Transplants: A New lease on life

Reba Paul 

Organ transplantation is hailed as one of the greatest advances of modern science in this century, giving millions of people a new chance at life.

Organ transplantation was a confusing, even horrific prospect for people living a few centuries ago to ponder.  All of the ethical, moral issues that the concept brings up in many communities have been allayed over the past few decades, and transplants are now widely considered by doctors and the public alike to be the best medical option for many diseases. In cases involving end stage kidney failure, this is the only solution that can ensure the patient a good quality of life. Organ transplantation is hailed as one of the greatest advances of modern science in this century, giving millions of people a new chance at life.

Based on human physiology, the heart, kidneys, eyes, liver, lungs, pancreas, intestine and the thymus can be transplanted. Tissues can also be transplanted – like bones, the cornea, skin, heart valves. In fact, musculoskeletal and corneal transplants are ten times more prevalent than organ transplants. In the organ transplant area, the kidneys are the most transplanted organs, followed by the liver and then the heart.

What does it entail?

Moving an organ from one body to another for the purpose of replacing the recipient’s damaged or absent organ, is a complicated endeavor. Previously it was a prerequisite that the donor and the recipient have matching or compatible blood groups. This is becoming increasingly flexible now, due to the new drugs in the market. Higher degrees of tissue compatibility are thought to help the success rate of the transplant. The first successful organ transplant happened when a kidney was transplanted between twin brothers in 1954. The main problem faced after a transplant is that the recipients’ body tries to get rid of the foreign organ.  Every body’s immune system clearly knows what belongs in the body and what is a foreign object. So after a new organ is transplanted, the immune system sees it as ‘foreign’ and keeps trying to get rid of it. This is what causes organ rejection. This problem is tackled by giving the recipient medicines that suppress this instinctive response of his immune system – these are called immunosuppressants.

Organ Donation

Any healthy adult who wishes to donate his organ is free to do so. Also, any healthy adult who wishes to bequeath his organs for transplantation after death can also do so. This is one way to positively impact the life of a fellow being even after your time on the planet is done. In case of a natural death, only a few organs can be ‘harvested’ – like the cornea, bone, skin and blood vessels. However, if a person is ‘brain dead’, then many more organs can be successfully harvested to benefit the life of other people – technically almost 37 different organs and tissues can be put to this worthy use.

The Indian Scenario

Generally speaking, chronic organ failure is still not being seen as the serious problem it really is. In India, thanks to improving mortality rates and disease management, most of the attention in the medical scenario is primarily focused on heart disease, diabetes and other such diseases. What we are failing to understand is that a huge chunk of the present population is going down the road that will inevitably lead to organ failure.

The rise in the incidence of organ failure globally has impacted India in many ways. At the time when transplants began to be commercially executed and were becoming popular, India had the rare combination of having trained transplant personnel, good medical facilities, a large impoverished population and lack of legal governance on organ transplantation. This made the country a quagmire of organ transplant activity from the late 1980s onwards. India got a lot of attention globally due to a multitude of reports regarding large-scale transplants being done with kidneys sourced from poor, illiterate donors under questionable circumstances. Following all the media criticism, the Government of India enacted the Transplantation of Human Organs Act (THOA) banning payment for human organ donation.

The Loophole

Despite this, most of the transplants happening in the country are from live donors who get paid for giving their organs. This is due to a loophole in the Act, which says that a donor can give his organs ‘for the reason of affection or attachment towards the recipient or for any other special reason’.  It is estimated that India has approximately 3500–4000 kidney transplants and 150–200 liver transplants happening every year. The main source is live or unrelated donors.

India’s Human Organ Transplantation Act says that a father, mother, brother, or sister can donate organs to the patient. Other live donors go through a screening process by a state transplantation authorization committee to make sure that they are donating organs purely due to emotional attachment to the patient and not for monetary or material gain. The fact that there are so many live, unrelated donors providing organs for the majority of the transplants seem to point to the fact that there is collusion between the agents who source the donors and the authorization committee. Several ‘kidney rackets’ have been busted which have had doctors working with kidney agents to get donors. These donors would have documents fabricated regarding their relationship with the patient, and would be eventually sanctioned by the screening committee. The worst part is that since the whole process is illegal, after the various cuts are taken by the agents and others involved, the donor actually gets only a fraction the amount that the patient pays for the organ. But the question is, when such a huge need for organs exists, should we not have a better solution?

