Time to turn to the experts!!
I have two very interesting cases that I need help understanding.  The
first one is a mom who just had her third child.  She had a "brain tumor"
14 years ago and had radiation that "completely destroyed her hypothalmus".
Although now she says they never did surgery so they are "suspecting" it is
completely gone.  With her first baby she initiated a milk supply but had
to supplement by 6-8 weeks as baby not gaining.  With second baby-1 year
ago-I saw her briefly but our other LC actually did her home visit.  She
had problems with her milk supply in the first week but we did not know
about the irradiated hypothalmus.  She said she did not tell us because her
doctors told her it would not make any difference.  She was on fenugreek
and blessed thistle, then Reglan with supplementing with a SNS and pumping
after feedings.  She says she never got much with the Medela Lactina and
hand expressed better even though that was not much.  This little guy is a
great nurser so I know stimulation was adequate but by day 2 she called me
saying he was not having output and was lethargic.  She had the baby
weighed and he was already down 10%.  She is against all the "equipment"
this time but really wants to breastfeed.  She is now supplementing and
putting the baby to the breast after and between feeds for comforting.  Her
breasts do not feel full and she can not hand express anything, per her
report over the phone.  Since the scenerio is following the same path
except with even less supply, I suspect the hypothalmus irradiation is the
problem.  I realize the secretion of oxytocin would be a problem and the
doctor's are recommending oxytocin nasal spray which will be difficut to
get around here.  I also think, after reading Lawrence, that the prolactin
levels are also affected because of the regulatory effect and the fact that
methods used to raise the prolactin levels failed last time.  What do you
think?  If there is no milk production, there isn't much use for the
oxytocin.  She is hearing conflicting information and holding hope that the
spray might work.  Very rarely do I feel like I need to counsel on
maintaining the breastfeeding relationshiip for comfort, etc. this early
but this one I do.  She wants to try the spray and if we can get it I don't
think it would hurt but I really don't think we are going to be
successful.  She had a severe postpartum depression with her first baby and
has been very tearful over this whole thing so I want to support her in
what she wants to try but I don't want to draw this out too long if there
is a primary physical problem.  I want her to enjoy the breastfeeding
relationship with him even if not for nutrition.  I am going to see her
Sunday afternoon so if more information would help, I would try to get it.
One other tidbit that may help is that she has diabetes insipidus (?sp) and
is on a medication for that which I can't remember and my notes are at
work. It starts with a "D".
The other case is a 9 week old that projectile vomits when she nurses on
the left breast only.  I had her pump finally to see if it was a milk
difference or a mechanics problem-this is over the phone but an experienced
mom-.  When she pumped she got 4 ounces from each side and when she let it
sit in the refrigerator, the right side had 1 ounce of fat and the left
side was 2 ounces of fat.  Is the concentration of fat making the baby
vomit?  Would it help to scald the milk she saves from that side?  I don't
see how the lipase would be making a difference right from the breast but
it is interesting!  What would you suggest she do?  Currently she is
nursing from the right breast only, giving the second breast only if
refuses to go back to right so she won't nurse as long on the left, then
she is pumping the rest to save.  Interesting moms and I love challenges!
Thanks for all your expert advice, knowledge and opinions.
Denise Stuart
<[log in to unmask]>
Kent, Wa

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