I am so sad! I was told I had lupus by my Dr., but then was refered to a Rheumatologist. I saw her yesterday and she diagnosed me with rheumatoid arthritis..at 26! She wants me to start some meds, but I have to stop nursing my almost 6 month old and go on birth control. I feel so guilty. I don't want to give him formula, but I can't live with this pain any longer. I don't understand why I got this. I never get sick...never go to the drs.(except when I'm pregnant)...now I have a life long problem. Sometimes life doesn't seem very fair. I just keep telling myself...it could be worse.

My SIL had to avoid conceiving for a few years, too.

Is there some way this can be postponed until you wean? Is the RA progressing rapidly? painfully?
What a tough decision to make! :(

Hard stuff, and I am so sorry you are having to go through this....

But,you have given your child more than many many children get,,he has been breast fed for 6 months! Feel proud of that! What a great start to life, what love you have shown him, and that love will not stop just because your breast milk will not continue to feed him....

I am sorry :( I was DX with JRA when I was 16. Mine isn't as bad as yours sounds right now, but I fear for it as all the women in my family are nearly crippled with it when they get older. Can I ask what meds they are wanting to put you on?

I am so sad! I was told I had lupus by my Dr., but then was refered to a Rheumatologist. I saw her yesterday and she diagnosed me with rheumatoid arthritis..at 26! She wants me to start some meds, but I have to stop nursing my almost 6 month old and go on birth control. I feel so guilty. I don't want to give him formula, but I can't live with this pain any longer. I don't understand why I got this. I never get sick...never go to the drs.(except when I'm pregnant)...now I have a life long problem. Sometimes life doesn't seem very fair. I just keep telling myself...it could be worse.

I am so sorry. My best friend was told she had RA at your same age and then it vanished without further symptoms.

I would consult with La Leche League first and see what your options are (if you wish to continue nursing your baby).

Hugs,

If you don't want to stop nursing, I'm sure you can find a way. Call your local LLL for medical references..the meds they want you on might be OK, you never know. The BC can be a minipill if need be or some other form...best of luck!

And if you do choose to wean, don't kick yourself..you've done a great job!

Oh, that's really tough! I'm sorry you have to deal with that!

I was just reading an email about a mom who feeds her baby formula with bottles. But she keeps it as close to breastfeeding as possible. The "rule" is don't do anything with the bottle that you couldn't do with the breast: Don't pass it over the backseat, don't prop it up in the stroller, don't let baby lay or sit and drink it alone, limit the amount that other people feed the baby... you get the picture. I'm sure you thought about all this already, but I just think it's so important to reinforce that the benefits of breastfeeding are not JUST nutritional. The bonding CAN still continue - and I know that it will!

I was diagnosed with it when I was about 20. Through furthur testing it turned out to be a virus. I think it was the human form of Parvo(?) if I remember correctly. I had all the RA symtoms and everything.

I agree with what the other posters have said...

1. Check w/ LLL or lactation consultant to see possible options. In my experience, doctors are way too quick to say you have to stop breastfeeding due to a medication. Dr. Thomas Hale has a book which is sort of considered the Bible among medications and breastmilk. Some mamas here might have a copy and can check things for you. LLL should have access to the book too. My own personal experience: I was told by doctor to stop nursing DS when I wanted to take Zoloft. I just didn't take the Zoloft until I later discovered it is actually quite safe to take.

2. If you must bottle/formula feed, you CAN still do so in a loving way which promotes bonding. My own personal choice would be to find a formula that does not undermine breastfeeding. Some formula companies lack ethics, etc - and if I had a choice I would stay away from them. Here is a company that looks interesting: http://www.naturesone.com/mission.htm I haven't done research, so I can't say much about it. I realize that either cost wise or diet wise that everyone doesn't always have a choice with formula brands.

Above everything else, you must do what is best and right for you and your baby.

Question: can you take the mini pill? I thought women who are breastfeeding can take the mini pill. For extra protection, could you combine the mini pill with condoms to avoid pregnancy?

there are less than a handful of medications which require a mother to stop nursing. however most doctors err on the side of "caution" b/c they do not know any better. a study by johns hopkins a few years ago found that in all of med school doctors in training only receive a few hours of bf information. they are the experts on medicine...but not the experts on medicine and breastfeeding...because they have not the training.

if you know the names of the medications, i'd be glad to look them up in thomas hale's "medications and mother's milk"...that's the book for doctors to use when medical issues and bf arise. but they usually don't. :(

or if you are more comfortable doing the research yourself, try this:

Breastfeeding and Human Lactation Study Center (phone 585-275-0088) at The University of Rochester in Rochester, NY, USA. This center maintains a database of drugs and medications and provides free information to physicians on their use and effects during breastfeeding. Ruth A. Lawrence, MD is the Director of the center. Your doctor can call and get info on the drug.

Do you see your drug in the following article? here's an excerpt from below: Methotrexate is excreted into milk in minimal amounts,8 and single weekly doses, such as those used for rheumatoid arthritis maintenance therapy, are unlikely to pose substantial risk to babies.

Which drugs are contraindicated during breastfeeding?
Practice guidelines

Myla E. Moretti, MSC; Amy Lee, MSC; Shinya Ito, MD

September, 2000


ABSTRACT

QUESTION
Many breastfeeding mothers are concerned about taking medications that might affect their babies. Are there any guidelines on which drugs are safe?

ANSWER
Only a few drugs pose a clinically significant risk to breastfed babies. In general, antineoplastics, drugs of abuse, some anticonvulsants, ergot alkaloids, and radiopharmaceuticals should not be taken, and levels of amiodarone, cyclosporine, and lithium should be monitored.