The Multi Organ Harvesting Aid Network Foundation (MOHAN)is a non-governmental organization that has, among many others, been campaigning for more cadaveric transplants. Doctors connected to this organization say that less than 600 cadaveric transplants have been performed in India since the THOA came into being. But the annual number of kidney transplants is over 2000. They point out that ‘there doesn’t have to be a shortage of cadaver organs in India- most relatives of brain dead persons are willing to donate, but there is no system in place in most hospitals to counsel relatives and harvest organs.’

The foundation has written to the health ministry requesting that the government take steps to promote cadaveric transplantation and also enforce stricter scrutiny of live, unrelated donors. They are still waiting for a response. Meanwhile, kidney and other organ rackets flourish in the country. Stray reports surface in the media regarding these from almost all major Indian cities, but no long term official solution seems to be in sight.

The cadaver donation solution

The urgency of the situation is due to the fact that the number of people who need a transplant to save their lives far outnumbers the number of live donors. The only viable solution we are left with is to promote cadaver transplants – which can be done only through people agreeing to donate their organs after death. Oddly enough, most public surveys show that organ donation has high support from the general public. The fact that this is not becoming a reality, is most probably due to the fact that after a patient dies, their relatives are either not aware of this, or are against it, and so the individual’s wishes are not carried out. Statistics say that as many as half of all families decline to donate the organs of their recently deceased loved ones.

In a country populated by more than 1 billion people, the pool for cadaver harvest is understandably high. But in India, the number of cadaver transplants is miniscule in comparison to live donation. Every year, almost 100,000 Indians suffer from kidney failure. Of these about 3,000 actually get a donor kidney, with a very small percentage being from cadavers. In the eight year span between 1995 and 2003, only 524 cadaver transplants were done. The critical shortage of available organs is only getting worse as more people succumb to kidney and liver failure.

The issue gets even more important as we consider that India has an ever increasing number of end stage liver failure patients. Patients who have kidney failure can be helped with therapies like dialysis. But liver failure has no such therapy, and transplant is the only solution. Of the majority of liver failure patients, only a handful get timely transplants that save their lives. The same is the issue with heart-lung transplants. Unlike the kidney, which a donor could give one and still survive well on the functioning of the remaining one, no one except a cadaver can donate his heart and lungs.

Cadaver Donor Program

It would not be an exaggeration to say that unless India develops a good cadaver donation program, we will remain right where we are now, with many of our citizens dying for lack of organs. This problem has to be addressed from the side of the government and policy makers, if any significant change is to take place.

Awareness has to be created about the existing problem, and the public has to be encouraged to be cadaver donors. The family unit has to be informed, and there has to be a way of ensuring that the individual who wishes to donate will have his wishes honored after his death. There should also be a practical and efficient organ retrieval mechanism that is implemented on a national level.

Well trained staff should be present in hospitals to educate and inform families about cadaver donation – in a way that this sensitive issue is handled impeccably without compromising on the optimum time for organ retrieval. One brain dead patient can help seven patients in critical stages, to lead normal lives. Another option to consider is that a national policy could be created whereby every patient in a hospital who becomes brain dead will have his organs harvested, unless otherwise clearly specified to hospital authorities. This way more organs can be made available for the living. Infrastructure should be created for harvesting, storing, biochemical work that will facilitate the best organ-recipient match. Organ donation is possibly the last and most noble act that any human being could undertake; don’t make it so hard to do.

Paid Donation – No good for Donor?

