September, 2008 NEWSLETTER

From Bio-Magnetic Therapy

 

Ischemic colitis

 

Low blood flow to colon

 

  • The pain that suddenly developed on the left side of your abdomen didn’t seem like anything to worry about. But then it got worse, and you had the sudden urge to have a bowel movement.  When you went to the bathroom, all that came out was bloody diarrhea.  Now you’re worried.
  • Your worry isn’t unfounded.  Bloody diarrhea requires prompt medical attention.  It may be a sign of a number of diseases or condition. But if you’re age is 60 or older, there’s a good possibility that you may have ischemic (is-KEM-ik) colitis.
  • Ischemic colitis occurs when blood flow to part of your large intestine (colon) has been suddenly reduced or blocked. This can lead to areas of colon inflammation and, uncommonly, permanent colon damage.  Fortunately, with proper medical care, the vast majority of those who have it recover within a day or two.

 

Blood flow, interrupted

 

  • Your colon is nourished by constant blood flow through a network of arteries.  The two main arteries that feed this network are the superior mesenteric artery, which nourishes the middle and right side of your colon and the small intestine, and the inferior mesenteric artery, which nourishes the left side of the colon.
  • Arteries branching from these sources form extensive connections between each other.  That way, if an artery is narrowed or even totally blocked, blood can almost always be rerouted around the blockage to reach the colon.  Still, blood flow to the colon can be diminished or temporarily blocked.  When the bowel doesn’t get enough blood, its tissues can be damaged, causing it to leak blood. This can occur by a number of mechanisms, including:
  • Narrowing and hardening of arteries (atherosclerosis) – Although atherosclerosis develops slowly and usually allows for the development of extensive connections, it can still diminish the overall capacity of your colon arteries and may contribute to an episode of ischemic colitis.
  • Artery tightening (vasoconstriction) – Colon arteries are part of a sensitive survival reflex in which less essential arteries are constricted during times of low blood pressure or low blood flow so that more blood goes to the brain.  This may bring on ischemic colitis.
  • Factors that may lead to low blood flow or blood pressure – and thus vasoconstriction – include congestive heart failure, dehydration or internal hemorrhage.  In rare cases, certain medications may trigger vasoconstriction. These include pseudoephedrine, migraine medications in the triptan or ergot class, the heart drug digoxin (Lanoxin), estrogen-containing drugs, and certain antipsychotic drugs.
  • Blood clots – These can form within a colon artery or break off from a clot in another area of the body and travel toward the colon.  Blood clots are more likely to cause problems on the right side of the colon.  When ischemic colitis occurs in an adult younger than 60, doctors often check for cardiac conditions such as atrial fibrillation or mitral valve disease, which can make you more susceptible to blood clot formation and clotting.
  • Abdominal surgery – Surgery in the abdominal area, such as repair of an aortic aneurysm, may require clamping off one or more arteries that supply blood to the colon.  This can be a contributing factor to an episode of ischemic colitis after an operation.
  • A number of other factors may be associated with ischemic colitis, such as diabetes, abdominal radiation exposure, blood vessel inflammation (vasculitis), infections and long-distance running. But in most cases of ischemic colitis, normal blood flow has already returned to the colon by the time symptoms appear.  By the time a doctor starts looking for a cause, it’s common hat there’s no cause left to be found.

 

Diagnosing the problem

 

·         Diagnosing ischemic colitis is as much about ruling out other causes as it is about finding evidence of ischemic colitis.  Tests that help confirm a diagnosis may include:

·         Computerized tomography (CT) scan – this X-ray test provides detailed cross-sectional images of your colon and can help diagnose certain problems such as inflammatory bowel disease.

·         Stool sample – This is used to culture bacteria that can mimic ischemic colitis.

·         Colonoscopy – This allows your doctor to look for signs of ischemic colitis such as inflamed tissue, bleeding and ulceration, or discoloration of the colon wall.  Your doctor may remove a small tissue sample (biopsy) for analysis with a microscope.  Importantly, your doctor can use colonoscopy to rule out other causes of abdominal pain and bleeding, such as colon cancer, inflammatory bowel disease, infection in the colon or divericulitis.

 

Treatment

 

·         In most cases, there’s no reason to directly treat ischemic colitis, because it resolves on its own within one to two days.  Still, people with ischemic colitis can feel quite sick, and it’s common to spend a day or two in the hospital receiving supportive care that may include:

·         Antibiotics – Areas of inflamed colon make it easier for bacteria to penetrate the colon wall and get into the blood.  Antibiotics can help stop bacteria from spreading.

·         Fluids – If you’re dehydrated, intravenous fluids can help restore blood flow and blood pressure.

·         Correction of underlying problems – This may involve using medications to raise blood pressure, optimizing your heart failure, or stopping the use of drugs that may be causing vasoconstriction. After recovery from an initial episode of ischemic colitis, any resulting colon damage typically heals completely within two weeks.  However, in a small percentage of people, healing may take longer and symptoms may linger.  Rarely, the colon doesn’t heal properly and surgical removal of the damaged colon segment may be required.