There is no question that breastfeeding is best for providing all necessary nutrients to infants for the first 6 months of life. Use of medication while lactating, however, complicates the decision to breastfeed. Fortunately, most drugs are compatible with breastfeeding and do not pose a risk to infants. While certain drugs are traditionally contraindicated for nursing mothers, many of these restrictions are based on theoretical concerns only rather than on evidence or clinical observation. In this update we discuss these contraindicated drugs in light of the practice guidelines of the Motherisk Program.

Drugs generally considered incompatible with breastfeeding

Antineoplastics. Anticancer drugs used in chemotherapy are generally considered incompatible with breastfeeding because even very low levels of exposure can prove toxic. If breastfeeding is continued, drug levels in milk and infant plasma, and infant hematologic parameters, must be monitored. Much research is still required in this area, and only limited information is available on some of these agents.

Nine cases of infants breastfed by mothers taking azathioprine (25 to 100 mg/d) appear in the current literature. All infants thrived and had no reported adverse effects. 1-3 Breastfeeding might be possible provided infants are closely monitored. Two cases of cisplatin excretion into milk indicated that patients excrete this drug in varying amounts into milk.4,5 The outcome of infants exposed to cisplatin through milk are not known. Adverse events, including neutropenia6 and leukopenia,7 are reported in two infants whose mothers used cyclophosphamide while breastfeeding.

In a single report, low levels of doxorubicin were found in breast milk5 although infant outcome was not known. Methotrexate is excreted into milk in minimal amounts,8 and single weekly doses, such as those used for rheumatoid arthritis maintenance therapy, are unlikely to pose substantial risk to babies. Use of methotrexate for cancer chemotherapy is not recommended for lactating mothers because we do not know how it affects suckling infants.

Anticonvulsants. Only a few anticonvulsants are excreted in high concentrations in breast milk. Phenobarbital, ethosuximide, and primidone might result in substantial infant exposure.9 Close monitoring of infants exposed to phenobarbital is warranted because their blood levels might approach therapeutic levels. Sedation has been observed, and there is potential for withdrawal upon weaning.

Drugs of abuse. Generally speaking, all drugs of abuse should be avoided by nursing women. In addition to unnecessary infant exposure, mothersí ability to care for their babies while under the influence of such substances becomes an issue.

Heavy alcohol consumption was associated with pseudo Cushing's syndrome in a 4-month-old baby.10 Ethanol was also associated with decreased milk intake by infants,11 altered sleep patterns,12 and slower neurologic development.13 If mothers drink alcohol, breastfeeding could be withheld temporarily (about 2 to 3 hours per drink) to ensure alcohol levels in the milk have diminished.

Amphetamines have been detected in infant urine following maternal therapy.14 Nothing is known about maternal amphetamine abuse and its potential effect on nursing infants. Cocaine is excreted into breast milk in notable concentrations; infants might accumulate the drug because they are less able than adults to metabolize it. Cocaine has been detected in infant serum, and toxicity has been reported in some infants.15,16 Infants exposed to marijuana through breast milk showed a delay in motor development at 1 year old.17 Heroin toxicity has been observed in infants breastfed by mothers abusing heroin, but at therapeutic doses, most opioids, such as morphine, meperidine, methadone, and codeine, are excreted into milk in only minimal amounts18,19 and are compatible with breastfeeding. Phencyclidine, a potent hallucinogen, has been found in breast milk several weeks after maternal dosing.20 This is attributable to its long half-life; nursing mothers should be encouraged to avoid it.

Ergot alkaloids. Ergotamine therapy during lactation was associated with ergotism (vomiting, diarrhea, occasional convulsions) in a 1934 publication21 but not in a more recent study.22 We do not know how much of this drug is excreted into milk. Until more data are available, other therapies should be considered for patients requiring headache treatment. Ergonovine is known to reduce serum prolactin levels and might inhibit lactation.23

Methylergonovine, used for uterine involution, does not influence milk supply. It is not found in clinically significant amounts in breast milk24 and can be used safely. Bromocriptine effectively suppresses lactation and, hence, is not compatible with breastfeeding. Also, it could be hazardous to mothers.25

Others. Although the drugs listed below can be used with caution, safer alternative drugs should be considered first if they exist for the particular indication.

Amiodarone excretion into milk varies from person to person. Nursing infants might ingest up to 50% of the maternal dose (on the basis of weight).26 Also, amiodarone contains large amounts of iodine that could affect infants thyroid glands. If the decision is made to continue therapy while breastfeeding, the drug should be monitored in breast milk and infant plasma, as should the infantís thyroid function.

Cyclosporine has been used successfully for several lactating mothers.3,27,28 Breast-milk levels ranged widely, although infant plasma levels, when detectable, were low. Because cyclosporine is a potent immunosuppressant, however, it should be continued during breastfeeding only if levels in milk and infant serum are monitored.

Similar to amiodarone, lithium concentrations vary greatly in milk. Although amiodarone is contraindicated by many authorities because infant plasma levels can reach one third to half of maternal levels,29 the only reported adverse event could not rule out possible effects of in utero exposure.30 Lithium is an excellent example of a drug that requires monitoring and case-by-case assessment so nursing mothers can be successfully treated.

Cigarette smoking should be minimized while breastfeeding. While second-hand smoke exposure is probably the greater concern, smoking might decrease milk supply and nicotine can be measured in breast milk.31

Estrogens found in oral contraceptives have been shown to reduce milk production in some mothers. On the other hand, progestin-only contraceptives are unlikely to affect milk supply. If estrogen-containing contraceptives are to be used, therapy should commence only after maternal milk supply is well established, about 6 weeks after delivery.32 Infant weight gain can be monitored to ensure sufficient milk is produced.

