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#1 of 16 Old 04-17-2010, 08:33 AM - Thread Starter
 
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Any recommendations?? I have a client, she is 39 weeks today. I am actually technically her "back-up". She is mennonite and planning a homebirth, so I have only seen her a once in the office. I have cared for several of her sisters and I know her "baby catcher" very well. Anyway, she called to tell me she had PUPPS and asked for any recommendations. I offered the usual, but I know she is not open for an induction (I did not even mention it). I did mention the possible need for a steroid cream or PO steroids. They were not interested at this time. So, I just wanted to pick your brains about this!

TIA
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#2 of 16 Old 04-17-2010, 08:27 PM
 
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four cups daily of stinging nettle tea!
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#3 of 16 Old 04-17-2010, 11:05 PM
 
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Dandelion root tincture

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#4 of 16 Old 04-17-2010, 11:57 PM - Thread Starter
 
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Thanks!!
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#5 of 16 Old 04-19-2010, 04:24 AM
 
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Just curious...Your usual recommendation for PUPPS are steroids and induction?

I had a very bad case at 37 weeks and the steroid creams did nothing, I think they even gave me stretch marks. And nobody MD or midwife offered induction.

The only thing that relieved my itching were cooling gels like aloe and miracle gel.I did the dandelion root, maybe that helped it go away after 2 weeks.
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#6 of 16 Old 04-19-2010, 06:04 PM
 
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Not a BP, but I took milk thistle caps (3) 3x a day for a week, then down to 2 caps 3x day, then 2 caps twice daily for maintenance for about 3 more weeks. It took about a week to get good relief. Steroid cream did absolutely nothing for me either, fwiw.

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#7 of 16 Old 04-19-2010, 07:46 PM - Thread Starter
 
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No, induction is not a treatment for PUPPS and not something as usual treatment. My "usual" treatments that I have offered her was an herbal salve made by another friend, benadryl to help her sleep (she had not slept in 4 nights when she called me) and cool oatmeal baths. I have seen some severe cases of PUPPS that required steroids. I mentioned that they could be a possibility if she were very uncomfortable.

I realize that the way that was worded came off a little weird. I guess what I had meant was that she was not like some of my patients who would have been begging for an induction....

I work in a very interesting community.I am the first midwife here. I have done a lot to decrease the induction rate, but it is ingrained in the culture up here because of the OB's that have been here for 30+ years. I have not actually had to induce anyone due to PUPPS, but I have been begged for it.
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#8 of 16 Old 04-19-2010, 09:09 PM - Thread Starter
 
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Just wanted to add (I am sure I am being overly sensitive). The Mennonite and women I usually back up generally only call me when their traditional measures have failed, and they are seeking a medical intervention. So, the fact that she called me was due to the fact that she had already tried a variety of traditional and home measures. Also, your anecdotal evidence that steroid cream gave you stretch marks does not make a randomized, double blind, placebo controlled clinical trial. I am not trying to offend you back, but you really have no idea no idea how I practice midwifery. I work to support my whole family (dh is a SADH). Most of my patients have no idea what a midwife is, and have never been to one. They did not seek me out because I am a midwife. I am really just an option and since I am a female they come to me. I generally provide 35-45 mins for each appointment (whether it is a GYN exam or prenatal appointment). I feel like I make a significant difference and I am doing a lot to change the accepted OB practices in my community, but it is a political battle. I prefer to ease my way in and gain the trust of the medical establishment.

Sorry, like I said, I am sure I am being overly sensitive. However, I did not come here to be bashed. I came here for other options that I may not have heard about.

I will let her know she can try aloe gel and/or miracle gel.
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#9 of 16 Old 04-19-2010, 09:15 PM
 
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I had it at the end of my first pregnancy. I took milk thistle, but didn't know what else to do. Since then, I've learned that dandelion and nettles tea can work really good. Just have her keep drinking both until she delivers. The milk thistle probably wouldn't hurt at the same time either.

The conventional treatments didn't work for me (steroid creams, oatmeal baths, cool packs, nothing!). What a horrible end to pregnancy, that is all I have to say about that!!! It's awful! =( I hope she finds relief SOON.

Amanda, wife to my best friend Josh, Mommy to Jenna, Lukas, Adam, Livea and Ethan!
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#10 of 16 Old 04-19-2010, 10:33 PM
 
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I'm not a birth professional, but I had PUPPPS last pregnancy and I got rid of it by using Coal Tar Soap (which cost $1.79 at the HFS). I would lather it up and leave it on for a few minutes in the shower.

Grandpa's Pine Tar Soap was what Dr Google recommended, but I couldn't find it here in Canada, so got the Coal Tar. It's certainly worth a try as it is so cheap and easy to find.

