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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Angielala on February 11, 2005, at 21:25:35
Hey all... I just want to update anyone with the information I recieved from the pdoc specialist i saw on Wed in Boston.
I take Lamictal, just came off of Paxil. I am 6 weeks pregnant now. My visit was to go over my history of bipolar and medication I have taken and take now.
In my particular situation, staying on Lamictal during the pregnancy is what the specialist has recommended. I was so relieved to learn that there have been *NO* cases of unhealthy babies born to women who took Lamictal through out the pregnancy.
Lamictal is still new, but this specialists' group works with the Lamictal registry to keep tabs on such things. She explained that the risk would be by going off of the medication during the pregnancy.
In my case, a bad depression (which I am prone to) could cause an early labor, miscarriage, etc. Bad manias can also cause big problems through out a pregnanct.
So I am staying on my meds, and she will be monitoring my depression and anxiety through out the pregnancy. She let me know that going on Klonapin (sp?) and/or an SSRI may be useful after the 1st trimester is complete. We'll see.
I asked about breastfeeding. I thought that breastfeeding was out of the question because of the medications. She explained that, in my case (I want everyone to know that this is all according to my history), getting up every 2-3 hours at night after the birth will cause me to be unbalanced. She recommended that formula be used so that I can get a few more hours of sleep and my husband can do one of the nightly feedings. This is all because of the wicked Post-Pardum Depressions that many can get, and Bipolar women almost always swing into. The more sleep I can get, the less wicked it will be.
Also- the post padrum depression may cause a post pardum psychosis, so she will monitor me for it. If need be, I may need to go on Zyprexa (sp??) for 2-3 weeks afterwards to ward that risk off. It depends on how I do. I have had minor psychosis in the past, and this is why it's something she's going to watch.
I was surprised that I'm not so limited... it's good to know that if things do get bad, an SSRI can be given to me, and that Klonipin (sp?) maybe more useful than Xanax to help calm me.
Oh- one other thing that I found out from her- there is no toxicity from taking too much Folate (Folic Acid). During your 1st trimester, if you are on medication for mental health, take extra folic acid. Prenatal vitamins have between 400-500mcgs. An extra 800mcg of Folic Acid will help the neural tube develope during that first trimester. The medications taken for mental health are more likely to effect the neural tube during the 1st trimster- so the Folic Acid helps defend that. It's piece of mind that I would like to give someone if they haven't found a doc yet and are in the early early stages of pregnancy.
Like I said- this is all based on my history of Bipolar and my history of medications, so it's not the same for everyone. I just want to give some idea of what options there are out there.
This is where I went: http://www.womensmentalhealth.org/
It's in Boston, Massachusetts. If you are not in the area- it's worth the visit to the website. Also- everyone gets a free first consultation, so if you are within driving distance and you really want piece of mind, I can tell you this group is worth it.Some other things I learned...
Because we end up having to do a lot of our own research via the web and reading, becareful. For example, there is a lot of current research happening with Paxil and pregnancy. Studies came out last week in the NYT saying that it's not good to use during pregnancy because of defects found. Because we do a lot of our own research, many women will go off Paxil without cinsulting a doctor, or a primary care doc will say "Hey, it was in the NYT, must be true" HOWEVER, the research being done doesn't let on as to what the control group as been. Meaning they might say 50 women had problems on it, but it won't say if these women were on other drugs at the time, or had issues like alcohol or genetic issues. Now there are women who would be a lot better off being on Paxil off of it because of this jaded research. Seek more info, ask more than one doctor. Make calls to places like the place I linked above, ask questions. Another example is ADitvan/Xanax during pregnancy. There is a study that claims that these drugs cause neural tube defects. At the surface, it seems to be confident reserarch. Looking deeper- one finds that this only occurs in women who took 4-5mgs of Xanax a day. That is a high dose of Xanax. There are many women who only take Xanax as needed, or take 1mg a day- .5 in the morn, .5 at night... or some even take only .25 as needed. These women do not have a risk of tube damage as the former women do.I want to make sure women do their own research and then verify it among different groups of people and doctors- it's important for their own piece of mind. Don't let one resource be your only resource- don't let this post be what makes or breaks you- don't let one person who knows someone who knows someone be where you get you only advice. Search around, ask questions, don't give up. You will feel a lot better once you reach a decision with a plethora of information.
I hope this helps someone out there, I know I was very lost with all of this only 3 weeks ago. Don't feel alone, there are people and places that specialize in this, there are doctors that know. Fidn them.
Ok, that's my bit.
~Angielala
Posted by Angielala on February 11, 2005, at 21:58:02
In reply to Bipolar Pregnancy, posted by Angielala on February 11, 2005, at 21:25:35
I meant Toxicity, not toxicology.