A group of independent American researchers, who tracked down over 300 individuals who had sold a kidney in Chennai, India, found that:

•         The donors received far less money than what had been promised to them during the process of initial bargaining

•         Instead of improving, their family income declined by about one-third after donation, and the number of participants living below the poverty line increased by about 20%

•         75% of the participants who chose to sell their kidney to get out of debt, continued to be in debt

•         More than 95% of the sellers admitted that the desire to help a gravely ill patient with kidney disease was not a factor in their decision

•         Almost 90% of them reported significant decline in their health status

•         In many cases, women had been forced to donate against their wishes because the husbands needed money.

When asked what advice they would give to others thinking of selling a kidney, more than 80% said that they would not recommend such a step. The authors concluded that the Authorization Committee failed in its duty, shattering the myth that the money earned by selling an organ helps the donor to improve their financial standard and get a fresh start in life.

Iranian Model of Organ Donation

The Iranian model of transplants is seen as the one that is the most fair to the recipient as well as the donor. It is a state supported program – the compensation and regulation are done by the state. This program started functioning in 1988, and gives financial incentives to living donors who volunteer their organs. These living unrelated donors get a sum of money, without having to go through any middlemen. Anyone who needs a kidney gets it. However, there are regulations in place that ensure that transplant tourism does not get the benefit of this. So foreigners cannot have a renal transplant from an Iranian national in Iran, nor can they be a donor.

After this system was in place, renal transplants increased so much that by 1999, the waiting list was eliminated. Right now, there is no renal transplant waiting list in Iran. The advantage of this model is that many of the ethical issues surrounding live, unrelated donation are eliminated, since the donor is directly connecting to the government for his compensation. Also, he will not know who is going to get his kidney, since it going to an organ pool and given to the patient who is the best match for it.

All hospital expenses are also paid for by the government, so even poorer patients can afford to have a transplant. The transplants are only performed in government hospitals that are affiliated to universities. The transplantation teams, including the doctors, have no connection with identifying possible donors and no middlemen are involved.  More than 50% of Iranians who had end stage kidney failure are living with a functioning transplanted kidney. It is the only country that has successfully eliminated a transplant waiting list in this manner.

mail to rebekaah.paul@gmail.com the author of this article published in the Novemebr 2011 Issue of THE HEALTH CAFE'. Sign in for the health cafe newsletter for a complimentary annual e-subscription. 

Easy Breezy Breath of Health!

Did you know that almost 70% of the toxins produced in your body actually leave through your breath?  So when you don’t breathe right, most of the toxins don’t leave; they accumulate in different parts of your body, and over time cause disease. So,  how about trying to breathe your way to a cleaner, fresher body?
Your nose holds far more than just mucus and nasal hair. It holds the potential to energizing and calming your body and mind.

Left, Right

The breath through the left nostril calms the body and the breath through the right nostril energizes you. When you breathe in through the left nostril, the right hemisphere of your brain is activated. This side of your brain is the ‘feeling’ side, which holds your creativity, emotions etc. Breathing through the right nostril activates the right side of your brain – which is the ‘thinking’ side. It holds your logic, linearity, mechanical and technical perception etc. You need both sides of your brain to work in a complementary and harmonious way, without one overshadowing the other. The alternate breathing technique is the best way to ensure this. When you do this breathing, you calm down your overworked left brain and awaken your ignored right brain.

The Purifying Breath

While you are doing this breathing exercise, you need to hold your right hand in a certain manner. Make a loose fist with your right hand. Now, open up your thumb from the fist, then open up the ring and little finger. You should have your index and middle finger touching your palm somewhere below the base of the thumb. Hold this position without straining your fingers, be easy and gentle. As you do the exercise, you may manipulate the fingers a bit for better comfort. As far as possible, do this exercise on an empty stomach, or three hours after a meal.

1.. Place your right thumb against the right nostril and gently close the nostril. Do not push hard against your nose.

2.. Inhale – a long and gentle breath- through your left nostril

3.. Pause for a second.

4.. With your thumb still holding the right nostril closed, bring your ring finger to your left nostril and close it. Release the thumb from the right nostril.

5.. Exhale through the right nostril.

6.. Holding your hand in the same position, inhale through the right nostril.

7.. Pause for a second.

8.. With the ring finger still holding the left nostril closed, bring thumb up to close the right nostril. Release the left nostril.

