I can only hope that the first draft of this letter did not get to you suffering lactnetters. I
will start all over.Today I had a 32 year old primip who has a hx of fibrocystic disease
including several biopsies, and was encouraged to BF by her surgeon.. She told me that she had
an elevated prolactin level for unexplained reasons, and didn,t require medication
(bromocriptine) to become pregnant. She receive different opinions from two doctors as to bf
with elevated prolactin. One dr. thinks she shouldn't and the other says she should for a month.
(This is not the main problem...I have access to both drs. and could get a straight story from
them and prehaps a different approach). This mother wanted me to know that she is a worrier and
everything goes wrong with her. Meanwhile her baby got " held up" in the Nursery
for logistic (unacceptable) reasons..which added to her anxiety. She then when on to show  me
that her mouth is full of thrush which was diagnosed at the beginning of her pregnancy and that
her doctor told her that it is not catching and that it is very stubborn and hard to get rid of.
(I am going to kill him!.) She denied any other yeast symptons and did not receive antibiotic rx
for "years". I was assigned the other side of the floor today and was not there when she was
reunited with her soon. The Nursery nurse told me that she had brought the baby and that his
mother had no nipples and the baby was also not bottle feeding well. So now I have  an extremely
anxious mother and a baby that won't eat. I had not read her chart because she wasn,t assigned
to me today..but she said that she had received pethidine (demerol) twice and she had also had a
vacumn extraction. We spent a while cozing up to this child...talking about possible (hah)
effects of pethidine on baby's suck When he was abit more awake I asked her if she wanted to try
latching him on....and there we are...I asked her if I could express a bit..to prehaps turn him
on...and we have green milk!.bilateral..oh well..it was one of those days. Her milk was
particuarly vile looking bile colored...lovely amount though. Fortunately her breast surgeon was
around and said he would see her if we could get a referral written...fast because he was on his
way to the OR. (I was dying to do some tests on this milk). I cornered a resident in the labor
and delivery suite..the request was writen and.she (the mother) got to the surgical ward
accompanied by my midwifery student. He was stumped and recommended a culture and cytological
analysis. Great...now I have a Dr. requesting. (some of you may remember that I had trouble in
the past getting green milk analyized) As we were preparing the slides this woman mentions that
she had a green discharge from her nipples before her pregnancy and it had been sent for
analysis and was epithelial debris...but she wasn't sure. I asked her to have her husband bring
in the report. After obtaining the slides we cleansed here nipples with antiseptic solution,
regloved and took a "mid-stream" culture. I hope that I will have some answers to share. This
mother is is a one of those people that every few sentences throws another bombshell into the
conversation...In reconstructing our conversations today...I don't think we directly asked her
if she ever had a green discharge before...but it was odd that her breast surgeon was unaware of
this. I hope I get to see her previous reports.. Meanwhile she is hand expressing as the doctors
want to either have it clear up...or get back reassuring reports before the baby feeds.By the
way she has flattish nipples that the "right" baby would do fine with. At least my student was
thrilled with the novelty of green milk. Bye for now -  -------------------------------------
Name: Toby Gish R.N.LLLL.IBCLC
E-mail: Toby Gish <[log in to unmask]>
Date: 12/03/96
Time: 06:55:49 PM

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