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Pregnant. Having sever back and joint pain. Taking FEROSE F for iron, Materna and Cal-Mag. Suggest

DOCTOR OF THE MONTH - Mar 2016
Mar 2016
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OBGYN
Practicing since : 2011
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Hello Doctor,

We are a married couple for 1 year now, and my wife is pregnant in her
6th month now with a boy, she is 31 years old and used to have back
pain on a regular basis, even before pregnancy. Recently she started
having a lot of pain in her bones and joints all over her body, in
addition to cramps in her muscles, especially on her right side which
makes it difficult to sleep on her sides, however this is her only
option since she can’t sleep on her back according to the advices to
pregnant women. It is hard for me to see her suffer like this
especially that my work requires me to travel a lot so sometimes I
leave her at home with her mother, so here are my questions:

1- As I said she has a lot of cramps and pain in her muscles generally
especially on her right side, so her doctor recommended that it could
be lack of Magnesium in the body so he prescribed “Spasmag” to be
taken one pill twice a day, she is also taking other prenatal vitamins
(Materna and Cal-Mag since the beginning of her pregnancy, and started
taking FEROSE – F for iron recently). She noticed that the Spasmag
does ease the cramps a bit, but we need to know how long the effect of
it lasts so that she can at least sleep at night. Now the big hassle
we are thrown in is that she needs to keep her prenatal vitamins and
elements away from her daily intake of Calcium which is taken through
milk, eggs and cheese, so we don’t know what is the best combination
or timing for the vitamins and food so that she would be able to sleep
well at night and don’t conflict between vitamins, minerals, calcium
and food that shouldn’t be taken simultanously, for example we know
that calcium should be kept away (at least 3 hours) from any other
vitamin or mineral. So please I need your help in arranging the timing
for her as following:
- She have breakfast at around 1 PM and includes calcium from Milk and diary.
- Lunch is at around 4-5 PM
- She takes another meal of calcium at night including Milk and diary
- Normal dinner without Calcium at night
- She needs to sleep at around 1-2 AM, so I believe that we need to
time the “spasmag” so that it eases the cramps of her muscles while
she is trying to sleep.

Vitamins and concentrations:
- “Materna” 1 pill
- “CAL-MAG” 1 pill which contains (665 mg Calcium Citrate) and (540 mg
Magnesium Citrate).
- “Spasmag” 1 pill twice a day, which contains (Magnesiums sulphate
trihydrate 423.5 mg which is equivalent to Magnesium 59 mg) and
(Yeast, saccharomyces cerevisiae 50 mg).
- “FEROSE – F”1 pill which contains (100 mg iron as iron (III)
hydroxide polymaltose complex) and (350 mcg folic acid).
So can you please help us with what will be the best timings of the
vitamins with the 2 intakes of diary calcium, lunch, dinner and sleep
time. And are there any other ways of easing the cramps which are very
difficult to sleep with?

2- She also started having a lot of pain in her bones, joints, arms
and ankles. What could be the reason for that, for example what is the
recommendation for her daily movement, or is it better to spend most
of the day resting? and could this be because of lack of Calcium ? we
are planning to make a calcium blood test to see if her calcium levels
are low.
3- We need to buy a good stretch marks cream, we heard about 2 brands
(Jellie or Palmers) which one is safer and have better results? or do
you have any better suggestions ? and do you have any considerations
as well while dealing with stretch marks cream ? and please indicate
the dosage (how many times a day and in which month she should start
taking it)
I would really appreciate your answers and feedback because my wife is
suffering a lot these days from the lack of sleep which is important
for her and the baby. In addition to the pain she is suffering from.
Your help will be very much appreciated.


Regards,

XXXXX
Posted Wed, 25 Sep 2013 in Pregnancy
 
 
Answered by Dr. S Patra 3 hours later
Brief Answer:
Arthritis is to be ruled out. Follow the measures.

Detailed Answer:
Hello XXXXX,

Thanks for writing to us with detailed history and current treatment. I am trying to give answers according to your concern.

First of all, mild to moderate abdominal cramp or low back pain is quite common during pregnancy period. It occurs mainly due to relaxation of pelvic ligaments by relaxin hormone. However, pain around different joints, bones, muscle spasm etc needs to re-evaluate with additional investigations & arthritis is to be ruled out at the earliest as she was suffering from this before pregnancy also.

1) With current treatment, she should follow this time schedule (if possible):

- breakfast at 10 AM with calcium from Milk and dairy. Add one CAL-MAG tab after 1 hr.
- lunch at 1 PM with protein XXXXXXX food subs (plant based or fish). Add SPAS-MAG one pill after 2 hrs.
- take adequate rest from 3-5 PM in left lateral position with pillow one side.
- second meal of calcium at 7 PM with Milk and dairy. Add one MATERNA pill after 1 hr (8 PM).
- take one FEROSE – F (iron) pill around 9 PM or 2 hrs before taking dinner.
- complete dinner around 11 PM and add one SPAS-MAG tab after 2 hrs.
- take sound sleep at 1-2 AM with left lateral position with pillow one side. 7 to 8 hrs sleep at night is sufficient for pregnant mother.

It is recommended to give at least 2 hrs gap between minerals and foods for better absorption. However, it is applicable for certain minerals only like iron & calcium etc.

