Monday, November 30, 2009

Concerned Parent

I know you're pregnant, ma'am, and I understand your concerns about not wanting to take a medication because it might harm your baby. I don't prescribe pills just for the hell of it, and try to weigh the risks and benefits.

But DON'T tell me that you're worried about the effects of the pills on a fetus when you just told me you smoke a freakin' pack a day, okay?

23 comments:

Helen said...

Ugh.

I saw a heavily pregnant woman smoking the other day. I know I shouldn't be surprised, but I was.

Anonymous said...

Do you tell the patient your thoughts on the matter?

Grumpy, M.D. said...

Of course. It never changes anything, but I still do.

Dr. Dad said...

"Doctor, You just don't understand, that's different."
There couldn't possibly be any data on the adverse effects of smoking during pregnancy. If there were, wouldn't they be on the package warnings? Oops. Never mind...

Old MD Girl said...

I don't know.... nicotine vs. depakote seems like a pretty obvious choice to me.

Celeste said...

http://www.llli.org/FAQ/smoking.html

La Leche League will give more respect to the smoking breastfeeder than to the non-smoking formula feeder. This link has a quote by Dr. Jack Newman which saying the risk of not breastfeeding is greater than the risk of nicotine.

I've always kind of thought it's silly for a woman to quit smoking while pregnant if she's just going to resume postpartum and bring the baby into a smoke-filled home and even smoke while breastfeeding. Even if she doesn't light up during the feeding, she is still exhaling toxins in her breath and has all sorts of chemical byproducts off-gassing from her hair and clothing.

I'm with you, Grumpy.

The Outsu Man said...

All the more reason to be careful with prescription medicine. She's already used up her safety margin. It's all about strategic deployment of resources.

Celeste said...

http://www.llli.org/FAQ/smoking.html

La Leche League has more respect for a smoker who breastfeeds than a nonsmoker who formula feeds.

minimedic said...

Oh my...speechless...are you serious? What the hell does she think nictotine and all the shit in a cigarette is, an effing herbal supplement? (Wait...don't answer that question.I think we already know.)

On a happier note: New shirt idea! This one, you talk about stupid medication people! (You know, like the one about the guy wanting to go off his pain medication because it took away his back pain...and that girl who wanted a different color medication.)

MJH, CPhT said...

We had an obviously pregnant woman come in a for nicotine gum a year or more ago, and I had the pharmacist come talk to her. It turns out that she already knew all the risks of smoking during pregnancy. In fact, she started smoking when she found out she was pregnant "to keep the baby's weight down so she wouldn't look so fat during her pregnancy." But now that she was nearing her due date, she wanted to stop smoking so her "teeth wouldn't get too yellow and icky-looking." Ugh.

Anonymous said...

I'm a pharmacist in a hospital, and our postpartum admission orders include check boxes for the three strengths of nicotine patches. I am appalled whenever I actually have to enter one of those orders.

The Mother said...

We know a pulmonary doc who smoked through her entire pregnancy. Explain that one!

Anonymous said...

So, I work in a hospital and was walking to get a bite to eat with one of the pulmonologists. A rather pregnant woman came up and asked us where to find the "smoking area." My jaw practically hit the floor. The pulmonologist decided it might be a moment to mention smoking cessation which was met with..."F-you!!" But the chick didn't find the smoking area from us!! Of course once again, I was standing there with my jaw on the floor!

student dr. blaze said...

that's just plain nauseating. let me guess, the patient is probably on some sort of government assistance that pays for her cigarettes, too, right?

Mr. Knucklehead said...

And when the baby's born with asthms, she'll undoubtedly blame it on the pills.

Anonymous said...

Not surprised.
Depa-bloat or smokey treats? Smokey treats for the win!

I worked with an oncologist, who had a 2 pack a day habit. This was back when you could smoke at the nurses' station. The whole place was litter with paper cups with water and snuffed. out sparkies. Ewwwww...

The whole station had a smoke haze just from him.

LD50 Rat

RxKerBer said...

My niece has read some article somewhere that having a breast-feeding mom who smokes somehow makes the baby less likely to have respiratory infections as they grow up. SO, she smokes away. I was too tired to argue.

Grumpy, M.D. said...

Old MD Girl & Anon- Depakote wan't the issue. I agree with you, it's likely not safer than cigs, but at least you can take folate to try and counter it.

The drug involved in this story was more benign, and category C.

Anonymous said...

Had a woman come into my pharmacy, not yet showing yet and actually asked me how she could keep her baby bump small and if i would recommend smoking as thats what her friends did.

Well at least she asked and I responded appropriately

Anonymous said...

Oh.My.God. I am about 24 weeks pregnant today, and apart from the clearly detrimental effects of cigarette smoke on adults AND fetuses, I absolutely cannot imagine wanting to be around the smell. I had to stop wearing my lovely perfume and switched to unscented body wash because I couldn't take the fragrance. I can't imagine willingly subjecting myself to cigarette smoke - I can barely walk past the cheese display at the market. And don't even get me started on the dumb-ass factor; that's been covered by others, I see.

Fiz said...

I have an acquaintance who smoked all through her prengancy and has a severely asthmatic son now. Another's husband smoked all through his wife's pregnancy despite her constant nausea and now has three kids, all three with asthma and the second also had severe ear problems, necessitating a minor operation when she was three! I have never smoked but I am allergic to cigarette smoke (asthma) and I find I resent it more and more as I get older and am smoked over by people outside pubs and clubs - they are so freaking selfish!

thegooddrlaura said...

Dear Dr. Grumpy,
Will your Category C medication prescription interfere with my baby's ability to get high on the methamphetamine I'm smoking? I also take OxyContin, so the baby won't be in any pain. Don't mess with that or the baby will go through withdrawals in my body and if I have a miscarriage, it will be your fault.
Love,
Mother of 6 from 5 different guys.

Anonymous said...

This post sooooo reminded me of this: http://www.funnyandjokes.com/wp-content/uploads/2007/10/smoking-while-pregnant.jpg

Sorry to say I live in this town and people are really that stupid here!

I ran across your blog this evening! Thanks for all the laughs!

 
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