9.. Exhale through the left nostril.

You have finished one round of alternate nostril breathing. When you start, do 1-3 rounds. If you are feeling comfortable with this pace, gradually increase the number of rounds. Remember to never force your breath – gentleness and ease of breathing will give you far better results than forcefulness. When you finish the exercise, sit with your eyes closed for a few minutes and breathe normally. Observe your mind.

There are certain variations to the technique that you can try when you get used to the routine. If you breathe in for a count of 4, hold your breath for a count of 8 and then exhale for a count of 8. As you progress, you can try to hold your breath for a count of 16, and then exhale in 8 counts. Do not hold your breath for a long count if you have a history of high blood pressure. Just do the exercise as it has been described, allow your blood pressure to stabilize and get to normal and then proceed to the more intense practice.

Benefits of Alternate Nostril Breathing

As with any exercise, you will get maximum benefits from this practice when you do it regularly. This is a great way to revitalize your system. So anytime during the day when you feel ‘low’, get to a quiet corner and do a few rounds of this to get your mood up! A few minutes of alternate breathing, gets you prepped up and calms your mind down to face an interview or an exam.

Regular practice of alternate nostril breath has also been found to improve brain function. It improves clarity and enhances focus, bringing in equal amounts of oxygen to both hemispheres of the brain. People who suffer from anxiety or are easily agitated, report that this kind of breathing helps them to naturally and easily calm their minds. No wonder the yogis used to say that regulating the breath helps to control the mind!

Perhaps the greatest benefit that this pranayama brings is the harmonizing of the two sides of our brain. Bringing our brain to its full use and potential could be revolutionary in our lives! Of course, breathing in through just one nostril can also be done to activate a specific brain hemisphere. Try this out for yourself – the next time you want to calm down and relax, try breathing in only through your left nostril and see what happens. Alternately, when you are driving or focusing on something, breathe in through only the right nostril for a minute and notice the difference.

This technique is excellent for cleansing the lungs. Just a five minute practice every morning, will get rid of the stale air loaded with impurities from the bottom of the lungs. Most of us do not use our whole lungs for breathing – we take shallow breaths, using only the top part of the lungs. This is why stale air that if full of toxins and impurities stays collected in the lower lungs. This technique also helps you sleep better – calming down your nervous system and slowing down your heart rate. If you have trouble falling asleep, try lying on your right side, and breathe in only through the left nostril.

So there you have it. One easy way to address many problems. Try it out for yourself, and do it for at least a week regularly to experience the benefits. All you have to gain is better energy flow throughout your body, more oxygen helping all of your systems to work right, and in the long run, protection from many illnesses – which means that you save money too! Don’t forget to tell us how it goes!

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Breast Cancer

Dr. JAYAPRAKASH MADHAVAN, Senior Oncologist in Kerala, and Head of KIMS Pinnacle Oncology, Thiruvananthapuram, gives an expert analysis to help empower you to combat breast cancer.

One of the biggest challenges that modern medicine faces today is understanding and dealing with the disease called cancer. The word “cancer” simply means uncontrolled growth of a few cells, which may invade into surrounding tissue and may even spread to other parts of one’s body. Breast cancer is the second leading cause of cancer deaths today, after lung cancer and is the most common cancer among women, excluding non-melanoma skin cancers.          

     Every woman is at a definitive risk of breast cancer, which is second only to cervical cancer among women in India. On rare occasions, men also present with breast cancer. The rise of breast cancer among women is being documented mainly in the metros, but it can be safely said that many cases in rural areas go unnoticed. It is reported that one in 22 women in India is likely to suffer from breast cancer during her lifetime. In Kerala, this is the most common cancer diagnosed among women. Statistics has it that approximately 4500-5000 women in Kerala develop breast cancer annually.       