Radiopharmaceuticals might require temporary cessation of breastfeeding because radioactivity sometimes persists in breast milk for hours or even days. Before procedures, breast milk may be pumped and frozen to be given to infants while breastfeeding is temporarily withheld. In addition, mothers should pump and discard their breast milk while the isotope is still present in order to preserve milk production. Recommendations to patients should be individualized to particular agents. Consultation with a nuclear medicine physician and reading the various literature resources available33,34 will assist in determining the length of breastfeeding interruption.

Conclusion

As experience with lactating womenís use of drugs increases, we are realizing that only a few drugs pose a clinically significant risk to infants. This is reassuring for both patients and health care providers faced with the risk-benefit dilemma. To make an informed decision, it is critical that appropriate and the most up-to-date sources be consulted when making recommendations to patients requiring drug therapy while lactating. Contact the Motherisk Program for specific information.




References

Coulam CB, Moyer TP, Jiang NS, Zincke H. Breast-feeding after renal transplantation. Transplant Proc 1982;14(3):605-9.
Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppressive therapy and breast-feeding after renal transplantation [letter]. Nephron 1984;37(1):68.
Nyberg G, Haljamae U, Frisenette-Fich C, Wennergren M, Kjellmer I. Breast-feeding during treatment with cyclosporine. Transplantation 1998;65(2):253-5.
De Vries EG, van der Zee AG, Uges DR, Sleijfer DT. Excretion of platinum into breast milk [letter] [published erratum appears in Lancet 1989;1(8641):798]. Lancet 1989;1(8636):497.
Egan PC, Costanza ME, Dodion P, Egorin MJ, Bachur NR. Doxorubicin and cisplatin excretion into human milk. Cancer Treat Rep 1985;69(12):1387-9.
Amato D, Niblett JS. Neutropenia from cyclophosphamide in breast milk [letter]. Med J Aust 1977;1(11):383-4.
Durodola JI. Administration of cyclophosphamide during late pregnancy and early lactation: a case report. J Natl Med Assoc 1979;71(2):165-6.
Johns DG, Rutherford LD, Leighton PC, Vogel CL. Secretion of methotrexate into human milk. Am J Obstet Gynecol 1972;112(7):978-80.
Nau H, Kuhnz W, Egger HJ, Rating D, Helge H. Anticonvulsants during pregnancy and lactation. Transplacental, maternal and neonatal pharmacokinetics. Clin Pharmacokinet 1982;7(6):508-43.
Binkiewicz A, Robinson MJ, Senior B. Pseudo-Cushing syndrome caused by alcohol in breast milk. J Pediatr 1978;93(6):965-7.
Mennella JA, Beauchamp GK. The transfer of alcohol to human milk. Effects on flavor and the infantís behavior. N Engl J Med 1991;325(14):981-5.
Mennella JA, Gerrish CJ. Effects of exposure to alcohol in motherís milk on infant sleep. Pediatrics 1998;101(5):E2.
Little RE, Anderson KW, Ervin CH, Worthington-Roberts B, Clarren SK. Maternal alcohol use during breast-feeding and infant mental and motor development at one year. N Engl J Med 1989;321(7):425-30.
Steiner E, Villen T, Hallberg M, Rane A. Amphetamine secretion in breast milk. Eur J Clin Pharmacol 1984;27(1):123-4.
Chasnoff IJ, Lewis DE, Squires L. Cocaine intoxication in a breast-fed infant. Pediatrics 1987;80(6):836-8.
Chaney NE, Franke J, Wadlington WB. Cocaine convulsions in a breast-feeding baby. J Pediatr 1988;112(1):134-5.
Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990;12(2):161-8.
Feilberg VL, Rosenborg D, Broen CC, Mogensen JV. Excretion of morphine in human breast milk. Acta Anaesthesiol Scand 1989;33(5):426-8.
Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997;44(6):543-7.
Kaufman KR, Petrucha RA, Pitts FN Jr, Weekes ME. PCP in amniotic fluid and breast milk: case report. J Clin Psychiatry 1983;44(7):269-70.
Fomina PI. Untersuchungen uber den ubergang des aktiven Agens des Mutterkorns in die milch stillender Mutter. Arch Gynakol 1934;157:275-85.
Jolivet A, Robyn C, Huraux-Rendu C, Gautray JP. Effet de derives des alcaloides de líergot de siegle sur la secretion lactee dans le post-partum immediat [Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period] (Fr). J Gynecol Obstet Biol Reprod (Paris) 1978;7(1):129-34.
Shane JM, Naftolin F. Effect of ergonovine maleate on puerperal prolactin. Am J Obstet Gynecol 1974;120(1):129-31.
Del Pozo E, Brun DR, Hinselmann M. Lack of effect of methyl-ergonovine on postpartum lactation. Am J Obstet Gynecol 1975;123(8):845-6.
Comabella M, Alvarez-Sabin J, Rovira A, Codina A. Bromocriptine and postpartum cerebral angiopathy: a causal relationship? Neurology 1996;46(6):1754-6.
McKenna WJ, Harris L, Rowland E, Whitelaw A, Storey G, Holt D. Amiodarone therapy during pregnancy. Am J Cardiol 1983;51(7):1231-3.
Flechner SM, Katz AR, Rogers AJ, Van Buren C, Kahan BD. The presence of cyclosporine in body tissues and fluids during pregnancy. Am J Kidney Dis 1985;5(1):60-3.
Thiru Y, Bateman DN, Coulthard MG. Successful breast feeding while mother was taking cyclosporin. BMJ 1997;315(7106):463.
Schou M, Amdisen A. Lithium and pregnancy. 3. Lithium ingestion by children breast-fed by women on lithium treatment. BMJ 1973;2(859):138.
Tunnessen WW Jr, Hertz CG. Toxic effects of lithium in newborn infants: a commentary. J Pediatr 1972;81(4):804-7.
Dahlstrom A, Lundell B, Curvall M, Thapper L. Nicotine and cotinine concentrations in the nursing mother and her infant. Acta Paediatr Scand 1990;79(2):142-7.
Kelsey JJ. Hormonal contraception and lactation [review]. J Hum Lact 1996;12(4):315-8.
Rubow S, Klopper J, Wasserman H, Baard B, van Niekerk M. The excretion of radiopharmaceuticals in human breast milk: additional data and dosimetry. Eur J Nucl Med 1994;21(2):144-53.
Romney BM, Nickoloff EL, Esser PD, Alderson PO. Radionuclide administration to nursing mothers: mathematically derived guidelines. Radiology 1986;160(2):549-54.

