To expect not to be told to stop breastfeeding in order to take a drug that has been classified as SAFE for breastfeeding

[BeyondTheLimitsOfAcceptability]

I have a rheum appt coming up and am psyching myself up for it. I have psoriatic arthritis and need to start DMARDs asap, however consultant refuses to prescribe them while I am breastfeeding. The paperwork I was given by the hospital says sulfasalazine is safe for BF, directly contradicting the consultant!

DS2 is 15m and on one feed a day now. I'm half tempted to say I've stopped, I won't as I don't tell lies to HCPs, but IABU to think the consultant is BU? I went in last time saying "but it says its safe" and was told I was wrong

And, what do I do? If it were a GP, I could get a second opinion easily, yes? How do I do that with an NHS specialist?

[TenaciousOne]

MrButtercup, what would you do with my DS who can't have cows milk or soya (yuk) in any form and I needed to take medication?

[Thumbwitch]

Actual science showing that consumption of dairy can increase the risk of some cancers, especially breast and prostate. Really not that great to replace breast milk, eh.

[SeriousWispaHabit]

I am a GP and I find it astounding how many HCPs are not well informed about drugs in breast milk. I had a patient in tears because she wanted antidepressants for her disabling PND but also wanted to continue breastfeeding and was convinced she couldn't do both after speaking to the psychiatrists, when there are several antidepressants that are absolutely fine to breastfeed with.

There are many drugs that are safe in breastfeeding if you look at the evidence ( Buttercat that may be a novel concept for you so sorry if this is all a bit over your head) and it is misinformation and lack of knowledge about breastfeeding that can lead HCPs to suggest women 'just stop' breastfeeding. I am on a one-woman misison to change things within our practice, and then our locality....

Buttercat you are coming across as one of those slightly hysterical Daily Mail types who are scared of 'chemicals' and who think that breastfeeding is actually a bit icky.

[missrlr]

OK there is a general acceptance (in the USA) that this particular drug CAN and DOES appear in breast milk, and metabolised derivative thereof, which frankly are more likely to be of issue here.

And I quote "This drug passes into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast-feeding." from here www.webmd.com/drugs/drug-6260-sulfasalazine+oral.aspx?drugid=6260&drugname=sulfasalazine+oral

It is also backed up here in the UK www.nhs.uk/Conditions/Arthritis/Pages/MedicineOverview.aspx?condition=Rheumatoid%20arthritis&medicine=Sulfasalazine

www.infantrisk.com/forum/showthread.php?569-Breastfeeding-on-Sulfasalazine explains the point well I am about to make below.

Bearing in mind the undesirable side effects of this drug are gastro-intestinal related let's face it exploding nappies and associated drama are fairly unpleasant to deal with

CLEARLY this is a case of INFORMED CONSENT - you the patient needs to know this is a side effect (to your child) and if you are happy to deal with this and accept the risk. I suspect some people would rather not risk such episodes with a small child, but also the consultant needs to explain to you why they think such a thing, for all we know there could have been some advice given to change the stance on this that has not filtered into the general populus now.

Take your information but don't treat this as a battle, you are still on a fact finding mission here, you may discover information you are not aware of now that may alter your thinking. Be open to information not just I am right.

Good luck and I hope you can come to a fully informed decision about your treatment that helps you and your DC

[neunundneunzigluftballons]

seriouswispahabit I wish you were my gp any chance you want to move to Ireland we would welcome your bf advice with open arms.

[MrButtercat]

No Serious not scared of chemicals however I would avoid exposing a newborn or toddler to drugs if I could ( the op can)as none of us can write the future.

Well aware of antibiotics in non organic cows milk.Strange some posters seem to have a fear of anything cow related however would happily expose young babies and toddlers to drugs far less widely scrutinised(or used).

Strange.

[redastra]

Health professionals do not take prescribing of DMARDs lightly. While most are safe for most people, they are a large number of people who have unwanted side effects - some noticeable like a twitch/tic,weight gain/loss, hirsutism and alpeocia amongst others. But they are equally as many that can cause hidden symptoms that can take a toll on the body as a whole - have effects on kidney and liver function, the body's ability to process certain other chemicals, occasionally rise in other hormones. (Look at Roaccutane as an example)

When an individual is started on a DMARD they are very closely monitored for the first 6 months and then are normally reduced to 3-6 monthly reviews, dependent on the drug and general health (this would then increase again if they become pregnant, or are commenced on other meds).

Personally I would not like to start a patient on a DMARD while they are pregnant or breast feeding without very careful consideration as their body is not in its natural state ie it already has elevated levels of hormones, proteins and enzymes which while are safe may mask the true effect of what the drug is doing. It is entirely different if they have been on it for some time prior to being pregnant/breast feeding as we already know what their resting state is.

