Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, in-depth interviews, and mixed methods analysis of scientific research and news media coverage of perinatal and maternal OUD, this research brings together the voices of women in recovery, clinicians, social workers, policymakers, and the public. Building from what Sanders (2014) refers to as the “gendered double standard” faced by women with substance use disorders, in this dissertation I characterize the intersecting identities of female, pregnant/mother, and substance user as a gendered triple standard. Throughout this work I argue that being held to this gendered triple standard intensifies the stigma faced by pregnant women and mothers with OUD as they navigate the medical, legal, and social service institutions. Key findings from this research include: (1) a predominating focus on “fetal victimhood” (Knight, 2015), which overlooks the needs of pregnant women and mothers with OUD that run concurrent to ensuring a healthy pregnancy and birth; (2) approaches to addressing the opioid “crisis” that elide key at-risk populations (e.g. People of Color, active substance users, and polysubstance users); (3) “folk” pharmacokinetic knowledge and practices utilized by pregnant women and mothers that function as both facilitators and barriers to treatment engagement; and (4) the traumas associated with institutional policies and procedures specific to the management of opioid use (e.g., practices associated with civil commitment to treatment, loss of custody, and intergenerational family separation via the criminal justice and/or foster care systems). Informed by key findings, this dissertation concludes with five specific recommendations for research and practice

“Giant Colonic Bezoar”: A Medication Bezoar Due to Psyllium Seed Husks

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74894/1/j.1572-0241.1984.tb05167.x.pd

Release of human pancreatic polypeptide and gastrin in response to intraduodenal stimuli: A case report

A recent clinical case afforded an opportunity to study the effects of duodenal stimulation on plasma human pancreatic polypeptide and gastrin concentrations, independent of gastric stimulation. A distension stimulus was provided by rapid injection of 100 ml of water and saline via a T-tube into an isolated duodenal afferent limb. In a third experiment, the saline contained 200 pg/ml of heptadeca-peptide human gastrin. Within 2 min after each injection, a rapid rise in circulating human pancreatic polypeptide levels appeared that fell promptly towards basal thereafter. Injections of 100 ml of Flexical, a supplemental tube feeding, resulted in a biphasic human pancreatic polypeptide response, the initial peak comparable to that seen following distension with water, saline, or saline containing gastrin, and a second peak of much greater magnitude and duration followed the initial peak. Plasma gastrin concentrations were not influenced following any of the stimuli. Duodenal distension alone may induce an early transient increase in plasma human pancreatic polypeptide concentrations, while intraduodenal nutrients per se may induce a later increment of greater magnitude and duration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23603/1/0000565.pd

Secretin, a stimulus for duodenal and pancreatic "gastrin" release: Possible pathogenetic significance in Zollinger-Ellison (ZE) syndrome

Ex vivo hemoperfused pancreaticoduodenal preparations from dogs have been used to study intraluminal and circulatory patterns of release of immunoreactive gastrin under basal conditions and after secretin stimulation. Bidirectional release of immunoreactive gastrin was maximal at 3 U/min secretin infusion, and release into pancreatic and duodenal juice exceeded that into portal venous blood. Molecular sieving chromatography of peptides with gastrin-like immunoreactivity recovered from duodenal and pancreatic juice indicated a single species of a molecular size equivalent to CCK8 and smaller than minigastrin (G-14). The exact identity has not been defined. This study demonstrates that secretin stimulates release of gastrin-like peptides into blood and lumen of extra-antral gastrin-producing tissues in the dog. Unidirectional gastrin release patterns from gastrinoma tissue may explain the paradoxical increase in plasma gastrin levels in response to secretin in patients with gastrinomas (Zollinger-Ellison syndrome).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23280/1/0000217.pd

The effect of pyloromyotomy on serum and luminal gastrin in infants with hypertrophic pyloric stenosis

Previous studies of the pathogenesis of congenital hypertrophic pyloric stenosis (CHPS) have implicated immunoreactive gastrin, although no consistent relationship has been demonstrated. In this study we have examined the effect which pyloromyotomy has on serum and luminal gastrin concentration after a mechanical and protein stimulus. Seventeen infants were examined preoperatively, and 1 week after pyloromyotomy. On each occasion, samples of serum and gastric contents were collected from fasting infants. Sixty cubic centimeters of water was placed into the stomach and further samples collected 20 min later. The water was then aspirated and replaced by 60 cc of 10% peptone broth and a third set of samples collected after 20 min. All samples from each patient were analyzed for immunoreactive gastrin in the same assay. Pyloromyotomy did not alter fasting serum gastrin (119.3 pg +/- 11.9 preop vs 164.7 +/- 29.9 postop) nor did it alter the gastrin response to water. Pyloromyotomy decreased the incremental serum gastrin response to peptone broth (66.6 +/- 16.9 preop vs 18.9 +/- 11.7 postop). Luminal gastrin concentration was not significantly affected by pyloromyotomy. When the pre- and postoperative serum gastrin increments for water and peptone were plotted against the fasting gastrin levels, an inverse relationship was apparent which was statistically significant by regression analysis. Seen in this way, intragastric water and peptone have a dual effect on serum gastrin; a rise if the fasting serum gastrin concentration is low; a fall or lesser rise if the fasting serum gastrin concentration is high. The data suggest that the direction and magnitude of serum gastrin response to intragastric water or peptone is set by the fasting level, and is independent of pyloromyotomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23236/1/0000169.pd