© Canadian Family Physician 2000;46:1754-7.

My SIL had to avoid conceiving for a few years, too.

Is there some way this can be postponed until you wean? Is the RA progressing rapidly? painfully?
What a tough decision to make! :(

The Dr. is giving me 3 weeks to wean. I have been really sick for about 3 months now...I need something.

I am sorry :( I was DX with JRA when I was 16. Mine isn't as bad as yours sounds right now, but I fear for it as all the women in my family are nearly crippled with it when they get older. Can I ask what meds they are wanting to put you on?

The Dr. wants to put me on Methotrexate. And she wants me on BC because the drug is known to cause birth defects if it even makes it to term.

I was diagnosed with it when I was about 20. Through furthur testing it turned out to be a virus. I think it was the human form of Parvo(?) if I remember correctly. I had all the RA symtoms and everything.

This is kinda what I wondering about. They think I also have some sort of virus because I have a rash and had fevers up to 104. Whatever it is...I want it gone!

:big hug: In whatever you decide to do. My dd was bottlefeed and my ds was bfed until 11 months. I was and am no more bonded to my son than my daughter. I actually worried for months that I was less bonded to him. lol
He was always asleep at the breast so we had so much less eye contact. HTH!

:big hug: I'm so sorry, mama.

Looks like Dr Hale even says this is a very very very bad drug to take as well if BF. It is even said that a husband shouldn't take it and have sex without a condom cause it gets into the sperm.

HUGS!

hey crystal! :D

my hale (2000) says:

"the authors conclude that methotrexate therapy in bf mothers would not pose a contraindication to bf. however, it is believed to be retained in human tissues for long periods" (and therefore one should not get pregnant while using it or even for months afterward).

the amount of the medicine excreted into the milk is a particularly small amount.

which version are you using?

did a websearch lol

It seems the drug itself is ok if it is in breastmilk but the bigger problem is that you are not supposed to get pregnant when taking it. Like I said before, I know women who take the mini pill and breastfeed. Is that an option? Perhaps the mini pill is not as effective as the regular pill - but then couldn't you do a combine mini pill condom thing as protection?

Breastfeeding is so very important to me. Honestly - I would even consider abstaining from intercourse if it meant I could no longer nurse my infant -- even if it was six months. Those are my values and I don't mean to push them on anyone else. In any case, my DH and I have fun in other ways other than actual intercourse. ;)

I found this on the internet:

Drugs That Are NOT Safe While Nursing:
Methotrexate (for arthritis): Can suppress the baby's immune system; unknown effect on growth or association with carcinogenesis; neutropenia.

the mini pill should not pose a problem...and many women even take the "regular" pill while bf...it is approved for use by bf mothers by the AAP. :D

it has been found to reduce milk volume in some women...advice is to wait 60-90 days of bf before beginning estrogen birth control so that bf can become firmly established. numerous studies have confirmed "minimal to no effect" on sexual development in infants.

Hale Medications and Mother's Milk ninth edition 2000 pg. 503.

i would advise shring all this info with your doctor and having him/her call the line i posted in my first reply. anecdotal info may go either way but i've been researching this since you posted and it definitely looks like both methotrexate and birth control are compatible with continuing bf...if that's what you want.

knowledge is power.--sir francis bacon

much love

joy

mama, you need to make your own decision. there are potential risks and side effects from taking any drug while bf. likewise, not bf and early weaning have been firmly established as conferring an array of risks to babies. i quoted from resources considered to be the authorities on the subject. i was a la leche league leader for 10 years and have a great deal of experience with which resources are research-based and which are not, and choose what i share with mamas accordingly. i hope you will avail yourself of the resources available to you like the # your doctor can call for the most up to date and authoritative info available...ruth lawrence who runs that research group writes breastfeeding: a guide for the medical profession and is considered one of the top breastfeeding experts in the world. calling LLL and asking that they contact their APL (area professional liason, usually a nurse or doctor who is also a LLLL) will also get you the very BEST, up-to-date, well-researched information. then make your decison knowing you did everything you could to seek out the best information possible.

it's your body, your baby, your choice. :D i think it's great you have given your baby 6 months of bf. and i ;m so sorry you are even having to think about all this. :heart:

peace,
joy

Methotrexate is chemotherapy. You cannot under any circumstance breastfeed while taking chemotherapy. I am completely appalled that chemo is being prescibed for arthritis. You really need to research before taking any drug. Ask the doctor for the Material Safety Data Sheet.

