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Subject:
From:
Katherine Lilleskov <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 25 Aug 2009 22:32:30 -0400
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Wondering if anyone would like to throw out some thoughts.

I'm working with a second time nursing mom, who has been plagued with 
severe pain since the birth of her second baby about 4 weeks ago. Her 
significant medical history includes a diagnosis of congenital adrenal 
hyperplasia between her two pregnancies and subsequent daily oral steroids. 
She is clearly having visible vasospasms, and her nipples are "raw" is how she 
describes them, though they have no visible cracks or damage. We used APNO 
which seemed to help alleviate some of the rawness for about a week and 
then it returned. A nipple shield helped with her nipple pain for a  while, 
though it seem to have lost its effectiveness. Her left breast was extremely 
tender to touch, with palpable areas of soreness especially covering the lower 
aspect of the breast. While she was being treated with APNO, she was put on 
antibiotics by her OB for her left breast tenderness, which did resolve, though 
the spasms never did. We have tried heat application, mildly helpful though 
the spasms return as soon as the heat is removed. We have tried Vitamin B6 
per Newman's protocol which did help a bit,but her supply plunged after 3 
days on high doses and even though we brought the dose down to 25mg she 
didn't recover her supply until we stopped the B6. I think it possible  that she 
may have yeast, and we are waiting (and waiting and waiting) a callback from 
her OB to discuss Fluconazole and posibly Procardia for the vasospasms. My 
gut feeling though is that the problem is primarily vasospasm not yeast.

What I am trying to tease through in my head is whether there is a 
connection between the CAH, the steroids, and the pain. Whether the 
condition or the meds could be predisposing her to the spasms. If I understand 
it correctly, steroids cause calcium to be lost from the bones - does this mean 
that there is then more circulating calcium in the bloodstream and could this 
be leading to her vasospasms???? Has anyone else worked with a mother on 
steroids who suffered from vasospasms (or CAH).Since we use calcium 
channel blockers to control vasospasms, I was wondering if there is a 
connection between high levels of circulating calcium and vasospasm and is 
there another way to deal with high blood levels of calcium if my theory is 
correct. Would a blood test for calcium show if her levels are high and how 
can they be safely brought down. For those of you in NYC who might suggest 
Mona Gabbay, she is on vacation til next week AAARRRGGGHHHH... Anyhow, if 
anyone can tell me if I am off base or has any other suggestions, I would be 
happy to hear them. BTW, I do not believe the baby has a posterior tongue 
tie for those of you who might want me to consider that one.

Thanks for any ideas - 
Kathy Lilleskov RN IBCLC

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