and can be quite vague at first. Frequent thirst, passing large amounts of urine, tiredness, which may be worse after meals. Some people also develop blurred vision and frequent infections, such as recurring thrush.

Management- Metformin HCl 1st choice for treatment of all patients (à weight loss, red risk of hypoglycaemic events and long-term CV benefits). Has an anti-hyperglycaemic effect, lowering both basal and postprandial blood-glucose conc. It does not stimulate insulin secretion and therefore, when given alone, does not cause hypoglycaemia. If metformin contra-indicated/not tolerated trial MR formulation or initial treatment should be a sulfonylurea e.g. gliclazide OR a dipeptidyl peptidase-4 inhibitor e.g. linagliptin OR Pioglitazone.

Insulin- can be added if intensification of treatment needed. If needed, bedtime basal insulin should be initiated, and the dose titrated against morning (fasting) glucose.

Diet & Lifestyle- Avoid foods heavy in saturated/trans fats, beef and processed meats, sugary drinks, high-fat dairy products and salty/fried foods & have fibrous fruits and vegetables, high omega-3 fatty acid food and poly/monosaturated fats. Lose weight and inc physical activity (min 5 x 30 min brisk walk / week) and smoking cessation.  Also see optician regularly in case of damage to retina, GP and podiatrist.

EXTRA INFO FOR BOTH

Holiday- Pack about x3 the amount of insulin needed, test strips, lancets, needles or glucose tablets you would use, in case you need it (take cool bag to avoid insulin getting too hot). Carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged (insulin can freeze and render it unusable). If injecting (i.e. will have needles/sharps) get a letter from your GP that says you need it to treat diabetes. If you use a pump or CGM, check with your airline before you travel about taking it on board as may require paperwork for medical equipment. If you use a pump, pack insulin pens in case it stops working. Take plenty of snacks in case there are any delays. Do not put your pump through the hand luggage scanner – let airport security know so they can check it another way.

<18 & Diabetic- Paediatric diabetes care team until 18 will help w injecting insulin, testing blood glucose levels, and diet. They can give advice on school or nursery and talk to your child's teachers and carers. Initially, every 1 - 2 weeks but will eventually be every 3 months.

Check Ups Needed- Annually get feet checked by podiatrist to check for loss of feeling in your feet, and for ulcers and infections. Get your eyes checked to check for any damage to blood vessels in the eyes, and checks for high blood pressure, heart, and kidney disease by your GP, also ensure to book in annually for a flu jab. Every 3 months have a blood sugar test (HbA1C test) checks your average blood sugar levels and how close they are to normal when newly diagnosed, then every 6 months once you're stable (~48-53 mmol/mol recommended).

Education- free education courses to help you learn more about and manage your diabetes, your GP will need to refer you. Diabetes UK run local charities for extra support, their website plus the NHS website offers a lot of diabetes information and advice. Maybe invest in a medical ID to carry w you.

Extra Lifestyle Advice- Eat a meal w carbs (e.g. pasta) before you drink alcohol and make sure people around you can recognise a hypo, choose diet soft drink mixers where possible, check your blood glucose regularly/before bed/the next day, drink plenty of water the next day. Avoid hypos by eating the right amount of carbs before, during and after exercise, adjust your insulin and check your blood glucose regularly, drink plenty of water. Recommended to have HbA1c <48mmol/mol when pregnant as high blood glucose levels can harm your baby, especially in the first 8 weeks of pregnancy, also a risk of having a large baby, which can cause complications during labour. Speak to your diabetes team If you're planning to get pregnant or if you get pregnant unexpectedly.

Item for disposal

Method of disposal

Needles

Sharps bin

Lancets

Sharps bin

Used blood test strips

Sharps bin

Leftover/expired insulin

Sharps bin/return to pharmacy

DVLA- tell the DVLA you’re diabetic or you could get fined due to hypoglycaemia/low sugar levels crisis. Check your blood glucose no longer than 2 hours before driving, check your blood glucose every 2 hours if you're on a long journey, travel with sugary snacks and snacks with long-lasting carbs, like a cereal bar or banana. If you feel your levels are low: stop the car when it's safe, remove the keys from the ignition, get out of the driver's seat, check your blood glucose, and treat your hypo, don't drive for 45 minutes from when you feel normal again.

Sharps Removal- Patients issued a sharps bin from the diabetes clinic/hospital on first diagnosis. Some pharmacies offer this sharps disposal service, or the diabetes clinic do too. Can arrange w GP/LHB for sharps collection (Cardiff Council does NOT offer kerbside sharps disposal)

Other Technologies- Insulin Pump (attached to skin via tiny tube which is replaced every 2-3 days & pump moved to diff part of body) will deliver a set background amount of insulin into blood day and night, can add your extra mealtime insulin using the pump. Continuous glucose monitoring (CGMs) means you can check your sugar levels at any time (see patterns in your levels, sends an alert if glucose too high/low) but as interstitial fluid sugar readings are a few mins behind your blood sugar levels you'll still need to do finger-prick checks every now and then. It’s a sensor you attach to your abdomen which needs replacing every 7 days, but some models can be worn for months. Free Style Libre is a flash glucose monitoring system measures your glucose levels continuously throughout the day via interstitial fluid (few mins behind). Attach sensor to your arm and a reader will scan to see your sugar levels (can also use a smartphone app to scan the sensor), sensors usually last for 14 days.

Testing blood glucose

Glucose monitor, specific in-date test strips, primed lancing device and cotton wool pad.

PRIMING LANCET

Twist cap off lancing device

Place fresh lancet into device so grooves line up and twist off the cover, so the needle is visible – change lancet every time so you don't get skin infections

Replace device cap - it should click and then adjust the depth metre – how far the needle will puncture – this is personal preference

Pull sliding barrel at bottom of device back to prime the lancet

CALIBRATING MONITOR

Turn on monitor – put new in-date test strip inside it and test it with in-date control solution – to make sure readings are correct

Do this every time you open a new pack of test strips, if you damage your monitor and if you think the readings are wrong.

TESTING process

Wash hands with warm water and soap and dry. Then rub hands for 10 seconds – warms hands to improve blood flow to fingers

Turn on monitor and place strip inside and wait for it say it’s ready for blood

Place device firmly on side of the finger (less nerves so less painful) and press release button then remove device from site. - change fingers regularly to stop hardening of skin.

Wipe first drop of blood away with cotton pad, use second one to test make sure by touching the blood onto the test strip

If successful wipe blood with cotton pad and apply plaster

Note readings

Remove cap of device exposing lancet. Place lancet cover on table and press lancet hard into this blue plastic cover – this will cover the needle and make it easy to remove

Place lancet and cotton pad in bin

Injecting insulin

Inject in stomach, thighs, or buttocks. Inject an inch away from previous site. Prevents lumps – this reduces absorption of insulin.

check that its correct insulin and is in date. Always check manufacturer’s instructions.

Wash hands with soap and warm water

Attach needle to pen – peel back cover, screw cap onto pen, remove white outer cover and the green cover to expose needle – change needle every time

Dial to 2 units and push plunger so you can see insulin coming out – to make sure no air stuck in there – can take multiple goes in new pens

Set correct dose

Press directly into skin and inject slowly – count to 10 

Remove needle straight without bending it

Use the white outer cap to remove the needle and dispose in yellow sharps bin

Asthma

Symptoms – episodic, worse at night/early morning, triggered by exercise, infection and exposure to cold air or allergens. Triggered by emotion and laughter in children. In adults by NSAIDS and BB use.

Common with atopic eczema, dermatitis and allergic rhinitis and family history

ACUTE EXACERBATION OF ASTHMA IN ADULTS

First-line treatment for acute asthma is a high-dose inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For patients with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer can be used. For patients with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. If the response to an initial dose of nebulised short-acting beta2 agonist is poor, consider continuous nebulisation with an appropriate nebuliser. Intravenous beta2 agonists are reserved for those patients in whom inhaled therapy cannot be used reliably.

In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone. Continue usual inhaled corticosteroid use during oral corticosteroid treatment. Parenteral hydrocortisone or intramuscular methylprednisolone are alternatives in patients who are unable to take oral prednisolone.

IN CHILDREN OVER 2

First-line treatment for acute asthma is an inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For children with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer device is the preferred option. The dose given should be individualised according to severity and adjusted based on response. For children with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. Parents/carers of children with acute asthma at home, should seek urgent medical attention if initial symptoms are not controlled with up to 10 puffs of salbutamol via a spacer; if symptoms are severe, additional bronchodilator doses should be given as needed whilst awaiting medical attention. Urgent medical attention should also be sought if a child's symptoms return within 3-4 hours; if symptoms return within this time, a further or larger dose (maximum of 10 puffs of salbutamol via a spacer) should be given whilst awaiting medical attention.