I meant 800mcgs of Folate in the prenatal, not 400mcgs.
I just want people to know in case that one thread comes up in a search and they can't see my corrections..
Would you be able to edi tmy first post to show these corrections by any chance?
Posted by daisym on February 12, 2005, at 0:38:56
In reply to Dr. Bob- can you help edit my first post?, posted by Angielala on February 11, 2005, at 21:58:02
Congrats on the pregnancy. I have a few things to add too -- if you develop morning sickness, talk to your MDs about switching your meds to evening so you can take them and go to sleep. I can't tell you how many women get out of wack because they throw up their meds and don't replace them. Also, watch your caffeine and your iron intake. Iron can block calcium uptake and if you are older (30+) you may lose it from your bones and not realize it.
I think the breast feeding issue is interesting. If it isn't a case of contaminated milk, would pumping be possible for night feeding by someone else? I just know how valuable the colostrum can be. Not worth a psychotic break though, just asking...
This is my area of speciality so I hope you keep us informed of how it is going.
Daisy
Posted by Angielala on February 12, 2005, at 1:29:18
In reply to Re: Dr. Bob- can you help edit my first post? » Angielala, posted by daisym on February 12, 2005, at 0:38:56
I'm so glad you added to this string!
I forgot to mention the Iron intake. I found that lots of women become aenmic during pregnancy and docs tell them to take more iron- what should they do in that case? Extra Calcium?
I figured out the meds in the evening- (now this will be gross) I noticed when I vomited, I could take my meds, so I switched the timing.
The contamination is the other issue. Seeing that the post pardum depression is such a scare in Bipolar women, they are often put on an SSRI or another AD and sometimes an Anti-Psychotic, which contaminates the breast milk. She told me that not taking care of the PPD with meds was too much of a risk to breastfeed. Which bums me out, but I understand it. It's strange because I hear that women who don't breastfeed often have a feeling of guilt. I can't win!
> Congrats on the pregnancy. I have a few things to add too -- if you develop morning sickness, talk to your MDs about switching your meds to evening so you can take them and go to sleep. I can't tell you how many women get out of wack because they throw up their meds and don't replace them. Also, watch your caffeine and your iron intake. Iron can block calcium uptake and if you are older (30+) you may lose it from your bones and not realize it.
>
> I think the breast feeding issue is interesting. If it isn't a case of contaminated milk, would pumping be possible for night feeding by someone else? I just know how valuable the colostrum can be. Not worth a psychotic break though, just asking...
>
> This is my area of speciality so I hope you keep us informed of how it is going.
>
> Daisy
Posted by justyourlaugh on February 12, 2005, at 1:46:29
In reply to Re: Dr. Bob- can you help edit my first post?, posted by Angielala on February 12, 2005, at 1:29:18
with my first child i breast feed for 3 days...went back to the hospital ...without him...
he had to take the bottle ....
for the next 4 kids ..all bottle feed..
no one missed out..
the bond was so wonderful..and husband could "feel" it too..
you must be aware of how "complete" formula is for baby...
you can babble mail me anytime..you have my support ...i have been in your shoes..
jyl
Posted by gardenergirl on February 12, 2005, at 9:51:42
In reply to 1 important point.., posted by justyourlaugh on February 12, 2005, at 1:46:29
Ang,
I'm so glad you were able to go there. It must be a huge relief to get your questions answered by someone whose judgement you trust. Yeah!Keep us updated on your pregnancy. I love vicarious child bearing. ;)
All I can manage for now....Thanks for sharing your experiences with us.
Take care,
gg
Posted by Daisym on February 12, 2005, at 11:04:30
In reply to Re: Dr. Bob- can you help edit my first post?, posted by Angielala on February 12, 2005, at 1:29:18
I'm a lactation specialist so I believe greatly in breastfeeding. But I know there are much more important things as well. Formula will be just fine nutritionally for the baby. Hold and snuggle while feeding, please don't prop in a chair with the bottle unless you have to. (We've all had to...)
You shouldn't feel guilty about making good, healthy choices for your child. We all face dilemnas like this. You can't sacrifice yourself for the baby, ever. What good would you be to the baby then?
I had a difficult time breastfeeding my first child. I was so uncomfortable and hated it. I stopped when I noticed I was avoiding him. I bottle fed the other two. (Yes, Gasp!) I was working in a hospital at that time and my nursing friends were shocked ("you know better", etc.) I just figured out last year that my abuse history effected this decision. At the time I told myself I was just to busy to sit still that much. All my guys are fine, btw.
As far as the iron issue, try not to take them all together. Separate calcium pills (check with your MD) are a good idea anyway. Usually prenatal vitamins have lots of iron and calcium grouped together. So if you can split one out, choose the calcium. Too much iron would be bad, you will get stopped up. You eliminate too much calcium easily.
