Thursday, October 29, 2009

Sometimes Breast Isn't the Best

Yesterday afternoon I was seeing a lady who'd recently had a baby. She came in to talk about resuming her migraine medications after pregnancy.


Mrs. Nursing: "I couldn't wait for this appointment, so I restarted Topamax after I got home from the hospital."

Dr. Grumpy: "Are you breastfeeding?"

Mrs. Nursing: "Of course! You know what they say, 'breast is the best'."

Dr. Grumpy: "You shouldn't be taking Topamax while you're breastfeeding."

Mrs. Nursing "Oh, I don't. I wait till the baby is done".

26 comments:

Amanda said...

Not that you need it but kellymom.com has a great chart for breastfeeding and medications. Here's a link to the one on migraine meds.

http://www.kellymom.com/health/meds/migraine-meds.html

vanity press said...

Perhaps this patient was not breast fed?

The Good Cook said...

Oey-ee-vay.

Flavius said...

And when she smokes in the car, she makes sure to roll down the window so the baby doesn't have to breath it. How considerate.

-Flavius

Jacqueline said...

WHAT. AN. IDIOT.

LOL...my verification word is deduche

Heather said...

Morons...I'm surrounded by Morons!!!

MJH, CPhT said...

Please tell her that a total hysterectomy will permanently cure her migraines... That DNA needs to stop being passed down.

The D-Bag Daily said...

Now I have a headache...from banging my head against the wall.

Anonymous said...

Per Dr Hale's "Medications and Mothers' Milk" (2008) Topiramate is an L3 ("Moderately safe"). "Due to the fact that plasma levels found in breastfeeding infants were significantly less than in maternal plasma, the risk of using this product in breastfeeding mothers is probably acceptable. Close observation for sedation is advised."

The need for mom to take medications doesn't automatically rule out breastfeeding. Those posters who are likening it to smoking in a parked car should do some research.

-lpnmon

Grumpy, M.D. said...

Ipnmom- It's a risk/benefit calculation. Given that it's safety is not clearly proved or disproved, I tend to be more cautious.

The D-Bag Daily said...

Ipnmom - I'm more concerned about her reasoning ("Oh, no. I wait until the baby is done.") The fact that MOM didn't do her research before taking it is what is frightening. What if it were a different medication that had more risks?

JTN said...

Reminds me of a conversation I had with a coworker once... she was being forced to go to prenatal classes and was shocked (and I mean shocked) to find out what she smokes, drinks, and eats gets passed on to the fetus as well.

dan said...

In the mouth, down the throat, and out the nipples. It's a direct line y'know.

Flavius said...

@lpnmom

Just commenting on the shear ignorance, not how safe the medication is.

Besides, risk vs. reward didn't seem to concern her much.

Since you're playing devil's advocate, what if the medication HAD been a dangerous one to the baby? It would've all been the same to her anyways. Of course, dealing with migraines is probably more important than insuring your child's safety, yes?

-Flavius

Fiz said...

I wouldn't say so, Flavius! Luckily for me, no periods while I was breastfeeding meant no migraines. However I went to a very fancy party at a private hospital (a doctor there was then married to my best friend). He got us both completely sloshed by adding things to our drinks, knowing we were both breast feeding, and making a crash cart into a crib with pillows. Neither his wife nor I were happy about this and kept creeping back to check up on our daughters. Mind you, he turned out to be a pyschopath (loooong story) and no longer works in medicine, which is probably just as well! P.S sign in is maters!

Gert said...

I assume you check for the presence of gray matter prior to taking on a pt?

Wow!

Anonymous said...

You wouldn't want Junior to get
fat, would you?

The Mother said...

I took Topamax for a while. I'm not sure you should take it while you have children, let alone while you're nursing.

I once left a whole load of groceries in the car. Great thing it wasn't a kid. Or two.

Anonymous said...

luckily we have smart people like this lady making medical decisions all the time for themselves and others...with absolutely no harm or concern. and why do we have doctors and pharmacists again??

Anonymous said...

It's a wonder the woman thought there was some actual benefit to breastfeeding other than just
'seemed the latest thing to do', or was 'easier than warming up bottles in the middle of the night' or something.

It's rather amazing to think people buy 'Head On', or
'Airborne' because it was developed by a 3rd grade schoolteacher. With that logic, one could easily consult a horoscope to base decisions on whether one should start a war, or think that an A-bomb or two would end one. Ahem.

purdueboilerz said...

LOL...I feel your pain! As a pharmacist we hear stuff like that all the time too! My favorite was a phone call from a mom complaining that the amoxicillin was making her son's ear sticky...she was putting it in the ear for his ear infection!! Yep lady, that's why it's bubblegum flavored...for the ear...idiots!

DreamingTree said...

Hmmmm...I'm not sure if my first attempt at a comment was lost in cyberspace, or not approved, but I'm trying again. While she lacks good judgment for taking a medication before making sure it's safe, her comment may not have been as stupid as it sounds. Waiting until after the baby breastfeeds has been recommended for other medications (my first comment cited research, but I'm too lazy this morning to do that again). This decreases the amount secreted into the breastmilk. Of course, drug onset makes a difference as does the feeding schedule. So...mother is irresponsible, but there may have been some logic in how she took it.

Grumpy, M.D. said...

Dreamingtree- I didn't reject any comments from you. Must have been an internet goblin thing.

Ware are we?? said...

I, too, have noticed that the world is full of idiots. I used to think I had an average IQ but now I'm beginning to think I am a genius. LOL

ERP said...

Oops. I guess that kid is going to be a little bit sluggish for a while

Knucklehead said...

Another poor child doomed to a life with idiot parents.

 
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