COPD

Symptoms - persistent respiratory symptoms and airflow obstruction, which is usually progressive and not fully reversible, exertional breathlessness, chronic/recurrent cough, or regular sputum production, wheeze

Treatment – education on condition and risk factors, smoking cessation, pneumococcal and flu vaccination yearly, treatment of associated comorbidities

1st line – SABA or SAMA to relieve breathlessness and improve exercise tolerance – reviewing medication, adherence, and inhaler technique regularly

THEN IF they have NO asthmatic features or no features of steroid responsiveness – offer LABA AND LAMA

If they continue to have day-to-day symptoms, consider 3-month trial of LABA+LAMA+ICS

If NO improvement go back to LAMA+LABA only but if it works continue and review annually

If they have asthmatic or steroid responsiveness features offer LABA+ICS if they have day to day symptoms of 1 severe or 2 moderate exacerbations a year, then offer LABA+LAMA+ICS

WITH ICS DISCUSS RISK OF USING ICS including pneumonia

Acute exacerbation of COPD – triggered by infections, smoking and environmental pollutants

Severe breathlessness, increased cough, increased sputum production and change in colour, increased wheeze, and chest tightness, cold or sore throat, reduced exercise tolerance, ankle swelling, increased fatigue, and acute confusion

FOR SEVERE exacerbation – ADMISSION

FOR non-severe – increase dose or freq of SABA and maybe change to nebuliser for ease of admission

If no contraindications with significant increase in breathlessness – offer 30mg oral prednisolone OD x 5 days or if caused by infection then amoxicillin 500mg TD x 5 days, doxycycline 200mg day 1, 100mg OD x 5 days, or clarithromycin 500mg BD X 5 days

Epilepsy

Cause – abnormal excessive or synchronous brain activity

Symptoms

Short-lived (less than 1 minute), abrupt, generalised muscle stiffening with rapid recovery — suggestive of tonic seizure.

Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure.

Behavioural arrest — indicative of absence seizure.

Sudden onset of loss of muscle tone — suggestive of atonic seizure.

Brief, 'shock-like' involuntary single or multiple jerks —suggestive of myoclonic seizure.

Management

During seizure – protect from injury by placing in recovery position. If tonic-clonic seizure is prolonged (more than 5 mins) or recurrent – emergency buccal midazolam or emergency admission

Annually reviewed – assess seizure control, how it’s affecting QOL, adverse effects and compliance with drug

Women of childbearing age – 13 to 60

Epileptic women not treated with drugs or on non-enzyme inducing antiepileptic (except lamotrigine) – contraceptive options are same as general population

Woman on exyzme-inducing drugs – drug can reduce effectiveness of combined hormonal contraception, progestogen-only pills, transdermal patches, the vaginal ring, and progestogen-only implants. OFFER medroxyprogesterone acetate injections or an intrauterine method (copper intrauterine device or the levonorgestrel-releasing intrauterine system)

Woman on lamotrigine – oestrogen containing contraceptive reduces efficacy of lamotrigine

USE progesterone only instead but educate them to report signs of lamotrigine toxicity

Category 1 (ensure the person is maintained on a specific manufacturer's product) — phenytoin, carbamazepine, phenobarbital, primidone.

S/E – common and usually mild, advise to report and can usually be fixed with dose adjustment or change of drug

Sedation and dizziness, suicidal thoughts and behaviour, acute psychotic reactions, weight gain and loss, skin rashes.

Safe in pregnancies – lamotrigine (Lamictal) and levetiracetam (Keppra) are safest options

Anxiety

Uncontrollable widespread worry and range of cognitive and behavioural symptoms

Slow onset and symptoms don’t usually improve but are better controlled with intervention

Diagnosis – worry associated with restlessness, insomnia and muscle tension, fatigue, poor concentration, irritable. ALWAYS ask about alcohol and drug use including OTC

Treatment

Establish diagnosis and severity of anxiety and any other comorbidities (usually insomnia and depression and whichever is the most pressing is treated first) – explaining the disorder and treatment opportunities and starting them with active monitoring of symptoms either self or through regular meetings

Offer CBT – non-facilitated self-help for 6 weeks, individual guided self-help, educational groups

High intensity CBT, applied relaxation or drug therapy

Drug therapy – 1st line is SSRI (sertraline, paroxetine, or escitalopram) 2nd line SNRI (duloxetine or venlafaxine). If both contraindicated or intolerable then Pregabalin.

Review effectiveness and ADR every 2-4 weeks during first 3 months then every 3 months.

Counsel on common effects during treatment initiation (suicidal thoughts and worsening of anxiety) but importance of reporting this instead of withdrawing from drug

SSRI – don’t take NSAIDS or if prescribed take with PPI

For pregnant women step 3

DO NOT give benzo or antipsychotics in primary care

Benzodiazepines (SCH 3 and 4)

Most commonly used anxiolytics and hypnotics

Short rem relief (2-4 weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress

use to treat short-term ‘mild’ anxiety is inappropriate

Sch 4 CDs, apart from temazepam

Sch 3 (CD no register) and midazolam

Pharmacological effects of benzodiazepines

Sedation, sleep induction

sleep, but can still cause arousal

decreased anxiety, amnesia at higher doses

muscle relaxation (both midbrain and spinal effects)

anticonvulsant activity

Reduced aggression

Depression

Persistent low mood and/or loss of pleasure in most activities and range of emotional, cognitive, physical, and behavioural symptoms

Diagnosis

Low mood

Loss of interest/pleasure from normally pleasurable activities (anhedonia)

Reduced energy (fatigue)

Low self-esteem; feelings of guilt

Inability to think/concentrate

Altered psychomotor activity

Sleep disturbance; early morning wakening

Altered appetite

Suicidal thoughts

Diagnosis requires 2 core symptoms plus 2 or more others present for most of the day on most days for the last 2 weeks

Differential diagnosis

Ensure symptoms are not caused by physical illness, alcohol, medication, or illicit drug use

The symptoms aren’t caused by normal grief (death of family) – maybe consider very long grief

Never been a manic (severe levels of high mood) or hypomanic (to a reduced level) episode

Treatment

Dependant on accurate assessment and diagnosis of depression

Psychological

CBT, behavioural activation, interpersonal psychotherapy, problem solving therapy

Social

Identify stressors and work on strategies/signposting to other supporting organisations

Biological – moderate to severe

Antidepressant therapy or antidepressant and antipsychotic combination therapy in psychotic depression

Drug classes

Tricyclic antidepressants (TCAs) e.g., amitriptyline

Selective serotonin reuptake inhibitors (SSRIs) e.g., fluoxetine

Serotonin and NA uptake inhibitors (SNRIs) e.g., venlafaxine

Monoamine oxidase inhibitors (MAOIs)

Irreversible e.g., phenelzine (MAO-A and B)

Reversible e.g., Moclobemide

Atypical antidepressants e.g., Mirtazapine

Noradrenaline reuptake inhibitors (NRIs) e.g., Atomoxetine

TCA - S/E – Short lasting (days) sedation, confusion, and Incoordination in both normal and depressed patients, antimuscarinic effects, dry mouth, blurred vision, decreased mucus production. Dangerous CV effects in OD 

Severe depressive at risk of suicide shouldn’t be given TCA

Interactions – potentiation of the effects of alcohol – alcohol is a depressant and will only compound the depressive effects

SSRI’s - S/E – nausea, anorexia, insomnia, and loss of sexual function

Less anticholinergic side-effects and less dangerous in OD than TCAs. Prolonged QTc – cardiovascular complications risk with citalopram  interactions – NSAIDs, Anticoagulants, triptans

SNRI’s - S/E – significant withdrawal effects – have short half-lives so need to be taken regularly to avoid these effects. Complex nature of TCAs makes them difficult to prescribe to complex patients unlike SNRIs

Interactions – NSAIDs and anticoagulants

MAOIs - S/E – antimuscarinic effects, restlessness as a result of CNS excitation

Interactions – serious food and drug reactions e.g., cheese (tyramine from food such as cheese is broken down by MAO. The lack of breakdown from MAOIs can lead to tyramine actively displacing neurotransmitters such as 5HT, DA, NA – causing hypertensive crisis

VERY IMPORTANT COUNSELLING POINTS

No other drugs or illicit drugs with this

Side effects

Drug and food interactions are unacceptable.

“Cheese reaction”: this occurs when amines that are generated during fermentation, like tyramine, are ingested and absorbed from the gut. (The main danger is ripe cheese, yeast products - Marmite).

Large rise in systemic tyramine indirectly results in a large release

    of catecholamines

Hypertensive crisis characterised by throbbing

            headache, tachycardia & cardiac arrhythmias.

Same can occur with drugs (Pseudoephedrine)

Atypical antidepressants - S/E- sedation, weight gain, increased appetite – good in patients with anorexia or depression causing loss of appetite or weight

Blood disorders – counselling

Withdrawal issues

Can be used with other antidepressants that cause sleep issues

Interactions – alcohol

FDA black box warning – suicide

Treatment

Mild symptoms – psychological therapy

Persistent mild symptoms or moderate to severe symptoms – combination of psychological and drug therapy

1st line treatment usually SSRIs

2nd line switch to alternate SSRI

3rd line switch to different class (normally an SNRI)

Practical issues

Initiating an antidepressant can cause feelings of anxiety consider co-prescribing short course of benzodiazepines to counteract the anxiety

During the first few weeks of antidepressant treatment can have worsening suicidal thoughts with improved motivation so ensure counselling and regular reviews

Consider prescribing limited supply of meds to reduce chance of OD

Side effects often transient and improve with time

Caution when switching antidepressants – table of different half-lives and how to taper them

Treatment approach

If no response to 3 antidepressants, then check concordance, review diagnosis, and consider if social problems are maintaining depression

Consider augmentation – addition of drug to the current therapy

Mirtazapine – sleep

Quetiapine – mood

Aripiprazole

Lithium – mood stabiliser

Lamotrigine – mood stabiliser

Electroconvulsive therapy

Response

2-4 weeks usually for response to be seen (longer in elderly)

Improvement greatest during weeks 1-2

If no response during 2–4-week period, consider first increase in dosage then if again limited efficacy, then switch to alternative