In addition, she can apply muscle relaxant gel and keep hot water bag around joints and lower back region to get relief from this type of pain. For effective result, she must do these thing 1/2 hr before sleeping.

2) For joints pain, muscle spasm, we need to rule out some possible reasons like like sciatica, osteoarthritis, gout, bursitis, strain or sprain, electrolyte imbalance, over weight, arthraglia, vitamin D & calcium deficiency etc.

She needs to undergo some test like blood sugar & serum electrolyte, RA factor, X-ray of different joints (only after pregnancy), blood uric acid & thyroid test, vitamin-D & serum calcium assay, ESR, CRP etc. These will help to elicit the exact underlying etiology.

Total 8-10 hrs rest and daily 1/2- 1 hr walking is recommended in pregnancy period. In this time, we have limited treatment option to cut down the joint pain. Only muscle relaxant gel and hot water bag (around knee, ankle or low back) are helpful at this stage. Drink more water or fruit juice to stay hydrated and better systemic circulation.

You need to consult with physiotherapist or orthopedic surgeon regarding this for next line management of the case.

3) In my opinion, "Palmers cocoa butter formula" stretch XXXXXXX cream is quite effective and safe than petroleum jelly. It is available in market with 125 gm pack.

I prefer 2.5 gm 2-3 times daily for my patient after 5 months of pregnancy till the stretch XXXXXXX is completely resolved.

Hope, above information is quite helpful to you. Let me know, if you need any further clarification.

Wish herr good health & successful motherhood.

Regards,
Dr Soumen
Above answer was peer-reviewed by
 
Follow-up: Pregnant. Having sever back and joint pain. Taking FEROSE F for iron, Materna and Cal-Mag. Suggest 2 hours later
Hello doctor, thanks for you reply, just one concern here, the time schedule you made will be very early for her to wake up and have breakfast at that time, can you please reschedule it so she won't have to wake up that early, she can take a medicine pill early and continue sleeping but not wake up and have a complete breakfast.
Also are there any restrictions of taking both the iron and spasmag intakes simultanously ?
And one of my original questions which I didnt get an answer for about the stretch XXXXXXX cream is as below:
We need to buy a good stretch marks cream, we heard about 2 brands (Jellie or Palmers) which one is safer and have better results? or do you have any better suggestions ? and do you have any considerations as well while dealing with stretch marks cream ? and please indicate the dosage (how many times a day and in which month she should start taking it)
 
 
Answered by Dr. S Patra 1 hour later
Brief Answer:
Palmers Stretch XXXXXXX cream is good.

Detailed Answer:
Hello XXXXX,

Thanks for follow up queries. Followings are my comments:

1) If she don't want to wake up early, then she can follow this schedule:

-breakfast at 12 PM with calcium from Milk and dairy. Add one CAL-MAG tab after 1 hr.
- lunch at 2 PM with protein XXXXXXX food subs (plant based or fish). Add SPAS-MAG one pill after 2 hrs.
- take adequate rest from 4-6 PM in left lateral position with pillow one side.
- second meal of calcium at 7 PM with Milk and dairy. Add one MATERNA pill after 1 hr (8 PM).
- take one FEROSE – F (iron) pill around 9 PM or 2 hrs before taking dinner.
- complete dinner around 11 PM and add one SPAS-MAG tab after 2 hrs.
- take sound sleep at 1-2 AM with left lateral position with pillow one side.

I have changed first 3 time schedule & it will be quite easier for her. She must try to maintain this schedule. Early breakfast is quite healthy than late taking and it helps in proper digestion. Long time empty stomach is not a good idea.

2) Iron and SPAS-MAG are not to be taken simultaneously due to lowering of intestinal absorption by cross react to each other.

Iron should be taken in empty stomach or with sour fruits, vitamin C to facilitate better absorption. 2 hrs gap is must before taking large meal.

3) I have already answered the right stretch XXXXXXX cream for her with doses and duration. Kindly, go through the "POINT 3" or last portion of the previous reply.

Hope, I have answered your all queries. If you do not have any other query, you can close the discussion.

All the best. Good luck.

Regards,
Dr Soumen
Above answer was peer-reviewed by
 
Follow-up: Pregnant. Having sever back and joint pain. Taking FEROSE F for iron, Materna and Cal-Mag. Suggest 27 minutes later
Thanks alot doctor for your help, one last thing, what is the frequency to use the stretch XXXXXXX cream, how many times a day and how much is the amount ? And should she start using it now, on her sixth month ? And for how long Are there any special considerations we need to know?
Thanks again for your help.?
 
 
Answered by Dr. S Patra 53 minutes later
Brief Answer:
Follow the amount & frequency as mentioned.

Detailed Answer:
Hello,

Thanks for your response.

Palmers cocoa butter formula stretch XXXXXXX cream is quite effective and safe. It is available in market with 125 gm pack.

It should be taken around 2.5 gm 2 to 3 times daily after 5 months of pregnancy till the stretch XXXXXXX is completely resolved.

Yes, she can start it now. After applying the cream, it should be left for one hr to work the cream effectively. No clothes should be touched.

Hope, it helps for you. Be well and take care of her.

Regards,
Dr Soumen
Above answer was peer-reviewed by
 
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