< Have you
read the research of Donna Ramsay - she is another of his PhD candidates
and is the one doing all the ultrasound studies on the breast.  She has
documented that milk moves down from the alveoli during milk-ejection, is
available for 2 or 3 minutes or so, then what hasn't been removed moves
back up to the alveoli again.>

As you may or may not know, Denise, I have great difficulty accepting
Donna Ramsey's conclusions in the exact way that so many people are
accepting them at "face values", "sight unseen", immediately, without
question etc. I mean absolutely no disrespect by this statement. I would
just like to understand the rationale and the nature of the proof much
more clearly, so as to integrate and synthesize it with what I have thus
far read of the microscopic anatomy of the breast.

I would very much like to have access to anything and everything that may
have thus far been published by her (and the group) on this subject. Does
it consist solely thus far of proceedings and transcripts of talks to
various groups??? How would I go about getting copies of all published
info? I would be delighted to pay for the references.  Collecting
references seems to have become a hobby with me:-)

I have held the opinion (by logic alone) for a long time that whatever
milk is not removed does in fact at least begin to separate so that the
fat globules, by virtue of their specific gravity (and perhaps the fact
that "oil and water don't mix") rise within the ducts, against gravity,
toward the ceiling. (like the cream in the milk bottles left on the
doorstep when I was a kid.)

Solely in my mind's eye, based on the physics described above, depending
on the mother's position (upright, for between 2-16 hours with infrequent
MER's, or lying down for 2-3 hours in any one same position with
infrequent MER's, as while asleep) more fat globules would end up either
at the upper parts and walls of all the ducts outside the lobules were
she sitting or standing, or on the upper wall of most all ducts, were she
sidelying. This would then effect the % of cream arriving forward in the
breast at the next MER. This, therefore would explain some of the
conflicting findings and opinions about foremilk and hindmilk.

And I can also understand that the dilatation of the ducts is temporary
during the height of the surge of the MER and that no large amounts are
stored in the ducts such as are stored in the udders of dairy animals. I
have a wonderful line diagram from the veterinary literature of the
1950's by Dr. Linzell, I believe, illustrating how ducts shorten in
length and dilate in circumference during the MER. It is my understanding
from what I have heard at several talks by Dr. Hartmann that this is
pretty much like one of the processes demonstrated by the current US
research.

It stands to reason (solely by my logic, for the sake of my own questions
about "why" things happen), that once the contraction of the
myoepithelial cells relaxed and the shape of the ducts resumed their
original longer length and narrower circumference, that the positive
pressure of the duct walls would cause some redistribution of the milk in
the direction of the upper collecting ducts. I personally cannot believe
though, that they are totally "empty" of milk however. I think this is
part of the mechanism that makes massage and breast compression effective
as feeding/pumping tools. And also part of the mechanism contributing to
plugged ducts if milk is not kept moving.

But if <She has documented that milk moves down from the alveoli during
milk-ejection, is
available for 2 or 3 minutes or so, then what hasn't been removed moves
back up to the alveoli again.> is actually precisely what she said, it
seems to me that that's inaccurate and mileading terminology.

I could accept "toward the alveoli". But to say it "goes back up to the
alveoli" should not be presumed to create such an absolutely precise
representation of exactly what's happening. We are not being told about
electron microscopic pictures of ductal lumens here. We are being told
about ultrasound shadows and her interpretation thereof.

The alveoli are arranged in small groups draining into a common vestibule
all of which form a lobule. The lobule is connected by a ductule to the
first collecting duct to which an MER will eventually transfer the milk.
The ductule is made differently, I believe, than a duct, ( I don't have
my references with me on vacation). Milk collects in the vestibule after
it has been secreted through the alveolar membrane but before it has been
forced through the ductule by an MER.   Off the top of my head, it seems
to me that it is impossible for the milk to re-enter through the ductule
back into the common vestibule of the lobule into which the alveoli open.


I don't mean to be presumptious or disrespectful by expressing myself
this way. I have a track record of identifying with the little child in
the Hans Christian Anderson fable of "The Emperor's New Clothes". I just
have to honestly say what I see in my mind's eye and ask questions, or
shut up, period. That's not why we are gathered together on this list
though, is it?

I'd like to hear what others think.

Jean
****************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio (currently in Arizona where they are hoping breathlessly for
rain!)

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