 

Preventing another attack

 

·         Ischemic colitis isn’t a particularly common problem, and the cause is often unknown.  The majority of those who have it recover quickly and never have another episode.  For these reasons, there’s really no proven way to prevent it.  Still, it makes sense to avoid a drug that may have caused ischemic colitis in the past.

 

Ruling out other causes

 

·         Signs and symptoms of ischemic colitis include abdominal pain, diarrhea, bright red or maroon-colored blood in the stool, low grade fever, and nausea and vomiting. They tend to come on fairly suddenly in people who were previously healthy.  Conditions that can mimic ischemic colitis include:

 

In Infections such as Escherichia coil O157:H7, campylobacter, shigella, Clostridium difficile, and others, the symptoms may be nearly identical to those of ischemic colitis. Some can cause other problems, including kidney failure

 

In Colon cancer the symptoms tend to come on more gradually than with ischemic colitis. 

 

In Diverticulitis the pain is similar to ischemic colitis, but not accompanied by diarrhea or blood.  Diverticula can bleed, but it’s not painful. 

 

In inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, beginning symptoms may be similar to ischemic colitis, but they won’t improve as quickly.

 

 

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Protect your baby from Group B Strep (GBS) — it’s preventable!

Worldwide, Group B streptococcus is a leading infectious killer of newborns. It is the leading cause of blood infection and meningitis in newborns. The good news is that it can be prevented, and you can help!

In regions where awareness and prevention efforts have been implemented, infant deaths from GBS have decreased as much as 70%.

What Is Group B Strep?

Group B strep (GBS) is a bacteria naturally found in the digestive tract and birth canal of 1 in 4 pregnant women. These women “carry” or are “colonized” with GBS. However, GBS can come and go at any time so each pregnancy can be different. Babies can be infected by GBS before birth and up to 6 months of age because of their underdeveloped immune systems.

GBS most commonly causes infection in the blood (sepsis), the fluid and lining of the brain (meningitis), and lungs (pneumonia). It can cause babies to be miscarried, stillborn, or die after being born. Some GBS survivors have permanent handicaps such as blindness, deafness, mental retardation, and cerebral palsy.

HOW DO I KNOW IF I CARRY GBS?

You may carry GBS with or without symptoms, such as vaginal burning/irritation or unusual discharge. If you have symptoms, see your doctor promptly for a bacterial culture test.

GBS can also cause bladder infections, with or without symptoms. Ask your doctor to do a urine culture for GBS and other bacteria (not the standard prenatal urine check.) GBS in your urine means that you are heavily colonized, which puts your baby at greater risk.1 Oral antibiotics should be prescribed.

It is now the standard of care in the USA and Canada for all pregnant women to be tested for GBS at 35 to 37 weeks of pregnancy. Your doctor will perform a swab test of your vagina and rectum and obtain the test results in 2-3 days. If the test result is positive, you carry GBS. Ask to make sure you are tested during each pregnancy!

Many hospitals now offer rapid, DNA-based tests such as the Xpert™ GBS Assay (Cepheid, CA, USA). This test can be performed during labor or any time during pregnancy with results in less than 1 hour.2 Rapid test results are important because your GBS status can change by the time you go into labor, culture tests can show a false negative, or your culture test results may not be available.

HOW CAN GBS INFECT MY BABY?

  GBS can infect your baby before birth — even before your water breaks. Procedures such as cervical exams and stripping membranes or using cervical ripening gel to   induce labor can all push GBS closer to your baby.3-8

  GBS can cause preterm labor so that your baby is born too early.

  GBS can also cause your water to break prematurely without labor starting, causing your baby to lose a significant layer of protection.

  Babies are most often infected with GBS as they pass through the birth canal. Internal fetal monitors can cause GBS to enter your baby’s bloodstream through the cut in his/her scalp.  GBS infections within the first week of life are called “early-onset”.

  Babies can become infected with GBS by sources other than the mother. GBS infections after the first week of life are called “late-onset”.

  Be aware that your womb and/or C-section wound can become infected by GBS.

HOW CAN I BEST PROTECT MY BABY

...during pregnancy?

   Ask your doctor to do a urine culture for GBS and other bacteria in at least your first and third trimesters.9

   See your doctor promptly for any symptoms of vaginal infection.10

   Make sure you are tested at 35-37 weeks.

   Avoid unnecessary, frequent, or forceful internal exams. Internal exams can tell how far you are dilated, but do not accurately predict when your baby will be born.5 (Vaginal ultrasounds may be available as a less invasive alternative.3)

   Talk with your doctor about not stripping your membranes or using cervical ripening gel to induce labor. 4,6-8

   Tell your doctor if you are allergic to penicillin. There are antibiotic alternatives.1

   Plan ahead if you have short labors or live far from the hospital. The intravenous (IV) antibiotics you should receive in labor generally take 4 hours to be effective. 1

   If you are having a planned C-section, ask to start IV antibiotics 4 hours before your incision. Your baby is still at risk if you have a C-section.

