The background:
Due to insurance enrollment, (and my old doctor moving away) I am without primary physician. His partner is very busy, and has no appts open until after New Years, when my new physician is covered anyway. Last I saw my old doctor, I was diagnosed with tendonitis in my shoulder. He said it should fade in a few weeks. It didn’t, and flared up badly yesterday. Upon checking my insurance again, I found that a nearby urgent care was covered. There I proceded, to see if there was anything that could be done. [Important: I am currently breastfeeding]
The Visit
After a short talk with the nurse, the physician, hereinafter called P, enters the room. He glances at my chart, then does his examination, proving that indeed, my shoulder hurts and is limited in how much I can move it.
P: Well, you don’t have tendonitis. You have bursitis.
Me: Ok.
P: The best way to treat this is to give you a shot of steroids in your shoulder.
Me. (pause. This sounds very painful, but hey, if it’ll cure it…) Ok. This won’t pass in my breastmilk, right?
P: You’re breastfeeding? Why didn’t you say so?
Me: Um, I did.
P:(glances at chart.) Well, so you did. Sorry. No, you won’t be able to feed him for about a week afterward.
Me:Is there any other way to treat this? I really don’t want to stop breastfeeding him- I don’t have any milk stored, either.
P:Oh, just give formula.
Me: Is there any other treatment?
P:I could put you on [drug] for a week. That’s a suboptimal treatment though.
Me: Would I be able to breastfeed?
P:No.
Me:(wonders if I hallucinated stating my preference) I would really prefer to keep breastfeeding him.
P: Look, you can give it-
Me:him
P:formula in a bottle, these are the two best treatments for what’s wrong with you.
Me:Are there any where I could continue breastfeeding?
P:(sighs) There are exercises that might help. However, the best treatment is either the shot or the anti inflammatories.
Me: What are these exercises?
P: The. best. treatments. are. the. shot. or. the. prescription.
Me: What are the exercises?
P: Look. I can’t help you if you won’t let me. When you decide which treatment you want, call or come back. (Leaves).
For this I paid $30? Why on earth would you not tell me what these freakin’ exercises are?? This is a painful shoulder, not a lifethreatening illness wherein I must take drugs!
Would it really kill the kid to eat formula for a week so you can get some relief? Or is it so important to you to keep breast feeding that you’re willing to put up with the pain?
You could save up some breastmilk then go back and get the shot.
Basic rule. Don’t go to Urgent Care for an ongoing problem. He doesn’t know what excercises to use and is really focused on finding an immediate problem that needs immediate attention. Beyond that he wants to tie a ribbon on you and get you out.
Are you on HMO or PPO or what?
You need to touch base with a good primary. They might not even need to see you and might be able to refer you directly to a physiatrist (an MD with rehab expertise) or to a Physical Therapist. They can tell you with more knowldge as to whether a local sho of 'roids really is contraindicated and specifically what excercises are advised. Might be a rotator cuff, might be relatd to postpartum hypermobility. Maybe related to how you hold you baby. Someone good can help figure it out. The Urgent Care aint the place for this kind of thing.
I’m on an HMO, and can’t see my (new) primary until Jan 7. My old doctor’s partner can’t see me until Jan 16, and doesn’t want to refer me until he sees me, and I can’t see him after my primary changes.
What annoyed me was the mention of exercises, then refusing to tell me what they were. As well as ignoring my stated wishes repeatedly. I can understand him getting annoyed, but hey, with an office visit charge (before insurance) of 209.00, he’s getting paid enough to work with me.
While it won’t kill me or the Alasprout to not breastfeed, I don’t get much milk when I pump. His ped said that I would probably have to stop for the week when I called. (So sue me. It hurt a lot yesterday, and towards the end of the day I started considering it.) So, I’ll wait until I can see my new primary.
My parents once tried to give one of my kids formula, when I was a little late picking him up. He absolutely refused it.
I also think it’s not wise to follow this guy’s advice. How the heck does he know whether it’s bursitis or tendonitis? He clearly isn’t willing to actually listen to you, or consider the specifics of your case, so why should you trust his judgement at all? The “just give it formula” says he’s not really thinking much about the kiddo’s interests, where a family doc would be more attuned to that.
I’d say a PT would be the way to go, too. Can you make it to January on ibuprofen, and maybe observing to see if there’s some activity that is making things worse, as ? I used to get a really annoying pain in my shoulder that would last for weeks–it was caused, I eventually discovered, by my typing on my laptop in a particular chair. I stopped doing that, and the shoulder thing went away. I’m not saying it’s neccesarily something like that, but it’s worth a thought. As DSeid says, a good PT should be able to help you with that. The urgent care doc really isn’t your best bet.
