Dear LACTNET friends,

I have a question regarding a mother who visited our B/F clinic. Permission
to post.... and sorry long post too.
Have any of you heard of or have experience with the condition MELAS (see
below) in relation to breastfeeding? One mother, who visited our b/f clinic
and myself wonder whether MELAS could affect/impede the fine muscles
contracting around the alveoli/milkcells during the milk ejection.
The mother breastfed her previous four children, but every time b/f for
shorter and shorter time (months => weeks). The first child child is now a
young adult. During this first b/f she also was a milk donor. According to
mother plenty of milk. But then, she explains, somehow despite whatever she
did, the milk dried up, and she could not get it going again. It is still
unclear to me whether the reason for this had been suboptimal breastfeeding
management, as we know often is the case, or whether it possibly could have
something to do with her medical condition. She also told me that when she
before has been going to the gym, she after a while gets a strong fatigue,
lactic acid in her muscles ... and even days after such a gym session, she
may get these muscle cramps.
She is now in the third trimester with her fifth child, who has a rare
condition for which he will need surgery soon after birth. She came to the
clinic because she needed info on how to get started with breastfeeding in
that situation.There are obviously going to be many challenges for her, the
baby and the family, and she got the basic b/f guidance for that situation.

I have not heard about MELAS before and could not find anything on the
internet about how it might or might not affect lactation/the milk ejection
reflex. The doctor I asked, who knew about this particular mum, could not
help either. According to what I read about MELAS, it could have an effect,
if it weakens the function of all muscles ... also those which contract
around the lactocytes during let down. Would be grateful if anybody have
some thoughts on this, experience or could guide me to texts from which to
learn more.
Warm greetings from a very hot Finland
Merete Willis, midwife, IBCLC

"This condition is inherited in a mitochondrial pattern, which is also
known as maternal inheritance and heteroplasmy.  MELAS is a condition that
affects many of the body's systems, particularly the brain and nervous
system (encephalo-) and muscles (myopathy). In most cases, the signs and
symptoms of this disorder appear in childhood following a period of normal
development.[3] <https://en.wikipedia.org/wiki/MELAS_syndrome#cite_note-3>
Early symptoms may include *muscle weakness *and pain, recurrent headaches,
loss of appetite, vomiting, and seizures. Most affected individuals
experience stroke-like episodes beginning before age 40. These episodes
often involve temporary muscle weakness on one side of the body
(hemiparesis), altered consciousness, vision abnormalities, seizures, and
severe headaches resembling migraines. Repeated stroke-like episodes can
progressively damage the brain, leading to vision loss, problems with
movement, and a loss of intellectual function (dementia). The stroke-like
episodes can be mis-diagnosed as epilepsy by a doctor not aware of the
MELAS condition.

Most people with MELAS have a buildup of lactic acid
<https://en.wikipedia.org/wiki/Lactic_acid> in their bodies, a condition
called lactic acidosis <https://en.wikipedia.org/wiki/Lactic_acidosis>.
Increased acidity in the blood can lead to vomiting, abdominal pain,
extreme tiredness (fatigue), *muscle weakness*, loss of bowel control, and
difficulty breathing. Less commonly, people with MELAS may experience
involuntary *muscle spasms *(myoclonus), impaired muscle coordination (
ataxia <https://en.wikipedia.org/wiki/Ataxia>), hearing loss, heart and
kidney problems, diabetes, epilepsy, and hormonal imbalances." (Wikipedia
for ease)

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