Cat scan and nursing - not possible??

[MyZymurgy]

I have to get an (upper) abdominal ct scan on Monday. I was told that I have to dump and dump for 48 hours!!! Eek! This is daunting on SO MANY levels. Can I successfully pump to keep up my supply. Can I get DD to actually take a bottle (which she never likes). Can I pump enough over the weekend to supply her for two days (very unlikely). Will she take the formula without too much drama. ACK.

Some looking on the Internet told me that some moms don't stop breastfeeding for a CT scan. So I called the pediatrician. They said have have to pump and dump for 48 hours if that is what the radiologist recommends. Well... the guy making the appointments told me this. Evidently this is their standard policy. So more investigating is needed, obviously.

Has anyone here breastfeed after a CT scan? I know I have to take barium 3 hours and 1 hour before the scan, if that helps make sense of this.

This will be 48 hours from hell, especially for DD, if there is no boobie allowed. She is only four months old!

Any experience or advice? Please help. Thanks!


Sorry for typos.... nak, of course.

[womenswisdom]

If it's just oral contrast, you usually don't need to pump and dump at all. When I had one last year, I just had the oral and did some research beforehand and found that it was very safe.

I would contact the InfantRisk Center, which has just opened a hotline. It's founded by Dr. Hale, a well-respected authority on medications and breastfeeding and is operated out of the Texas Tech University Health Sciences Center. Here is the link to the web page. You should be able to call tomorrow and find out whether you need to be worried. You might also check kellymom.com.

[PatioGardener]

what kind of scan? iv contrast or not?

nak

will find info.

eta http://www.kellymom.com/health/meds/radioisotopes.html

[ssh]

Kelly mom says it doesn't have to interrupt breastfeeding, specifically "Barium is sometimes used as a contrast agent; it is not absorbed orally and thus does not affect breastfeeding." Here's the website http://www.kellymom.com/health/meds/radioisotopes.html . You can also call the facility where the actual test is being done and talk with a radiologist. Doctors offices often give out wrong info because they really don't know and just want to be safe. Here's the info from Lactmed http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~XnVOqz:1 . It also says barium isn't absorbed at all.

I wouldn't interrupt breastfeeding for just the barium. If you keep talking to people you should be able to find some who actually knows or will look it up, if you need to hear it form a professional.

[PatioGardener]

also remember that formula changes gut flora, and so is not without risk itself. the docs often forget that. http://massbreastfeeding.org/formula/bottle.html

[MyZymurgy]

Thank you all so much!!

I called the radiology department to try to clarify exactly what was going on. I talked to a woman who was very kind and sympathetic... but she made it clear that the 48 hours were required. She said it was because I am getting both a scan with and without contrast, and it's the injection that is really problematic.

Oh lordy... I feel so bad for my DD. These are going to be some tough days. I just really hope it doesn't screw us up long term. My milk supply is always on the low side anyway. I nurse her on demand, which is nearly every other hour during the day.

I guess I gotta try to figure out how to get something pumped so she can at least have some bm over those two days.

[womenswisdom]

I would find out EXACTLY what they are using and verify it through another source that is specifically acquainted with breastfeeding and medication. Many times there are also alternatives that they can use if what they normally use is truly contraindicated. Many, many docs will say 48 hours as a standard for liability reasons. Please follow up with the InfantRisk center I posted above. They know what they are talking about and can offer alternative suggestions. They will also take calls from health care professionals. You may have to advocate for this, but I guarantee that it's worth it!

ETA: This page lists some safe agents and more specifics.

[PatioGardener]

Originally Posted by womenswisdom

I would find out EXACTLY what they are using and verify it through another source that is specifically acquainted with breastfeeding and medication. Many times there are also alternatives that they can use if what they normally use is truly contraindicated. Many, many docs will say 48 hours as a standard for liability reasons. Please follow up with the InfantRisk center I poted above. They know what they are talking about and can offer alternative suggestions. They will also take calls from health care professionals. You may have to advocate for this, but I guarantee that it's worth it!

ETA: This page lists some safe agents and more specifics.

and hale http://neonatal.ttuhsc.edu/lact/radioactive.pdf

[MyZymurgy]

You guys are such an excellent resource - thank you! I got some pumping supplies at the store (I only had one bottle here for storage... not a big pumper, obviously). I'll pump and prepare for this, just to be safe.

But I've printed off the resources you've shared and will bring them with me when I pick up the barium. I'll also call that hotline if I can tomorrow.

