Guest post by Ruzawench: “Fat and breastfeeding? The amphetamine script’s in the mail.”

This guest post is from Ruzawench, a FOAF of Lauredhel’s. She is posting her experience as a comment on how unexpected weight gain is treated by the medical community, and as a warning to other women.

~~~

I had a baby in August and am breastfeeding. When I got home from hospital I weighed myself out of curiosity and found that I weighed the same as I did prior to pregnancy. However, in a few weeks I noticed that I started gaining weight. I kept gaining weight without any good reason that I could see and contrary to most breastfeeding women who lose weight!

I consulted with my GP and she ordered some blood tests. These all came back normal, however, I had since put on more weight (it was then 10kg’s within 4 months!) and I was worried that there was something wrong with my hormones, specifically my thyroid. She referred me to Dr M. I didn’t see Dr M because he charges $1200 per consult!

I was told Dr Z only charged $400 per consult (still very high!) and specialised in womens weight issues etc. I organised an appointment with her in December.

I had a 1-hour consult with Dr Z, during which time I explained that I was still breastfeeding and that I was concerned about my recent weight gain being caused by a hormone imbalance. She ordered some more blood tests and advised that some women are unable to lose weight while breastfeeding due to the effect of the prolactin on their bodies, so we would have to be careful about how we proceed in my weight loss plan. She also asked whether I considered surgery to be an option.

Prior to leaving she asked me to do a fat scan – which basically is a scan of your body to show the approx weight of fat, muscle and skeleton. This was a further $120.

I had my blood taken on the 2nd of January and waited on her call for the results. After a week I called her office and left a message – she was on holiday. I called again a couple of weeks later and left another message. I received a call from an assistant stating that all the blood results had not yet been received and that Dr Z would email me.

I received an email on the 2nd of Feb asking me to keep a food and exercise diary and to make a further appointment in a months time with the Dr. I found this to be totally unsatisfactory and replied in email that I could not afford to continue with consults, I was too focused on caring for my baby to be worried about keeping tabs on food & exercise and that I was still awaiting test results – I requested that they forward my results to my GP if they were unable to get them to me.

A week after telling them I no longer required their services, I received two prescriptions in the post from Dr Z – one was for EAC – which is a combination of Ephedrin, Aspirin and Caffeine. The other is a script for three medications Bupropion, Duromine and Sibutramine. There were no instructions with these scripts and no information on what these medications do. I looked them up on the Internet (Wikipedia) and found that two of them were anti-depressants, and I already knew what Duromine was. I didn’t think any of these were suitable for a breast feeding mother.

I plan to take these scripts to my GP to discuss further with her, but I do not plan on filling them. I am shocked to have received these scripts with a further consult, or without even being given my test results.

~~~

Note from lauredhel: There are multiple layers of wrong in this story. I’m sure you’re all astonished and disgusted that scripts for a whole pile of these extremely powerful and potentially very dangerous medications would be just thrown at someone with neither discussion nor informed consent. Even if the medications were appropriate (and I believe that weight loss medications are not), it would have been very simple for the consultant to write a letter to Ruzawench’s GP so that the GP could discuss them with her in person. Consultants are required by medical ethics (and sometimes by law) to provide a report to a referring doctor with their findings and management plan.

Most medications are very safe in breastfeeding, though doctors will often tell you they are not, and will inappropriately suggest pumping and dumping, or even weaning. There are a number of resources available to check out the safety of medicines in lactation. (I can perhaps put these in another post if people would like?)

Amphetamines are one of the very few classes of medications that are generally recognised as being unsafe in breastfeeding, along with medications like lithium, radioactive iodine treatment (not diagnostic scans, just treatment), and most chemotherapy.

Be careful out there.



Categories: media, medicine, social justice

Tags: , , , , , , , , ,

21 replies

  1. Something of a side note: rxlist.com is a really good site for looking up prescription drugs. I’ve been mismedicated (and in some really frightening ways) so many times that i won’t take something without looking it up first.

  2. What an extraordinary story! Thanks for this guest post, this is one of those stories that you have to hear first hand, because when you feel *that* disturbed by the medical system you need to know it really, truly happened. Outrageous.

  3. Be very very wary of doctors who simply claim your thyroid tests are “normal” without telling you the numbers. Always get a copy of your pathology results! The “normal” range for the TSH test, the main diagnostic used by doctors for thyroid function, is considered far too wide by an increasing number of doctors.
    Check out the last 5-6 posts at Mary Shomon’s thyroid blog – they’re all to do with TSH testing, pregnancy and breastfeeding.

  4. This is appalling mistreatment, both dangerous and unethical. Would Ruzawench consider posting this over at First Do No Harm? I found it rather cathartic, and a lot of other women seem to find the information there useful. Unexplained weight gain seems to equal “you are a fat, lazy, stupid, lying woman” to most doctors, rather than “symptom to be investigated”, and it is a disgrace.
    Most pharmacists should have the Royal Children’s Hospital “Drugs and Breastfeeding” book available, so your local pharmacist is also a good resource. This book is slightly out of date now, but I believe a new edition is expected soon.

  5. I’m presuming Ruzawench is based in the US, since I know for a fact that Australian GPs are perfectly capable of managing low thyroid problems on their own (I have an underactive thyroid, and for most of the time, the main people involved in dealing with it have been my GP, and the local pathology lab). Certainly there’s no real reason why an Australian GP should need to be referring you to a specialist for such a thing. If your doctor is referring you to a specialist, it should be an endocrinologist, not a dietician.
    Meg Thornton’s last blog post..Meggy brane broked.