Here is a link to a MSDS for that particular drug:

http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial_s&hl=en&q=material+safety+data+sheet+for+Methotrexate&btnG=Google+Search

It is carcinogenic. It may mask your current symptoms but the long term effects are devastating. I would be looking for another answer to your problem.

What exactly are your symptoms?

Michelle,

I am so sorry this is happening to you! I can't even imagine your heartache.

First of all, call the pharmacy where you get your meds. Your pharmacist will have a list of drugs for RA. He/she will also know which ones you CAN BF and their classifications. You can get an IUD and your insurance should pay for it for your BC and it can be the ultra low dose local hormone IUD Mirena.

Second, if your pharmacist (or Hale's book) doesn't have any suggestions for RA drugs that are ok for BFing, then see if you can start taking the drugs just after 6 months. The current recommendation for starting solids is 6 months after 6 months of exclusive breastfeeding. A BFed baby is going ot have problems digesting formula at first, so you might talk to your ped about Neocate or the other Rx formula. It might help a lot to start with that until your baby is more like 8 months old, then move on to nutramagen or something like that until 1 year.

Again, I am so sorry! Please ask the pharmacist about the drugs for RA. They know a LOT more about the meds than the doctors do, and may be able to help you find something suitable.

HUGS!

Methotrexate is a powerful chemo durg, but it has been widely used in small doses for RA.

To all mama's who have expressed their opinion on this so far: This is a tough road for any mom to handle and a very personal one. I think we need to support this mom and whatever she chooses. She has already expressed guilt about stopping breastfeeding and although it is nothing to feel guilty about at all, moms will just do that. Formula feeding an infant from six months is nothing to be upset about. Six months of breastmilk is much more than most infants get and a mom who feels like crap b/c she is delaying or refusing proven treatment can't be a 100 percent even if she is still breastfeeding. I agree that knowledge is power and she needs to know her options, but let's be very careful and not add to the guilt. I for one would choose to wean rather than take that particular drug while nursing. I would be sad, but not guilty.

Momtoboys: Take care of yourself and you can take care of your babies! Be proud of what you have done and what you will continue to do to love those children no matter what you choose.

hit and run post
http://www.fedupwithfoodadditives.info/

this site talks about an elimination diet...to see if eliminating certain foods will improve symptoms. people have had great success with this:)
also nightshade plants-tomato, eggplant, potato(i think there is one more...but it is escaping me)...should all be avoided.

whatever you decide-Hugs-mama-i hope you get some pain relief soon.

khlinville, since you quoted my knowledge is power reference...i feel i have standing to respond on this one.

i have but one agenda when helping/advising moms with bf questions...to empower them to make their own decisions based on accurate, empirically based information gleaned from research. i have seen hundreds of women do exactly what the doctor says (even when the doctor is wrong) and not feel good about it. weaning is a big decision to make. IMO, the best way to make any mother feel good about her decisions is to give her information and resources so that she feels secure in making her own decision. that shows true respect for her as a mother and a woman.

Michelle, I am so so sorry you are going thru this. I wish there was some way i could help you :tear: Just know that you are in my thoughts all the time!!! :big hug: And remember, if you ever need to talk i am here for you...anytime!

I would question the diagnosis, as well as the fact that your dr. has "given" you three weeks to wean.....sounds like he/she isn't willing to work with you on that one.

There are other things that can masquarade as RA, Celiac disease and other food intolerances are some that come to mind.

Even w/out bdfding being an issue, I would look into alternatives rather than taking a harsh drug like that.

Kristi

This is kinda what I wondering about. They think I also have some sort of virus because I have a rash and had fevers up to 104. Whatever it is...I want it gone!


Human Parvo is the same thing as Fifth Disease, and I was just diagnosed with it, pg no less, so I have learned a lot! In adults it can cause any combination of a rash, fever, cold-like symptoms, and joint pain and swelling. The joint pain can last for months from what I read. Luckily for me, I only experienced the joint pain and swelling and only for a little over a week and a half, but I was utterly miserable and literally could hardly move during that time.

I hope you do get a definitive diagnosis one way or another, and I know how tough a situation this must be. (((((HUGS)))))

First supporting this mom in any decision she makes is good.
Jumping in very late on this one, but I have to second each and every post by Joy. I am a nurse and IBCLC. I have worked in Rheumatology and OB only. Interesting combination, but gives me quite a bit of background on this issue.
Hale is the expert in Medication and excretion into mothers milk. Please do not pull random information of hte Web and quote it as reliable. All of us should know better! Just because it is online in print does not make it true!
As for the methotrexate reference as chemo, yes it is. It attacks the killer cells in RA that are essentially attacking the body. RA is a variation of a autoimmune disease and spreads similar to the way cancer does. It has been used for many years and was a drug of choice waaaay back when I was in that area 12 years ago.
KNOWLEGDE IS POWER, if you do not know better you can not do better!
Peace-
Karen

Hale is the expert in Medication and excretion into mothers milk. Please do not pull random information of hte Web and quote it as reliable. All of us should know better! Just because it is online in print does not make it true!
As for the methotrexate reference as chemo, yes it is. It attacks the killer cells in RA that are essentially attacking the body. RA is a variation of a autoimmune disease and spreads similar to the way cancer does. It has been used for many years and was a drug of choice waaaay back when I was in that area 12 years ago.
KNOWLEGDE IS POWER, if you do not know better you can not do better!
Peace-
Karen[/QUOTE]

I don't know who exactly you are referring to with your "pulling random information off the web" but since you are knowledgable on this topic would you please also include an explanation of the side effects, long term effects, etc. of using a chemotherapy drug. A "drug of choice" does not a good decision make. Let's trade one problem for another.