Posted by Angielala on February 12, 2005, at 18:47:05
In reply to 1 important point.., posted by justyourlaugh on February 12, 2005, at 1:46:29
You just made me feel all warm and fuzzy... thank you...
> with my first child i breast feed for 3 days...went back to the hospital ...without him...
> he had to take the bottle ....
> for the next 4 kids ..all bottle feed..
> no one missed out..
> the bond was so wonderful..and husband could "feel" it too..
> you must be aware of how "complete" formula is for baby...
> you can babble mail me anytime..you have my support ...i have been in your shoes..
> jyl
>
Posted by Angielala on February 12, 2005, at 18:53:49
In reply to So glad you went, posted by gardenergirl on February 12, 2005, at 9:51:42
Thank you GG- I'll definitely update all of you- I can't wait to find out if it's a boy or a girl!
Posted by Angielala on February 12, 2005, at 18:55:40
In reply to Breastfeeding, posted by Daisym on February 12, 2005, at 11:04:30
Reading all of this makes me feel so much more at ease...
Thank you for keeping me informed, my little one owes all of you :)
> I'm a lactation specialist so I believe greatly in breastfeeding. But I know there are much more important things as well. Formula will be just fine nutritionally for the baby. Hold and snuggle while feeding, please don't prop in a chair with the bottle unless you have to. (We've all had to...)
>
> You shouldn't feel guilty about making good, healthy choices for your child. We all face dilemnas like this. You can't sacrifice yourself for the baby, ever. What good would you be to the baby then?
>
> I had a difficult time breastfeeding my first child. I was so uncomfortable and hated it. I stopped when I noticed I was avoiding him. I bottle fed the other two. (Yes, Gasp!) I was working in a hospital at that time and my nursing friends were shocked ("you know better", etc.) I just figured out last year that my abuse history effected this decision. At the time I told myself I was just to busy to sit still that much. All my guys are fine, btw.
>
> As far as the iron issue, try not to take them all together. Separate calcium pills (check with your MD) are a good idea anyway. Usually prenatal vitamins have lots of iron and calcium grouped together. So if you can split one out, choose the calcium. Too much iron would be bad, you will get stopped up. You eliminate too much calcium easily.
Posted by pegasus on February 12, 2005, at 21:58:03
In reply to Bipolar Pregnancy, posted by Angielala on February 11, 2005, at 21:25:35
Hi Lala,
Congrats on being pregnant! And thanks for sharing what you learned. I was a little concerned to hear about the recent results of Paxil research, because I'm pregnant now and on Paxil. Before I started trying to get pregnant, I did a lot of research and decided that even though we didn't know enough about Paxil and pregnancy, there also didn't seem to be any evidence that it would harm the baby. And Paxil has been a life saver for me. So I stayed on the lowest dose that still worked for me.
Lately, I've been feeling like I may need to up the dose to remain stable. Which is scary. But I'm at 7 mos. now, and I'm hoping it won't cause any problems for the baby. I *know* that ramping up to my normal levels of anxiety and depression would be really bad for her. I'll have to check into that recent research you mentioned.
Good luck with the pregnancy, and being a new mom! I know the bipolar will give you extra challenges, but it sounds like you've found a really good doctor and some wonderful advice.
pegasus
Posted by Daisym on February 13, 2005, at 1:03:09
In reply to Re: Bipolar Pregnancy » Angielala, posted by pegasus on February 12, 2005, at 21:58:03
Wow -- I didn't realize it was so close. How are you feeling, besides perhaps needing a med boost?
Posted by Angielala on February 13, 2005, at 20:59:06
In reply to Re: Dr. Bob- can you help edit my first post?, posted by Angielala on February 12, 2005, at 1:29:18
Posted by pegasus on February 14, 2005, at 11:31:40
In reply to 7 months already!? » pegasus, posted by Daisym on February 13, 2005, at 1:03:09
Hi Daisy!
I'm feeling pretty good, although BIG. Thanks so much for asking. I know that's normal for this stage, though. I am getting more moody, and considering my history it's hard to tell whether that's normal pregnancy, normal stress from impending big changes, or a med issue. But I'm trying to work it out with my pdoc, who is good.
I have another ultrasound this Thurs, and am so excited! Allegedly it's to make sure the placenta is in the right place (earlier it was a bit low), but I'm sure that's all fine and I really just want another peek at my little miracle baby!
I'm also having major job stress, because my job is one of those where you always have more than you can realistically do. I'm dropping to 60% time after the baby, but it's like pulling teeth to get my boss to talk about what I can drop to fit my job into 24 hours/week. I think he's in denial. But I'm trying to be clear that I *won't be there* more than 24 hours/week, so if we don't figure this out in an organized way, it's going to be decided in a disorganized way.