Extended duration if treatment trial will lead to additional benefit in some

Differences between drugs

Mirtazapine, escitalopram, venlafaxine, and sertraline

more efficacious than

duloxetine, fluoxetine, fluvoxamine, paroxetine and reboxetine

Reboxetine less effective overall

Escitalopram and sertraline

better tolerated than

duloxetine, venlafaxine, fluvoxamine, paroxetine and reboxetine

Preventing relapse

Relapse rate 3-6 months post remission is 50% with no drug treatment

A/D treatment reduces absolute risk of relapse by about 50%

After 1st episode continue for 6-9 months

After 2nd episode continue for 12 months

After 3rd episode continue for 2 years

Insomnia – difficulty in getting to sleep or staying asleep long enough to feel refreshed the next morning

Causes

Recreational drugs

caffeine, nicotine, alcohol, cannabis)

Medicinal drugs

anticonvulsants, antipsychotics, b-blockers, SSRIs, MAOIs, steroids, decongestants, Alpha agonists and antagonists, narcotic analgesics

Drug withdrawal

from CNS depressants (eg alcohol, anxiolytics/hypnotics)

Physiological

Diet, late night exercise, shift work (night and evening work)

Environmental

Noise, bright lights, extremes of temperature

Medical conditions

Psychological - anxiety, depression, grief, stress

Non-psychological eg chronic pain, gastric reflux, asthma, sleep apnoea

Types of insomnia

Primary insomnia - insomnia not attributable to a medical psychiatric or environmental cause

Secondary insomnia- insomnia secondary to another condition

Transient (2-3 days) – caused by changes in routine (for eg. change in time zone, alteration of shift work)

Short term (<3 weeks) – may result from temporary environmental stress

Chronic insomnia (>3 weeks) –usually secondary to other conditions

Treatment

FIRST LINE IS ALWAYS NON-DRUG treatments e.g., lifestyle changes and CBT

Drug therapy – Hypnotics

Benzodiazepines

Benzodiazepine-like drugs (Z-class)

melatonin

BEFORE hypnotic is prescribed the cause of insomnia must be established and where possible, underlying factors should be treated

NICE recommends

if hypnotic medicine is the appropriate way to treat one for only short periods of time and strictly according to the licence for the drug. (Usually, 1-2 weeks and max 4 weeks) and should be prescribed on a weekly basis

Benzodiazepines

 Most benzodiazepines

decrease time taken to get to sleep

in individuals who habitually sleep <6hr, the drug increases duration of sleep

Few short-acting BDZs recommended for insomnia (short-term treatment – max 2-4 weeks)

Should only be used when SEVERE, DISABLING or causing EXTREME DISTRESS

Benzodiazepine – like drugs

Z -Hypnotics – Zaleplon, zopiclone, zolpidem (Short acting – t1/2 < 8 hr)

Short term use only (2-4 weeks)

Lack of anxiolytic effects –drowsiness or dizziness - just induce sleep

Melatonin treatment

Prolonged release melatonin available for primary insomnia in over 55yr olds (can be used up to 3 weeks)

Antihistamine gen 1 – can cause drowsiness

Anxiolytics

Kalms, Kalms day, Karma, Karmamood, Potters Newrelax, Relaxherb, Stressless

Hops, valerian, passionflower, passiflora, vervain, St John’s Wort

Sedatives

Kalms night, Kalms sleep, Dormesean, Niteherb, Nytol herbal, Potters Nodoff, sominex herbal

Hops, valerian, vervain, skullcap, wild lettuce, passiflora

Some herbal remedies do contain active ingredients so be careful of interactions

Lifestyle changes – promote sleep hygiene

establishing fixed times for going to bed and waking up

trying to relax before going to bed

maintaining a comfortable sleeping environment avoiding napping during the day

avoiding caffeine, nicotine, and alcohol late at night 

avoiding exercise within four hours of bedtime 

avoiding eating a heavy meal late at night

avoiding watching or checking the clock throughout the night

using the bedroom mainly for sleep if possible

avoid going on phone, looking at screens immediately before bed or whilst in bed

ADHD

Persistent developmentally with inappropriate levels of over reactivity, inattention and/or impulsivity

Diagnosis – based on observation there are no biomed tests

Symptoms – 9 symptoms across 2 domains

Hyperactivity/impulsivity

Inattention

Can be combined type or dominant in one

ADHD – Predominantly inattentive type

Fails to give close attention to details or makes careless mistakes.

Has difficulty sustaining attention.

Does not appear to listen.

ADHD – predominantly Hyperactive/impulsive type

Fidgets with hands or feet or squirms in chair.

Acts as if driven by a motor.

Blurts out answers before questions have been completed.

Difficulty waiting or taking turns.

Interrupts or intrudes upon others.

ADHD – Combined type

Patient meets both sets of inattention and hyperactive/impulsive criteria

ADHD – Differential diagnosis

Sensory impairment – leading to under or over-sensitivity to triggers

Epilepsy and related states – could present as inattention

Effects of head injury

Acute or chronic medical illness

Poor nutrition – linked to poor behavior – not directly linked to ADHD

Sleep disorders – linked to poor behavior – not directly linked to ADHD

Side effects of medication

School or classroom difficulties – bullying or other factors

Large links to exposure to smoking and drinking during pregnancy, childhood illness such as meningitis or other viral infection, low birthweight/prematurity. HIGH heritability

Treatment

Mild-moderate –1st line - parent-training/education programmes with parent and child, group based or individual sessions. Teachers receive ADHD training and offer intervention in schools.

2nd line – CBT or social skills training

3rd line – DRUG THERAPY ONLY FOR SEVERE and should be offered along with psychological, behavioural, and educational interventions

Drug therapy

Methylphenidate – generally first choice

Atomoxetine - if other tics, Tourette's syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

D-amphetamine – ONLY if other drugs ineffective at raised doses – CD2 high risk in addiction and dependence and misuse so used as last resort

Decide which drug treatment to use based on:

their different adverse effects

potential problems with compliance (for example, if a mid-day dose is needed at school)

potential for drug diversion (taken by others) and misuse

preferences of the child or young person and their parent or carer

When a decision has been made to treat children or young people with ADHD with drugs, healthcare professionals should consider: –

methylphenidate for ADHD without significant comorbidity

methylphenidate for ADHD with comorbid conduct disorder

methylphenidate or atomoxetine when tics, Tourette’s syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

atomoxetine if methylphenidate has been tried and has been ineffective at the max dose, or the child intolerant to low or moderate doses of methylphenidate.

Atomoxetine

Closely observe children or young people taking atomoxetine for agitation, irritability, suicidal thinking, and self-harming behavior, particularly during the initial months of treatment, or after a dose change.

Liver damage in rare cases (usually presenting as abdominal pain, unexplained nausea, malaise, darkening of the urine or jaundice).

Treatment of adults

In adults, methylphenidate normally first line treatment

Consider atomoxetine or dexamphetamine if symptoms do not respond to methylphenidate or the person is intolerant to it ~6 weeks.

Selection of appropriate medication

Immediate-release preparations if more flexible dosing is required or during initial titration to using methylphenidate, consider determine correct dosing levels

If there is a choice of more than one drug, use the drug of lowest overall cost

modified-release preparations for convenience…

their pharmacokinetic profile,

improving adherence,

reducing stigma (because the drug does not need to be taken at school)

reducing problems of storing and administering controlled drugs in schools

abuse liability

AUTISM

Symptoms

Socialization

Impaired use of non-verbal behaviors to regulate interactions

Delayed peer interactions, few or no friendships, and little interaction

Absence of seeking to share enjoyment and interests

Delayed initiation of interactions

Little or no social reciprocity and absence of social judgment

 Communication

Delay in verbal language without non-verbal compensation (gestures)

Impairment in expressive language and conversation, and disturbance in pragmatic language use

Treatments

NEED early diagnosis and defined biomarkers

Currently intervention is through family and educational support

Only some specific programs have an evidence base

Aim is to ‘improve the functional status…through skill acquisition in core areas’

Eg developing relationships

Achieving social and environmental milestones through play

Positive reinforcement of social communication

Pharmacological treatments for co-morbidities

Developmental

Hyperactivity/impulsivity (see ADHD)

Psychiatric

SSRIs, other antidepressants for depression

atypical antipsychotics for OCD

SSRI or a2 agonists for anxiety

Behavioural

Atypical antipsychotics (irritability, aggression)

Sensory

Neurological

anticonvulsants and fits, a2 agonists for tics

Gastrointestinal

Sleep disruption

melatonin and clonidine

Dementia

Symptoms –

Higher cognitive function affected

Memory, thinking, comprehension, learning capacity, language (speaking and understanding it)

Daily living activities/emotional behaviour (non-cognitive symptoms)

Behavioural and psychological symptoms of dementia (BPSD) – include agitation, apathy, depression, anxiety, delusions, hallucinations, irritability, and wandering

Treatment -

Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine) — as monotherapies for managing mild to moderate Alzheimer's disease.

Memantine (a N-methyl-D-aspartic acid receptor antagonist):

As monotherapy for managing Alzheimer's disease for people with moderate Alzheimer's disease who are intolerant of, or have a contraindication to, AChE inhibitors, or for people with severe Alzheimer's disease.

In addition to an AChE for people with established moderate or severe Alzheimer's disease who are already taking an AChE

For people with non-Alzheimer's dementia the use of AChE inhibitors or memantine is unlicensed, but they may be prescribed by a specialist for people with:

Mild to moderate dementia with Lewy bodies:

Donepezil or rivastigmine are recommended first line.

Galantamine is an option if donepezil and rivastigmine are not tolerated.

Severe dementia with Lewy bodies:

Donepezil or rivastigmine are recommended.

Vascular dementia:

AChE inhibitors or memantine are options if the person has suspected comorbid Alzheimer's disease, Parkinson's disease dementia, or dementia with Lewy bodies.

Risperidone and haloperidol are the only antipsychotics licensed for treating non-cognitive symptoms of dementia, although other antipsychotics are often prescribed off-label for this purpose.

