I have been in phone contact with a client whom I had seen several times
during the first month after she delivered twins.  The boys are now 2 months
old and weigh 9 and 13 pounds.

The mother is taking ibuprofen (Motrin, Advil), carisoprodol (Soma) and
hydrocodone with acetaminophen (Vicodin, Lortabs) for "sciatic pain" which is
so severe that she is unable to walk or care for her babies.  She is pumping
and dumping her milk (not sure how often) and now getting almost nothing
after having had a full supply for twins a week previous.  She also has
undiagnosed nipple pain.  I have not seen her nipples, but her OB and peds
have ruled out thrush.

I recently heard that a local LC has seen several cases of inability to
let-down milk apparently caused by high levels of ibuprofen.  What are your
experiences?  Any references in the literature?  What are her chances of
getting back her milk supply after getting off the meds if she continues
pumping.  I recommended pumping at least 4-6 times a day which I felt was a
realistic goal in her situation.  Would more frequent pumping help?  She is
using a hospital grade electric pump and was previously able to increase her
supply using this pump.

Please reply privately as well as to the list as I am currently NOMAIL.

TIA
Bonnie