Childbirth is possible for a woman with spinal cord injury at any level. Healthy babies have even been born to women who were injured during their pregnancy. If you are emotionally ready to have a child and have considered the physical aspects of parenting, being pregnant and becoming a mother should be an exciting and fulfilling experience.You need to consider several potential complications of pregnancy, however, if you have a spinal cord injury. Pressure sores may occur more often during pregnancy because of increased body weight or anemia, and you need to do more frequent weight shifting or pressure releases. Urinary tract infection is more likely during pregnancy, but can generally be managed with antibiotic treatment. An increased risk of autonomic dysreflexia occurs as the pregnancy progresses. This can be caused by sexual activity, and it may be advisable to avoid sexual intercourse after the seventh month to reduce the risk of complications.The risk of autonomic dysreflexia increases during labor and requires close medical supervision. Other complications include the possibility of early delivery or the inability to feel contractions that indicate the start of labor. These problems can be managed by frequent medical checkups after the thirty-second week of pregnancy. Once dilation has begun, hospitalization and bed rest are usually advisable so the course of the labor can be closely monitored. Delivery may be vaginal or by cesarean section, depending on the individual needs of mother and baby. Episiotomy (surgical incision of the vulva to assist with delivery) may or may not be necessary. Finding an obstetrician, who has some experience with spinal cord injury, or coordinating care between your obstetrician and physiatrist, is the best way to ensure a healthy pregnancy and delivery.Breast-feeding your newborn may be possible, perhaps with some help in positioning. Consult with your doctor or a nurse lactation specialist if you want to breast-feed your baby. Keep in mind, too, that breast-feeding is not essential for the well-being of your child, and you and your infant can form a strong emotional bond through bottle-feeding, snuggling, and other forms of nurturing and closeness.
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There are several therapeutic options that can help relieve the symptoms of narcolepsy. Such stimulant drugs as methylpheni-date (brand name Ritalin) or pemoline (Cylert) may help relieve feelings of drowsiness. Tricyclic antidepressants (such as protriptyline and imipramine) can alleviate cataplexy. It may be months, however, before the positive effects of drug therapy are fully experienced. Sometimes, unlike epileptic seizures, narcoleptic attacks can be arrested by stimulating the victim through talking or gentle shaking. In many cases maintaining a regular sleep-wake schedule and arranging periodic naps can help minimize the number of daytime attacks. Supportive counseling can work wonders in helping narcoleptics adjust to their situation, especially if situational depression is present. However, as I mentioned, many forms of psychotherapy, such as drug management for depression, are obviously inappropriate, since they do not address the cause of narcolepsy.*154\226\8*

Risk factors, as they pertain to coronary artery disease, are obviously different from the coronary artery disease itself.Treating or correcting a risk factor does not cure coronary artery disease; rather, it helps prevent it from occurring. Thus, modifying your risk factors can be thought of as preventive maintenance. Taking steps to reduce your risk factors before coronary artery disease develops is called primary prevention.Although improved treatments for heart disease are saving more lives, about half of all deaths occur before there is time to start treatment. Thus, treatment, no matter how sophisticated it may become, is not the ideal solution for reducing deaths from heart disease. Preventing heart attacks by reducing or eliminating risk factors undoubtedly can save lives.SECONDARY PREVENTION. What if you already have coronary artery disease and are experiencing angina or have even had a heart attack? Evidence shows that you can still reduce your chances of further complications if you reduce your risk factors. Secondary prevention is the attempt to reduce risk factors after you have documented coronary artery disease or a heart attack.When you treat risk factors aggressively, atherosclerosis can actually improve. By giving up smoking, exercising regularly, and developing healthful eating, living, and working habits, you can diminish the effects of existing cardiovascular disease.Cardiovascular rehabilitation programs after heart attacks are an example of secondary prevention. They try to help you reduce the risk of a second heart attack, compensate for the heart damage, decrease the extent of atherosclerosis, and resume as normal a lifestyle as possible.*226\252\8*