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>There are 12 messages totalling 301 lines in this issue.
>
>Topics in this special issue:
>
> 1. Marijuana
> 2. Information on LAM (2)
> 3. Herbs again!
> 4. LC job description
> 5. LAM, ditto!
> 6. Thyroid question
> 7. 5%- insufficient milk
> 8. slow gain baby
> 9. witch milk
> 10. WIC Again
> 11. receding chin?
>
>----------------------------------------------------------------------
>
>Date: Fri, 19 Jan 1996 10:32:37 -0600
>From: "Dr. Tom Hale" <[log in to unmask]>
>Subject: Re: Marijuana
>
>To : Dr. Montgomery
>Re : Marijuana and drugs of abuse.
>
> This question concerns a mom who has in the past month used
>Marijuana(MJ) and wishes to breastfeed. This is a question that I am
>asked almost every week, particularly from child protective services.
>Unfortunately, its a judgement call that has to be weighed closely.
>
> First, marijuana is a very lipid soluble drug, that is sequestered
>for long periods of time, not in the brain, but in lipid rich(adipose)
>tissue of the body. It produces sedation, decreased aggressive behavior,
>and the classic "Amotivational syndrome". Chronic high dosage produces a
>dose related depression of ovarian function, a decrease in LH and FSH and
>anovulatory menstrual cycles; and in males may reduce
>spermatogenesis(lowers testosterone). Animal studies suggest a decrease in
>prolactin production and milk production.
>
> The elimination half-life is approximately 30 hours, although
>certain metabolites may be longer. Because MJ metabolites are retained for
>long periods in lipid rich tissues, small(but detectible) levels are
>excreted for weeks. Such levels lead to a positive urine screen for at
>least 2 weeks, and maybe a month in chronic high-dose users.
>
> The milk:plasma ratio is approximately 8, and it appears that
>marijuana is readily transferred into human milk. We do not know if the
>levels are high enough to produce neuroleptic effects in a nursing
>infant... I rather doubt they are but this would depend on dose and
>temporal factors. More importantly(legally), the infant and mom will
>continue to test positive on drug screens for some time(even if mom has not
>smoked recently), even though the infant may be only exposed to minuscule
>concentrations of MJ. Thus far, a number of studies seem to indicate that
>there are no long term sequelae from prenatal or postnatal exposure to
>marijuana, although there is room for argument.
>
> So I generally recommend to Child Protective services, that mom be
>routinely screened for drug abuse(cocaine, MJ, etc.). Because the process
>of breastfeeding is so terribly important for bonding and medical reasons,
>I think continued breastfeeding is worth the risk of exposure to small
>levels of drugs of abuse(which we know seldom produce pharmacologic
>effect).
>
> So I recommend continued monitoring, and let the mom breastfeed.
>Both she and the infant will probably still be positive for MJ for up to a
>month, but the urine levels should be dropping. What do you do if the mom
>still tests positive for MJ use after one month...use your best judgement,
>knowing that the neuroleptic effects of low dose marijuana in the infant
>will probably be minimal.
>
> This is one of those times, that pharmacologic reasoning should
>probably over-rule our emotions, and when the wonders of breastfeeding
>significantly outweigh smaller risks of exposure to MJ.
>
>Tom Hale
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 12:50:00 -0500
>From: Cynthia Visness <[log in to unmask]>
>Subject: Information on LAM
>
>For information on LAM, write to:
>
> The Institute for Reproductive Health
> Georgetown University
> Department of Obstetrics and Gynecology
> 2115 Wisconsin Avenue NW, 6th floor
> Washington, DC 20007
>
>Miriam Labbok is the Director of BF and MCH at the Institute and
>is in charge of research and promotion regarding LAM (primarily
>work in developing countries funded by USAID). They have lots of
>good information.
>
>I also have a 1-page fact sheet on LAM ("Is Breastfeeding an
>Effective Contraceptive?) that I would be happy to share. Send
>me a snail-mail address. (However, I can't be sending out 700+
>of these things. Is there some more central LC resource place
>that would like a copy or stack of copies?)
