Diana wrote:
<(e.g.,  increased
sodium, reduced fat, and increased vitamin C -- she is trying each in
isolation, starting with reduced fat, to most clearly evaluate the
result).  I have very little experience with the influence of such
dietary
factors, so I will be very interested to see if they are effective.>

I interpreted Jan's post to refer not so much to total reduction in fat
in the diet, but just as much to a change from saturated fats to poly-or
better yet, monounsaturated fats. I remember seeing some reference in the
past to show this actually changes the type of fat in the mother's milk.
This would theoretically effect the tendency and the temperature at which
the fat in the milk would solidify.

<If she is a pumping mom, maybe the pump flange is not a good fit. Maybe
>she is getting poor drainage actually. Maybe measure her exact nipple
size
>and get a flange to fit exactly?

This is an excellent point and one that did not occur to me
initially.  After about a week or so of working with her, though, I did
take measurements, but found that her size was appropriate to the flange
she was using.>

Despite the confusing multiple viewpoints that currently exist on the
subject of milk sinuses, I firmly believe in their existence, and that
they, like other parts of the reproductive tract, probably temporarily
change in size, configuration, consistency, elasticity, etc. during
different parts of the reproductive cycle.

Have you attempted fingertip expression in order to palpate the
location(s) of the distal (furthest from her body) and proximal (closest
to her body) ends of the sinuses in relation to distance from the base of
the nipple? Getting behind the sinuses (as in the Marmet method of
fingertip expression) and extrapolating from that may be the only way to
assess their extent at 7 weeks, since IME they have usually fully
developed their elasticity and are often hard to feel directly by then.

While I am far from being an expert on the size of the pump flanges in
relation to the size of the nipple, I am very experienced in palpating
the location(s) of milk sinuses, and have found them at random locations
and often much deeper in some moms than others. In those situations, I
think it is worth a trial of different size flanges just to observe the
effect and the flow rate of pumping. You mentioned that she has a very
strong MER. That may mask the fact that the pump flange may not be
compressing the sinuses in the most effective way.

(I am specifically referring to the inner ring or circle of the flange at
the location where the anterior areola compresses itself against the
flange when positive atmospheric pressure pushes on the adjacent breast
tissue to try to equalize the effect of the pump's negative pressure
inside the flange. I firmly believe negative pressure never "pulls" on
anything.)

I think it is theoretically possible that a pump flange whose inner
circle meets the breast anterior to the distal openings of the milk
sinuses could have the effect of stripping the milk in some of those
sinuses back upwards into some of the ducts. While that principle is part
of temporary use of Reverse Pressure Softening in the very early weeks of
breastfeeding, I wonder about its effect consistently during pumping.

I remember your remarking on the presence of vivid (external) stretch
marks. This led me to believe that perhaps the mother began with a
smaller breast cup size, and the skin developed these stretch marks in
stressful response to the rapid need for tissue expansion when
overproduction developed.

Both the skin and the entire glandular/ductal portion of the breast
develop from the ectodermal embryonic layer. The outer layer cell type
(squamous epithelial) normally extends continuously from the outer
surface, continuing inside the ducts in the nipple all the way to an
abrupt demarcation with a different kind of cells (cuboidal or columnar)
at the lactiferous sinus entrance. There are some conditions in which the
squamous epithelial cell lining spreads (abnormally) to the lining of the
sinus, often leading eventually to abcesses.

I also believe you mentioned the doctor's suggestion for ductography,
though I may be confusing this with another post. This might allow not
only for ultrasound mapping of her ducts/sinuses, but to identify whether
the plugs are composed of saturated fat and/or
the nature of the cells lining the sinuses.

But then again, I am certainly out of my realm at that point and might be
in the science fiction realm when I try to project my thinking to
ductography.

Your explanation of the history thus far and your rationale for your
interventions are very clear and thought provoking.

Jean
*********************
K. Jean cotterman RNC, IBCLC
Dayton, Ohio

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html