As a writer, I receive a lot of comments on columns. I read and listen to all the feedback I'm getting, and make adjustments as needed.

Sometimes people tell me, "wow, what you just said is unbelievable," like when I tell them calcium has been linked to prostate cancer.

I truly like the honesty of comments like that, because I’m reminded of the first time I read that statement on the FDA website. I couldn’t believe it either. I didn’t even tell people about it because I didn’t understand it and I couldn’t explain it.

I forgot I had that reaction to that FDA statement years prior to writing about it, and now I’m comfortable sharing this discovery. I still don’t understand it completely, but I put that information out there for people to use however it can help them.

I also receive hypercritical, judgmental comments that I feel are an attack and insult to my personal character. These types of comments used to make me feel sad because I believe I was being misunderstood.

I thought of the song by the Animals: "please don’t let me be misunderstood, I’m just a soul whose intentions are good."

I’m learning how to avoid being misunderstood. I’m learning how to be very clear with my messages. I’m also learning a lot from the editors of this magazine. They do an amazing job adjusting my articles. I’m learning to follow their lead.

In my recently-published column, “The Number One” I used the emotionally-charged word “hate” 3 times. "I hate this question. I hate being the bad guy. I hate that feeling."

The point of the article was that as a pharmacist, sometimes I’m forced to tell patients no, they cannot have their medications for various reasons, and by doing so I become the bad guy.

That was the point of article but in looking at some of the feedback I have since recieved on this column, I realized never to use emotionally charged words again. In future articles I’ll say “I dis-LIKE that feeling, I dis-LIKE being the bad guy.”

I re-wrote the article with new insight and understanding on how my choice of words was making my readers feel (see below). I don’t want my readers to experience any negative emotions when they read my articles. I only want to encourage and enlighten my readers. Truly, that is my only intention when writing articles.

I care about your feedback and comments. Thank you for all the kind comments in the past. I don’t want to forget those in light of the rare unkind ones. Please feel free to share your thought on the subject. I’m still listening to you.

The Number One Most Dreaded Drug Question I Get Asked

The number 1 most dreaded question I get from people is "can I take this medication and breastfeed my baby?"

I usually look in a lactation reference to see if any adverse reactions have been reported or if the drug crosses into the breast milk. If there is no information on the drug other than it does cross into to the breast milk I say, “It crosses into the breast milk and there is no telling what it could do to your baby.” It seems like 90% of the drugs fall into this category.

That’s usually when the mother asks me again. “Are you sure?” And then I feel bad for interfering with nature and the love between a mother and her baby.

I don’t like that feeling. I don’t like being the bad guy, but if I say “yes” and her baby is harmed, then I’m responsible and the baby suffers consequences.

The problem is that we don’t have a lot of lactation drug studies. There is a lot that we don’t know because no one wants to volunteer to see if the drugs harm babies, because they might.

There are some drugs I know off the top of my head that will mess up breast milk. Strong antihistamines can dry up the production of milk. When I tell mothers this they usually say, “I will suffer without that medication so I can continue to feed my baby.”

In the hospital, we prescribe life-sustaining drugs to nursing mothers who want to continue to breastfeed. One lady broke down in tears when I said no because she said she knew that was going to be her last baby and last chance to breastfeed.

Knowing that postpartum mood changes are as common as 35% to 75% of the time

,

¹

I want to be sensitive to that fact. The mother is asking me her question for the first time, and I’m hearing it for the umpteen million time.

Instead I respectfully recommend pumping and dumping. This is an option for short-term drugs like antibiotic. However, in the hospital many times we are starting long-term drugs and pumping and dumping is not an option.

Pumping and dumping is when a mother formula feeds the baby while on the medications. So that her milk doesn’t dry up, we recommend that she pumps the breast milk out and throws it away. When she completes the drug treatment and the medication is out of her system, she can resume breast-feeding. I often recommend this when possible.

There is an excellent article on this topic in

Pediatrics

titled: "

The transfer of drugs and therapeutics into human breast milk: an update on selected topics,"

for anyone wanting to know more on the subject and to possibly diffuse the stress of answering this question.²

Drugs that are considered safe to take when breastfeeding. (

This information can be found in any drug reference book

.)

Acetaminophen

Acyclovir and valacyclovir

Antacids (Maalox, Mylanta)

Bupivacaine

Caffeine (up to 3 drinks/day) - (coffee, soft drinks)

Cephalosporins (Keflex, Ceclor, Ceftin, Omnicef, Suprax)

Clotrimazole (Lotrimin, Mycelex)

Contraceptives (progestin-only) - (Micronor, Norplant, Depo-Provera)

Corticosteroids (Prednisone)

Decongestant nasal sprays (Afrin)

Digoxin

Erythromycin

Fexofenadine

Fluconazole

Heparin

Ibuprofen

Inhalers, bronchodilators, and corticosteroids

Insulin

Laxatives, bulk-forming and stool softening(Metamucil, Colace)

Lidocaine

Loratadine

Low molecular weight heparins (enoxaparin)

Anticoagulants

Magnesium sulfate

Methyldopa

Methylergonovine (short courses)

Metoprolol

Miconazole (Monistat 3)

Nifedipine

Penicillins (Amoxicillin, Dynapen)

Propranolol

Theophylline

Tretinoin (Retin A)

Thyroid replacement (Synthroid)

Used to treat thyroid problems

Vaccines (except smallpox and yellow fever)

Vancomycin

Verapamil

Warfarin

References

1. Seyfriend LS, Marcus SM. Postpartum mood disorders.

Int Rev Psych. 2003;15(3).

2.

Hari, Cheryl Sachs and Committee on Drugs. 2013. The transfer of drugs and therapeutics into human breast milk: an update on selected topics.

Pediatrics

. 132(3):e796-809.

http://dx.doi.org/10.1542/peds.2013-1985

.