And I was not linking an unreliable source. Most people are not aware that they can request a fact sheet on drugs. It's not something that the doctors or hospitals hand out. After all, we wouldn't want anyone to know what they are taking.

Okay my Hale book (02) says its okay in acute usage but contradictary in chronic use.

How long does your Doctor wish you to be on Methotrexate? I agree that you should make a decision that you are comfortable with but you also need to be as well informed as possible in making that decision.

There is the link to the section discussing Methotrexate on Dr. Hale's forum.

http://neonatal.ama.ttuhsc.edu/discus/messages/48/1322.html (http://)

Hi Michelle/momtoboys. I've been thinking about you ever since I read your post.
I was diagnosed with RA in 1998, at 23. I know what you are going through. I have been on methotrexate off and on since then, and it truly is my "wonder drug". I have tried everything from elimination diets to alternative meds, and this is the only thing that worked for me. I went through severe depression before I was able to accept it.
I wasn't nursing at the time, but I do remember how wonderful it was when the drugs finally kicked in and I was able to do normal things, like hold my child, without the pain. You will feel like a whole new person when you find what works for you. There are other choices besides the methotrexate, but it usually works for people, so the doctors try it first.
Please pm or email me if you would like to talk to someone who's been there.

I found this on the internet:

Drugs That Are NOT Safe While Nursing:
Methotrexate (for arthritis): Can suppress the baby's immune system; unknown effect on growth or association with carcinogenesis; neutropenia.

could we have your source for this please?

I agree with a lot of what has been said above. Dr Hale is the expert in medications during breastfeeding. he does the research. I would trust him more than any other source out there.

To the OP..mama, I am sorry that you are going through this. I would just say to do your research and do additional testing if you don't trust the diagnosis. I would hate to see you give up BF and in 2 months find that you really don't have RA and you gave it up for nothing. I only say this because I lost my first real nursing relationship to a hasty decision, and I tried to relactate, couldn't and regretted it for a long time.

We will be here to support you no matter what you decide. I hope that some of this information that has been posted will help you in the ways that you need it.

:hug:

This is kinda what I wondering about. They think I also have some sort of virus because I have a rash and had fevers up to 104. Whatever it is...I want it gone!
this may be a really stupid suggestion but I'll say it anyway...

over a year ago I got fifths disease. Marked by high fever, rash and intense, incredible, joint pain. I could hardly move...couldn't grip a cup and the pain of walking was unbearable. I read online that it could take an adult up to 6 months to recover. It took me almost 5 weeks.

I know you are probably really tired of being sick and in pain...I hope you can find some relief. Hopefully you will see a couple of Dr.s and get a couple of second opinions before you quit breastfeeding.

And I was not linking an unreliable source. Most people are not aware that they can request a fact sheet on drugs. It's not something that the doctors or hospitals hand out. After all, we wouldn't want anyone to know what they are taking.

True. I am only going to comment on one part of this and it is to say that often the PDR and other texts used by physicians are using the information provided to them by the pharmaceutical companies. Generally speaking, these companies have not tested their drug on lactating women. Thomas Hale (a pharmacologist, if I remember correctly) has studied the affect of certain drugs on lactating women and their babies. Many drugs have a molecular weight too great to even enter breastmilk and are therefore fine for a breastfeeding mother. Others have short half-lives and can be taken when timed appropriately. Much of this information is not available in resources other than Hale's (referenced) book. Hale's Medications and Mother's Milk is available to the general public - your local bookstore or library may have it or be able to get it for you quickly. It's also available from LLL. Ruth Lawrence's book is also widely available.

If a mother seriously wants to continue breastfeeding, it is worth it for her to do some of her own research. There are times that a physician is NOT fully informed on the options available. Many times they see breastfeeding as something easily abandoned as there is formula available and it's "just as good."

I have met many mothers who get information about a drug/condition/what have you months after she's weaned for that reason and then find out that they could've continued to breastfeed, if only she had had access to more information. Joy is not making the decision for this mother - she can't. What she is doing is giving information. Here are the tools, you decide which ones might be helpful for the task at hand.

~amey

I'm so sorry you're having to endure the pain of this decision while dealing with the pain of RA (or whatever else might be causing the pain). I'm surprised that no one has recommended getting a second opinion. I know before taking such a potent drug, regardless of breastfeeding, I would make sure that was the best recourse and I had a correct diagnosis. I would also try to make sure the 2nd opinion was wess informed about breastfeeding and medications, and willing to do the research rather than taking the easy way out.
Thomas Hale is the authority on breastfeeding and medication. I would trust him before any doctor or drug company. He also has a book called "Clinical Therapy" It may have a section on RA. If it does, it would cover appropriate treatment for breastfeeding patients. Good luck!

True. I am only going to comment on one part of this and it is to say that often the PDR and other texts used by physicians are using the information provided to them by the pharmaceutical companies. Generally speaking, these companies have not tested their drug on lactating women. Thomas Hale (a pharmacologist, if I remember correctly) has studied the affect of certain drugs on lactating women and their babies. Many drugs have a molecular weight too great to even enter breastmilk and are therefore fine for a breastfeeding mother. Others have short half-lives and can be taken when timed appropriately. Much of this information is not available in resources other than Hale's (referenced) book. Hale's Medications and Mother's Milk is available to the general public - your local bookstore or library may have it or be able to get it for you quickly. It's also available from LLL. Ruth Lawrence's book is also widely available.