     When diagnosed early, breast cancer can be treated using surgery, radiation therapy and systemic therapies (chemotherapy, hormones or both). If diagnosed in the early stages, this cancer is pretty much curable. Unfortunately, the majority of patients in India come in for treatment when the disease has already reached advanced stages. In such scenarios the onco-surgeon and oncologist have fewer options of treatment to offer to the patient and breast removal is a norm either with or without chemotherapy, followed by radiotherapy many times.  Since the incidence of breast cancer is increasing in India, it has become very important to prevent and detect it early in order to reduce breast cancer related fatalities.

Risk factors

Most breast cancers are sporadic, caused by multiple factors. Only about 5-10% are due to familial cancers. The hereditary breast cancer is traced to inherited mutation in the BRCA1 and BRCA2 genes. The main identifiable risk factors for breast cancer are family history of breast cancer, increasing age, early menstruation with late menopause, and women who have had no children or have had their first child after 30 years. There are also other factors like long-term use of post menopausal replacement therapy and early exposure of chest or breast to radiation.

Symptoms and early detection

                The most important feature of breast cancer is a lump that develops in the breast or surrounding area. The mass that develops is often painless. Since most breast cancers are painless, and not all lumps are cancers, it is advisable to follow the following steps to facilitate early detection. Women aged 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health. Women in their 20’s and 30’s should have a clinical breast examination (CBE) as part of a periodic health examination by a health professional, at least every 3 years. After age 40, women should have a breast exam by a doctor or a trained nurse every year. 

Breast self exam (BSE) is another option for women starting in their 20’s. Women should be informed about the benefits and limitations of BSE. Any changes in the breast tissues to the doctor right away. Current recommendations emphasize that women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.       

     Many a time breast cancer may present or be associated with skin changes called peau d’orange appearance (the skin will have a pitted surface, like the peel of an orange), dimpling of skin, nipple retraction, or crusting of the nipple. Associated nipple discharge may also be present. These are due to the strictures and contractions formed by the growing cancer beneath.

Diagnosis

      Diagnosis of breast cancer is done from history, physical examination and mammography. Diagnosis is confirmed by cytological or histopathological examination of a biopsy sample. Fine needle aspiration cytology (FNAC), core needle biopsy, incisional or excisional biopsies are done to obtain the tissue sample for examination. Pathological examination helps to grade the tumor, and assess the completeness of the surgery. Special immunohistochemistry examinations and molecular markers (like ER – Estrogen Receptor, PR– progesterone receptor or Her2Neu – Human Epidermal Growth Factor Receptor 2) help to assess the receptor status to predict the behavior of the tumor and select the appropriate treatment for a particular tumor. Medical science is moving to the era of personalized treatment.

Staging

     After confirming the diagnosis of breast cancer, staging investigations are done to assess whether the tumor has spread to other areas. Cancer can spread to lung, liver, bone and brain. So imaging studies like CT scan, MRI scan, bone scan and PET scan are done to rule out this possibility.   Once all the investigations are obtained, the patients are advised to decide the optimal management. Breast cancer patients require surgery, radiation, chemotherapy, hormones and biological agents for treatment.

Treatment

For treatment purposes breast cancer patients can be divided into three major groups  

     1- Early operable breast cancer 

     2- Locally advanced breast cancer

     3- Metastatic breast cancer

Surgery: Earlier the better

                Early breast cancer is operable and usually limited to breast alone or and to axillary lymph nodes. Treatment of early breast cancer has two components. The first step is local treatment surgery alone or surgery and radiation. The second step is systemic treatment - chemotherapy, hormones and biological agents. This systemic treatment is called adjuvant treatment.                        

Local treatment varies from removal of the breast and axillary lymph nodes (Modified Radical Mastectomy) to lumpectomy and radiation. (breast conservation treatment). In breast conservation treatment, the tumor with a thin rim of normal breast tissue all around the tumor is removed (lumpectomy). After lumpectomy, the breast is irradiated. Both mastectomy and breast conservation treatments have shown equal success in locally controlling and curing the tumor. In western countries 90% of patients present with early stage disease and the majority opt for breast conservation treatment. Even after a mastectomy, some high risk patients require post operative radiation to the chest wall and the armpit. Breast reconstruction surgeries can be done after the mastectomy.

