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From:
SHAWN PARRY <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 7 Jul 2008 03:12:31 +0000
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Hello wise ones.  I am a lurker. I have permission to post. Mom is eager for more input. Below is a summary of a friend/client of mine. I saw her around day eight and thought maybe her milk was affected due to her gastric bypass,I can't remember exactly what the test weight showed (I'm at home) but thought it was within normal limits. In fact I remember Michell saying she felt as though she had a lot of milk. I suggested she take her supplements which she hadn't taken during pregnancy because she wasn't anemic. The baby could have been more aggressive at the breast but she was 13 oz under birth weight and I felt she would do better when her weight increased. I am not sure if Michell continued her supplements, her pedi told her it would not affect her milk. I am confused by the GI doc's advice. It just does not make sense to me. Why can't she breastfeed and supplement? Couldn't we obtain a crematocrit to assess her milk? What can this mom do to continue breastfeeding? Thanks so much.Carla Parry RN IBCLCLakeland Florida   Hi Carla, here's my info I had gastric bypass, Roux-N-Y 2-7-2005.  I have lost 127#.  Before my surgery, I was diagnosed with PCOS, but had two successful pregnancies and breastfed both of my girls with no problems.  They were born in 1996 and 2000 I had no problems with my pregnancy with Molly.  She was born 4-8-2008 and was 7# 13oz at birth.  At day 8, she was 7#0oz and the pedi asked that I start supplementing 1/2-1oz after each feeding.  I was able to supplement with expressed breastmilk most of the time, but used 22 cal formula (per the ped) when I did need to use formula.  I began taking More Milk Special Blend and Domperidone 3 tabs, both 3 times/day.  She slowly gained weight.  At 7 weeks, the ped told me she had mild reflux because she was coughing and gagging in her sleep.  She told me to feed her 2-3 bottles per day of Enfamil AR, and that would help.  SHe also said to give her Mylicon as she needed it, since she has excessive and explosive gas.  She was 8#12oz at that visit. We went to MI on vacation and she was getting increasingly fussy and inconsolable.  I took her to the old ped we took our two older girls to.  They started her on Zantac.  At that time, she was 9#10oz, 10 weeks old.  We were supplementing more with formula at that time, because she was so fussy I thought that she was hungry.  The ped told us that she was eating for comfort, since the erosions in the esophagus would be comforted by the food.  He told us to let her eat as much as she wanted until we got the reflux under control.  The Zantac was making her spit up, so a week later we took her back and saw a different ped.  At that point, 11 weeks, Molly was 10#8oz.  She had gained almost a pound in a week.  The ped told us we were overfeeding her.  She changed Molly to Prevacid, told me to breastfeed as much as possible and only supplement with 2oz if she needed a top-off.  They felt that her gas and fussiness was due to the reflux and that there would be no problem with me breastfeeding her. Molly was seen on 7-2, at 12 wks 1 day and was 10#4oz at her regular ped office.  She increased her Prevacid by 1/2 tab, and told me to use Nutramigen when I supplemented.  Molly was still getting fussier at this point.  This last week was horrible, with her crying almost all the time.  The ped told me she was worried and wanted Molly to see a pediatric gastroenterologist because of possible allergy.  She was seen by the specialist 7-3. The specialist had an Upper GI done that showed significantly delayed gastric emptying time and severe reflux.  She advised that this long weekend, I do not breastfeed and only give Molly Nutramigen, made to 24 calories.  She wanted to experiment.  After 1-2 days if she was not better, I was to add Oatmeal to her formula.  If after that, she did not improve, we were to start her on Elecare formula.  She has done fine on the Nutramigen alone.  She is now on a different dose of Prevacid, Gaviscon, Mylicon, and they are wanting to add Reglan for the motility.  The GI said that since my surgery has affected my absorption, my milk is most likely too low in calories and fat, so therefore Molly is only getting the equivalent of foremilk, which is partially to blame for the gas and lack of weight gain.  She also said that even though I am being careful with what I eat, there is obviously something that is offending her.  Without directly saying it, she told me to quit breastfeeding- she said I could donate my milk to a bank.  I do have to admit, Molly has done much better on all of the meds and on the formula. So, I am pumping to maintain my milk, as I am not yet willing to give it up.  I am heartbroken, since I was hoping to nurse until Molly was at least 2.  I have been trying so hard to maintain supply and increase the quality of my milk- diet, supplements, herbs.  I was going to ask on Monday if I could at least give her my milk in her cereal, since I have a good stash built up, and at least she will still get some benefit.  Plus, I'll feel better about it. Thanks for any help.  I'll be on call on Monday, so I'll stop in and see what info you can find out.  Please call me anytime if you get any suggestions.  Thanks again.  Michell
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