I have high bp and recently had to bring in a list of bf-safe drugs to my pcp to show her there were safe alternatives to the methydopa I was on in pregnancy. You all are right that a lot of doctors aren't up on what is safe for bfing and they err on the side of caution.

I know you all understand that 48 hours of not breastfeeding is a BIG deal (esp. to dd!! But to me too.) Docs think "it's only 48 hours" but that's years to a tiny baby! BFing isn't just about nourishment, afterall.

Thanks again.

[PatioGardener]

Originally Posted by MyZymurgy

I know you all understand that 48 hours of not breastfeeding is a BIG deal (esp. to dd!! But to me too.) Docs think "it's only 48 hours" but that's years to a tiny baby! BFing isn't just about nourishment, afterall.

so true! i like this ped's take on it:

http://www.drjen4kids.com/

A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.

[Mom2M]

I had a cat scan with and without contrast and didn't stop breastfeeding and never pumped and dumped. I can't remember what the contrast was though.
They also told me the same thing, pump and dump; I think they have to say that, kind of like every med saying breastfeeding is not recommended.
Check DR. Hale's site. Look for your specific contrast, they have to tell you what it is.

Here is the page specifically dealing with contrasts. http://neonatal.ttuhsc.edu/discus/me...tml?1266590593
Many of them are fine.

This article is written by radiologists at the Cleveland Clinic and discusses specifically IV Iodinated contrast agents for CT scans.

http://www.ccjm.org/content/74/5/361.full.pdf
It says they are safe for breastfeeding because barely any of it goes into the milk.

Just find out specifically what yours will be. It is so hard to interrupt breastfeeding, I hope you won't have to do it.

Good luck with your test

ETA I just saw you are having barium, not an IV. This is absolutely fine. It is not absorbed by your digestive tract, that's why it's used for imaging, it goes right through it. So there is no way for it to get in your milk.
http://www.kellymom.com/health/meds/radioisotopes.html

[poorlittlefish]

nak
i had this done with iv contrast at 1 week postpartum and was told that the recommendations just changed and i didnt need to pump and dump.....

[kcstar]

I had this done at 1 week postpartum. The hospital lactation consultent came and visited and provided a hospital pump for me to pump and dump the 48 hours. DS drank formula until they'd let me nurse again.

[MyZymurgy]

I wanted to post a little update... And, just to clarify, I am getting barium AND a contrast dye IV for this ct scan.


I didn't get a chance to call the InfantRisk Center, but that is an awesome resource that I know I'll be calling in the future. I found this on their website:

Iodinated X-ray Contrast Media (Ionic and Nonionic)
Background:
The plasma half-life of intravenously administered iodinated contrast medium is approximately two hours, with nearly 100% of the agent cleared from the bloodstream within 24 hours. Because of its low lipid solubility, less than 1% of the administered maternal dose of iodinated contrast medium is excreted into the breast milk in the first 24 hours (1, 2). Because less than 1% of the contrast medium ingested by the infant is absorbed from its gastrointestinal tract (3), the expected dose absorbed by the infant from the breast milk is less than 0.01% of the intravascular dose given to the mother. This amount of contrast medium represents less than 1% of the recommended dose for an infant undergoing an imaging study, which is 2 mL/kg. The potential risks to the infant include direct toxicity and allergic sensitization or reaction, which are theoretical concerns but have not been reported.
Recommendation:
Mothers who are breast-feeding should be given the opportunity to make an informed decision as to whether to continue breast-feeding or temporarily abstain from breast-feeding after receiving intravascularly administered iodinated contrast medium. Because of the very small percentage of iodinated contrast medium that is excreted into the breast milk and absorbed by the infant's gut, we believe that the available data suggest that it is safe for the mother and infant to continue breast feeding after receiving such an agent. If the mother remains concerned about any potential ill effects to the infant, she may abstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period. In anticipation of this, she may wish to use a breast pump to obtain milk before the contrast study to feed the infant during the 24-hour period following the examination.

I had to go to the hospital to pick up the barium today. I asked to speak to the radiologist. He told me that he didn't want to officially advise me b/c he wasn't the doc overseeing my cat scan. But he was very cool and obviously pro-bfing. He said that he often thinks the risks of compromising breastfeeding are far greater than the risks of bfing after the contrast iv. He repeated much of what is quoted above from InfantRisk. He said I'd need to talk to the radiologist tomorrow, but it basically came down to me.

I feel so much less stressed out about this now. I will, of course, talk to the doc tomorrow. But I have pumped enough to give DD pumped milk for maybe half a day. So I think I'll pump and dump for 12 hours, which is probably unnecessary but extra cautious. Hopefully DD will accept the bottle... and if not, I won't fret too much about giving her some boobie even earlier.