The Aveeno Anti Itch lotion gave some relief without steroids (I avoid these), though it was short lived (the effet lasted about 10 mins) and made me a bit sticky and dirty feeling. I would save the application for when I thought I was going to have to take to my tummy with a fork.

I hope your client can find some relief until the baby is born.

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#11 of 16 Old 04-20-2010, 01:42 AM
 
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I had a client who had PUPPPS with a previous pregnancy so badly that she begged for induction - and that was with all of the standard medical treatments. With the next pregnancy she saw a naturopathic doctor who prescribed a variety of herbal treatments, both topical and ingested. She had it under control within a week or two, and kept it at a manageable level for the rest of her pregnancy. This was not your average alternative medicine-minded woman, either.

Is naturopathy an option where you are?

Doula, CBE, Placenta Lady
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#12 of 16 Old 04-20-2010, 08:22 AM - Thread Starter
 
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Quote:
Originally Posted by TO Doula View Post

Is naturopathy an option where you are?

I wish! Maybe in Cornwall, I have not investigated the other side of the border too much...
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#13 of 16 Old 04-20-2010, 12:42 PM
 
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This is my old PUPPP post that I always like to share. I wrote this 4.5 years ago so I am going to cut and paste. Hope it is helpful.

This is what worked for me!
PUPPP is the worst!!!! I am 38.5 weeks pg with twins and started having symptoms at about 35 weeks. This is more than just an itchy belly. It starts with the stretch marks on your belly and then spreads almost everywhere. Not only is it the kind of itching that make you feel like you are losing your mind, but it is an ugly rash. I had little blisters and hives on my arms, legs, tops of feet and hands, hips, butt...it sucked! Over the counter steroid cream was useless, and Benadryl helped me sleep a bit, but did nothing for the rash. Oatmeal baths were useless. I have, however, been completely cured. This may not work for everyone, but it did for me!

1. On the advice of my midwife I took Dandelion Root extract tincture. This seems to have variable results, but my midwife put me on a huge loading dose and I think this made a difference. I took a half a dropperful every hour for the first day, four times a day on the second day and went to twice a day by the third day. She said I would see results within 48 hours and sure enough, I started to get some relief right at 48 hours and within 5 days I was totally better.

2. She also recommended I take Milk Thistle and Choline. I am blanking on the doses she recommended, but I took less...I am wary of taking anything in pg, esp. starting a bunch of new stuff at once. I ended up taking 350 mg of the Choline and 300 mg of the Milk Thistle twice a day. All these herbals are liver tonics.

3. On the advice of another MDC mom (Thanks Shannon0218!!) I had dh paint my body in a water and cornstarch paste with just a few drops of tea tree oil. I left it on for 30 minutes. I think this really paved the way for the rash to start drying out.

I don't know what, if any of these measures worked. I have read in at least one place that the first week is the worst and that the symptoms can resolve on their own, but most of what I have read indicates that delivery is the only real cure. I feel soo lucky to not have PUPPP anymore. It was like torture. People are induced early because of PUPPP or put on high doses of systemic steroids.

For symptom relief I also found that ice packs were really helpful. I would put them in the worst spots instead of scratching.

This is a really helpful website as well:
Naomi's PUPPP page

Best of luck and please feel free to PM me if you have other questions. This is all very fresh in my memory!!
__________________

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#14 of 16 Old 04-20-2010, 02:28 PM
 
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I'm curious- do you draw a liver panel to rule out ICP? While PUPPS would not warrant induction, ICP with elevated serum bile acid levels might.
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#15 of 16 Old 04-21-2010, 03:55 PM
 
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Wow, I was not aware of a randomized, double blind, placebo controlled clinical trial that shows steroid creams relieve PUPPS , or do not cause stretch marks.
It is all over the drug literature that a side effect of steroid creams can be straie.
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#16 of 16 Old 04-22-2010, 09:08 AM
 
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I would run some labs to be sure it isn't cholestasis
either way I would recommend eating artichokes everyday and taking a milkthistle seed/dandelion root combo ,lecithin this is an emulsifier and will help to keep any gallbladder sludge from settling into stones and it is part of what your lungs produce for surfactant more on this later, evaluate intestinal motility- consider magnesium supplement not only will this work to help bowels move magnesium that is absorbed can help with calming irritation, and increase dietary fiber- whole grains, an apple a day, fermented foods (for intestinal flora) recolonizing the intestines can reduce overall body inflammation and may reduce the skin inflammation- be sure mom is drinking her 8 glasses of water a day and that doesn't include Mt Dew, Cola, Monster infact for any caffeine there needs to be additional water-
topically what ever works from herbal things to steroid cream what I keep in mind is that skin is the largest organ of elimination with it being stressed we need to keep the others(liver,bowels, lungs and kidneys/bladder) functioning well to help relieve the stress
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