If a mother seriously wants to continue breastfeeding, it is worth it for her to do some of her own research. There are times that a physician is NOT fully informed on the options available. Many times they see breastfeeding as something easily abandoned as there is formula available and it's "just as good."

I have met many mothers who get information about a drug/condition/what have you months after she's weaned for that reason and then find out that they could've continued to breastfeed, if only she had had access to more information. Joy is not making the decision for this mother - she can't. What she is doing is giving information. Here are the tools, you decide which ones might be helpful for the task at hand.

~amey


I am not good at getting my point across :-) Bear with me. I'll reply whereas you quoted me.

I wasn't looking at the drugs in relation to breast-feeding when I made the comments I did. I was just thinking of the mom and the adverse effects on her from taking that type of medication.

I have not read Dr. Hale's book. I have heard of breast-feeding moms referencing his book though with regards to taking prescriptions.

I hope that the op is able to continue nursing her child. I am a huge lactivist. I nursed my dd forever ;-) I don't ever want to see anyone have to stop nursing until both the mom and child are ready unless there are extenuating circumstances. Maybe this is one of them. I just really wish that the medical profession would offer all sides not just their slanted version. People have a right to know what they are getting into as far as prescribed drugs. And now I wish I had never spoke up.

I will encourage you only to get a second opinion, and ensure that you do indeed have RA. Then, you do what you have to. My mother has RA & is on Methotrexate. That, paired with Humira, is what enables her to do frivolous things like get up out of bed and move around. If you have RA, it is something that is very serious & will indeed require treatment.

When you take any drug, it is a matter of weighing the risks and the advantages. If you have RA, you pretty much have two choices. You can not take the medication, and have a breastfed baby whose mother cannot pick him up or play with him, or you can take the medication and have a formula-fed baby whom you can actually interact with. (Or, you can hope you have a very mild form of the disease which never worsens, although generally the RA diagnosis is not made until it gets bad enough to interfere with life.)

Good luck in whatever you decide in the end, and please do get a second opinion. I have not heard of RA ever causing a rash, so it sounds that at the very least you have something else in addition to the RA, and hopefully you have a misdiagnosis on your hands.

You have received so much wonderful information from so many wonderful mamas. Hopefully you are not feeling attacked or upset by the posts. I think what everyone is trying to say is please get a second or even a third opinion before doing anything. Also please research not only any and all drugs a doctor may suggest or recommend but also any alternative (not herbal I mean other medications that work just as well with less effects) medications there may be as well.

Sadly doctors do NOT know everything. We always think they do but sadly they know very little about most things and alot about nothing much. :(

The more you research the more you will know about what is being put into your body, the effects it has, whether or not it is right for you, whether or not the treatment you are receiving is the best, and everything else you need to get the care you deserve.

Don't give up yet. If you truly want to keep breastfeeding then do some reading from some of the resources listed. Talk to the doctor about what you find. Also, to be honest it sounds like your diagnosis is sketchy at best. What I mean is that this may be a misdiagnosis and there could be other underlying problems. Get a second opinion. There's nothing worse than being treated from something you don't have and still having to suffer the things you DO have. Make sure they get it right the first time.

If after all that you find out you still have to stop breastfeeding then do so knowing you did everything you could and are making the right and best decision for you and your little one and there is NO shame in that at all. It is heartbreaking yes but you won't be left wondering if you did your best and tried your hardest and trust me, that is truly a comfort on the nights when your heart is breaking during weaning. ;)

Take care of yourself and good luck.

I want to thank everyone for their help and information. I guess I have a lot of research and thinking to do. I am just always so tired...I hope I can find the energy to get this all done. Thanks again.

I forgot to give you a link to this website: http://arthritis.about.com/
It has a lot of great info, and the people in the forum are very helpful and nice.

Thoughts I had this morning were:

Fifth's disease (parvo virus) is checkable with a blood test, I think. My midwife in CT checked to see if I had antibodies to it when I was pregnant.

Have you been checked for Lyme's Disease? The symptoms are similar. Again, easily checkable.

And finally, ask about being tested for Multiple sclerolis. It too has similar symptoms.

Warmly,
Amey

hit and run post
http://www.fedupwithfoodadditives.info/

this site talks about an elimination diet...to see if eliminating certain foods will improve symptoms. people have had great success with this:)
also nightshade plants-tomato, eggplant, potato(i think there is one more...but it is escaping me)...should all be avoided.

whatever you decide-Hugs-mama-i hope you get some pain relief soon.

The one you're forgetting is peppers.

My mother has RA & is on Methotrexate. That, paired with Humira, is what enables her to do frivolous things like get up out of bed and move around. If you have RA, it is something that is very serious & will indeed require treatment.

When you take any drug, it is a matter of weighing the risks and the advantages. If you have RA, you pretty much have two choices. You can not take the medication, and have a breastfed baby whose mother cannot pick him up or play with him, or you can take the medication and have a formula-fed baby whom you can actually interact with.

Thank you Sabra!

As a mom who has had RA for more than 15 years reading some of these responses has made me so frustrated!

Michelle needs support from us. IMO she does not need us to second guess her doctor or recommend alternative therapies. I'm sure that the doctor in question did blood tests and a physical history. RA has a very specific pattern that doesn't mimic anything else. My educated guess is that the preliminary diagnosis of lupus was linked to the rash. (Lupus has a trademark "butterfly" rash across the face) Rheumatologists really are the authority on arthritis.

