Hi all.

I would like to thank everyone for their help with this challenging situation. Especially to Pat Young and Jan Barger, and also to the person who suggested she attempt breast massage every am and pm, pretending her breasts are a bag of marbles. I have passed those suggestions on to her. And she has found them to be very helpful.

Lecithin like many other vitamins and minerals is good, but too much a good thing can be bad for you sometimes. Sometimes people mistakenly think they can take unlimited quantities of vitamins, which can be dangerous. This mother was taking 2 to 3 times the recommended dosage of lecithin beginning in the 9th month of pregnancy and daily throughout lactation, not just for a week or two as most mothers do. She also began taking even before lactation was well established. The side effects of lecithin are as follows:

Possible Side Effects 

In high doses, lecithin and choline may cause sweating, nausea, vomiting, bloating, and diarrhea. Taking very high dosages of choline (10 grams a day) may produce a fishy body odor or a heart rhythm disorder. 

This patient told me that she felt like her heart was racing and pounding very loudly in her chest, and she was constantly sweating profusely. She would have to get up in the middle of the night and change her pajamas because she was continually sweating so much. She was taking multiple showers each day. This is why we tested her for hyperthyroidism, which she doesn't have. She told me yesterday that those symptoms have improved since stopping the lecithin. I think she clearly was taking way too much. Lecithin is also a fat emulsifier. This is probably how it works to prevent plugged ducts, because it breaks down the larger fat molecules in milk, helping the milk to pass through the ducts more easily. This mother has successfully nursed many, many children. Somehow she was able to successfully nurse 5 children with the demands of a busy family life and they were fat, happy babies. Then the minute she starts on the lecithin she has all FTT babies. Like
 flipping a light switch. It just seems obvious to me that we should at least look at this as a possible cause.

Parents of large families will often tell you that after having 4 or 5 children, it's not more work to have more because the older children begin helping the younger children. However, they will also tell you that they often face stigma and prejudice in our society today, including the assumption that they can't possibly care for that many children well. I must say I was shocked through all of this how often that was the first reaction of most MDs, RNs and LCs that I've told this story to, the assumption that she didn't have time to feed the baby was almost always the first suggestion. And yes, I've seen this before too, mothers who are seemingly too busy to nurse their babies. But not always with large families either, sometimes only 2 or 3 children. I think this has been part of her problem in getting treatment for this all along over the past few years. No one is taking her seriously, the LCs and MDs have been assuming she isn't taking care of herself
 or taking time to feed the baby and it's resulted in her not getting the help she needs. 

I understand the idea of "eliminating horses before zebras" but I did do that. I didn't go into many long details in my post, but I have been doing this for 20 years and I went through all the obvious reasons. At first the infant was sucking well, nursing frequently and swallowing, but of course over time, she lost interest more and more as she wasn't being satisfied. I set her up with an SNS now and it's helping get the baby more interested in the breast again. We can also see the same thing happening with mom's EBM though. She will drink 3 oz and still be fussy, crying and then drink 2 oz of formula and be satisfied. At 3 weeks she should be satisfied with 3 oz EBM at least for a little while. And no, the baby isn't jaundiced because we started it on supplemental formula stat. It is gaining well with supplemental formula now.  This baby was a homebirth, natural, no complications. I would love to find out what the caloric content of her milk was, but I
 don't have a creamatocrit and I don't know anyone that does. The mother has already stopped the lecithin, but she may have some milk in the freezer from when she was taking it. If anyone knows someone in the northern Chicago area that has one and would be willing to test the milk, I'd be very grateful.  
 
Thank you,
Tricia Shamblin, RN, IBCLC

"When you have eliminated the impossible, whatever remains, however improbable, must be the truth." -Sherlock Holmes

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