A question came up about compounded All Purpose Nipple Ointment (aka APNO) that feigned outrage over using medicines that would be ingested by the new baby, and possibly cause some harm. Sure, too many people take too many drugs, and there always will be legitimate drug uses that relieve symptoms and support healing. That’s what the APNO does for thousands of nursing mothers.
Nursing moms explain that the pain can be intense and that it penetrates deep inside and over the whole body. It would not be unexpected for someone in that kind of a pain to have animosity toward the person causing the pain, her new child. And fathers have described that their wives had been crying from the pain.
The combination of the drugs in APNO is effective and quickly gives the mother relief, and no one ever has offered evidence that any harm has been done to the child, or the mother. The doses are exceptionally small and the length of therapy rarely exceeds a few weeks. Women rarely request refills. Every user recounts how they don’t know how they would have made it through that time without the relief they got from the APNO.
It’s the height of insensitivity to even suggest a new mother’s pain is unworthy of the best treatment because there is no so-called scientific evidence she is complaining about “nothing beyond ‘soreness’” (a comment made by a pharmacist who opposed the use of this healing ointment). It would be irresponsible for any compounding pharmacist to refuse to prepare and dispense the APNO. It works exceptionally well and has a solid record of safety.
For those concerned about the actual doses, consider that the final preparation contains one-third betamethasone 0.1%, meaning the final preparation is 0.0333% betamethasone, which delivers 0.333 mg of the drug in each gram. The applied dose is somewhere in the neighborhood of 0.05 gram, which works out to 0.0166 mg. of betamethasone, only a part of which actually comes in contact with the baby. Five feedings per day will have a total 0.08 mg., a pittance.
Somehow the word has gotten around to use the ointment for only two weeks. It is unfortunate because many mothers are getting so much better, but not pain-free, by the time they believe they have to stop. Some hot-shot pharmacists have said that the steroid in the ointment will cause thinning of the skin. It is a concern with any steroid one puts on the skin, but real-life experience demonstrates that it has not occurred with APNO. Of course, anything is possible but there’s scant wisdom alarming someone with a tale of what might happen rather than supporting a mother who has pain and enough anxiety about feeding.
Any drug should be used for the shortest period of time necessary, whether it’s taken by mouth or put on the skin. There is no problem using APNO for two, or three, or even more weeks. Even stopping and starting again is fine. Nothing in health is so precise that one size fits all.
Medicine is far more than lab tests and drugs-for-life. It’s finding better ways to help relieve suffering and improve life. Yes, extremely sore nipples cause unnecessary suffering even though it may seem inconsequential to someone without the experience. When all is said and done, a primary goal of medicine must be to relieve pain and suffering.
Larry Frieders is a pharmacist in Aurora who had a book published, The Undruggist: Book One, A Tale of Modern Apothecary and Wellness. He can be reached at thecompounder.com/ask-larry or www.facebook.com/thecompounder.