>
>-----------------------------------------------------------------
>Cynthia Visness Voice: 919.544.7040
>Research Associate Voicemail: 919.544.6979 x586
>Family Health International Fax: 919.544.7261
>Contraceptive Use & Internet: [log in to unmask]
>Epidemiology Division
>
>Post Office Address: Shipping Address:
>P.O Box 13950 2224 Chapel Hill-Nelson Hwy
>RTP, NC 27709-3950 USA Durham, NC 27713 USA
>-----------------------------------------------------------------
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 13:31:58 -0500
>From: Dany Gauthier <[log in to unmask]>
>Subject: Herbs again!
>
>To Kris:
>
>Cascara is an anthracene derivative. In Berkowitz's second edition "Handbook
>for Prescribing Medications During Pregnancy", it says:
>
>" The presence of anthracene derivatives in breast milk and the incidence of
>diarrhea among nursing infants whose mothers ingest these substances are
>controversial. In his book on drugs in breast milk, Wilson notes that the
>standard recommendation is for nursing mothers to avoid these medications,
>but that documentation of risk is lacking.
>
>In another reference "Self Medication - A Reference for Health
>Professionnals" from the Can. Pharm. Ass. (988: 329-30), it says:
>
>" Stimulant laxatives produce severe abdominal cramps frequently, increase
>mucus secretion and in some individuals, lead to an excessive evacuation of
>fluids."
>
>I also found that Goldenrod leaves have allergenic properties. Licorice root
>in large amounts can cause sodium and water retention, hypokalemia,
>hypertension, heart failure and cardiac arrest (B Bannister et al, Br Med J,
>2:738, 1977; TJ Chamberlain, JAMA, 213:1343, 1970; M Koster and GK David, N
>Engl J Med, 278:1381, 1968.
>
>By the way, just a little something from Berkowitz on Aloe:
>
>"Aloe is contraindicated in pregnancy because it can cross the placenta and
>stimulate the fetal intestine, leading to the passage of meconium."
>
>Aloe is also an anthracene derivative and its ingestion often results in
>colic! A warning for moms who wish to use it on their nipples. I have known
>some who would take the aloe directly from a cut plant and apply it directly
>to their nipples before feeding...
>Dany Gauthier IBCLC
>[log in to unmask]
>Montreal, Canada
>Tel: 514-923-3792
>Fax:514-923-3802
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 13:57:13 -0500
>From: Elisa Hirsch <[log in to unmask]>
>Subject: LC job description
>
>Do any of you LC's that work in hospitals strictly as LC's have a job
>description? This does not exist in our hosp and I'm considering putting one
>together. If you can help please let me know.
>
>TIA
>Elisa Hirsch, RN, IBCLC
>Westlake Village, CA
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 13:33:43 -0400
>From: "Linda Volkovitsch, Nursing Mothers Counselor" <[log in to unmask]>
>Subject: LAM, ditto!
>
>I would like to second Julie Brill's request. I did not save the LAM
>information and now would like to know much more about it. I would truly
>appreciate it if I could also get copies of any and all LAM information. I
>am slowly but surely learning to save everything (and wondering if buying
>stock in disk companies is the way to go....?)
>
>TIA,
>Linda V.
>[log in to unmask]
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 14:39:24 -0500
>From: Anne Andrianos <[log in to unmask]>
>Subject: Thyroid question
>
>Back in Oct. I posted a message re: a mother experiencing a hyperthyroid
>crisis. She was losing 1# per day, racing heart rate, elevated blood
>levels. Was beginning to wean for treatment. Then, a reversal started.
>A brief period of normal values and feeling well, milk supply which had
>dipped, was returning. But now is in a hypothyroid condition. She is
>receiving replacement hormone. but is having difficulty getting the dose
>right. With one dosage (1.25mg. synthyroid she's symptomatic, with 1.50
>she's hyper...etc.) The question she asked...does the fact that she is
>lactating make controlling her condition more difficult? Her baby is 7
>mos. on some solids, but still nurses a lot. She feels that since
>lactation is the normal condition for a woman 7 mos post partum, that
>BFing is not complicating her treatment, but requests some other
>opinions. Her MD's have spoken with R. Lawrence when she was
>hyperthyroid, I suggested a 2nd consult. TIA, Anne Andrianos
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 15:04:35 -0500
>From: pat Bull <[log in to unmask]>
>Subject: 5%- insufficient milk
>
>Sorry Jan or Marsha if you have already responded to this issue. I am still
>60 messages behind.