Acetylcholinesterase inhibitors

NMDA receptor antagonist

Cholinesterase inhibitors for mild to moderate AD (eventually stop working)

NMDA receptor antagonist for severe AD and moderate AD in some cases

Treatment must be started only by a specialist clinician

Rheumatoid arthritis

Inflammatory disease causing persistent symmetric joint synovitis

Presents as pain and joint stiffness with heat and swelling progressing at rest and after periods of inactivity with malaise, fatigue, fever, and weight loss

Risk factors – smoking, eating large amounts of red meat, drinks excessive coffee

Symptoms

Joints

Pain

Swelling

Stiffness

Systemic

Fatigue, depression, irritability

Anaemia

Flu-like symptoms, such as feeling generally ill, hot, and sweating

Pain worse in morning

Treatment

Drugs, mild exercise (enhance flexibility of joint and muscle strength), lifestyle changes (rich antioxidant diet, no smoking)

Main types of RA meds

NSAIDs (short term symptomatic relief) – reduce inflammation. OTC (ibuprofen, naproxen). POM (celecoxib, etoricoxib)

S/E – GI irritation, ulcers (use at lowest dose and take with food, use PPI to lessen effects)

Caution – asthmatics and renal impairment and patients with increased CV risk

Disease-modifying anti-rheumatic drugs (DMARDs) – 1ST LINE for active RA (methotrexate, sulfasalazine)

S/E – Nausea, diarrhoea, oral ulceration, alopecia, cough, SOB, bone marrow suppression – CAN BE REDUCED by co-prescribing FOLIC acid 1mg daily

Biological therapies (type of DMARD) – used when DMARDS don’t control RA

Glucocorticoids – short term treatment when starting new DMARD for rapid symprom control  - also used in flares

Analgesics (painkillers)

Drug Treatment Schedule

Start two DMARD regime once diagnosed, using titration regimens

Use anti-inflammatories (NSAIDs), paracetamol with or without corticosteroids until effective

Review after 6 months: increase dose or switch as clinical condition determines.

Patient counselling in RA

Place of drugs in therapy

Onset of action

Side effects

Immunosuppression

Regular painkillers

Regular monitoring including blood tests

Dexterity aids, prescription services

Osteoarthritis

Predominantly non-inflammatory and caused by cartilage loss from synovial joints and bone remodelling due to excessive and repeated overloading on weight bearing joints or stress of a joint over tome and specific injuries

Risk factors – genetic, age, gender, obesity, damage, occupational, and stress

Symptoms

Pain – tends to be worse when using the joint and at end of the day (Worsens on use, resolves at rest)

Stiffness – feel stiff after rest, usually wears off as you get moving

Grating or grinding sensation (crepitus) – joints creak or crunch as you move

Swelling – may be caused by osteophytes (bone outgrowth) or caused by synovial thickening and extra fluid

Muscles around joint look thin/wasted

Unable to use joint normally – doesn’t move as freely or far as normal

Joints give way – muscles have weakened, and joint is less stable

Management

Provide information on sources of advice and support

Advice on self-care strategies such as;

Weight loss, local muscle strengthening exercises and aerobic fitness training

Appropriate footwear, local heat, or cold packs

Odder psychosocial support – career and occupational health assessments if needed

Advice on simple analgesia

Arranging regular reviews to assess response to treatment

MANAGEMENT GOAL – pain reduction and symptomatic relief

First line:

Paracetamol regularly – 4g daily

Topical NSAIDs

Additional treatment:

Oral NSAIDs– not first line

-Start with ibuprofen

-Monitor for side effects

-Possible place for topical therapy

Topical capsaicin – adjunct and helpful in knee and hand – works by stimulating then decreasing the pain sensation

Corticosteroid injection: â pain and inflammation of flare-up

Role of pharmacist

Counselling:

dosage regimen

side effects

warnings

Monitoring for side effects

Weight loss advice

Physiotherapy advice

Compliance aids & living aids

Gout

Type of inflammatory arthritis – causes severe pain and damage to joints

Caused by abnormal high levels of uric acid in blood which deposits urate crystals in joints and tissue

3 phases

Asymptomatic hyperuricaemia – can remain in this stage for life

Acute attack of gouty arthritis – can vary from months to years before another attack

Final period of chronic tophaceous gout – nodules effecting joints

Treatment

Acute

Ice

Rest affected joint

NSAIDs – short term, 7-14 days, high dose, for pain relief and anti-inflammatory

Colchicine (Dose: 500mcg 2-4 x daily until symptomatic relief or SE (stomach cramps, diarrhoea, vomiting)), steroids (used when NSAID and colchine is contraindicated or not useful)

Choice of drug dependant on comorbidities and renal function (NSAID cause fluid retention whereas colchicine doesn’t)

Colchicine use limited as it can have sudden toxicity at higher conc

Combination treatment can be used as well if monotherapy isn’t controlling the attack

Long term treatment to reduce urate

Lifestyle modifications (reduce dietary intake)

Drug therapy: Allopurinol (1st line – offer to all, 100mg od, increased in 100mg increments every 2-3 weeks) S/E – rashes

Febuxostat (2nd line only use when allopurinol intolerant or contraindicated – 60mg OD dose)

Monitor urate level – aim for < 360 μmol/L or 6 mg/dl (critical level)

Muscoskeletal

Sprain

Commonly ankle, wrist, thumb, knees – pain, swelling, tenderness, bruising, disabled use and no weight

Strain

Common in legs and lower back – pain, swelling, bruising, red, and reduced function

BOTH

Self-limiting gets better in 4-6 weeks and full recovery in 12 weeks

Non-pharma advice

PRICE (Protect, Rest (48-72hrs), Ice immediately after, Compression bandages and Elevate to reduce swelling

Reduce HARM (Heat, alcohol, running and massaging for 72hrs.

Avoid NSAIDs for 72hrs

Exercises for sprains

Gently move joint in all directions to increase and maintain flexibility (lack of movement can delay recovery BUT severe sprains with complete lack of movement rest for 10 days first)

Treatment – topical and oral analgesics

Refer – severe pain, possible break or fracture, no alleviation with OTC meds

Lower back pain

Symptoms – pain, tension, soreness, stiffness without underlying cause

6 weeks usual recovery can be up to 12 weeks

Advice

Back exercises, improve posture, yoga, avoid lying or sitting for too long, remain active.

Sleep in different positions, pillows between legs, under knees, hot baths, hot water bottles, ice packs.

Treatment

OTC – topical analgesics or co-codamol if still painful

Refer

No improvement in 3 days, continues for more than 6 weeks, pain travels higher, pain after injury, younger than 20, older than 50, pain affects sleep, unsteady on feet, unexplained weight loss

EMERGENCY

Pins and needles in back, genital, bum, both legs, lose urine or bowel control

Conjunctivitis

Symptoms

Bacterial

Viral

Allergic

Eyes affected

1 or 2

Both

Both

Discharge

Pussy

Watery

watery

Sensation

Gritty

Gritty

Itchy

Co-presenting symptoms

None

Cough/cold

Rhinitis

If pussy, red or gritty it is contagious – allergic ISNT contagious

Advice

Don’t wear contacts, hold cold flannel on eyes for few mins to cool them, use FBC water to gently wipe lashes and clean off crust and clean with cotton wool pad. Use a different one for each eye

Control spread by – reg wash hands with hot soapy water, cover mouth and nose when sneezing, don’t share towels or pillows and don’t rub eyes

Refer

Baby less than 28 days old with red eyes, allergic reaction, or spots on eyelids. For all – symptoms not resolved after 2 weeks

111 - Severe pain, sensitive to light, sudden changes to vision

Treatment

Viral – self-limiting, use hygiene and non-pharma advice

Allergic – Opticrom eye drops (Adults and child – 1-2 drops in each eye up to 4x daily)

Bacterial – over 2, chloramphenicol drops/ointment (Optrex Bacterial Conjunctivitis 1%w/w Eye Ointment) - apply a small amount of ointment in the affected eye 3-4 times daily for 5 days

Blepharitis

Symptoms

NOT contagious, rims of eyelids are inflamed, burning, soreness or stinging in the eyes, crusty lashes that stick together, itchy eyelids

Advice

Clean eyelids at least 1x daily, clean eyes even if symptoms clear, don’t wear contacts, or eye makeup

Cleaning eyes – soak a clean flannel/cotton wool in warm water and place on eye for 10 mins, gently massage eyelids for 30 secs, clean lids using cotton wool. Baby shampoo at 10:1 ratio good.

Refer

No improvement after 2 weeks of cleaning eyes

Treatment OTC

Brolene eye drops – 1-2 drops in each eye up to 4 x daily. If not better in 2 days refer

Dry eyes

Symptoms

Dry feeling, sensation of something in eye, burning, grittiness, itching, light sensitivity, over-blinking, redness, excess tears (randomly tearing)

Causes – over 50, contacts, digital screens, AC, windy/cold/dry/ dusty environment, smoking, alcohol, meds (antidepressants/BP) medical conditions (blepharitis)

Refer

Treatment failure after 2 weeks, change in eyelid shape

111 – severe pain and red, contact wearer with red eyes (could be an infection)

999 A&E – sudden change in sight, bursts of light sensitivity, severe headache/nausea, dark red eyes, injured/pierced eye, something stuck in eye

Advice

Clean eyes daily, take breaks when using screens, use screens below eye level, use humidifier, wear glasses instead of contacts

Treatment 

Light lubricant – Optrex Double Action Drops for Dry and Tired Eyes - Apply 1-2 drops in each eye.

Hyaluronic Acid - Artelac Rebalance Drops, long lasting relief - Place 1 drop into the conjunctival sac 3-5 times daily or more frequently if required.

