Mary,
Nifedipine is a drug that drives the production of nitric oxide. Nitric oxide is a vasodilator. There can be numerous reasons she is not making sufficient nitric oxide, from phenotypic mutations in the methylation pathways to insufficient substrate (L-arginine) to mouth breathing (nose breathing allows for normal nitric oxide production while mouth breathing creates a deficit). The easiest way to support nitric oxide production is to provide the substrate. Instead of a drug, she can simply take L-arginine. 500mg 3 x per day. It usually works within hours. You can search pubmed. It is very well referenced for treating Reynauds. A nice side effect is increased milk production for women whose nitric oxide pathway is impaired since we need good blood supply to the breasts to make milk. 
Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC



Date:    Wed, 7 May 2014 14:01:55 -0400
From:    "Mary Jozwiak BS, IBCLC, RLC" <[log in to unmask]>
Subject: Re: Resistant TT

Thank you, Jeannette, Thank you, Kerri, 

Saw this Mom this morning. I suspected Raynauds originally, but mom was having 
such a rough time, she didn't understand. With the shower causing so much pain, 
and today, after the baby unlatched (using a shield on one side, because she's 
so overwhelmed with the pain and the baby has no idea what to do with his tongue 
yet, and the shield was helping him hold it down)  I sat there and watched the 
blanching spread across the flat tip of her nipple. She was more coherent and 
said, yes, her fingers and toes get white and cold and get "hives" after coming 
in from the cold. It makes total sense. She;ll be using warmth on the nipples 
immediately after each feeding and gently allow it to cool to room temperature, 
so the capillaries and vessels don't overreact to the pressure. suction and 
temperature changes. I've seen this work before, so I hope it does for her. If 
not, she can talk to her MD about Nifidipene. 

She's dealing with so much, but she's such a trooper. She's really working hard 
and I'm her biggest cheerleader (next to her baby and her husband, of course) 
The upper lip flanging is SO much better now. The baby has it figured out. 

We're using finger/mouth exercises and mimicking exercises (as of now, he really 
tries to mimic sticking out his tongue when you do it, and he laughs and smiles, 
and opens his little mouth and coos.... and can't quite get control of his 
tongue yet.) I did a gentle very soft sell when I gave her a list of CSTs, but 
they may need to come to that solution when it makes more sense to them. 

She knows I'm on her side. We talked about "resting" the nipple (the right one 
is much worse) and that she would do that as a last chance. She did OK with the 
shield (but with the Raynaud's it is still blanching in response to ANY 
pressure, suction, heat cold etc.) 

Thank you to all who emailed me as well. I see a lot of TT and TLF but this is a 
complicated case. Mom knows she can text or call or email me and I'll get back 
to her asap.

Warmly,

Mary Jozwiak, IBCLC, RLC
Board Certified Lactation Consultant, Post Partum Doula
Birthwaysinc. 
Chicago, IL







 

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