>
>Marsha Walker and I were talking in FL. about this issue and she brought up a
>good point. Many insufficient articles talk about the mothers BF, but what
>do they mean by breastfeeding mothers? Putting the baby to the breast once?
>twice? every hr.? etc. Of course some of these mothers claimed to be
>breastfeeders have insufficient milk. All due to mismanagement. We have to
>be careful with where some of this research comes from.
>
>Pat Bull, RN, IBCLC
>>From Chicago where it has dropped to -20=cooooold!
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 15:52:56 -0500
>From: M Kennedy <[log in to unmask]>
>Subject: Re: Information on LAM
>
>Please post 1 page hand out on LAM on Lactnet.
>
>Thanks, M. Kennedy
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 16:04:12 -0500
>From: "Natalie Shenk, BS IBCLC" <[log in to unmask]>
>Subject: slow gain baby
>
>Denise,
>Thanks again for the update. I look forward to hearing chiropracter's
>report.
>
>A question I have is, Can a receding chin affect bottle-feeding this much?
> Baby was having trouble with both. Curious why baby had to be weaned to the
>bottle...or is a different bottle style & nipple helping?
>
>I'm glad mom has found a way to enjoy comforting baby at breast and to get a
>little taste of that closeness.
>
>Natalie Shenk
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 16:06:24 EST
>From: Duncan Broadfoot <[log in to unmask]>
>Subject: witch milk
>
>My son claims I got a message re the above - but it has disappeared. Could the
>sender please re-post?
>
>TIA
>
>Mary Broadfoot, Paisley, Scotland
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 15:13:09 -0600
>From: "Debra J. Salings" <[log in to unmask]>
>Subject: Re: WIC Again
>
> I agree that wIC is at least trying to promote breastfeeding and
>that you can't make someone learn about breastfeeding if they don't want
>to hear it.
> However, I disagree with the fact that they are (at least in
>Missouri) advocating starting cereal in exclusively breastfed infants at
>4 months and starting vegetables at 5 months...this is what they are
>teaching.
> I have had a lengthy discussion about this with one of the
>nutritionists at our local WIC office; but again, you can't make someone
>learn if they don't want to listen...the position taken is that iron
>stores are depleted at 4 months and must be supplemented with cereal or
>iron-fortified formula.
> We need to have a program that not only gives lip service to
>promoting breastfeeding but gives the correct information as well. I was
>told that breastffeding up to one year of age is "highly unusual" and
>that an infant should be 'weaned to a cup' by then.
> I was looking forward to becoming a peer breastfeeding counselor,
>but I am not sure if I can hold my tongue with these attitudes!
> Maybe I just need to cool down a bit...
>
>------------------------------
>
>Date: Fri, 19 Jan 1996 16:19:28 -0500
>From: Sue Jacoby <[log in to unmask]>
>Subject: receding chin?
>
>Denise's slow gaining baby story raises a recurring questions for me. << Baby
>has seen an OT who felt that her receding chin was the problem and was pretty
>furious that the baby hadn't been sent to her sooner. Within a day of her
>initial evaluation, etc, the mother received a call from pediatrician and OT
>that the baby needed to be weaned to a bottle immediately.>>>
>
>My question is: how likely is it that a *receding chin* would cause
>breastfeeding problems? I was always led to believe that babies have
>receding chins on purpose, so they can get up close to the breast. Now, I
>HAVE heard one LC talk about jaws that don't line up, so to speak, so that
>the jaws don't effectively compress the sinuses. How much of a connection is
>there between receding chins and jaw compression issues? Does anyone have
>anything to say about assessing jaw alignment? This is unfamiliar territory
>for me. TIA Sue Jacoby, IBCLC & LLLL suejacoby@AOL
>
>------------------------------
>
>End of LACTNET Digest - 19 Jan 1996 - Special issue
>***************************************************
>
>
Lynda Millman
Stephen J. Millman, M.D.
Fellow, American Academy of Child
and Adolescent Psychiatry
PO Box 3516
La Mesa, CA 91944-3516
Fax 619-589-6971
619 469-2088
|
