Kathleen,
The vacillation in supply is fascinating. Although I was initially cuing
into baby's oral motor issues, that would not explain the extreme ups and
downs. No weight change between 6 and 9 mos is definitely a red flag. I
personally experienced this due to my fourth baby's suck issues
(undiagnosed), and there were no fluctuations in milk supply. The
fluctuations coupled with the fact that this also occurred to a lesser
degree with baby #2 suggests a primary issue to me. I assume that baby's
suck is consistent in response to flow?

Regarding let-down, I believe this to be a function of milk supply and thus
reflective of her low supply at that point in time; she is not letting down
well because supply is low. 

It sounds like there are hormonal issues going on. I would key in on menses
issues *except* that 1) mom says she has only had one period, around 7 mos
(before starting domperidone), and 2) domperidone should raise prolactin,
which would in turn suppress ovulation. Mom really should be in an
amenorrheic state due to induced hyperprolactinemia. 

I would be interested in knowing exactly how much domperidone mom is taking,
as well as each of the herbs. MM+ and goat's rue are good products *if* the
address the right issues and *if* the dosage is adequate. 

Do we have any records of the supply variations? They have been described
generally, with low supply being described as happening "up to 2 weeks"---
but how much time in between? How long does good (adequate) supply last? I
think a clearer picture of the milk supply fluctuations would be helpful. 

Since mother has not had any hormone panels, I do think that it would be
appropriate to check her prolactin, estrogen, testosterone, TSH (use new
guidelines!), insulin (and insulin resistance), and cortisol (draw after 2
hours no breast stimulation).  Prolactin baseline should be high; I wish we
could see the feeding spike as that is supposed to be stunted for obese
women, but domperidone as an artificial source of prolactin will
artificially blunt the spike, so that would not be useful. If all these can
be tested, it would be important to note exactly where mom is in her cycle
of fluctuations (during high supply? Low supply?), and then a re-test if
possible during the other side of the fluctuation might yield some clues
(test at same time of day as first test). Perhaps this list could be pared
down for the second testing, but this is such a mystery that it is difficult
to know exactly where to focus. I know tests are expensive though. 

In the absence of the answers to some of these questions, it is difficult to
devise a game plan. Hormonal fluctuations suggest that something that is
balancing to hormones may be appropriate. Metformin may work if mom has
insulin resistance/PCOS; it sounds like it will be difficult for her to get
a diagnosis, though. Weight loss alone may help to correct some of the
hormonal stuff. 

Someone suggested the Ca/Mag supplement; I think that is worth trying as a
"can't hurt, might help" thing. 

~Lisa Marasco

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

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(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html