13 Mar 2012

Dear Paramedic: I'm Transgender!

toy firetruck
Last night I sat on the cold bumper of a fire truck parked in front of my house and told a young, dashing male paramedic surrounded by burly firefighters, "well, I'm transgender and I, uh, breastfeed my baby."

He didn't blink an eye. I guess he sees all sorts of strange people in strange situations all night long and he was just doing his job. I, however, was a little bewildered to find myself coming out in this fashion.

This weekend I had the flu, or maybe food poisoning, and I was still feeling nauseous last night. I was nursing Jacob in bed when our carbon monoxide detector went off. Ian opened the windows and doors and called police non-emergency but was told that he ought to dial 911. Could be deadly serious. We waited outside on our front steps and the fire truck pulled up within minutes.

Since carbon monoxide poisoning can resemble flu symptoms, the paramedic wanted to check me out while the firefighters went inside to measure the CO levels. He took my vitals and soon asked, "are you on any medications?"

"Yes, I take domperidone." This is a drug normally prescribed, ironically enough, for controlling nausea.

"And what do you take it for?"

"Um, well, I'm transgender, and I, uh, breastfeed my baby. Domperidone increases milk production..."

So my lovely paramedic got a mini-lesson in lactation - queer lactation, at that.

As it turned out, it was all a false alarm. The firefighters determined the house to be fine, and I must have just had the flu. Unfortunately Jacob is not yet at an age where he can appreciate a fire truck but all the commotion left him wide awake until 1:15am. We'll be replacing our CO detector today.

And while I'm on the subject of domperidone, Health Canada recently came out with a new warning against its use: http://www.cbc.ca/news/health/story/2012/03/08/domperidone-maleate-drug-.html

Breastfeeding expert Dr. Jack Newman had this to say about it on Facebook:
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"Based on a study that was published in Belgium which looked at over 1000 cases of sudden death and found that some of the people who died suddenly were taking domperidone, Health Canada has put out a warning about possible concerns about treating with domperidone. This is a bit of an overreaction on the part of Health Canada. Well, a big overreaction given the data.

"Note that in the study, the youngest person who died was 55 and the average age of those who died was 75 years. What has this to do with breastfeeding mothers who are rarely older than 45 years and are usually in reasonably good health? Furthermore, this information came from a data base with no clinical information. It simply has information that so and so died suddenly and was taking such and such a drug. The thing is that domperidone in these patients was used for reflux and we know that heart disease is frequently misdiagnosed as reflux; severe pain at the top of the abdomen or lower part of the chest is typical of both reflux and cardiac pain. Misdiagnosis is particularly possible in Europe where domperidone is available in countries like the United Kingdom, Belgium and the Netherlands without a prescription and it is likely that many people are self-diagnosing and self-medicating.

"So that's it and it does not mean that domperidone kills. I will continue to prescribe domperidone at our doses which are based on many years of clinical experience. I have treated many thousands of women with it with only minor side effects. I believe this article from Belgium proves nothing and does not require us to stop prescribing it.

"It would be a pity that mothers and babies not benefit from domperidone when used in conjunction with our Protocol to manage breastmilk intake."
Thanks for the insight, Jack! Although you might want to add "fathers" to the list of those who derive benefit from this drug.

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