Nina,  we've all gotten calls like this from moms who are looking for answers or a "fix" over the phone but frankly unless you could see them and gather the appropriate history and visual you'll be spinning your wheels.  There is so much to know here and all you have is what the mom has told you -not enough.  A lot can happen in 3 weeks including misinterpretations,  bad assumptions and poor management by the time your " sucked in" its a convoluted mess. Also, there are moms that call and pick the brains of many LC's just to say they spoke to everyone and it still didn't work.  Kinda like setting you up for failure.  Usually in these cases even if you decide to suggest something -they say they have already done it or refused to try it  and decline to pay for a consult.  Expecting you to assess and evaluate her situation over the phone is not appropriate as it wouldn't be with any other profession.  As much as we feel bad and want to help mothers, there is a certain protocol in which we need to practice.  Setting boundaries on that type of behavior is important.  Suggesting she contact the LC who she originally worked with, like you did or offering your services like I am sure you did as well - that's it.

As far as her micrprolactinoma and blood work is concerned, she should have an endocrinologist who follows her.   FYI-Pituitary hormones are extremely dynamic thus quantifying them accurately can be tricky.  The blood samples need to be drawn in a fasting state, mom has to be rested for at least 30 min prior but not just woken up and ( for prolactin) no breastfeeding or breast exam -I think for at least half hour or so prior to draw. If they are not done this way -it's simply inaccurate.   Then the results need to be properly interpreted in the context of the situation possibly with additional testing ie 24 hr urine, saliva and CT scan/ MRI.  Very complicated. Usually if there is something quite serious ie macroadenoma of the pituitary, Cushings etc- there are multiple symptoms experienced.  Again, not our job - but the job of her doctors.  

I don't mean to sound harsh or cynical but I feel it's important to discuss this type of "call" for the benefit of everyone.

Maria Parlapiano RN IBCLC
Chatham, NJ

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