I don't like Reglan, personally, so would wean her off as soon as the milk
supply is up. Hopefully the synthroid will cause a definite increase.
yes--she should have a primary care provider prescribing her thyroid
replacement, as well as diagnosing what is causing it to be low!
Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE
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----- Original Message -----
From: "LACTNET automatic digest system" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 04, 2006 11:07 PM
Subject: LACTNET Digest - 4 May 2006 (#2006-519)
> There are 3 messages totalling 176 lines in this issue.
>
> Topics of the day:
>
> 1. MDs giving outdated Mastitis info
> 2. Synthroid and Reglan
> 3. Breast feeding record set in Manila
>
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>
> Date: Thu, 4 May 2006 20:54:26 -0400
> From: =?UTF-8?Q?Sarah_Reece-Stremtan?= <[log in to unmask]>
> Subject: Re: MDs giving outdated Mastitis info
>
> I'm probably the most recently out of med school (graduated in 2004), and=
>
>
> this is what I remember learning in my OB rotation:
>
> *Do not prescribe combination OCPs to lactating moms because the estrogen=
>
>
> will likely decrease milk supply (I do recall one of the OB residents
> pimping me about the pathophysiology of this during clinic one afternoon)=
>
>
> *Treat mastitis with dicloxacillin and encourage mom to keep breastfeedin=
>
> g
> as often as possible -- she likely has a staph aureus infection that she
> picked up from baby's mouth (this was also on our peds shelf exam as well=
>
> as
> the OB one).
>
> We never had any formal teaching during our 3rd and 4th (clinical) years =
>
> --
> but based on course objectives and review books I learned the two "pearls=
>
> "
> above. I also saw one patient with mastitis during an urgent care rotati=
>
> on,
> but breastfeeding usually never came up in clinical scenarios (quite low
> breastfeeding rates among the population served by the university
> out-patient clinic and the community health clinic I worked at for my ped=
>
> s
> rotation). During our first year, I think there was maybe 20 minutes of
> lactational physiology included in a physio lecture, and I don't recall e=
>
> ver
> thinking or hearing about lactation during 2nd year. I had mastitis last=
>
>
> August (got my single day off from the wards that week while I was febril=
>
> e
> in bed) and was pleasantly surprised when one of the 4th-year students as=
>
> ked
> me what antibiotic my OB had prescribed: when I told her it was
> dicloxacillin, she said, "excellent, that's the drug of choice!"
>
> The professor who's coordinator for the 3rd-year OB rotation has told me
> that he could probably work me in for a 30-minute talk on breastfeeding f=
>
> or
> each group of students rotating through each month but I just haven't had=
>
>
> the time or energy to put something together yet (I say this after having=
>
>
> worked from 7:30am yesterday to 2pm today without a chance to even close =
>
> my
> eyes except for blinking.... But that's a rant for another listseve, how=
>
>
> the ER attending, who only knows how to practice defensive medicine, forc=
>
> ed
> us to admit a patient with dehydration/over-diuresis because she was
> doubling up on her Lasix dose, another patient with pancreatitis, another=
>
>
> with asthma, and another with pneumonia to the CARDIOLOGY service. Sorry=
>
> ,
> still exhausted, bitter, enraged, etc, ready to quit and be a stay at hom=
>
> e
> mom...) Also want to put together a 2-week elective for 4th year med
> students in "breastfeeding medicine," just need to hammer out the logisti=
>
> cs
> and get another of the OBs to agree to be the coordinator. Basically, I
> just need to keep reading Lactnet to gain the motivation to get these
> going... keep the horror stories coming! :)
>
> -Sarah (starting anesthesiology residency in July, thank God I'll be done=
>
>
> with medicine!, aiming to finish my MPH in mat/child health at SOME point=
>
>
> this year...)
>
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> ------------------------------
>
> Date: Thu, 4 May 2006 21:02:42 -0400
> From: James O'Quinn <[log in to unmask]>
> Subject: Synthroid and Reglan
>
> Okay wise ones I need your help again...
>
> Remember the vegan mom I posted about who had no breast changes
> during pregnancy,
> didn't describe lactogenesis II as vigorous but had a baby who gained
> weight normally at least until day 10
> but when I saw her on day 18 the baby looked skinny and only
> transfered 2/10 of an ounce milk at a nursing and may have lost 4
> ounces?
>
> I sent her home with a scale and most nursings were under 20 grams...
> I asked mom to see a doctor and get her thyroid checked and get
> Reglan...
> She did both and on Reglan her supply has increased since Monday but
> it has been very erratic
> The most milk she has measured at one time was 68 grams but there are
> still nursings where just 6-8 grams of milk are transferred...
>
> Today she got a call from the doctor that her TSH levels were high
> 12.36 reference range 0.4-6.0
> indicating hypothyroidism and he prescribed synthroid one 25 mcg
> tablet daily...
> I'm encouraged that it doesn't look like she has secondary
> hypothyroidism...
>
> So now my question is..is there a protocol for withdrawing Reglan
> after thyroid replacement begins
> or should the mom continue on the usually course of Reglan?
>
> My other concern is that she saw a physician at an urgent care
> facility...
> Should I encourage her to find a specialist or GP to for follow up?
> I'm concerned about her not being under the care of someone who feels
> responsible for her on-going health...
>
> Jen O'Quinn
> IBCLC
>
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> ------------------------------
>
> Date: Thu, 4 May 2006 21:16:16 -0400
> From: Cindy Curtis <[log in to unmask]>
> Subject: Breast feeding record set in Manila
>
> http://tinyurl.com/k7xuh
>
> Follow that link to read about the record and see a short video clip !
> Cindy
>
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> ------------------------------
>
> End of LACTNET Digest - 4 May 2006 (#2006-519)
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