I agree that it is important to research meds and Dr Hale is the referrence I always look to. However, his opinion on methotrexate must have changed. When my oldest child was born in 1996 methotrexate was considered very dangerous so I weaned at age 6 weeks. Since then other meds have come along -- one is Enbrel which has a molecular weight that makes it impossible to pass into breastmilk. I requested it from my rheumatologist after the birth of my second child. I've been nursing for more than 4 years straight and only stopped the Enbrel during pregnancy. So, we who have RA and need immunosuppressive meds can breastfeed our babies. However, Enbrel (and other similar new drugs) costs more than $1200/mo and most moms can only take them if their insurance covers them.

I'm afraid that I'm not very eloquent and fail to make my point without sounding inflammatory. (nice pun, eh?) I get very upset when the incredible, constant pain of RA is not understood. We're talking not able to get up from a chair or climb the stairs pain. In my worst days I couldn't even get up and down from the toilet unassisted. I was unable to change my baby's diaper and was grateful that I knew about slings because without one I wouldn't have been able to hold him.

Sometimes well meaning comments can hurt. I'm not speaking for Michelle, but for myself and many of the comments in this thread fell into that category.

how do i get my child to stop breest feeding? :happy:

from www.lalecheleague.org (http://www.lalecheleague.org/bfinfo.html)

Weaning Basics
[excerpted from "How Weaning Happens," by Diane Bengson, 1999, LLLI]
Weaning can happen in many ways, but weaning methods fall into four basic categories: abrupt weaning, planned or gradual weaning, partial weaning and natural weaning. Here is a brief overview of each method.

Abrupt weaning means a sudden end to breastfeeding, with no warning or pre-planning. Some situations make this unavoidable, but whenever possible, mothers should try to wean more gradually. Abrupt weaning is difficult for both mother and baby. Because breastfeeding is the baby's source of comfort and closeness as well as food, a sudden, forced weaning is emotionally traumatic for the baby. Meanwhile mothers experience the physical discomfort of engorged breasts and risk a possible breast infection. The sudden shift in hormones associated with the abrupt weaning may leave some women feeling sad and depressed for a time, especially if they are not comfortable with the idea of weaning.

In a planned or gradual weaning, the mother encourages the child to wean by providing interesting distractions and other nourishment in place of breastfeedings. The mother eliminates one feeding every few days, giving the baby or child plenty of other loving attention while they both make the transition from nursing to other forms of nutrition and comfort. The mother may offer other food and beverages more often and may read to or play with her child in place of nursing. When weaning happens over a period of a few weeks or months, the child is less likely to be distressed, and the mother is less likely to suffer from engorgement or sudden hormonal shifts. A mother may choose a planned, gradual weaning when she wants to wean but her child does not seem ready to wean on his own. When planned weaning is accomplished gradually and lovingly, it can be a good situation for many mothers and babies.

Mothers who try partial weaning are looking for a compromise between nursing a toddler frequently and weaning entirely. With this method, a mother gradually eliminates most nursings but continues to nurse her child once or twice a day. Often a mother chooses to keep the nursing sessions that her child relies on most, such as the one before sleep or immediately upon waking. A mother may also choose to eliminate the nursing sessions that are the most difficult for her, such as during the night.

Natural weaning means allowing the child to outgrow nursing on his own timetable. Many mothers choose this approach because they recognize how important breastfeeding is to their child, or because they find it easier to wait for the child to wean himself. However, that doesn't mean the mother has no influence in the process. Natural weaning incorporates the natural limit-setting that babies need as they grow into toddlers. A mother who is practicing natural weaning views weaning as a developmental skill and lovingly guides her child as he learns the skills that replace nursing. This guidance may involve asking the child to wait to nurse or providing food or stimulating activity in place of nursing. It involves respecting the mother's feelings and preferences about breastfeeding while also taking into account the needs of the child.

I meant to post this as a new topic, sorry.

How are you doing? You've been in my thoughts. I hope you are in less pain, and that your child is healthy and well.

ari

How are you doing? You've been in my thoughts. I hope you are in less pain, and that your child is healthy and well.

ari

Thank you so much for thinking of me and my baby.
I did stop nursing. My baby is doing just fine. He doesn't seem to mind the formula.
I had to make a choice and I was in too much pain to not start the meds. They are helping, but I still have a lot of inflamation. They just higher my dose. I really hope I can feel normal again one day. I am just greatful I can pick my baby up again.

I was diagnosed with lupus was I was 14 (!). I went to sick kid's regularly. I had rashes, inflamation, severe fatigue, became allergic to the sun, had siezures, to name a few symptoms. I was on tons of meds, in a lot of pain, and sometimes could not even walk.

I feel your pain.

Suddenly in my early twenties ALL my symptoms disappeared. They call it permanent remission. I still am ANA+ (of course, always will be). I have to take very good care of myself (and who shouldn't!). I have had some issues with inflammation, but not because of lupus, but because I will develop arthritis when I am older (both parents have it), but nothing that has needed medication.

I went on to have four kids.

I just wanted to share my story to give hope.

(((Michelle)))
I feel your pain and your joy! :happy:

I had to wean my firstborn at 6 weeks so I could take methotrexate. I was so sad about weaning, but so overjoyed that I could hold and care for my son.

I'm so happy that you are feeling a bit better. Please keep in touch (and get support when you need it) through our AP Arthritis Moms group. :)

Hey! That's really great that the pain has gone down! That's relief that your son is okay with the formula. I am so glad you two are able to be in a good place.

Methotrexate sounds pretty rough on you. Although, not having so much inflammation- it does feel like a slow burn, doesn't it?- must be so nice.

I am so glad you two are doing well.

ari