Meanwhile, assuming that the diagnosis is correct, you can go on line for excercises aimed at rotator cuff tendonitis (the rotator cuff consists of the tendons of the shoulder joint). For example: http://www.jhmi.edu/~kbmiller/shoulderex.html Just Google “Rotator cuff tendonitis excercises” … and also look at how you hold your baby. Consider getting a sling or Geri carrier and use it most of the time, try different breast feeding positions …
Can you stop breastfeeding and then go back to it? Or do your glands stop working if they’re not used continuously? If so, the hell with the medication!
If your transcript is close to accurate I think you did an excellent job of maintaining a civil tongue in your head. Given the circumstances I do not think I could have done as well. Congratulations.
The mother’s body will adjust milk production according to how much milk is consistently removed. During the initial flow, it’s common to produce much more milk than the baby needs. However, the mother’s body WILL adjust, in most cases.
Suddenly quitting breastfeeding is PAINFUL. Even a late feeding can get painful, as the breasts are engorged with milk. Since Alatariel says that she’s not able to express much milk manually, this means that she’s going to have painfully engorged breasts, unless she takes medication to “dry up”. Combined with the first fact, this means that even if she expresses milk, she’s not likely to have enough milk to resume breastfeeding after a week.
Babies can get “nipple confusion”. That is, some babies don’t recognize that a baby bottle is also a source of nourishment. Those who DO successfully learn to bottle feed sometimes don’t want to go back to breastfeeding, as it requires more work on the part of the baby.
Some people know that they have milk allergies in their family, or have other medical reasons to want to breastfeed.
Some of us also think that babies are meant to drink human milk, at least at first. Besides which, breastfeeding is an enjoyable experience, for the most part.
I don’t think that I’d care to follow that doctor’s advice. He doesn’t seem to want to do anything but dispense medication. And, since I’m allergic to some medications, I wouldn’t even go to him for THAT, as he doesn’t seem to read or listen to his patients very well.
No, it wouldn’t kill him to have formula. But that isn’t the only consideration. I had to stop nursing for two days once because I had to be tested for a blood clot in the lung. For those two days, I gave her formula and did the old “pump and dump” routine. Even with the pumping, my milk supply plummeted and it took a few days after resuming breastfeeding for it to return to normal. If I’d had to stop for a week, I probably would’ve had to stop altogether, something I was not yet ready to do. I imagine this is the main drawback for Alatariel.
And Lynn is right on, especially about the engorgement. Imagine having two rock-hard, feverish basketballs hanging on your chest. We are talking DD cup boobies here that pointed right to the ceiling when I lay on my back. Much pain, much MUCH pain!
When my younger daughter was just three months old, I had to have a thyroid scan done. When I asked the physician’s assistant who ordered the test done whether it would interfere with breastfeeding, he said it would not. Luckily, I am moderately well-educated and I realized that a test involving the ingestion of radioactive iodine was not likely to be compatible with safe milk production. Had I not known that, I’d have walked into the testing center the next day completely unprepared to wean my baby for two to three weeks.
I was able to postpone the test for a week. During that time, I consulted the lactation specialist at the hospital where I’d given birth, rented a serious electric breast pump from the hospital, stored at least a little milk, and gradually introduced the baby to formula. I was able to maintain my milk supply by pumping for two weeks, and the baby accepted formula tolerably well, but the transition from and back to the breast was not easy.
If you do end up weaning the baby for a week, I strongly suggest you talk to a lactation consultant (if there’s a La Leche League group nearby, they may be able to help) and get a good electric breast pump beforehand. I was never able to get much milk out by hand pumping, but the one I rented worked amazingly well.
This happened with my brother; he was four months old and we had to fly somewhere, and it being 1984 our mom wasn’t quite prepared to breastfeed on a plane, since she’d probably have been shooed into the bathroom and that’d have been impossible. So she brought bottles. He took one swallow and never looked back. Formula all the way.
I have a variety of medical “oddities” which requires doctors to be able to be flexible when providing me with medical care.
Some doctors are not flexible. Some doctors are convinced that they know what’s best, and that you can’t possibly know anything because you are not a doctor, and if you say otherwise, you’re being argumentative.
Doctors like this are best avoided. You did the right thing.
Also, what Wang-Ka said. I’ve seen a lot of doctors in my day. If a doctor won’t listen to you, go elsewhere. Even if they turn out to be right, they do NOT have to be jerks about it. I know they’re training them differently these days, since I got extra credit in a psych class once for being a fake patient as part of a med school class on relating to patients. We got to critique THEM.
Any doctor who refers to a lactating woman’s child as an “it” is an ass and doesn’t deserve another moment of time. “You can just give it formula” is a statement of extreme ignorance and disrespect, and that a medical professional would be so stupid as to let something like that come tripping out of its (ha!) face is frightening.
Alatariel, you were wise to blow this guy off. I hope you can hang on through the pain until you can get a real PCP and have a thorough workup and real personal attention.
