Some drugs are secreted in breast milk. They are not required for the baby and may be harmful. Most drugs excreted in breast milk are less than 10% of the therapeutic dose in children. As a general rule, breastfeeding should not be done for 3 hours after taking a drug. 90% of patients with rheumatoid and other inflammatory arthritis suffer a disease flare within three months of delivery. It may be prudent to stop feeding the child early in case of need to start contraindicated drugs for patients with nonresponsive arthritis. It must be kept in mind that optimal disease control is essential for the prevention of deformities. A disabled mother, due to deformed joints, will undoubtedly be unable to bring up her child well.
Recommendations on the use of drugs during breastfeeding are given in the following table.
| Drug | Remark | |
|---|---|---|
| 1 |
Paracetamol |
Safe. Feed after 3 hours. |
| 2 |
Anti-inflammatory Painkillers |
Safe/no substantial information. Ibuprofen, Indomethacin, Diclofenac, and Naproxen are compatible. Ibuprofen is the best choice. |
| 3 |
Steroids |
No adverse effects on children up to 10 mg/day. Prednisone preferred, Less than 0.1%excreted in milk |
| 4 |
Hydroxychloroquin |
Safe. 2% of the dose excreted in milk |
| 5 |
Sulphasalazine |
Safe. Caution in premature babies and infantile jaundice. |
| 6 |
Methotrexate |
No reported risk. Less than 10% excreted in milk. Do not feed for 9 hours after tablet. Monitor the child. |
| 7 |
Leflunomide |
Insufficient data about secretion in milk. Avoid if possible. |
| 8 |
Azathioprine |
Safe. Almost undetectable in milk. No evidence of adverse effects in infants. Monitor the child. |
| 9 |
Cyclophosphamide |
No data. Avoid if possible. |
| 10 |
Mycophenolate |
Avoid. |
| 11 |
Tofacitinib |
Excreted in animal milk. Avoid. Not known whether excreted in human milk. |
| 12 |
Etanercept Infliximab Adalimumab |
Minimal excretion in breast milk. Compatible. |
| 13 |
Rituximab |
Insufficient data. Not recommended. |
| 14 |
Tocilizumab |
Insufficient data. Not recommended. |
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General instructions about exercise
Do exercises in fresh, pleasant environment.
It is better to exercise on empty stomach (morning/evening).
Do not eat anything for about an hour after exercise. Sips of water or other fluids are allowed.
Wear comfortable cotton clothes during exercise.
Use proper footwear during exercise. Use of sports or canvas shoes recommended.
Breathe in and out normally from nose. Avoid mouth-breathing.
Concentrate on your exercise and exercise slowly. Never exercise hastily; do not jerk your joints.
Rest for a minute or so if you feel fatigue.
Concentrate on the joint or muscle group for which you are exercising.
Learn exercises, especially those for shoulder, from a physiotherapist.
One should feel relaxation of muscles after exercise. Increase in pain after exercise may indicate wrong method. Stop exercise and meet your physiotherapist again in such situation.
Be relaxed and maintain proper posture during exercise. It is good to look into a mirror during initial days of exercise.
Maintain a posture for about 10 seconds and return back slowly to resting position.
Start low - for some minutes - and increase your work-out gradually.
Exercise one sided limbs at a time initially. Simultaneous exercise for both limbs will be possible after some days.
Exercise twice each day. Regularity is of utmost importance.
Look for a friend if exercising alone gets boring. Exercise accompanied by music is quite entertaining.
Balanced diet is also necessary appropriate benefits of exercise. Meal timings should be strictly adhered to. Consult a dietitian for reducing weight.
General instructions for yoga practice
Yoga postures should be practiced in a clean and fresh surrounding. Do the asanas on a soft and clean mattress. Use clean, light, loose and minimum clothing.
Do the asanas in morning or evening on empty stomach. Eat light food half an hour after completing practice.
Warm-up, in the form of Soorya-namaskar is desirable prior to asanas.
All movements should be gentle and controlled. Do not jerk your body. Do not over-stretch. Do not use any force to overdo.
Watch your breathing. Breathing should be easy and natural. Exhale while you bend forwards and inhale while bending backwards. Never hold breath.
One should be comfortable in any asana. Do whatever little you can. Do not try to overstretch to attain a pose as given in pictures. Trembling during asana implies overdoing.
Steadiness is of utmost importance. Period of staying in a single pose will increase with practice. Try to contract only those muscles that are required for a particular pose while relaxing all other muscles.
Draw your mind away from your body and concentrate on breathing on attaining desired pose.
Select and practice a few asanas and try to master them.
There should not be any pain, fatigue or sweating during asanas. Do a resting asana if any of these appear. One should feel enthusiastic after a yoga session.
45 minutes of yoga practice each day is desirable. Pranayama may also be done for a few minutes. Regularity is the key to success.
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