   Talk to your doctor about whether or not to use internal fetal monitors during labor before you have had IV antibiotics for at least 4 hours. Benefits may outweigh the risks.

...when my water breaks or I start labor?

Call your doctor.

If you tested positive for GBS, immediately go to the hospital to start IV antibiotics.

If you do not have a GBS test result, and your hospital does not offer a rapid DNA-based test such as the Xpert™ GBS test, you should be offered IV antibiotics based on the following risk factors:

   You have already had a baby with GBS disease.

   You have had GBS in your urine during this pregnancy.

   Your baby will be born before 37 weeks.

   Your water has been broken 18+ hours without delivering. (Even 12+ hours increases the risk.11)

   You have a fever of 100.4 °F or higher during labor

In half of GBS infections, the mother has no risk factors.12 This is why testing is so important!

...after my baby is born?

   Antibiotics generally take 4 hours to be effective. If you give birth before this, the hospital may culture and observe your baby for 48 hours.

   You can ask for your baby to have antibiotics while waiting for the results of the culture.

   Some hospitals will give your baby a penicillin shot within 1 hour of birth to further reduce the risk of GBS infection.1,14 Ask your doctor.

   Have everyone wash their hands thoroughly before handling your baby.

   Breastfeeding can supply your baby with important antibodies to fight infection. 15

WHAT GBS SYMPTOMS DO BABIES SHOW?

Take your baby to the emergency room or call your baby’s doctor immediately if you notice these signs:

   High-pitched cry, shrill moaning, whimpering

   Marked irritability, inconsolable crying

   Grunting as if constipated

   Projectile vomiting

    Feeds poorly or refuses to eat

   Sleeping too much, not waking for feedings

   High or low temperature; hands and feet may still feel cold even with a fever

   Blotchy, red, or tender skin

   Blue, gray, or pale skin due to lack of oxygen

   Fast, slow, or difficult breathing

   Body stiffening, uncontrollable jerking

   Listless, floppy, or not moving an arm or leg

   Tense or bulgy spot on top of head

   Blank stare

REFERENCES

1.   Morbidity and Mortality Weekly Report, Prevention of Perinatal Group B Streptococcal Disease Revised Guideline from CDC, Centers for Disease Control and Prevention, Vol. 51, No. RR-11. August 16, 2002.

 2.  Haberland et al., “Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction.” Pediatrics 110:3. September 2002.

3.  McGregor, James A., MD, CM, “Group B Strep: A Patient/Provider Approach for Optimizing Care.” www.OBGYN.net.

4.  The Jesse Cause, “Interview of Parents of GBS-infected Babies,” July 1997-Sept. 2002.

5.  Akin, W., Fatheree, D., Klausing, C., “Vaginal Exams in Late Pregnancy.” www.childbirth.org.

6.  Akin, W., Fatheree, D., Klausing, C., “Stripping the Membranes.” www.childbirth.org.

7.  DeMott, K., “Cervical Manipulations linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis.” (Eight Case Reports),” OB/GYN News, Oct. 15, 2001.

8.  Hannah, Mary E. MD,CM, et. al. “Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor.” Am J Obstet Gynecol 177:780-785. 1997.

9.  Antimicrobial therapy for obstetric patients. ACOG educational bulletin no. 245. Washington, D.C.: American College of Obstetricians and Gynecologists, 245:8-10, March 1998.

10. McGregor, James A., MD, “Infection and prematurity: the evidence is in,” Medical Tribune Opinion, Feb. 6, 1997.

11. Rosenstein N., Schuchat A. Neonatal GBS Disease Study Group. Opportunities for prevention of perinatal group B streptococcal disease: A multistate surveillance analysis.” Obstet Gynecol 90:901-6. 1997.

12. Society of Obstetricians and Gynecologists of Canada, Canadian Pediatric Society. National Consensus statement on the prevention of early-onset group B streptococcal infections in the newborn. J Soc Obstet Gynaecol Can 1997 Publication number 61. June 1997.

13. CDC/NCID “Group B Streptococcal Infections” Brochure, August 1998. 

14. Siegel, Jane D. MD, Cushion, Nancy B., MBA, RN. “Prevention of Early-Onset Group B Streptococcal Disease: Another Look at Single-Dose Penicillin at Birth”. Obstet Gynecol 87:692-8. 1996. 

15.  Lagergard T, Thiringer K, Wassen L, Schneerson R, Trollfors B. Department of Medical Microbiology, University of Goteborg, Sweden. “Isotype composition of antibodies to streptococcus group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk.” Eur J Pediatr. 151(2):98-102. Feb 1992.

 

Till next month

 

Gary & Janet