Hypromellose drops – 1-2 drops 3 x daily

Excessive ear wax

Symptoms – hearing loss, earache, noise/ringing, vertigo, dizziness, and nausea

Causes – narrow/damaged canals, hairy canal, skin condition affecting scalp around ear, inflammation of ear canal

Refer – not cleared in 5 days, badly blocked, severe, complete loss of hearing, likely infection

Advice – don’t use fingers or cotton buds to remove wax

Treatment

Olive oil drops – 2-3 drops in affected ear and massage around outside of ear BD x 7 days

Use dropper when lying down with head to one side to allow oil into ear, over 2 weeks then lumps should fall out, but symptoms should be better within 5 days

Otitis externa

Symptoms - pain, discharge, itch, irritation, external ear/canal appears red, swollen, eczema, deafness, skin swells, tender to touch

Refer – ear pain in children, inflamed pinna, unsuccessful treatment (after 4 days), hearing aids, excessive discharge (wax or pus), high fever, vomiting, fatigue, confusion, dizzy, stiff neck, rash, slurred speech, fits, light sensitivity

Advice – avoid under/over dressing feverish child, lower heating, offer regular fluids, avoid dummies when lying flat, give paracetamol/ibuprofen if child is unwell/distressed (not together)

Treatment

Acute localised (furunculosis) – infected hair follicles in outer-ear causing swelling and irritation

Treatment – hot flannel, oral analgesics, antibiotics if severe

Acute diffuse (over 3 months – more widespread inflammation of skin, bacterial/fungal infection or contact dermatitis due to irritant/allergens

Treatment – earwax plus or EarCalm

Otitis media

Symptoms – earache, discharge, hot, irritable, sleeplessness, ear pulling/rubbing, crying, temporary deafness

Refer – recurrent infections, no improvement in 3 days

Treatment

Self-limiting should be better in 3 days, single analgesics for pain

Hyperthyroidism

Too much thyroid hormones produced naturally

Symptoms

Tremor, warm sweaty palms, weigh loss despite increasing appetite, heat intolerance, diffused alopecia, hair thinning, tachycardia, diarrhoea

Advice

Healthy diet with foods rich in antioxidants, green leafy vegetables (broccoli, cabbage etc)

Vitamin D, omega 3 fatty acids and calcium rich foods. Smoking cessation

Treatment

Carbimazole (adjunct B blocker propylthiouracil for adrenergic symptoms) – block and replace regime

Combo of fixed high dose carbimazole and levothyroxine

Radioactive iodine destroys thyroid cells, surgery to remove some thyroid

Hypothyroidism

Thyroid gland doesn’t produce enough hormones caused by immune system attacking thyroid gland and damaging ait or by damage to thyroid that occurs during treatments for a hyperthyroidism or thyroid cancer

Symptoms

Fatigue, muscle pain, weakness, weight gain, sensitive to cold, dry skin, brittle hair, nails, depression, reduced libido

Advice

Eat antioxidant rich food, seeds and nuts, tyrosine (meat, dairy, legumes)

Avoid – soy, iodine rick food, leafy green vegs, caffeine, alcohol – quit smoking, alcohol.

Inform GP if pregnant (needs treatment and monitoring during)

Treatment

Levothyroxine 1st line – dose depends on blood test and progression – take tablet at same time every day (MORNING) If taking too much causes sweating, chest pain, headaches, diarrhoea, vomiting. Supressing thyroid supressing hormone with high doses causes atrial fibrillation, stroke, osteoporosis

Cold sores

Symptoms

Simplex - Pain, burning, itching, tingling before lesions and lasts 6-48 hrs

Crops of vesicles burst and crust over and heal, commonly on lower lip and ends of mouth

Gingivostomatitis – fever, malaise, sore throat, painful nodules in cervix or under jaw, excessive salivation. Painful vesicles on a red swollen base that rupture to form ulcers inside mouth, covered with yellow/grey membranes

Refer – immunocompromised, unable to swallow, risk of dehydration, severe infection, complication, pregnant, recurrent

Treatment

Paracetamol/ ibuprofen for symptoms

Topical acyclovir/penciclovir OTC – use from onset of symptoms before lesions until lesions heal

OTC topical anaesthetic or analgesics, mouthwashes, or lip barriers – topical analgesics aren’t licensed in children

DON’T prescribe oral antiviral for healthy people

Consider prescribing oral antiviral for healthy people with episode of primary oral herpes simplex, recurrent labialis if lesions are severe, frequent, or persistent and recurrent

And for those who are immunocompromised

Should take at onset and until lesions have healed – minimum of 5 days

Choice of aciclovir or valaciclovir based on preference, dose, regimen, and adherence

Advice

Reassure its usually self-limiting and heals without scarring

Adequate fluid intake

Offer leaflets or websites for more info

Avoid kissing, oral until lesions fully healed, don’t share pillows, makeup, or lip balms. Don’t touch lesions other than when applying treatment – dab instead of rubbing. Wash hands after touching.

Athletes foot

Interdigital — most common; affects the lateral toe web spaces first; usually caused by Trichophyton rubrum.

Moccasin or dry — diffuse chronic scaling and hyperkeratosis affecting the sole and lateral foot; usually caused by Trichophyton rubrum.

Vesicobullous — least common; multiple small vesicles and blisters mainly on the arches and soles of the feet; usually caused by Trichophyton interdigital.

Risk – hot, humid, occlusive footwear excessive sweating, contaminated surfaces, immunocompromised

Advice

Wear well fitting, open footwear that keep feet cool and dry, replace old shoes that may be contaminated. Maintain good foot hygiene – wear different pair of shoes every 2-3 days. Wear cotton, absorbent socks, don’t scratch skin, after washing feet dry then well and between toes, don’t share towels and wash towel freq.

Treatment

Topical antifungal cream in mild, non-extensive disease

Terbinafine 1% cream (12 and over – apply thinly to affected area 1 or 2 daily for 7 days) or clotrimazole 1% cream (2-3 times daily and continue for 4 weeks minimum) okay for kids – OTC for some ages

Additional mild topical corticosteroid if there’s inflammation

Hydrocortisone 1% cream (OD for max 7 days)

Adult severe or extensive – oral antifungal with confirmed fungal infection

1st choice – terbinafine (250 mg once daily for 2–6 weeks, depending on the severity of infection)

2nd – itraconazole, Griseofulvin if not tolerated or contraindicated

Refer

Treatment failure, severe pain, got, painful and red (indicative of serious infection), infection spreads, diabetic patient, immunocompromised

Warts and verrucae

Warts – small, rough growths caused by infection of skin with HPV, form anywhere on skin most commonly on hand and feet

Verruca – (plantar wart) wart on sold of feet

Spread by direct contact, occur and clear spontaneously at any time or may take years

Common warts are firm and raised with a rough surface that resembles a cauliflower (common on knuckles, knees, and fingers).

Periungual warts are common warts around the nails that can be painful and disturb nail growth — nail biting is a risk factor.

Plane warts are usually round, flat-topped, and skin coloured or greyish yellow (common on the backs of hands).

Filiform warts have a finger-like appearance and may have a stalk (more common on the face and neck).

Palmar and plantar warts grow on the palms and the soles of the feet (verrucae). They often have central dark dots (thrombosed capillaries) and may be painful.

Mosaic warts occur when palmar or plantar warts coalesce into larger plaques on the hands and feet.

Not harmful and don’t come with symptoms and resolve with treatment

Advice

Reducing transmission and limit spread, keep feet dry, wear slippers or waterproof plaster in shower and communal areas. don’t share towels, socks, shoes. Don’t scratch lesions, bite nails or suck fingers with warts

Refer

Painful, facial, uncertain diagnosis, immunocompromised, extensively infected

Treatment

Only treated if painful, cosmetically unsightly, or patient request and persistent as the treatment is long and can have side effects.

Topical salicylic acid – up to 12 weeks

Duofilm® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for plantar and mosaic warts.

Bazuka® extra strength gel (salicylic acid 26%) — licensed for warts and verrucae.

Occlusal® (salicylic acid 26%) — licensed for common and plantar warts.

Salactol® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for warts, plantar warts, and verrucae.

Apply OD at night, file and soften area by soaking in warm water for 5-10 mins, peel of remaining film before administering next dose, don’t apply on healthy skin

Cryotherapy – every 2 weeks for max 6 treatments

Liquid nitrogen – only for older children and adults

Corns and calluses

Hard or thick areas of skin that can be painful

Corns – lumps of hard skin on knuckles and joints of toes

Callouses – larger patches of rough, thick skin

Both can be tender and painful

Refer

Diabetic, heart disease, circulation issues. Bleeding or puss, treatment failure after 3 weeks, severe pain

Advice

Wear thick, cushioned socks, wear wide, comfortable shoes with low heel and soft sole, use insoles or heel pads, soak corns and calluses in warm water to soften them, use pumice stone regularly or foot file to remove hard skin. Moisturise.

Don’t try to cut them, walk, or stand for long period, wear high heels or tight pointy shoes, go barefoot

Treatment

Heel pads and insoles, OTC products, pain relief

Carnation brand caps for both – adhesive dressing

Fungal nail infection

Caused by dermatophyte and non-dermatophyte moulds and yeasts

Symptoms

Discoloured, abnormal, small flaky white patches and pits on top of nail and becomes rough and eroded. Nail lifted, wite or yellow opaque streaks on one side of nail, scaling, thickening

Refer

Diabetic, severe, treatment failure, spread to other nails

Advice

Keep nails trimmed short and filed, don’t share clippers and files. Well-fitting shoes, cotton socks, maintain good foot hygiene, weak shoes in communal places, avoid nail trauma

Treatment

Not needed if patient not troubled by appearance and infection is asymptomatic

Advise antifungal treatment if – walking uncomfortable, distress, cosmetic, co-morbid complication, or complication

If dermatophyte or candida infection conformed – topical antifungal treatment 0f 50% of nail involved, 2 nails infected, contraindication to oral antifungal

Topical – amorolfine 5% mail lacquer – OTC apply 1 or 2 weekly to affected nail after gentle nail filing – 6 months minimum for fingernails, 12 months for toenails

If dermatophyte nail infection is confirmed:

Prescribe oral terbinafine first-line.