Overall, though, things are going pretty great. I'm just ecstatic about being a mom.
Thanks so much for asking. I've been thinking about you much lately, and all of the difficulties you've been going through. Please know that I'm sending you positive thoughts, even if I'm not posting them.
pegasus
Posted by Angielala on February 14, 2005, at 17:15:16
In reply to Re: 7 months already!? » Daisym, posted by pegasus on February 14, 2005, at 11:31:40
When did they give you your first ultrasound?
Just wondering... I can't wait to look inside!!
Do you know if it's a boy or girl?
Posted by pegasus on February 15, 2005, at 12:19:19
In reply to Re: 7 months already!?, posted by Angielala on February 14, 2005, at 17:15:16
Well, because I conceived through artificial insemination, the very first ultrasound was at 7 weeks (if you don't count the one on the day of ovulation, to make sure I had ovulated). That was when we saw the heartbeat for the first time and knew it had really worked.
But normally the first ultrasound is at around 20 weeks. We had one then too, and it was really cool. I got a great picture of her profile. Her little nose is so sweet!
So, yeah, we know it's a girl. I'll let you know how the next ultrasound goes this Thursday. She'll be 31 weeks, so I'm guessing we'll see a lot more. And I wouldn't mind confirmation that she's a girl. We're beginning to collect a lot of pink frilly things from relatives . . .
So, Lala, how far along are you? When is the due date? I hope you're feeling relatively well. And I hope this pregnancy is a magical time for you!
pegasus
Posted by Angielala on February 15, 2005, at 13:47:05
In reply to Re: 7 months already!? » Angielala, posted by pegasus on February 15, 2005, at 12:19:19
I'm almost 7 weeks. I'm still at the point where keeping food down is hard... in fact if I smell the wrong thing, up comes everything... I feel like I have the nose of a bloodhound!
My hubby and I are really excited, and of a little scared. My first doctor's visit has been bumped up to March 8- soI'll be just about 10 weeks at that point.
Right now the due date is about October 6th.... Fall baby!
I keep having the strangest dreams too- sometimes it's a girl and sometimes it's a boy... but more often it's a girl, so strange.
Do you get strange dreams about the baby?
> Well, because I conceived through artificial insemination, the very first ultrasound was at 7 weeks (if you don't count the one on the day of ovulation, to make sure I had ovulated). That was when we saw the heartbeat for the first time and knew it had really worked.
>
> But normally the first ultrasound is at around 20 weeks. We had one then too, and it was really cool. I got a great picture of her profile. Her little nose is so sweet!
>
> So, yeah, we know it's a girl. I'll let you know how the next ultrasound goes this Thursday. She'll be 31 weeks, so I'm guessing we'll see a lot more. And I wouldn't mind confirmation that she's a girl. We're beginning to collect a lot of pink frilly things from relatives . . .
>
> So, Lala, how far along are you? When is the due date? I hope you're feeling relatively well. And I hope this pregnancy is a magical time for you!
>
> pegasus
Posted by pegasus on February 15, 2005, at 18:27:18
In reply to Re: 7 months already!?, posted by Angielala on February 15, 2005, at 13:47:05
Yes, it's exciting and kind of terrifying isn't it? But I hope for you it'll become more exciting and less terrifying as you go along. I was also pretty sick during the first trimester. I couldn't walk into a grocery store. I couldn't make dinner or do the dishes. Fortunately, my sweet husband was very supportive. But he did celebrate when I got to the second trimester and made dinner for the first time.
I've had a few crazy baby dreams. In one I'd had the baby, who had to stay at the hospital because of some complication. My husband and I went home and forgot all about the baby for a few days, and were having a lovely time alone. At one point, I suddenly remembered and said, "Oh, the *baby*! She's at the hospital! We should go visit!" As if one could forget such a thing.
I've also had dreams about having kittens and puppies and such things.
So, one book that I have to recommend is Ina May Gaskin's "Ina May's Guide to Childbirth". I found it really comforting and it helped me put my fears about labor and birth into a helpful place in my mind. It's very pro homebirth (Ina May is a famous midwife), but even if you're certain you'll be at the hospital it's great to read all the birth stories, and hear about how our bodies are designed to do this.
much luck
pegasus
Posted by Angielala on February 16, 2005, at 13:08:48
In reply to Re: 7 months already!? » Angielala, posted by pegasus on February 15, 2005, at 18:27:18
The books sounds good- I'll check it out
Yes, the dishes and dinner haven't happened for weeks now, so I'll be sure to tell my husband that it's not just me- haha
My dreams are starting to consist of me meeting older kids (around 8) and them asking me to pick them as the baby.
So strange!!
This is the end of the thread.
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