Saturday, June 21, 2008

I'm a (web)MD!

I'm pretty sure BJ has pneumonia. He's headed to Urgent Care when he gets dressed to find out. I've had seriously bad luck with the doctors at that doc in a box, but I figure if I'm smart enough to diagnose him (with a little help from WebMD) then they should be able to handle it.

Part of me wants to pin a note to his shirt that says, "Dear Doctor, I am reasonably certain that this patient has pneumonia for the following reasons. A, B, C. Please treat him accordingly so that I don't have to write you a nasty letter when you diagnose him incorrectly and then he goes to our real doctor, gets diagnosed with pneumonia, and treated properly. It'll save us both a lot of time. Sincerely, Amy"

Yes, I'm that patient.

You see, when I was pregnant with Claire, I was still nursing Mary Grace. We got some kind of virus (this was in November, then we got rotavirus in February. I'm not sure what the November virus was, but it doesn't matter. It was nasty) and I went to the Urgent Care... Well, here's the letter I sent afterwards, which tells the whole story.
To Whom It May Concern:

I am writing to file a formal complaint about the treatment I received on November 3, 2006.

I am 18 weeks pregnant, and I am nursing my 14 month old daughter. I am also taking Zoloft for post-partum depression. On Friday, November 3, I came down with a severe stomach virus. I violently vomited 4 times in 3 hours. I was unable to keep down even a sip of water. Out of concern for my unborn child, I called my OB’s office and asked them what I should do. The nurse, Tammy, recommended that I take phenergan, and said that she would call in a prescription to my pharmacy.

As I always do with unfamiliar medications, I quickly looked phenergan up on the internet. I found that it was a pregnancy category C, meaning that its effects on unborn children are not known. I asked Tammy if she was sure it was safe, and she replied, “The doctor wouldn’t prescribe it if it wasn’t safe.”

As a skeptical consumer, I chose to read further. I discovered that nursing while taking phenergan is not recommended, and that it is also not to be used in combination with Zoloft. I mentioned, again, that I was both breastfeeding and taking Zoloft. Tammy said that she’d speak with the doctor and call me back.

When Tammy called back, she said that I should go to Urgent Care for fluids. I mentioned that I was having stomach cramping, and I was concerned about the baby, and she said that they could do fetal monitoring as well. She again mentioned taking the phenergan as a suppository, but I decided to speak with the doctor at Urgent Care about it before consenting to take it, because I still had grave concerns about breastfeeding while taking this medication, and I was not being given an opportunity to speak to my OB directly.

When I arrived at Urgent Care I was quickly taken back to a treatment room. A friend drove me, and she remained with me at my request. The nurse came in and I told her that I was both breastfeeding and on Zoloft, and that I was very concerned about the medication that my OB’s office was recommending, because my research showed that it was incompatible with breastfeeding. She suggested that I speak with the doctor.

Dr. MF (I'm not kidding, those are really his initials!!) then came in and promptly kicked my friend out. This bothered me, as the decision to have a third party in the room should be mine, and not his. Frankly, though, at the time I was too sick and too tired to argue about it. I again mentioned that I was breastfeeding my daughter, and that she was also ill with the same stomach virus, and that I was concerned about taking phenergan while nursing. I told him that my OB’s office had sent me in for fluids and fetal monitoring, and to get a suppository of phenergan, but that I was not comfortable with taking the phenergan. I thought I made myself clear that if it wasn’t safe to nurse while taking phenergan, then I did not want to take it. Dr. MF left the room to look up the drug, and left me alone. He returned and offered me a shot of phenergan, because they did not have an adult dose in suppository form. I had taken a shot of this medication before, and it burned, so I requested oral medication. He said that they had it in a gel that you put on your wrists, and I said, “ok,” to that.

I figured, at this point, that he had looked it up and found that phenergan was ok in my specific circumstance. However, just to be cautious, when the nurse came in with the gel and began putting it on my arms, I mentioned again that I’m breastfeeding. She said, “Oh, well you’re going to want to throw it out for a couple of days.” I was stunned. I had assumed that since it was being given to me, that there was nothing to worry about. I said, “I can’t throw it out. I’m pump resistant. I have never been able to pump more than a few drops!” She replied, “Well, then I guess you’ll have to quit.” (As if it is that easy!)

When Dr. MF came back in, I tried to get a sense of how dangerous the tiny amount of phenergan that would pass from my system to my baby’s would be. He said that they don’t like to give phenergan to children under 2. I said, “I understand that, but it would be a tiny amount that would pass through to her.” At that point, he visibly got exasperated and said that I would have to discuss the continuation of breastfeeding with my daughter’s pediatrician. Essentially, he “passed the buck.”

