Yesterday morning upon arrival to the hospital, all the nurses pounced
on me with lists of moms I had to see immediately.  Obviously the niece
of the head of the dept. got top priority, but the second chart really
caught my attention.
A 34 y/o pp in advanced stages of Amyotrophic Lateral Sclerosis ALS  or
as Dr. Mira told me better known as Lou Gherig's disease had delivered
by VE a 3k250g healthy boy. Conception with hormone treatments.  I could
not decipher the handwriting of the person who scribbled the chart,
therefore I can't be more exact about the treatment.
Onset of the disease was at age 21, and her present condition is as
follows:
flaccid paralysis in all limbs, lower facial muscles, and tongue
inability to speak although her mother and husband are able to
understand the sounds she makes
sensory perception is unaffected
no known thyroid dysfunction
bowel and bladder  control

Her husband, whom she met during her army service, at age 19,  is
extremely doting and supportive.

Hand expression produced relatively copious colostrum.
With the help of many pillows, and mom lying on her side, I was able to
get the baby latched on to the breast and the huge smile on her face was
all the affirmation I needed to know that he was sucking well.
When I came in this morning, her DH had the baby latched on in classic
position propped on a crescent shaped   pillow.....I wish my physically
UNchallenged moms could get the position right like that!!! I offered
the husband a job as my assistant, but he is obviously very busy at the
moment.  For the second breast we put the baby in
football/clutch/whatever you call it position and with pillows and
blankets    supporting his head, he nursed like a pro.
The mom's prognosis is very poor.  There was some remission of her
disease during pregnancy.
I canceled my whole morning  today to help her because this will
probably be the only thing she will be able do actively for her baby .
At first most of the staff thought I was nuts, but after seeing first
that the baby is really breast feeding, and secondly seeing the smile on
the mom's face, they became very enthusiastic and offered wonderful
advice about baby slings and the like!!
Questions:
1. Has anyone ever worked with a mom with this problem, or similar
(flaccid as opposed to spastic paralysis)?  I had no luck getting the
archives to work today.....it is still searching for the past half an
hour.  Found nothing in Riorden or Lawrence.
2. If pregnancy brought about a slight remission, wouldn't elevated
prolactin levels during breast feeding have a similar effect?  Or could
it be the opposite?
3. If anyone comes up with any articles on ALS and breast feeding ( I
didn't find), please e-mail me privately.

I had the couple's full permission to post this story.

Happy Easter and  Passover to everyone.
By the way, Gail's pin's and LGB's have become status symbols in my
hospital.......in great demand!!
Everyone is begging for them.

Breast feeding Crime of the Week:
A gynie, not on our staff, prescribed hormone treatment for a woman
fully breast feeding, 3 months post partum for amenorrhoea.  Dr. Mira,
get out there and start giving your lectures, FAST!!!!

Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
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