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Re: pain from symphysis pubisFrom: Peter V. Weston, M.D. (weston@ICSI.Net)Fri Jul 19 11:01:43 1996
>A twenty-five-year old gravida 4 para 3 with treated thyrotoxicosis, had >been on prolonged steroids which were stopped before she became pregnant. >She is now at 26 weeks, with separation of the pubic symphysis, and in >crippling pain so that she has to lie still all the time, and even then it >continues to ache. The usual supportive measures have failed to help at >all (they never seem to do any good). The available analgesics are not >strong enough, and I am reluctant to put her on an addictive drug at such >an early gestation. I asked one of our local orthopaedic surgeons if he >had any bright ideas (an impossible combination?) and whether he would >consider fixation with screws, wires or a plate-but he refused as all the >others have done before him. Have any of you suggestions for management, >and do you know if surgery has ever been tried for this condition >antepartum or postpartum and if so what are the short term and long term >results? Please. > Brian, This patient can be treated the same as one would treat a patient who has has a symphysiotomy as that is what she has done to herself. In my opinion surgery is contraindicated. My suggestion is that you find a saddle maker or cobbler to make a padded leather belt about 3" wide with buckles that can be placed around her greater trochanters. This will hold together and stabilize her symphysis so that she will be able to ambulate without discomfort. Make sure that the upper part of the belt fits below the enlarging abdomen. For the remainder of the pregnancy she will need to wear the belt when out of bed. Until you can have the belt made she can be given temporary support with a wide rib brace with Velcro fasteners. One patient for whom I used this method was a 95 lb physiotherapist who had recurrent diastasis of her symphysis in 2 subsequent pregnancies. The belt was her saving grace. She was even able to walk up stairs with the belt. If you have any questions please write privately to me. Good luck Peter Cap'n Pete -- Peter V. Weston, M.D. <weston@icsi.net> Soon to be at Clear Lake, Texas ^ /| ^ / |\ /| / | \ / | / | \ _ /__|_/____| __\_ ~~~~~~~~| /~~~~~~ Pearl
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