250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails

Oral itraconazole if an alternative drug is indicated.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

If Candida or non-dermatophyte nail infection is confirmed:

Prescribe oral itraconazole first-line.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

Prescribe oral terbinafine if an alternative drug is indicated.

Prescribe 250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails.

[babymother91]

Pregnancy  | Pregnancy of a woman | First week of pregnancy

Pregnancy is an amazing process that lasts about nine months. During this, the fetus grows inside the woman's uterus.

Pregnancy begins with ovulation, which is the release of an egg from the ovary.

If the egg is fertilized by sperm, it will travel to the uterus and become embedded in the lining of the uterus.

The fetus then begins to grow and develop rapidly.

The first week of pregnancy

It is the beginning of a new journey. The first week of pregnancy begins a new and exciting journey for a woman.

This week, the fertilized egg begins to implant in the uterus lining, and then hormones change.

A woman may not feel any symptoms this week but may develop some in the second or third week.

Can you feel a baby in the first week of pregnancy?

There was no major development in the baby during the first week.

During this week, the baby is called a blastocyst. So you can't feel a baby in the first week of pregnancy.

What happens in the first week of pregnancy?

Day 1 to Day 4

The egg is released from the ovary in a process called ovulation. If the egg is fertilized by sperm, it will travel to the uterus.

Day five to day seven

The fertilized egg implants in the lining of the uterus. This process is called implantation.

Day 8 to Day 12

Hormones begin to change, such as human chorionic gonadotropin (hCG). This hormone is produced by the placenta.

An organ that grows inside the uterus during pregnancy. hCG is the hormone that is detected in home pregnancy tests.

Pregnant mother

Baby's size

There is no baby size in the first week of pregnancy. That is because you are only technically pregnant in the first week.

The first week is included in the pregnancy calendar on the 1st day of your last menstrual cycle.

From this, the doctor predicts the EDD, which also is the expected due date of the arrival of your little angel.

A common change in your body when a baby changes

Exhaustion

Also, constipation

Additionally, tender Breasts

Also, morning Sickness

What are the symptoms of pregnancy in the first week?

Dizziness

Mood Swings

Also, breast swelling

Vaginal bleeding

Increased urination

Also, lower back pain and cramps

You will feel moody and irritable

Bloating in the belly right before or during your period

Have you ever been pregnant and experienced these symptoms? Please answer us in the comments.

Belly at the 1st week of pregnancy

In the first week, your body isn't only releasing the last month's egg. It also starts forming a uterine lining to hold or protect the next month's egg.

Hence, your belly isn't going to show anything in the first week.

1 Week Ultrasound

In normal pregnancies, there is no ultrasound done in the 1st week.

If you are undergoing some treatment to get pregnant. The doctor may advise an ultrasound to search for fibroids and follicles in the ovary.

What should a woman do in the first week of pregnancy?

If you think you are pregnant, you can take a home pregnancy test. If the test is positive, make an appointment with your doctor or nurse.

Your doctor will be able to confirm the pregnancy. Also he will discuss appropriate health care for you and your baby.

Healthy foods for pregnant mothers

Eat a healthy, balanced diet.

Don't forget to eat berries, whole grains, and also avocado.

Additionally, eat broccoli, dark leafy vegetables, lean meat, and fish liver oil.

Include prenatal vitamins in your diet after consulting your doctor.

Include dairy products, legumes, sweet potatoes, salmon, and also eggs.

Consume extra protein and calcium for the needs of the growing fetus.

Healthy habits for the pregnant woman

Get enough rest.

Also, exercise regularly.

Put lots of water in your diet and drink plenty of fluids.

Important things you must do as a pregnant woman

Make all the necessary changes in your lifestyle and eating habits.

Also, start the intake of prenatal vitamins with 400 mcg of folic acids every day.

Consult an OB-GYN to understand all about genetic diseases and the risks of environmental hazards.

Don't do this thing during pregnancy

Drugs

Also, avoid smoking

Additionally, avoid drinking alcohol

Taking medicine without consulting your doctor

What should I shop for?

Pregnancy book.

Buy moisturizer for dry skin.

If your breast feels sore, then get cotton bras.

Here is a collection of the best-selling products recommended for pregnant women. You can buy it from any store you want, Click here.

1- Fruit of the Loom Women's Beyond Soft Front Closure Cotton Bra

Fruit of the Loom Women's Beyond Soft Front Closure A cotton bra. It is a popular item with its lightweight, breathable fabric.

It features a front-close design for easy preparation and is unlined. Also, wire-free, and offers full coverage.

The bra features front ruching, hook-and-eye closure, back smoothing, and soft, thick straps.

It is made from 95% cotton and 5% spandex. Click here to buy.

2- Mama Belly Butter with Shea Butter and Vitamin E, Burt's Bees

This product offers Burt's Bees Belly Butter with Shea Butter for mothers.

To nourish their bellies before and after pregnancy. It includes a pregnancy lotion that softens and smooths skin. With cocoa shea and jojoba butter.

The fragrance-free lotion gently moisturizes during pregnancy and helps with skin recovery post-pregnancy.

The lotion is non-irritating and 99% natural, avoiding phthalates, parabens, petrolatum, or SLS. Click here to buy.

3- What to Expect When You're Expecting a Book

America's pregnancy bible provides comprehensive information on pregnancy.

Including tests, eating for two, spinning classes, fish safety, and working until delivery.

It demystifies the pregnant body, covering topics. Like headaches, foot swelling, back pain, and labor.

The book also covers prenatal screenings and safe medications. And also birthing options like water birth and gentle c-sections.

It also covers the pregnancy lifestyle, including eating and drinking coffee. Also, working out, sex, travel, beauty, and skincare.

Pregnancy symptoms are addressed, and chapters cover multiples and fatherhood.

The book is filled with practical advice, realistic insight, and easy-to-use tips. Click here to buy.

4- Motherhood Maternity Full Length BellyLeggings,-Black,- Medium iRIP

Motherhood Maternity Full Length Black Medium Irip Baby Leggings.

They are a great value option for layering during pregnancy. They feature Motherhood's exclusive secret fit belly panel.

Also, a seamless stretch maternity panel that grows with you. The stretchy fabric provides a comfortable, flattering fit all day long.

Shop by clicking on the Motherhood Maternity logo. Click here to buy.

If you are a pregnant woman, I want to congratulate you on your pregnancy first. Did you benefit from today’s article? Please answer us in the comments.

[shannontracysblog]

My Story May Be Your Story

I suffer from multiple Auto-Immune Illnesses; Crohn's, Celiac Disease, Scleroderma, vitiligo and Osteoarthritis and I am only 46 years old. These illnesses and my passion for understanding the "root" of my illnesses, not just what pills to pop to manage symptoms, lead me down a rabbit hole of research, which kept taking me to terms like "Gut Health", "Microbiomes", "Brain Fog" and "Chronic Inflammation" and "Weight Gain"; All of which I was experiencing. I also decided I would take this passion a bit further and have earned my Certifications as a Health Coach through #IIN (Institute of Integrative Nutrition". This was in 2021, and also the same year I birthed our 2nd miracle daughter.

If you have an Autoimmune illness (or a few) and become pregnant you may notice your symptoms often subside, Thank you surge of pregnancy hormones and baby! However, once baby is born, typically within 6-12 months our immune systems come back with a vengeance. My Ulcerative Colitis became Crohn's, my Vitiligo spread like wildfire under my arms and the trunk of my body and although I no longer had gestational diabetes, I had metabolic testing done and I was Insulin Resistant. Through the colonoscopy of tissue sampling and bloodwork it was discovered I also have Celiac disease.

I was put on Mesalamine for the Crohn's, removed Gluten from the diet and since my resting glucose was 137 and A1C was 5.8 I was placed on Mounjaro 2.5 dosage, weekly injections. This past month I had my labs repeated after 6 months and my Glucose is now 97 and A1C is 4.6! I am also down 20 pounds. In August I will be stopping the Mounjaro to see if I can maintain by a whole foods, veggies most diet with lean proteins and fiber filled carbs. I am a big water drinker, so that never has been a struggle.

At this point in my journey, I have educated myself, became certified as a health coach and basically through nutrition and of course Licensed Medical Doctor supervision, I have coached myself and proof the product works. Product, meaning myself, techniques and way I can help. Since I have spent the past 6 months focused on nutrition, and down 20 pounds, I am ready to incorporate daily movement, with a low-impact program.

Full disclosure - I had a L5-S1 spinal fusion in 2007 and after years of desk jobs, 2 pregnancy’s and always relying on the one sided "mom hip" to carry these toddlers around I am wrapping up Physical Therapy now and after a final evaluation next Tuesday, will be discharged from twice a week sessions. I was also directed to choose from Barre, Yoga, Pilates, Walking and swimming, to avoid the risk of future injury, yet be able to build strength, especially in my core (2 c-sections later).

