I have a question about the cumulative effect of some meds.  This mother has
a history of cancer as a child, which was treated and she has been cancer
free for >15 years.  She had some residual effects on her heart, however,
those also subsided and she has required no further management, meds or
otherwise, for several years.  Just a few weeks prior to delivery at term,
she started experiencing SOB and some cardiac related symptoms.  She
eventually had a c/s and was dx with an enlarged heart.  She was here in
hospital post delivery for about a week and was sent home on several cardiac
meds, all cleared through Hale, with baby breastfeeding well.  She was
readmitted 4 days later for temp >102(.  She had a red hardened, warm to the
touch area on one breast (no surprise after spending a week here with us!),
and of course, got a complete work-up with her cardiologist thinking it was
related to her heart.  She has an elevated white count, and no other
identified source of infection after 3 days of tests.  Her baby comes in to
visit a few hours a day (she's on a different floor for heart monitoring)
and she's pumping of course.  Her docs still don't think she has mastitis or
that it is the source of these symptoms (!) and they are putting her on more
meds.  My question is, she has been taking lasix, which looks to be ok
according to Hale, but now they want to add Spironolactone, another diuretic
(even though she doesn't think she needs it) and, while that's ok according
to Hale also, I just wonder if the cumulative effect might be a decrease in
milk supply where that might not happen on either one alone.  At any rate, I
told her neither of the meds are contraindicated and the most we can do is
just be aware it might cause a decrease and that's about it.  I've had this
type of situation come up before where a mother is put on more than one
medication.  Though all are individually ok through Hale, how about the
cumulative effect?  Add on top of that, a brand new milk supply and a
newborn baby and it complicates the issue a bit.  I have still just told the
moms what side effects  Hale advises looking for in babies, assuming that
all is well in the absence of those.  What do the rest of you do/think?  I
mean we can be pretty sure it's ok if there's only one med, but how about
several, and where some of them are L2 and L3 category?  I'd love to hear
the collective wisdom.
TIA,
Marsha, who is grateful this mom has a supportive/knowledgable sister and
husband.

~~~~~~~~~~~~~~~~~~~~~~~~~~~
Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
John S. C. Abbot
~~~~~~~~~~~~~~~~~~~~~~~~~~~

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