On two bottles of children's aspirin

The latest thing I've decided to toss for my making space project is two unopened bottles of cherry chewable children's aspirin. These bottles are nearly sacramentals, being the visible sign of a eucatastrophe.

When Thomas was released from Children's Memorial Hospital last year, November 3, he was receiving 22 doses of various oral medications a day. We had a full-page chart just to keep track of which ones he should get when, and plastic bags with the time of day (he had to take them at five different times) with the appropriate syringes inside so we didn't get mixed up, forget one, or give him one twice. One of the medications he was on was aspirin, regimentally, as a blood thinner. He had to take one-half of a chewable children's aspirin tablet once a day, crushed, dissolved in breast milk, and administered with an eyedropper or oral syringe. It was definitely the most time-intensive medicine to administer, although he actually liked the taste, which was something.

At less than $2 a bottle generic, it was definitely his cheapest medication. There are 36 tablets in each bottle, so each one gives 72 doses. 72 days after Thomas got out of the hospital was Sunday, January 14. I went to Walgreens that day to get more aspirin, and bought the three-pack. "He'll be taking these for a long time," I reasoned.

That Friday, January 19, Thomas had a followup with his cardiology team, including a chest x-ray, which they do every January for all their patients, and an echocardiogram. The echo showed heart function just on the low end of normal -- improvement beyond the hopes even of his very optimistic cardiologist. The x-ray tech was a very nice woman; I asked her if I could see the image when she was done (and Thomas was rescued from her chair, which he liked not at all).

When Matt and I saw Thomas's chest x-ray in the emergency room on October 12, we stared at it, silent, stunned and disbelieving. His heart was expanded all the way out to his ribs, and the whole chest cavity was a dull gray cloud.

January 19, though, Thomas's heart was the shapely core of his being, surrounded by a fabulous tree of glowing white blood vessels carrying life out to his whole body. I could hardly be surprised when his cardiologist called me at quarter to ten that night. "I'm sorry to call so late, but I just saw his x-ray," she gushed. "It's so beautiful! Can I put it in my presentation?"

Based on this amazing recovery, Thomas's cardiology team started weaning his drugs, and aspirin was the first to go. Thus, I only used two and a half of the 108 aspirin I bought January 14. Now he's down to two medications and one dietary supplement, some of which they're talking about eliminating at his next visit. And Amy's slide show, to teach the med students at Children's Memorial about cardiology, had a very happy ending.

These two unopened bottles of aspirin are toast. But I'm keeping the open one. I crushed the fourth aspirin in it last week and dissolved it in water to display the first flower Thomas ever brought me. I still have enough in there for 32 more flowers!

On experts who bother

This week I went to the doctor and, long story short, I have to go on a course of vaginal antibiotics. Well now, this is an issue because whenever you take medicine while breastfeeding, you have to find out whether the medicine you've been prescribed is compatible with breastfeeding. And this is an issue because there are relatively few studies done on medicines and breastfeeding, and those that are done do not differentiate between breastfeeding newborns and (let's say) 10 month olds. Obviously there is a weight difference as well as a difference in the child's physical development and ability to process drugs. Also 10 month olds nurse less frequently and get proportionally less of their calories from breastmilk. So there are differences.

The problem is that despite these differences, even well-informed medical professionals seem to mostly read the yes-or-no answer to breastfeeding while taking medicines off a table somewhere. These tables are clearly based on medical data, but it's data I don't have access to, so I am unable to make my own informed decision. In this case, my gynecologist told me that the medicine he had prescribed was compatible with breastfeeding, and the pediatrician said it was not. Grr. In fact it was the nurse at the pediatrician's office that actually returned my call, and she was clearly reading it off a table, and did not pay attention to the fact that I mentioned the medicine was not oral but topical (which means less is absorbed into my bloodstream, so less is available to the milk-making process). She told me I needed to just pump for a week and throw out the milk.

Now, when you're nursing a baby who's ten months old, eating solids, and drinking from a cup, and is used to breastfeeding about 4 times a day, forgoing nursing altogether for a week doesn't just mean he's going to be very mad (though I wouldn't look forward to that), it might mean he gives up nursing altogether. So I called the gynecologist back to see if he could prescribe a different medication. He called me back himself (concept) to say that he still thought the original medication would be fine vaginally, but he had another thing he could prescribe. It was often used to treat premature infants, he said, so was ok for babies. Then he called back again and said, regardless of the fact that it is used in pediatric patients, that medicine is specifically not recommended for breastfeeding mothers by the American Academy of Pediatrics (why? wouldn't we like to know?). He said we'd have to go back to the first medicine, but we wondered if I could still nurse a couple of times a day without affecting Thomas too much.

Well, there's something I always do when I have medical questions about Thomas I can't answer. I try to put it off as long as possible when the questions aren't cardiology-related, but... I inevitably call his cardiology team. Because they answer the phone, they answer my questions, and they always thank me for calling. So this time I called, and I got Kerry, and I explained the problem. She would consult with the hospital pharmacist, she said, and call me back. When she did, she said the pharmacist had looked up some studies and had some numbers for me. There were no studies on breastfeeding while on the vaginal preparation, but there were studies that showed that the concentration of antibiotic in the blood while using the vaginal preparation were 1/50th of the levels while taking the oral preparation. About a third of women still reported side effects. Breastfeeding while on the oral antibiotic tended to cause diarrhea (a major problem in a newborn; less so in an older infant). After discussing it with her, I felt confident that I could store some milk in the fridge and then try nursing Thomas, see if he has any problems. Nursing him a couple of times a day will almost certainly not cause a problem.

I told Kerry she deserved a medal, and she denied it. I don't think people like her realize what an amazing luxury it is to have someone like her, with medical knowledge and access to specialists outside her area, just a phone call away.

I was going to end this post with a special tribute, but it's already too long and I have too much to say about the tributee. Next time.