The weather has broken here in Michigan, and I have intentionally begun to block 30 minutes out mid-day, to walk outside while listening to podcasts (typically when I get my daily dose of spirituality and gratitude in). After reviewing a streaming library of over 1000 at-home workouts, trust me when I say I drilled down that refined search, to only those programs that made sense for where I am at on this wellness journey. I have chosen a Barre program to start on May 1st. The program is 30 minute workouts Monday - Friday which gives me the weekends to just be MOM, play and be with the kids, resting & replenishing.

I wish to take my knowledge, education, experience and passion to empower women with Auto-Immune diseases feel their best through personalized wellness routines to meet their unique health goals. The first step will be for me to host a virtual community beginning in May. Maybe you desire nutrition only, or maybe a fitness program to meet you where you are, because you also have nutrition down to a science, there is not a one size fits all, and why I personalize the plans to set you up for success.

I am ready to elevate my own health journey & would like you to walk alongside me :-)

"Curiosity is one of those insatiable passions that grow by gratification" - Sarah Scott

Feel free to message me or email directly to bewell.staywell4u@gmail.com for more information

[womenandwellness]

PREGNANCY

Symptoms of the initial months of pregnancy are critical and crucial for women. At WomenWellness360.in, we aim to support you through this entire journey from pregnancy to childbirth. The Common 1st month of pregnancy symptoms are missed periods, experiencing nausea, fatigue, and random mood swings. A few women also experience tender breasts, frequent urination, and mild abdominal cramping as their body adjusts to the initial/early stages of pregnancy.

Knowing pregnancy symptoms in the first trimester is essential for maintaining your body and your baby’s well-being and health. It’s common to have these concerns during this time, and our platform, WomenWellness360.in, can help. We offer a community of like-minded people and informative content in videos, blogs, and articles, and we seek help with expert consultations to guide you through the early stages of pregnancy at no cost.

Remember, every pregnancy journey is unique, and knowing the symptoms of the first month can help you prepare for the journey ahead. Let WomenWellness360 be your trusted partner/buddy in this beautiful experience.

https://womenwellness360.in/category/pregnancy-and-childbirth/

[divinemotherpots]

1st Trimester of Pregnancy Precautions: Must Check!

The nine-month journey of pregnancy is divided into three stages, so let's take a look at what the first trimester is about. Generally, the first trimester of pregnancy covers the first third of pregnancy, and it typically ends at week 12, although some say it may extend until the 14th week.

The first month of pregnancy is generally characterized by symptoms such as missed periods, nausea, dizziness, mood swings, and other pregnancy-related symptoms. Moreover, the first twelve weeks of pregnancy are the most critical, hence it is important to take care of yourself during these weeks Precautions for the first trimester of pregnancy are essential for your health and the health of your baby.

[tacticalvalor]

«────── « HEADCANON » ──────»

TW / CW for: Death, Slavery, Kidnapping

I've always had some thoughts about the relationship that Boone and Carla had prior to her being sold off to the Legion, so what better way to share them than to make a sort of timeline of events.

As we know, Boone and Carla met either just before or just after the Bitter Springs Massacre:

Some time after Bitter Springs, Boone was discharged from the NCR Army, but not before meeting Carla while on leave.  Carla was the only thing in the world who made him feel calm and happy in life. When he listened to her, she made him forget about everything he did in the military. He left the military, married Carla, and moved to Novac at the invitation of his 1st Recon friend, Manny Vargas.

There’s a lot of mystery around Carla and her relationship with Boone, mostly because outside of Boone’s personal quest, Carla played no real part in the plot of Fallout: New Vegas.  However, there are some things that can be taken into consideration to determine just how long Boone and Carla were together (re: married) before Boone inevitably killed her and their unborn child to save her from a lifetime of slavery in the Legion. This post will be broken down into the following sections:

Boone’s Military Service

Discharge

Carla’s Pregnancy

Social Implications and Marriage

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BOONE’S MILITARY SERVICE

It is unknown when Boone joined the New California Republic (NCR), however his time in service prior to the Bitter Springs massacre is not entirely important, but we’ll delve into it anyway:

The Bitter Springs massacre occurred in 2278, meaning that at the time Boone was at the ripe age of 23 years old (as Boone is 26 in 2281).

Given the fact that Boone is a member of the 1st Reconnaissance Battalion (1st Recon), we can assume that he would have joined between ages 18-21 due to the fact that generally speaking, most specialized unit training can take 1.5 to 2-years. This is based off of general time estimates for the United States Marine Corps, which has a 1st Reconnaissance Battalion of its own.

NOTE: This is assuming that the NCR was running at a functional and operational level, as Boone and numerous others state that the Republic is heavily disorganized and that the selection process for the Recon is being “the best shot on the range”. This may mean that he could have been in service for a lot shorter, or that this training did not occur.

Moving on from this portion of Boone’s service, we know that Boone was placed on leave prior to his discharge after the Bitter Springs massacre, which it was during this time when he met Carla.

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DISCHARGE

Let’s dive into the conditions of Boone’s discharge, as that will help determine a time frame for how long his leave would have taken.

Given the circumstances of the Bitter Springs massacre, it is most likely that Boone filed for a Total and Permanent Disability (TPD) Discharge.  

This would happen on the grounds that, due to the events that unfolded, Boone found himself having severe symptoms of Post-Traumatic Stress Disorder (PTSD). Many of these symptoms are still found in 2281, even if not as severe. The TLDR is that this form of discharge would require a formal diagnosis which can take weeks or months, as an adult must have symptoms for at least 1 month:

At least one re-experiencing symptom

At least one avoidance symptom

At least two arousal and reactivity symptoms

At least two cognition and mood symptoms

Given that there is no definitive timeline, this process could take anywhere from two months to a year, which means Boone most likely met Carla between ages 23 and 24 while on leave for this diagnosis and discharge process.

This gives us a little more of a timeframe, which will be expanded on in the next section.

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CARLA’S PREGNANCY

According to the official Bill of Sale that can be found in the Dino Dee-lite Motel, Carla was sold for a tidy sum of 1,000 caps, plus another 500 caps for her unborn child, to slavers in Caesar’s Legion. There is also mention of a bonus 500 caps if the child “made it to term”, meaning that Carla still had plenty of time to go before giving birth.

Anyway-

Going on the assumption that, due to various medicinal tools and practices being lost in the Great War, pregnancy test were not available to those residing in the Mojave, for anybody to really know that she was pregnant, she most likely would have to have been showing her pregnancy.

If this is the case, then Carla was pregnant for any time between 12 and 16 weeks, approximately 3 to 4 months.

NOTE: Again, this part is based on the assumption that pregnancy tests were unavailable. This may be wrong or inaccurate.

However, the letter that can be found on Boone suggests that Carla was further along in her pregnancy than mentioned above, considering the circumstances:

Everyone that enters the NCR army is required to write a letter to be passed on to their loved ones if they die in action. Boone had written this to his wife Carla, apparently during her pregnancy. Boone kept his note and carries it around with him, possibly as one more way to carry on her memory.

This means that Boone wrote the letter prior to discharge, whether it was during duty or while on leave. The latter is the most likely instance, since having Boone actively on duty would mean the pregnancy would have been well over 9 months.

The letter is as follows, and addresses both Carla and their unborn child:

Carla,

If you’re reading this, then you know. Sorry. Wanted to make it back home to you.

The pension won’t be much but it should help you and the baby get by. Want you to remarry when you meet the right person. Don’t want you to have to be on your own.

Not sure the right way to say how I feel about you. Think you know already, though. Always seemed like you knew what I meant, maybe better than I did. Wish I was there with you now.

There are things I couldn’t tell you. Tried. Whatever you learn over time about my service in the NCR, hope you can forgive me.

Lastly, know you were against it, but if it’s a girl, want her to be named after her mother. Know it’s playing dirty to win the argument this way, but too bad. It’s worth it.

Craig

So realistically, Carla could be anywhere from 3 months to 7 or 8 months pregnant. Regardless, it’s known that Carla is pregnant.

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SOCIAL IMPLICATIONS AND MARRIAGE

Now, given the fact that Boone met Carla between ages 23 and 24, this would mean that by this point, Boone and Carla have at least known one another for two or three years. 

This means that they could have been married for:

Two years (assuming that they dated or were just acquainted for that first year)

3 - 8 months (assuming Boone married her when the news of her pregnancy first broke)

Looking at the social implications, though, it can be assumed the latter is the truth. This is because of various recollections of the relationship between Boone and Carla by the townsfolk of Novac:

Jeannie May Crawford describes Carla as being similar to a cactus flower; “Real pretty to look at, but there’s no getting close to her.”

Ranger Andy describes her as a “knockout” and says that Boone always had a “funny grin on his face” when they were together. Unlike the other residents of Novac, Ranger Andy doesn’t have a problem with Carla. He acknowledges her sour attitude and the poor opinions the other residents had of her, but he confides in the Courier that he always believed Carla’s cold demeanor was just a cover for her unhappiness and says he doesn’t blame her for wanting to think there was “something better out there than this (Novac).”

Alice McBride has a similar opinion of Carla to Ranger Andy.

Manny Vargas, Boone’s former friend, says that he and Carla couldn’t see eye-to-eye on anything, and he argued with her frequently. Carla wanted Boone to end his service in the NCR which eventually led to a rift between Manny and Boone. Manny also testifies that Boone and Carla often fought since they moved to Novac.

Cliff Briscoe states that Carla always had a sour look on her face whenever she was in his Dino Bite gift shop.

These testimonies, particularly those praising the relationship that Boone and Carla had, would suggest they are still well within the “honeymoon phase” of their marriage.

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TLDR

It’s very hard to put together the timeline of Boone and Carla’s relationship, and it’s very likely that Boone and Carla may not have been married for too long before she was killed, as evidence suggests they were still in their honeymoon phase before she was sold.