The very personal and private decision of whether or not to wean my daughter was taken right out of my hands, by a complete stranger. I could understand giving me the drug anyway, if I had been in an emergency situation where I had to either stop vomiting or lose my pregnancy, but this was clearly not the case. In fact, Dr. MF never gave me the IV fluids or the fetal monitoring that my OB’s office had sent me in for! He listened with a Doppler and said that he could tell the baby was fine from the heart rate. We discussed the pains I’d been having, and he said that they were intestinal pains. I would’ve felt a lot more comfortable having that verified by a non-stress test, but again, at that point I was too sick and too tired to argue. I have a regular OB appointment on November 6, so I will ask for an NST then if I am still having pains (I am writing this on November 5, and I am still having pains, by the way).

Phenergan is an antihistamine. All antihistamines will dry up breast milk. Furthermore, abrupt weaning can cause mastitis – a very serious breast infection whose symptoms are very similar to the stomach flu. If I had developed mastitis as a result of abrupt weaning, my symptoms would’ve been masked by the flu I already had. Not to mention the trauma to my daughter, who was struggling with the same virus herself, if Mommy came home and refused to nurse her! How do you explain that to a 14 month old? It could have been physically and psychologically devastating to her. Additionally, it would’ve made my already difficult week (being sick, pregnant, and having a sick child and a sick husband) more difficult by forcing me to deal with an angry, frustrated, abandoned-feeling baby.

As a result of Dr. MF’s “care,” I also get to spend the next 22 weeks wondering whether or not this medication has done damage to my unborn child. It was a gut-wrenching decision to continue to take Zoloft through my pregnancy, and it is a category B. Phenergan is a category C, which means it’s more dangerous. Once again, I was not given the option to make my own decision. The decision to put my unborn child at risk was thrust upon me by Dr. MF. He never discussed the risks to my unborn child with me.

In fact, by giving me phenergan in spite of the fact that I’m on Zoloft and it is counter-indicated, Dr. MF effectively put my entire family at risk. Myself, for the Zoloft, my 14 month old daughter because she’s nursing, and my unborn child because he or she is unborn! Maybe I should send my husband in to juggle knives with him or something. He might as well make a clean sweep of it…

What really makes me angry is that I made every effort to be sure that my conditions were known, and that my concerns were known, and the doctor did not listen to me at all. I made it abundantly clear that breastfeeding was my priority, and that I did not want the phenergan if it would interfere with breastfeeding. When he sent the nurse in with the medication, I was stupid to assume that he was implying that it was safe. I wonder how less well-informed patients would’ve been treated under the same circumstances?

By the way, treatment of this nature doesn’t make it any easier to swallow the recent 46% increase in our health insurance premiums (the largest increase that our agent has seen in 18 years of working there!). Once this baby is born, we will be shopping for a new health insurance provider.

I believe that Dr. MF should be reprimanded for his treatment of me. I feel that an appropriate consequence would be for him to attend a series of La Leche League meetings to educate himself about breastfeeding and the breastfeeding relationship between a mother and child. In fact, it wouldn’t hurt if all Health Plan doctors were to receive further training on breastfeeding, as this is not the first problem I have had with an Health Plan doctor regarding breastfeeding. (Another doctor told me to “just give her a bottle” when I had a hard time nursing her as a newborn. That is not a supportive attitude for a medical professional to have toward breastfeeding.)

I would be happy to discuss this further if necessary.

Amy Prettybaby
So, you can see why I'm a little nervous about sending BJ to the Urgent Care. I didn't talk to Tammy at my OB's office for the rest of my pregnancy. I complained to my OB about her, and he said, "Yeah, we don't like to let her answer the phone, and we avoid it whenever we can, but otherwise she's a good nurse..." So, from then on, if I got her I would ask for Linda (who is super). If Linda wasn't there, I would just wait an hour and call back.

I have a really hard time with incompetent people. This is the reason why I can't/won't/don't work with the public.

If you're local and you want the full names of the folks involved, just e-mail me. I'll be happy to tell you who to steer clear of. I just looked, and Dr. MF is still practicing with the same group. I wonder if he ever was disciplined.

Maybe BJ should ask when he's there.. Nah.....


Jenn said...

How awful ,I don't blame you I'd be upset too!

Sarah M. said...

How frustrating!!!!!

And if you ever need information on drugs and nursing again to wave in incompetent dr's faces ;), you can also try Dr. Hale's Medications and Mother's Milk. He's the renowned expert so they can't really argue with him, yk? If you go on and search for his book you can then search for any medication inside that book.

Man, they could have just given you Zofran. How screwy of them. Grr.