  6. Meg: Ruzawench is in Australia, and Dr Z is not a dietician; she is a medical doctor. I hesitate to give much more detail without R’s consent, but I will add that my understanding is that Dr Z has somewhat of a reputation as a ‘holistic’ physician. (R might correct me on that.) Nor does Ruzawench have a diagnosis of thyroid disease.
    Unfortunately endocrinologists here, in my experience, are (along with surgeons) leading the charge toward crash diets, diet pills and weight loss surgery, so they’re not exactly the way around problems like this.

  7. My GP tested my thyroid and a few other things initially, and when they came back within normal range she referred me to a specialist. Upon discussing my symptoms with Dr Z she ordered further tests which included another test of my thyroid. I’ve not been diagnosed with anything, and I’m sure if it was something obvious my GP would have picked it up as she’s very good, I’ve been seeing her for at least 10 years. The only reason I was referred elsewhere is because we were both concerned about the weight gain.
    Unfortunately I haven’t had time to go back to my GP yet, but I’ve got a feeling she will be as amazed as I am at what has transpired.

  8. Yes, this is pretty unbelievable. I think that a posting on drugs and breastfeeding would be very useful. When my wife was breastfeeding, she was prescribed something – I don’t recall what. I tried to find out whether it was safe, and couldn’t find any good information – and I consulted MIMS too. As I say, I don’t recall what. And I’ve not run into the RCH book. So this kind of information is very useful. thanks Oz

  9. Note that Mary Shoman’s blog is US. I don’t know how applicable her comments are to Australia. It’s also important to ask – if we get to this level of detail – what the lab normal range is based on – is it a 95% interval of a “normal” population (and how was that determined), or is it based on something else – like what the kit says, or what the pathology quality program says? These are all important questions. The correct answer is to take note of the reading, but interpret it against the other clinical symptoms…. But not to practice like Dr Z, of course

  10. Hello all, delurking here.
    Like Lindsay, I’ve been mismedicated in some frightening ways. I’ve finally found a very good GP, thank gawd.
    I still find stories like Ruzawench’s shocking though. Especially this:
    “She also asked whether I considered surgery to be an option.”
    Bloody hell? What kind of surgery?

  11. EAC – which is a combination of Ephedrin, Aspirin and Caffeine
    Does this sound like Bex to anyone? (As in, a bex and a lie-down 1950s housewife respite?)

  12. The Dr was referring to weight loss surgery – gastric banding or something like that I assume. She said it was a popular option with her more expensive counterpart.
    I’ve never heard of EAC before, I just did a bit of a search online and it appears to be commonly known as the ECA stack, one website called it the “Granddaddy of all fatburners”!

  13. I went to a doc who was not my usual doc for the morning-after-pill, as it was a Sunday and my usual doc doesn’t work on Sundays.
    As he was writing out the prescripton he just casually says “So, have you ever though of gastric banding for that weight problem?”
    I have a WTF? moment, ask for the ‘script and high tail it out of there. Never going there again!

  14. I’ll put my hand up for the ‘which drugs are safe during breastfeeding’ post, please. I think I was over-cautious, and I’d like to spare my mum-since-yesterday sister-in-law the same inconveniences.

  15. Purrdence, oh my God! I wonder if he has ever thought of duct tape for that speaking out of his ass problem?
    Ruzawench, your story is appalling. Thank you for sharing it.
    I was annoyed enough at one of the GPs at my clinic – a women’s clinic, mind, where I have retreated despite the high fees, in hopes of getting doctors who will listen to me. I last went when I was worried about excessive fatigue and tremors.
    She ordered thyroid and iron tests, fine. Then she did a BMI calculation. I know just enough about why that test is mostly bullshit to be critical of it, and that she allowed me to see her monitor show “overweight”, (by .17kg, apparently! Oh no!) and then told me she wanted me to lose two or three kilos … it just seems irresponsible. I don’t have a recent history of eating disorders, but she doesn’t know that. And of course I have just as much society-programmed image crap as every other woman.
    If weight is a health issue, fine. But flat-out telling a woman she is overweight, especially according to BMI, is dangerous and unnecessary in my book.
    But it’s minor stuff, in comparison to some of the horror stories I’ve read here and elsewhere.

  16. Jet: did you go and have a pee, then say “Weigh me again”? *eyeroll*

  17. Ephedrin, Aspirin and Caffeine

    Sounds like a good time in Vegas, if you ask me.

  18. Oz Ozzie, the Australian “normal” range for TSH was derived from the same studies which the USA uses. The problem with the range is that it is really too wide; the healthy population is not evenly distributed over the range. In Australia, the lab range is usually 0.5 – 5.0, however the normal-thyroid population is heavily clustered around 1.3. The original study to determine normal TSH neglected to remove those with a family history of thyroid disease or undiagnosed thyroid dysfunction and had a few other problems as well. The American Association of Clinical Endocrinologists has stated in recent years that the range should be more like 0.3-3.0, and there are other professional health groups that believe it should be even lower at 03.-2.0. I’ve seen recommendations from a few Australian endocrinologists that anything over 2.0 should be considered suspect if there are notable hypothyroid symptoms present.

  19. Ruzawench: are you going to report Dr Z to the appropriate medical college?

  20. Ruzawench: I have two kids, and I breastfed each for a year. Both times, I would lose a little weight in the initial post-partum period, and then gain weight continuously the entire time I was lactating. Both times, as soon as I weaned, the weight fell off rapidly.
    I’m not the only person I know who is like this. Apparently, although the majority WILL lose more weight while breastfeeding, a certain percentage of women have the opposite problem.
    I do have hypothyroidism, but I was diagnosed years before I was pregnant, and my levels were within the normal range while I was gaining all that weight.

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