I think that sometimes the public are very judgemental about HCPs and their opinions on breastfeeding, and while I will agree that some are archaic and lacking in knowledge. The vast majority actually do know what they are talking about. (I will probably be flamed for this comment).

I tend to find that breastfeeding is such an emotive issue for some that if I suggest that a Mother were to stop breast feeding for reasons pertaining to her own health. They immediately stop listening at the point when i make the suggestion and dont actually listen to the explanation.

Just for those who might say that I dont know what I am talking - I breast fed until my daughter was 9 months and stopped due to being so grossly anaemic, vitamin deficient that i had to have specialised high dose therapy along with other drugs (including an anti-depressent) in an attempt to normalise by levels. I also take a drug similar to a DMARD once weekly to maintain these levels and am expecting my second child in Jan 2014.

[ICBINEG]

it's not just antibiotics butter there are tons of chemicals and drugs in cows milk organic or not. And as several people on here have or know DC that went into anaphylactic shock on introduction of cows milk, you will no doubt understand why we find advising people to introduce cows milk a somewhat risky activity.

[redastra]

sorry didnt realise that that was so long

[MrButtercat]

Anyhow op you chose to post on aibu,I answered.If you don't like answers different to what you want to hear don't post or bother with consultant appointments.

[ICBINEG]

butter nobody likes answers that differ from the truth though...whether or not they support your point of view. Your answers fail the evidence/truth test not the popularity of opinion test.

[MrButtercat]

Icb the vast maj of kids don't have dairy allergies.This thread isn't a dairy allergy thread.

I have nephews with a cows milk allergy,they had goats milk formula on prescription.There are alternatives.

[CrackersandCheese]

Your posts are so ridiculous MrButtercat.

What a shame everyone on the thread can see that and you can't.

[MrButtercat]

Whatever.

[TarkaTheOtter]

MrButtercat I have no problem with cows milk. I drink it. My 17 month old drinks it since I stopped bfing. I just thought that your logic that the op should not expose her child to any risk, and switching to cows milk being the way to achieve that, was nonsensical. Everything carries a risk.

[MrButtercat]

No not any risk,the risk of a drug with side effects as described further down.Op doesn't need to take the risk.She asked for an opinion and she got it.

[HoneyDragon]

Being sacred of cows is sensible. I once spent half an hour up a tree to avoid cow related death.

[BeyondTheLimitsOfAcceptability]

Redastra, thank you for posting exactly what the consultant should have said to me if that was the problem! I accept that as a reason, makes perfect sense to me. No idea why the consultant thought it would be best to tell me it was a definite no way, not ever though?! Because that is not the same thing by far! :)

MrButtercat - "Anyhow op you chose to post on aibu,I answered.If you don't like answers different to what you want to hear don't post or bother with consultant appointments." Are you confusing me with someone else? I'm quite sure I havent told you or anyone else not to post?

[TenaciousOne]

It may not be a dairy allergy thread, but I did need medication and my son can't have dairy nor goats milk, nor soya. So what was I to do? Not take the medication or leave my son without any milk as he won't take the amino acid based formula.

[neunundneunzigluftballons]

As opposed to goat's milk formula Mr Buttercup that poses no risk. You do realise that the benefits of breastfeeding are a thinly veiled disguise for the risks associated with formula don't you? Do you inflict those risks on your children?

[neunundneunzigluftballons]

Do = did

[VinegarDrinker]

Apologies for derailing even further but Tenacious - all proteins (including milks) are amino acid based. It's the definition of a protein.

[MrButtercat]

Sorry Neu your post makes no sense.

Op glad you got the info you needed,did you not ask why when you went in?

Soooo all those posts saying ignore him were worthwhile then,glad the op stuck around and didn't sail off into the sunset.

[TenaciousOne]

I know but thats what the HCP that prescribed the formula called it. I call it fake milk or that disgusting stuff but I'm not sure either of those would go down well.

[neunundneunzigluftballons]

Well Mr Buttercup if we follow good science and use the biological norm as breastfeeding and then rewrite the so called 'benefits' of breastfeeeding we soon find ourselves seeing the risks of formula.

Formula does not contains antibodies which help protect babies against infections such as coughs, colds, chest infections and tummy upsets.

Formula increases the risk of childhood obesity.

This list is clearly not exhaustive and doesn't include the formula risks for the mother such as an increase in certain forms of cancer in women who do not breastfeed.

My question was are you consistent and did you not expose your children to those risks?