Very itchy torso w/ no visible rash? UPDATE: Cholestasis

[~Adorkable~]

So I'm being driven slowly insane with an itch that seem to start on my upper chest and now is most everywhere but focused on my torso. It is on way more than stretching skin, like also on my neck and arms and there is no rash that I can see. Though now some marks but I think my scratching caused them.
The only thing I notice that you can see is possibly that notice that my skin is a tad redder in general, like a very slight sunburn that you can leave a mark in by pressing on. I do seem to be retaining some fluid, since I really notice how my sheets imprint in my skin when I sleep.

Any ideas? This has been slowly progressing for a few weeks, I have been upping my water intake and putting coconut oil on my skin, seems nice but not a fix.

Update: I have been dx'd with cholestasis, you can read more in my posts below, very freaked out now, learning as much as i can.
Edited by ~Adorkable~ - 12/13/10 at 1:55pm

[myk]

is it an allergic reaction? i've been having something similar, but on and off.. i would see your care provider just because of the fluid retention (might be nothing, might indicate a problem). in the mean time, i find that soaks in Aveeno bath powder helps some. in my case i think it's partly the winter air here, it's been cold and dry for some time, but it's not completely resolved by applying cocoa butter.

i hope it's nothing serious. hugs!

[MaryElizabeth]

Have you considered PUPP? Its a pregnancy related ailment that drove me to the brink of insanity. Mine did not show the red marks that others did until I had it for months. The only thing that helped was... well giving birth haha. Hopefully this isn't what you have!

[~Adorkable~]

I've pondered it being a allergic reaction, but the locations that it itches the most are not really the spots that i would think it would be (not were something rubs and not in the most sensitive areas like behind my knees or inner arms.) but you never know 

thankfully i am seeing someone already on Monday so i will ask them as well.

as for PUPP, i did not know that could come without a rash? i will do a bit more reading on it, i hope that is not what i have either

thanks for the input gals

[pregnant@40]

 Consider cholestasis of pregnancy if you have itchy palms/soles.

[Aliy]

i'd question PUPP i had a friend who had it but no rash

[~Adorkable~]

Originally Posted by pregnant@40 

 Consider cholestasis of pregnancy if you have itchy palms/soles.

Ok this totally sucks, I have been peliminarily diagnosed with cholestasis after a Liver function test today, they are still running the more detailed serum bile acid test but that takes a week to get back. So they want me on medication ASAP since this can apparently be very bad for my babies.

I'm freaking out for the first time in my pregnancy.nothing i read is doing anything but making me panic more. I have closed all my research windows and asked my very together mother to look things up and tell me what all I need to be doing. I'll go back to reading in a few hours after I calm down.

If you know any good websites I should include on my reading list please let me know. What they are prescribing looks like the standard appropriate go to drug. And mom is looking up milk thistle and stuff so i can help my liver from that end.

I need to call my HB midwife and find out what she knows and feels about things and if this changes our plans.
does anyone have information to help me understand the reality of them saying they are going to want to deliver prior to 37 weeks? I want to keep them safe, and just wanting the facts.

[Jenne]

Oh, Adorkable! Okay, from what I know and read...depending upon your liver bile and bilirubin levels depends on how serious this is. So, once you have that information you can go from there. You've probably already read this:

What is the treatment for Cholestasis of pregnancy?
The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options include:

Topical anti-itch medications or medication with corticosteroids
Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
Cold baths and ice water slow down the flow of blood in the body by decreasing it’s temperature
Dexamethansone is a steroid that increases the maturity of the baby’s lungs
Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging
Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver
Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
Regular blood tests monitoring both bile serum levels and liver function

Treatment for cholestasis of pregnancy needs to be determined by your physician who will take the following criteria into consideration:

Your pregnancy, overall health, and medical history
The extent of the disease
Your tolerance of specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference

So, it sounds to me like if your levels are not dangerously high that you can be treated without induction. I know you are trying to grow your babies until they choose their due date and that may still be possible. You may be itchy and uncomfortable but it may still be possible. You have good care that is going to help you make decisions about keeping your babies and your body safe. Hang in there! You are already making great treatment decisions by putting the interwebs away. Less stress is always better. You are a great mama. You can do this.

Please update us when you have your levels back.

Jenne

[Italiamom]

I developed mild cholestasis at around 34 weeks, and it is nighmarish, I am sorry you're going through it.  I was up for almost three days, itching and crying...  My liver levels came back alarmingly bad, BUT when my serum bile levels came back a week later, they were within normal range.  Regardless, it meant twice weekly ultrasounds and much terror and disappointment on my part.

A few thing you can do to help your liver:

-- Get thee, right away, to an acupuncturist.  Let them know you're being treated by a regular physician, but that your liver needs help!

-- Milk thistle tincture AND dandelion root tincture helped with the itching for me.  If I would take only one, and not the other, the itching would return.  Awfully.  I used the "Herb Pharm" brand.

-- WATCH your fats.  Fat exacerbates the work of the liver and gallbladder.  Sugar is a big no no as well, but really watch your fat intake.

-- No tylenol.  My cholestasis onset after two days of taking tylenol to control a fever.  I know that many women consider it safe in pregnancy, and I believe it is for most, but not if your liver is flaring up.

