OB-GYN-L Messages for November, 2007: Re: ACOG Antepartum Record

Re: ACOG Antepartum Record - Pain Scale?

From: FRANCES WREN

fwren@shaw.ca

Sat Nov 24 11:13:35 2007

other thing is 15% of caucasians don't have the requisite enzymes to metabolise the codeine in T3's to morphine therefore may keep taking too many to try and stop discomfort.... thus the benefit of NSAIDS in lieu of tylenol with codeine. frances wren MD FRCS

>----- Original Message -----
From: "Meenan, Anna" <annam@uic.edu> Date: Friday, November 23, 2007 4:37 pm Subject: Re: ACOG Antepartum Record - Pain Scale? To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>

> A small percentage of moms (it varies by ethnicity) rapidly
> metabolize codeine to morphine. I wouldn't say codeine is
> contraindicated in breastfeeding moms, but needs to be given for
> only
> a few days, and if pain continues, the situation needs to be
> re-evaluated, which is why I have to keep reminding my residents
> not
> to send more than 2 or 3 days worth of T3 home with
> breastfeeding
> moms and to tell them to call if still having pain requiring
> narcotics when that runs out.
>
> Anna Meenan, MD
>
> >In the UK a post Caesarean breast feeding patient kept
> complaining
> >of pain (no apparant cause) and was given repeated doses of
> >codeine.There was a neonatal death on day 15 suspected to be
> due to
> >resp.depression.Therefore now is strictly contraindicated in
> breast
> >feeding women
> >Aditi
> >

>> >----- Original Message ----
> >From: "art fougner, md" <evsono@pipeline.com>
> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >Sent: Wednesday, 21 November, 2007 5:47:57 PM
> >Subject: Re: ACOG Antepartum Record - Pain Scale?
> >
> >She's Dead, Joe.
> >
> >Art
> >
> >At Wed, 21 Nov 2007,
> <mailto:DoctorJoe@aol.com>DoctorJoe@aol.com wrote:
> >
> >>You know, (1) you can't trust the patient not to be faking,
> and (2) you
> >>don't want to be embarrassed by a lawyer ("Didn't you see,
> Nurse
> >>Jones, that when
> >>you recorded 'asleep' the patient wasn't breathing and his
> tongue was
> >>lolling out to the side? The patient was DEAD, Nurse Jones, he
> was DEAD!!")
> >>
> >>Joe P.
> >
> >--
> >art fougner, md
> >"May The Wings of Liberty Never Lose a Feather." - Jack Burton
> >
> >For ideas on reducing your carbon footprint visit
> ><http://uk.promotions.yahoo.com/forgood/environment.html>Yahoo! For
> >Good this month.
>

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<DIV>other thing is 15% of caucasians don't have the requisite enzymes to metabolise the codeine in T3's to morphine therefore may keep taking too many to try and stop discomfort....</DIV> <DIV>thus the benefit of NSAIDS in lieu of tylenol with codeine.</DIV>

><DIV>frances wren MD FRCS ----- Original Message ----- From: "Meenan,  Anna" <annam@uic.edu> Date: Friday, November 23, 2007 4:37 pm Subject: Re: ACOG Antepartum Record - Pain Scale? To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > A small percentage of moms (it varies by ethnicity) rapidly > metabolize codeine to morphine.  I wouldn't say codeine is > contraindicated in breastfeeding moms, but needs to be given for > only > a few days, and if pain continues, the situation needs to be > re-evaluated, which is why I have to keep reminding my residents > not > to send more than 2 or 3 days worth of T3 home with > breastfeeding > moms and to tell them to call if still having pain requiring > narcotics when that runs out. > > Anna Meenan, MD > > > >In the UK a post Caesarean breast feeding patient kept > complaining > >of pain (no apparant cause) and was given repeated doses of > >codeine.There was a neonatal death on day 15 suspected to be > due to > >resp.depression.Therefore now is strictly contraindicated in 
> breast > >feeding women > >Aditi > >R>> >----- Original Message ---- > >From: "art fougner, md" <evsono@pipeline.com> > >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > >Sent: Wednesday, 21 November, 2007 5:47:57 PM > >Subject: Re: ACOG Antepartum Record - Pain Scale? > > > >She's Dead, Joe. > > > >Art > > > >At Wed, 21 Nov 2007, > <mailto:DoctorJoe@aol.com>DoctorJoe@aol.com wrote: > > > >>You know, (1) you can't trust the patient not to be faking, > and (2) you > >>don't want to be embarrassed by a lawyer ("Didn't you see, > Nurse > >>Jones, that  when > >>you recorded 'asleep' the patient wasn't breathing and his > tongue was > >>lolling out to the side? The patient was DEAD, Nurse Jones, he > was   DEAD!!") > >> > &gt&#
059;>Joe P. > > > >-- > >art fougner, md > >"May The Wings of Liberty Never Lose a Feather." - Jack Burton > > > > > > > > > >For ideas on reducing your carbon footprint visit > ><http://uk.promotions.yahoo.com/forgood/environment.html>Yahoo! For > >Good this month. > </DIV>

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