Recurrence-Another threat 

     Adjuvant systemic treatment (supporting treatment) is given to early breast cancer patients because many such patients come back with the cancer recurring at distant sites. At present we do not have mechanisms to predict which patient is going to relapse and which patient is going to be cured by local treatment. Therefore, all are given adjuvant systemic treatment to prevent future recurrence of the disease. The choice of the drugs for adjuvant treatment is determined by factors like stage and grade of the tumor, age, menopausal status, and molecular markers

     Adjuvant treatment is given for a definite period of time. Almost all early breast cancer patients receive chemotherapy. Some of them require hormones and or biological agents like Trastuzumab in addition to chemotherapy. These adjuvant treatments are very effective in significantly reducing the number of breast cancer related deaths.

Locally advanced breast cancer

     More than fifty percent of women approach the doctor when the disease is at an advanced stage.  This group requires anterior chemotherapy to reduce the tumor  in order to facilitate complete surgery. After mastectomy they need local radiation to the chest wall and local lymphatic drainage area, along with systemic treatment.

Metastatic breast cancer

     When breast cancer spreads outside the breast and regional lymph nodes to distant areas, it is called Metastatic breast cancer. The objective of treatment at this stage, is control of disease and prolongation of life. Only subsets of patients achieve long term relief and cure. At present metastatic breast cancer is treated with systemic treatments. The main groups of drugs are chemotherapy, hormones and biological targeted drugs. These drugs are used in combinations or sequentially to control the disease and improve the quality of life. Occasionally patients need radiation treatment to bone and brain metastasis.

Prevention and early detection

     The incidence of breast cancer is increasing in India. It has been observed that lifestyle changes contribute much to this. Low fat intake and regular exercise can reduce the incidence of breast cancer. Drugs like raloxifene are effective in preventing breast cancer in the high risk group of women.

     Early detection is very important, because early stage breast cancer has a high cure rate. The currently available methods of early detection are self examination, Physician breast examination and Mammographic Breast Examination. Mammographic examination uses soft X-rays to image the breast. With this test we can detect tiny, even non palpable breast cancer. Mammography is used for women above 40 years. In high risk women below the age of 40, MRI examination of the breast is useful to detect early cancers. The American Cancer Society recommends annual mammographic examination for all women above 40 years of age.

     Early detection and adjuvant treatment of breast cancer have contributed immensely to reducing breast cancer related deaths. Early detection will help the majority of our women with breast cancer to undergo breast conservation treatment also, which in turn can help them lead a normal life.

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Women at high risk include those who:

•Have a known BRCA1 or BRCA2 gene mutation  •Have a first-degree relative (parent, brother, sister, or child) but have not had genetic testing themselves  •Have a lifetime risk of breast cancer of 20% to 25% or greater, according to risk assessment tools that are based mainly on family history

•Had radiation therapy to the chest between the ages of 10 and 30 years

•Have Li-Fraumeni syndrome, Cowden syndrome, or hereditary diffuse gastric cancer, or have first-degree relatives with one of these syndromes

Women at moderately increased risk include those who:

• Have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based mainly on family history (see below) 

• Have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH) 

• Have extremely dense breasts or unevenly dense breasts when viewed by mammograms

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Sick of Morning Sickness?

Pregnancy and nausea often go hand in hand.

Here’s your guide to the phenomenon of morning sickness.

Anyone who has had a baby will tell you that the glow of health that lights up a woman’s visage during early pregnancy is almost always accompanied by a ‘not- so-welcome companion’ – morning sickness. This is a feeling of nausea, which often leads to vomiting that occurs during the first few months of pregnancy.

     Some women have the odd bout of mild queasiness when they first wake up, while others may have to endure weeks or even months of feeling or being sick all day long. Morning sickness reportedly affects 80% of pregnant women. Since each woman is different and each pregnancy is unique, the severity of nausea and vomiting of pregnancy (NVP) will vary from woman to woman. Fortunately, this condition is generally mild and self-limited and can be controlled with conservative measures.

