I feel the need to post on a few topics, will start with the "hot" topic on my
mind:
  St. John's Wort has had some success as antidepressant but the fact that it is
over the counter should not cloud our thinking - it is an MAO inhibitor and has
precautions/interactions with foods, other meds and medical conditions.
I have our pharmacy research line doing more digging but feel the caution is
advised due to mix of easy availability and potential hazards. Also, info on
this substance in English is spotty.  Used more in Germany.

Breast pumps:  our patients who initiate breastmilk supplies without an infant
who can reliably stimulate/retrieve milk on her own find the interior-piston
pumps superior in comfort and efficiency.
We have a significant number of deliveries at a high risk center to warrant our
confidence in their feedback in numbers and reliability.  We find an analogue
dial on strength of suction and probable smoother suction curve make the
difference.  Until proven otherwise, we continue to make our recommendations on
PATIENT (not necessarily manufacturer's) response.
For patients who have purchased small pumps which have caused them pain, I
encourage them to slap them on the counter and demand a refund, claiming bodily
harm.  Very few counter attendants will ask to see the proof.

Reglan: have to echo Joanna Koch's response on Reglan (Hello, Joanna!) and have
had reports of tremors (med dc'd STAT), overwhelming sleepiness.  We never
suggested use beyond 10 days, always had mom start the med at home, with a
partner available for back up if she felt drowsy, etc.  Also, made sure she and
her doc had the info sheet on side effects, contraindications.
Find fenugreek as or more effective, few side effects, we use "beano" to help
with gas complaints.

Diflucan:  we are using it for our mom's with duct yeast, and recommend a 400
mg. loading dose, then 200 mg. daily - generally for 5-7 days, depending on
duration of symptoms.  Would appreciate any feedback on gut response in moms
after a few days on this. One source recommends dropping dose for a few days
until this clears. We find this helps. comments?

Engorgement:  Find more patients edematous as inductions rise,  and that fluid
in tissues plays HUGE role in nerve response for milk ejection.  We go after
edema at the site as well as overall management without meds - with areolar
"rolling": manual pressure right before the latch on that sie or before pumping,
to press flud out of the tissues and give them some elasticity,so the nerve can
sense the stimulus: it needs a compression and a stretch to perform best.  Again
- any comments?

Appreciate the forum, apologize for length.