I''ve been saving up, but I'll try to keep this short:
1) A while ago I posted about a pregnant mom with "accessory nipple sites"
that were leaking (they had previously been operated on by a plastic surgeon
who told mom she didn't have adequate breast tissue to nurse). Thanks for the
responses. Well, her exam was interesting in that her breasts were small and
very assymmetric, and the sites were not located along the nipple line, but
were scattered over her torso. They varied in size and looked like large,
nipple colored moles. I do not know what they looked like pre-surgery, but
apparently the plastic surgeon took pictures of her as well as several of her
sisters, who have the same anatomy. Mom told me that half the members of this
large Utah family have this problem. I've called the surgeon to see if he'll
let me review his records for this family. Has anyone else seen a clearly
autosomal dominant transmission of breast or nipple problems or similar
nipple anatomy?
2)For inspiration: last week while it seems so many physicians were handing
out bad advice, I was involved over the phone with the nursing mother of a
one-month old who last week had a benign mass removed from one breast. At her
follow-up appointment, the surgeon noted that she was leaking from her
incision site, and recommmended that she immediately wean on that side or she
would "develop an extra nipple". When I called his partner on behalf of the
mom and discussed my concerns (especially mastitis risk), the initial
response was "well then, we can tell her to stop on both sides and give her
somethiing to dry up the milk." BUT, after a few minutes of discussion,
including a the mom's family history of breast cancer, he actually came
around to "it sounds like the best thing is for this lady to just keep
breastfeeding." He even called his partner, who called to thank me and called
the mom himself on his day off to recommend that she keep nursing on both
sides. These were SURGEONS, mind you!
3) In my (busy) pediatric office, we do have toys- a toy kitchen with
foodstuffs, a train table, wooden bead mazes... as well as lots of books.
Our staff disinfects the toys frequently throughout the day, and parents know
that they can use the disinfectant spray themselves if they want. We keep the
obviously infectious kids (draining eye, rashes) out of the waiting room. So
far, not one Brio train has been pilfered- they check them out from the woman
at the front desk if they want to play. The books occasionally disappear, but
as long as they're reading them somewhere that's ok with me!
Jennifer Cox, MD,FAAP-pediatrician in Salt Lake City
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