As I said, the serum bile acid test came back negative for me, despite my concerning liver levels.  But within a few weeks I was able to bring those levels back to normal, and so they just watched me very closely (twice weekly ultrasounds and liver checks), and I ended up having a completely uncomplicated, freestanding birthcenter birth at 39 weeks.  That said, I did a lot of research in those 2 weeks.  Had the serum bile acid test come back with bad news, I would have most likely had my child in a hospital.  (And let me pause and say that the prospect was heartbreaking and frightening.  Don't let anyone here downplay how hard that is).  I'm fairly certain that induction at 36 weeks is standard in obstetric cholestasis cases, just because the stillbirth rate rises dramatically afterward.  But in my case, my partner and I chose to continue with the extra monitoring because of the results of the serum bile acid test, and because I was able to qet my liver levels quickly back in check.

I did start taking evening primrose oil, to prepare my cervix in case of induction, pretty much a couple days after first having my liver tested.  Also, lots of loving from the hubby!

Another thing, in your myriad of research details, is to consider taking the vitamin K shot/drops for your LOs once they arrive.  For normal and healthy pregnancies, it seems silly (to me) to do so, but obstetric cholesasis is a condition that affects infant vitamin K stores.  It is probably something worth checking up on,

[Stayseeliz]

If you want to send me your email offloop I'll shoot it over to a friend of mine who is pregnant with Cholestasis for the second time (6th child). She knows a lot!

[MCatLvrMom2A&X]

A great resource for cholestasis is http://www.itchymoms.com/ tons of important information can be found there. I had undiagnosed cholestasis when I was pg with dd she was born a week late and healthy thankfully. At the time I didnt have internet access and thought itching was normal with pg even though it was so bad I had to sleep in the floor with a fan on me to get any relief at all.


Only after dd was born did I find out how much danger she was in and how lucky we all where.

[m0xxie]

Just wanted to say thank you, Adorkable, for this thread... I knew nothing about this condition until I read about it here, and although I have no intolerable itching so far, I did have my gall bladder removed years ago, and I'm glad to know to be on the lookout for any symptoms of this condition. Sending my wishes to you for a successful treatment and healthy babies for you! Please keep us posted!

[~Adorkable~]

so i went to the high risk OBs today, they are the ones that usually give me my once a month U/S and stuffs, starting next week i will also be getting my NST thru them.

babies are looking great and are 4lb10oz and 5lb10oz and still both head down though baby A has turned face up so I'll work on that.

As for the cholestasis, they actually were pretty calm about it, said they just want to get them out at 37 weeks (better than i read in some places that say no latter than 37)

since it seems like no study has yet identified what the connection or causality between the increased bile or other unknown factor and the increase in risk of still birth, they do not really like to change plans that much even if i can get my levels down, though one said he would be willing to push it a week if levels were great.

that brings back one of the early issues in that the Bile Acid test takes at least a week and sometimes longer than 2 to get the results back, it seems the huge frustration for everyone. So since levels are known to change very suddenly, it does not seem like something you can monitor very well if at all in a time frame that gives you time to respond.

we may be able to say something about my levels going up or down based on my horrific itching, but that is way less than factual to say the least. and since we don't know what anything correlates to or what levels are "safe" its a guessing game.

So our current plan is to still look at our home birth given the ability to do two things:

naturally induce labor at 37 weeks, using the gentlest stuff first but rapidly moving down the list, i do not think I'm going to dispute the need to go early and I'm also choosing to trust that my babies are going to be ready, they are getting big and strong every day and at this rate should be really healthy at 37 weeks, when i spoke to my midwife about natural induction she sounded confident she could get things started in the right way in 24 hours or so if need be.

I'll start leaning more about that now.

the other question that is left open so far is references to maternal and fetal vit K issues since K is a fat soluble vitamin and that requires liver. so clearly the babies will be getting a K shot right away and that is fine the question is will i need something to make it thru a home birth with two placentas. the OBs are looking into the K thing, they did not know much about it and said they did not remember seeing bleeding issues in other cholestasis mothers. So the fact that they were not already worried about that is a good thing, I'm guessing

So I'm now on a mission to learn about blot clotting and vit K issues as well

But so far it looks like i may have my home birth still and if not i do feel at least while the hospital i would be going to is lame in the nth degree, the doc i would hopefully have is actually pretty level headed and i work well with. and if i went in to birth there, i would still do everything in my power to go  in well into labor that i got started spontaneously or on my own terms.

[Jenne]

It sounds like you have a really great birth team and a very level headed plan. I'm not sure what you induction list includes but I've heard lots of good things about pumping with a breast pump and using warm compresses alternately to begin and maintain contractions. You might check Ronnie Falco's site for other induction methods.

On one had you are doing such a remarkable thing but on the other you are doing exactly what a mama should. You are making the best decisions you can for your family, yourself, and your kiddos with the information you have available. Hang in there! You'll be meeting those strong, healthy babies in no time!

Jenne

[~Adorkable~]

Thanks Jenner, yeah I feel a lot better about things after hearing the tone the two high risk OBs took yesterday. Of course sadly they both think I'm going to deliver there with them as I can not say for insurance reasons that I'm staying home.
I so wish I could be honest with them. (though after my first long talk when I met the best of the two, I would be shocked if he hadn't thought for a minute at least that I plan a oops or something, I was pretty honest about my stance on hospital and home births)

At this point I'm still not in love with my HB midwife, but for no huge reason, probably because our entire relationship has been on the phone, we meet next Wed.

If I could change about 3 or 4 realities (that sadly are unchangeable) with the hospital I would actually maybe, start to, kinda, consider going there since I do really click with the one OB. so if I end up there, at least I have that.


Oh and yes, I am going to be talking to our hospitals LC about their rental pumps since with everything I'm doing I'm thinking having some big guns in that area will be a very good thing!