Tuesday, March 03, 2009

In which I don't even know where to begin

Earlier today I had in mind the post I was going to write tonight. It was going to be quite the post. I was going to bring you all up to date on the soap opera that has been our household for the last week or so. I was going to vent. I was going to yell and scream. I was going to bellow my outrage to the very corners of the Internet.

Yeah, well, I was going to. But it's 11:20 and I'm too tired, and I already told it all to Grandma E on the phone earlier. So you get the short, drained, low-volume version.

1. I have bronchitis. I had another episode of asthma or bronchospasm or whatever you want to call it on Shabbos, and on Sunday I got antibiotics. It all sounds so quick and easy when you put it in one sentence like that, doesn't it? Believe me, it wasn't.

2. Iyyar needs his tonsils and adenoids out and it all sounds rather scary and urgent. At the last ENT appointment (which, at the time, sounded scary to me) I was told to schedule the sleep study, and then make a followup appointment two weeks later to discuss the results, which (said the good doctor) took two weeks to come in. I was surprised, therefore, to get a call from the doctor this morning. Somehow or other he had the results already. I did not feel that this boded well. I was correct.

The sleep study was awful. Really really bad.

[Blog post interrupted to go deal with screaming children.]

One of the numbers that should have been, at most, 5 was in fact 80. That one sticks in my head. Anyway, he has very severe sleep apnea, and while this means he really needs his tonsils out, it also means that he is considered very high risk, which means doing it at the children's hospital, with an ICU available, etc. The doctor was explaining to me all the risks (yes, I want to know, but I don't!) and at the end there was a bit of a pause. Which I filled by telling him, point blank, "Don't kill my baby."

There was another pause after that. Apparently no one has ever told him that before. Strange, isn't it?

3. Work is insane. Quite literally in at least two respects. I can't get into more detail here because I don't blog about work. But oh, if I did... I would have a lot of material.

4. It's my anniversary today. Six years! And we still like each other most of the time. (Okay, there were a few minutes yesterday when I wanted to kill him. But only a few.)

5. I'd like to tell you about the appointment I had on Sunday morning about my inability to breathe. I'd also like to tell you about the total jerk of an osteopath I saw, and about his inability to imagine that I had accurately read the package insert that came with the albuterol inhaler, or that I knew the difference between "teratogenic" and "tumorogenic." I'd like to tell you about how much his attitude, and his disinclination to get his information right, ticked me off. But I'm tired, so I won't. Instead, I'll let you read the following, cut and pasted from the original. Note that the correspondent who can't read package inserts is, inexplicably, the only one capable of using the shift key.

----- Message -----
Sent: 3/1/09 07:38 PM
Subject: Medication Advice

Dear Dr. Withheld,

When I came home I checked up on albuterol online. It is indeed an FDA category C drug, with both teratogenic and tumorogenic risks, not a category A as you assured me this morning. Also, so far as I can tell the categorization system is per the FDA, not the WHO.

Summary can be found here:


Fuller info here:


The package insert advises to either discontinue the medication or discontinue breastfeeding.

I thought you should be aware of this.







03/02/2009 1:20 PM

thanks for the update. i must have misspoken if i used the term "class A'.
as you know, the FDA category system refers to drugs in pregnancy, not drugs in lactation.
in our discussion yesterday i was referring to the World Health Organization listing, which for albuterol is
"1. Compatible with breastfeeding
Drugs are classified as compatible with breastfeeding if there are no known or theoretical
contraindications for their use, and it is considered safe for the mother to take the drug and continue
to breastfeed."
different organizations and dr's do use different classification systems and have differences of opinion.
cautions for using a drug are weighed against expected benefits and i knew you were aware of the information on albuterol since we discussed it. i'm sorry for the mix up.


miriamp said...

Have you checked with Dr Hall's book? but I've used albuterol while breastfeeding and just simply ignored that silly part about stop breastfeeding. You should too. Hey, my lactobacillus supplement says not to use it during pregnancy or lactation. ("Unless your doctor tells you to.")

The way I understand it is that (a.) they feed the albuterol to the test animals. Spraying it in your lungs doesn't feed it to the baby. Not enough gets into your bloodstream that way, and (b.) a not breathing/oxygen deprived/dead (C"v'Sh) mommy serves no one, and if a little does get into the milk... well, then the baby will breathe better too!

A doctor told me that the oxygen deprivation for the mother is the big thing, and that's why they now give asthma drugs even to pregnant mothers, because the risks to the baby are less from the drugs than from the O2 deprivation.

SuperM said...

This one might be worth a call to your pediatrician because they might be a little bit more informed about this. The systemic exposure to inhaled albuterol is fairly minimal (whether it's minimal enough is a different question) and it's definitely a whole different issue than the awful liquid stuff.

I hope that you feel better soon and that everything goes well with Iyyar. Do the doctors think his tummy issues are somehow related to the tonsils/adenoids/sleep apnea?

As for Dr. Withheld, if such a thing is possible or appropriate, a polite word to the head of the practice might not be a bad idea. I once had occasion to say something (unrelated medical issue, similar sort of an experience), and while I don't know if anything was ever said to the doctor in question, it certainly made me feel better and when I next encountered him years later, he was a much better doctor.

uberimma said...

I don't think albuterol is that much of a risk for me personally. That's not the issue. The issue was that he looked at me with this patronizing, belittling stare and intoned, slowly, "The World Health Organization [impressive pause] calls it a Class A drug. That means it's known to be totally safe." I told him what was on the package insert and he shrugged it off, saying I'd misunderstood. "The World Health Organization [impressive pause redux] etc." I said, "Yeah, but the package insert cites tumorogenic potential," and he said, "Teratogenic effects are only a concern in pregnancy." "I didn't say teratogenic, I said tumorogenic." To which he replied in the same drone, "The World Health Organization..." I wanted to smack him. And he was wrong to boot.

uberimma said...

And the other thing that makes me mad is the way his reply covered his tuchus--breezing past his total dismissal of my concerns while putting in writing that I was aware of the risks. See! She knew the risks and took the drug anyway!


He did apologize, but it wasn't a misunderstanding.