[46ten]

Brief notes on correspondence of Philip Schuyler and John Jay

I wanted to confirm the transcription of the 7Feb1785 letter from Philip Schuyler to EH was correct - that Catharine Schuyler had been ill - and found it in a letter to AH 11Jan1785 (that doesn’t wish AH a Happy 28th Birthday):

Mrs. Schuyler has been much indisposed since my last. We began to be very apprehensive of her situation but our fears are vanished with the untoward Symptoms which occasioned them. She is now so well as to go abroad and we have well grounded hopes of a perfect restoration.

It’s also confirmed here (Philip Schuyler to John Jay, 22Jan 1785):

I was in hopes to have had a tete à tete with you at new york about this time but Mrs. Schuylers indisposition has deprived me of that pleasure.

The next month (PS to JJ, 21Feb1785): 

The attention to be paid Mrs. Schuyler who has been confined to her bed since the 10th Instant has prevented a more early answer. [He then provides him with advice on the plan of his house, which Jay had sent to him; PS also provided the wood for it.]

I haven’t found more about what was afflicting her; PS’s letter to EH indicates that she has mostly enjoyed good health, which is interesting to me considering her numerous pregnancies/premature births/loss on infants. 

There’s also this sad note that PS had been saving planks for the Churches to build their home. They wouldn’t be back in America permanently for another 12 years. 

When Mr Church arrives at New York Inform your self If he will build & want the boards which I have reserved for him, and which are three to four years old, and have been constantly stacked & Covered.

I guess there was no point offering wood to build a house to the destitute Hamiltons scraping by in their rented house on Wall Street. 

A great 1785 letter where Philip Schuyler describes the role of men such as Jay (and himself) in government: “It is a wise, and a true Maxim, and which I think I have heard you ^urge^ more than once, that to serve ones country is the first of dutys, next to that which we owe to the supreme being.” (PS and friends had tried to convince Jay to run for governor of NY; they had already united the families in Albany in opposition to Clinton; JJ was eventually NY gov with Stephen Van Rensselaer as his lieutenant, from 1795-1801, after JJ’s stints as 1st Sect of State and 1st Chief Justice of the Supreme Court). 

Always interesting to see how PS described his family and read that he’d made the decision in 1783 to retire from public life (that did not last long) PS to JJ, 1July1783. :

Mr. Carter my son in law, will have the honor of delivering you this, he and Colo: Wadsworth have furnished the supplies for the french army, and have acquitted themselves with great propriety, and to the entire satisfaction of the french commander and chief, and the other officers, they go to sollicit a discharge of the bills which have been drawn in their favor. It is probable that by your intervention their business may be much expedited, will You permit me to intreat Your Attention to them & ^to^ their concerns.

Since you left America two of my daughters have married, Colo: Hamilton has Betsy and Mr. Stephen Van Renselaer has Peggy.

My health is so much impaired, that It is become absolutely necessary, in order to pass the remainder of my days with tolerable satisfaction, that I should retire from public life, and retreat to my Saratoga hobby-horse, where I hope some day to have the pleasure of embracing You, unless you should consent to remain in Europe.

I also came across this little bit (Jay to Schuyler, 19Feb1780):

My Views are at present confined to a Segment of that Circle—but that Segment affords Field for many Inquiries, and yields Matter for Observations—both interesting and entertaining— I will share them with you if you please—and to do it the more effectually, wish you would send me a Plan and Explanation of the Cypher you once shewed me at Rhynebeck, but which I do not now well recollect. Let the Key Word be the Name of the man who so long and regularly placed every Day a Tooth-Pick by Mrs. Schuylers Plate, written backwards, that is the ^last^ Letter in the Place of the first and so on

I assume this is a servant/enslaved person that was with the Schuylers for a long time. The beginning of the letter is also a good example of manners in 18th century letters. Jay and Schuyler do like their cyphers, as discussed in the first letter above: 

You have probably a better Cypher than that I shewed & sent you. I have lately contrived one which I prefer to any I have yet seen, on account of Its expedition, and the impossibility, as I conceive, of decyphering it without a previous knowledge of the Key

To finish up this little diversion on some of John Jay and Philip Schuyler’s correspondence, here’s the text of the letter Jay sent following AH’s death:

Bedford, 25 July 1804

My Dear Sir,

The Friendship and attachment which I have so long and so uniformly experienced from you, will not permit me to delay expressing how deeply and sincerely I participate with you in the afflicting Event which the Public are now lamenting, and which you have so many domestic and particular Reasons to bewail.

The phylosophic Topics of Consolation are familiar to You, and we all know by Experience how little Relief is to be derived from them. May the author and only Giver of Consolation be and remain with You. With great Esteem and affectionate Regard, I am my Dear Sir, Your obliged and obedient Servant,

P.S. to myself, the letter from Benson to Jay, 4th January 1805, questioning whether/why Jay has not yet subscribed to the loan for the Hamilton family, is pretty great at summarizing the financial plan of the trustees and executors. Yet:

The principal Motive however for a numerous Subscription ^is^ that it will be more honorable to the Memory of our Freind— All that took place here immediately on his Death may be considered as the Effect of Sensibility for the Moment, but what We are now about to do is, in my View of it, the best possible Means to express our sincere and fixed Affection for him ^and^ some of his superlative Worth— Clarkson has increased his Subscription from 5 to 10 Shares, and I think his Example will not be without it’s Influence

Of course he did. 

[herhealths]

20 Challenging Health Issues Women Should Not Ignore

A woman’s health is different from a man’s health and it is very important to be aware of the potential health issues that could arise in a women’s lifetime. There are many Health Issues Women Should Not Ignore are like heart disease, stroke,  mental health, reproductive health, osteoporosis, and many more . In this article, we will discuss 20 such conditions which every woman in her lifespan may face. To help ensure you stay healthy and aware of such potential conditions it is important to understand the cause and preventive measures which can be taken to avoid and cure such issues.

List of 20 Health Issues Women Should Not Ignore.

1. Menstruation and Menstrual Disorders

The process that a woman’s body goes through to become ready for pregnancy is called the menstrual cycle. Normally, the menstrual cycle lasts 28 days, however, it can also be 21 to 35 days long. The menstrual cycle is controlled by hormones that are produced by the hypothalamus, pituitary gland, and ovaries

The most common menstrual disorder are as follows.

Dysmenorrhea (painful periods), is characterized by cramping and pain in the lower abdomen both before and during menstruation.

Amenorrhea (absent periods): This occurs when a woman doesn’t menstruate for an extended period of time.

Menorrhagia (heavy bleeding): This is characterized by excessive bleeding during menstruation.

Polymenorrhagia (frequent periods): This happens when a  menstrual cycle occurs more frequently which is earlier than 21 days.

Oligomenorrhea (infrequent periods): This happens when a cycle occurs less frequently that is after more than 35 days.

Premenstrual syndrome (PMS): This is a group of physical and emotional symptoms that occur before and during menstruation.

Premenstrual Dysphoric Disorder (PMDD): This is a severe form of PMS characterized by severe emotional symptoms, including depression and anxiety.

Read Article on tips to feel better during period.

2. Menopause and Perimenopause.

The natural biological process known as menopause represents the end of a woman’s reproductive years. Although it can develop earlier or later, it normally happens between the ages of 45 and 55. Menopause is the term used to describe the end of menstruation permanently, which is verified after 12 months without a period.

Perimenopause is the time preceding menopause when a woman’s body experiences a variety of changes. It may begin several years before menopause and continue for a number of years after. A woman’s ovaries gradually generate less estrogen and progesterone throughout this time.

Symptoms of menopause and perimenopause include:

Hot flashes and night sweats

Vaginal dryness

Irregular periods

Mood swings

Anxiety and depression

Sleep disturbances

Fatigue

Loss of libido

Memory and concentration problems

Joint and muscle aches

Headaches

3. Pregnancy and Childbirth.

Pregnancy is the period of time during which a woman carries a developing embryo or foetus within her uterus. The process of pregnancy and childbirth typically lasts around 40 weeks and is divided into three trimesters.

1st trimester (weeks 1-12): During the first trimester, the fertilized egg implants in the lining of the uterus, and the placenta and umbilical cord begin to form. The embryo develops into a foetus, and the baby’s major organs begin to form. The mother may experience morning sickness and fatigue.

2nd trimester (weeks 13-28): During the second trimester, the foetus continues to grow and develop. The mother may experience a decrease in morning sickness, and her belly will begin to grow. For the first time baby’s movement may be felt.

3rd trimester (week 29-40): During the third trimester, the foetus is fully developed and the mother’s body prepares for childbirth. The baby’s head may drop down into the pelvis, and the mother may experience Braxton Hicks contractions.

Childbirth begins with labor, which is the process by which the uterus contracts to push the baby out of the mother’s body. The process of pregnancy and childbirth typically lasts around 40 weeks and is divided into three trimesters.

Childbirth begins with labor, which is the process by which the uterus contracts to push the baby out of the mother’s body.

Complications that can occur during pregnancy and childbirth include:

Miscarriage: This is the loss of a pregnancy before 20 weeks.

Preterm labor: This is labor that occurs before 37 weeks.

Placenta previa: This is a condition in which the placenta covers the cervix, making vaginal birth dangerous.

Gestational diabetes: A type of diabetes that develops during pregnancy. Sometimes it goes away after childbirth.

High blood pressure: This can be a serious pregnancy complication and can lead to preterm labor or a condition called preeclampsia.• Postpartum hemorrhage: This condition where excessive bleeding occurs after childbirth.

Cesarean section: This is a surgical procedure in which the baby is delivered through an incision in the mother’s abdomen.

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