     No one knows exactly what causes nausea during pregnancy. Most researchers believe it is caused by a combination of the physical changes that take place in the mother’s body such as the elevated levels of hormones. There is also some research that indicates that the mother’s diet may also be a contributing factor – since  women who had a healthier, plant-based diet were found to have less or no morning sickness, whereas those with a high meat based diet were seen  to suffer more.

     Characteristically, nausea and vomiting begin around the sixth week of pregnancy. This is called ‘morning sickness’ because it occurs most often in the morning, but this does not in any way mean that the sickness is limited to the daytime. Many women experience NVP several times during the day and sometimes, at night. For 80% of expectant mothers, this condition wears off around the 12th week of pregnancy. The remaining 20% are usually afflicted by the condition for a longer period of time.

     Triggers for the NVP are usually smells and foods, with the most commonly reported aversions or repulsions being towards meat, fish, poultry and eggs. Interestingly, some doctors who research the condition, point out that these are the very foods that are most likely to carry harmful micro-organisms or parasites. This indicates that NVP could be the body’s own highly developed radar that encourages the mother to eat foods that are most beneficial to the baby during the most crucial days of fetal development.

How does it affect you?

     Most cases of nausea and vomiting in early pregnancy aren’t harmful to the mother or the unborn child. Rather, there are indications that the body could actually be expelling foods that were hard to digest, or were potentially damaging to the fetus when its developing internal organs are most vulnerable to parasites and chemicals. While short-term dietary deficiencies do not appear to have any harmful effects on the pregnancy’s outcome, severe and persistent nausea and vomiting pregnancy symptoms can affect the mother’s health.                                Most women experience nausea or have episodes of vomiting at certain points of the day, and can eat and manage to keep food down during the rest of the day. However, mothers who are acutely affected may be missing or skipping meals for days together, which could mean that the baby may not be getting all the necessary nutrients for optimal growth. Excessive vomiting in early pregnancy could lead to the loss of almost 5% or more of the mother’s body weight.

     About 1% of pregnant women worldwide suffer from excessive vomiting in pregnancy-medically called “hyperemesis gravidarum”. Hyperemesis Gravidarum (HG) is a severe form of morning sickness, with “unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.” Hyperemesis is considered a rare complication of pregnancy but, because nausea and vomiting during pregnancy exist on a continuum, there is often not a good diagnosis between common morning sickness and hyperemesis.       

                One of the main things to watch out for during morning sickness is dehydration. This happens when the body does not have adequate amounts of fluids which may be caused by losing the fluids that were taken in, or by not consuming enough. Severe cases of dehydration may require intravenous fluids and vitamin supplementation from the hospital. Systematically rehydrate or seek medical attention if the mother shows signs of dehydration – such as infrequent urination or dark yellow urine.

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Tips to control nausea and vomiting

DIET – Food

• When you wake up, eat a few crackers, or similar carbohydrate –high substitute and then rest for 15 minutes before getting out of bed.    

• Eat small meals or snacks often so that your stomach does not become empty (optimally every 2 hours). Try not to skip meals.    

• Do not hesitate to eat whatever you feel like eating, whenever you want to.     

• If cooking odors trigger the condition, try to get soemone else to cook. If you have no other option, ventilate the room as well as you can.   

• Try eating cold food instead of hot (since cold food may not smell as strong as hot food).

DIET – Drinks

• Drink small amounts of fluids frequently during the day.    

• Avoid drinking fluids during meals and immediately before or after a meal.

LIFESTYLE

• Get plenty of rest since nausea tends to worsen when you are tired. Taking naps during the day is ideal since a pregnant woman needs more sleep in the first three months of pregnancy.    

•  You may need to take some time off work or make other arrangements for household chores and childcare.    

•  Do not hesitate to enlist the support of friends and family.     

•  Get plenty of fresh air and avoid warm places. Feeling hot can add to nausea.     

• Try ginger, an alternative remedy that is often effective in settling the stomach. Dosages of up to 250 mg four times a day appear to be safe.    

• Try taking your prenatal vitamins (one with a lower amount of iron if that mineral makes your nausea worse) with food or just before bed. If multivitamins make your nausea worse, take folic acid alone on a daily basis.

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