Dear Rachel -

In response to your questions...

>>Bright red rectal bleeding means lower GI.
 What about something structural like a fistula? Maybe nothing to do with 
diet.<<

MD's have allegedly ruled out a fistula or any other structural damage. 
She has been assured by two different pediatricians this is not the case.

>>Or what about Celiac Disease, commonly cause rectal bleeding.<<

Just spoke w/ her regarding this...she is willing to try a "rare-foods non-
allergenic diet" as recommended by several people...but, we need to know 
what foods she CAN eat. We have eliminated so many things from her diet 
that I don't really know where else to turn. She is approx 10 lbs below 
her pre-pregnancy weight and baby is only 9 weeks old (and she was pretty 
thin to start with).

 
>>Has the stool been hemoculted to be sure this is blood and not 
discolored stools?<<

Yes, and it is blood. 

>>IF the baby is having lots of bright red bleeding with clots it should 
have a lower Hgb/Hct.<<

Amazingly, Hgb/Hct have remained stable during 5 weeks of bleeding. I have 
read in the archives that this is common w/ breastfed babies and lower GI 
bleeding. It seems that the Hgb/ Hct dive when you change to formula. 

 
>>IF Baby's blood work is stable and baby is thriving why change anything. 
It seems only mom is concerned.<<

It is easy for us to say that "only mom is concerned" when we are not the 
ones changing 4-8 grossly bloody diapers everyday. We both (myself and the 
pt) have agreed on this philosophy and are doing everything we can to 
support her continued breastfeeding. Still, I am all the way across the 
country (we have racked up several hundreds of dollars in phone bills) and 
I can't be there to look her in the eye and tell her it is going to be ok. 
She does not have an MD who is supporting, nor a local LC. The "LC" she 
has been in contact with recommended she follow the pediatrician's advice 
(start formula)...As I mentioned, Dad is deployed and nearest family 
member is in Colorado. She has been so strong in coping w/ this by 
herself...but she is losing momentum, along w/ her strength and her weight 
and her confidence that she is doing the right thing.  

Thank you for your interest in this case. Good luck to you in your pursuit 
of IBCLC and thanks for what you do w/ LLL.

Respectfully,
Leah Kaiser, RN, BSN, IBCLC, RLC
Mom to 19 m.o. Nicole and 11 week old Joshua

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