I'm so relieved! Thank you all for sharing great links and info.

eta: link for above quote --> http://www.infantrisk.org/content/re...ontrast-agents

[MyZymurgy]

Just wanted to give one final update in case other nursing moms needing a ct scan find this thread.

I had my scan this morning. The Radiologist was a mom too! She was wonderful. She echoed much of what we have discussed here. She told me that 48 hours of pumping and dumping was very much the old rule from back when the injected contrast dye was more toxic. She said the "standard" advice is to tell mom to wait 24 hours, however this was being overly cautious. She said it was up to me, but in her opinion I'd be safe to start nursing much sooner after the test. She advised me to drink a lot (I mean A LOT) of water to flush the dye out of my system. She said the sooner I start drinking water, the better... the less time the dye is in my system the better. She said if I needed to nurse right away it would likely be just fine. If it made me feel more comfortable, perhaps I could wait a few hours.

So I came home. DD had already had her pumped breastmilk (which she only finally took, apparently, after much drama. She just doesn't like bottles!) She was full and content so I pumped and dumped about 2 oz. When she is ready to eat, I'll go ahead and breastfeed her and freeze the rest of the expressed milk for any future needs. Oh, and I've been drinking a LOT of water.

I'm so glad that I pressed everyone (in the medical community) for answers. If I had gone with the initial advise from the first couple people I talked to and not questioned it, this would be the longest 48 hours of my life (and DDs for sure!) I'm so glad to not have the stress of not breastfeeding to deal with... I can focus on my health and DD and I can continue to enjoy our favorite mother-daughter activity.

Thanks, again, everyone!

[kcstar]

Originally Posted by MyZymurgy

I had my scan this morning. The Radiologist was a mom too! She was wonderful. She echoed much of what we have discussed here. She told me that 48 hours of pumping and dumping was very much the old rule from back when the injected contrast dye was more toxic. She said the "standard" advice is to tell mom to wait 24 hours, however this was being overly cautious. She said it was up to me, but in her opinion I'd be safe to start nursing much sooner after the test. She advised me to drink a lot (I mean A LOT) of water to flush the dye out of my system. She said the sooner I start drinking water, the better... the less time the dye is in my system the better. She said if I needed to nurse right away it would likely be just fine. If it made me feel more comfortable, perhaps I could wait a few hours.

Ah, see, every situation is different. I'm so happy that things worked out well for you!

In my situation, I was already experiencing fluid overload, so drinking a lot after the CT scan was not an option. And, unfortunately, I was already in the ER when they recommended doing the scan, so I couldn't go home, get online, and get facts outside what the doctors told me

[MyZymurgy]

Originally Posted by kcstar

Ah, see, every situation is different. I'm so happy that things worked out well for you!

In my situation, I was already experiencing fluid overload, so drinking a lot after the CT scan was not an option. And, unfortunately, I was already in the ER when they recommended doing the scan, so I couldn't go home, get online, and get facts outside what the doctors told me

Yes, every situation is different for sure! It sounds like you did exactly what you had to do at the time. Lactation consultants are excellent advisors. I'm glad you were able to pump and keep your supply up! Thanks for sharing your story too!

[PatioGardener]

Originally Posted by MyZymurgy

I had to go to the hospital to pick up the barium today. I asked to speak to the radiologist. He told me that he didn't want to officially advise me b/c he wasn't the doc overseeing my cat scan. But he was very cool and obviously pro-bfing. He said that he often thinks the risks of compromising breastfeeding are far greater than the risks of bfing after the contrast iv.

to informed health care providers!

so glad it went ok for you!

[womenswisdom]

If you are feeling advocate-ish, I'd suggest maybe you write a letter to the department praising how up-to-date the radiologists are and suggesting maybe they need to do a little extra training with whoever gave you the information about 48 hours, because most mamas wouldn't even know to pursue it enough to find out what you did. Glad it all turned out okay!

[angelachristin]

Originally Posted by womenswisdom

If you are feeling advocate-ish, I'd suggest maybe you write a letter to the department praising how up-to-date the radiologists are and suggesting maybe they need to do a little extra training with whoever gave you the information about 48 hours, because most mamas wouldn't even know to pursue it enough to find out what you did. Glad it all turned out okay!

2nd that, because it's really sad that I bet a lot of mamas would give formula or even wean altogether based on being told something like that. I hate hate hate that!