Jamie I looked at Dr. Hales site for info on Zoloft. It is the recommended antidepressant for nursing Moms. there was no info on supply issues. I am sure if there were a problem with that he would have mentioned it and wouldn't be recommending it.

THanks! I have left a message with the LC who was at the hospital when my trio was born. I justrealized that I haven't taken any herbs in about three weeks. We ran out and with getting ready for the homestudy it slipped my mind, and having to pay the adoption agency, we can't afford it until next week anyway. COuld this have such a profound affect?

I would think it could yes, Especially since you cut out all herbs. If you add back Fenugreek now at least it would be helpful.

Hi Jamie,

I have a concern about what is going on. It may be the herbs or it may not. Are the babies refusing to go to that breast at all or are they going and then coming off after a few minutes? What exactly is happening?

Regarding Zoloft, it's the antidepressant of choice for breastfeeding moms. Much better than Prozac or Paxil according to Dr. Hale.

Best,

The babies latch onto the breast, but start fussing after a few seconds. I squeeze my nipple when this happnes and only a tiny bit oozes out. It has been better today. I was able to get through one whole feeding for one baby on that side, and have done partial feedings too, switching to the other side after a few minutes. It still isn't back 100%.

I dodged a bullet not taking the Provigil the doc gace me too! After finding out what it does to milk supply, I also read that it should not be given to people with heart conditions. i don't know why that slipped by him.

Hi Jamie,

Expressing by squeezing the nipple is not effective. You have to squeeze from behind the nipple where the areola is. The nipple is just the exit.

Your babies are likely getting more milk from your breasts than you think. Babies are very efficient feeders. Your babies are four months old right? They may be experiencing a growth spurt that makes you feel like you have insufficient milk when in fact they are just temporarily more hungry.

As I mentioned on your other post, I've emailed Dr. Hale for his recommendation regarding a substitute for the Provigil.

Does caffeine help you? Did you know you can drink 2-3 cups of coffee or other caffeinated drinks per day while breastfeeding?

Best,

I'm sorry, I should have said I squeeze my breast behind the nipple. I don't think I could ever squeeze the nipple directly! (Shudder!) I realize that this isn't a completely accurate way to tell how much I'm producing, but when my babies are pulling away every few seconds and fussing, the lack of milk when I squeeze seems to confirm that not much is coming out, especiallywhen I get sprays from doing the same thing on the other side.

I'm sure the two little ones, my identical guys, are going through a growth spurt. Dh is home today, and has supplemented a couple of times with a bottle. These two have almost literally done nothing but wat all day long.

I can still tell that there is less coming out of the left breast. I am wondering if there may be something hormonsal going on? My face has broken out a lot in the past couple of weeks, about the same length of time I've been having the milk issue. I haven't had acne since I was a teenager. I am seeing a gyn tomorrow, to talk about bc and I'll bring it up then. I haven't had a period since I began the ap, and I wondered if mycycle was getting ready to start again.

About caffeine-- it hasn't helped me in the past, but I could always try to drink more. I've been feeling sluggish today and fear I might have a flare coming on. (I so hope not!) I would still appreciate your letting me know when Dr. Hale gets back to you. Thanks! <img src="/ubbthreads/images/graemlins/smile.gif" alt="" />

Hi Jamie,

It could be that your breast is suddenly not producing for some unknown reason which is quite odd or it could be something else.

Ok, I'm taking a deep breath before I tell you this information.

This is something you need to be aware of called "Goldsmith's Sign". This is when a baby suddenly refuses to nurse from one breast and can be an indication of something serious. By all means I don't mean to alarm anyone and I don't want to be the bearer of gloom and doom. This could all be for nothing but whenever a mother comes to our clinic with this indication we send her straight for a consultation with a breast specialist.

It is very difficult to do a mamogram on a lactating breast but we still need to have this investigated. Studies have shown that if this is a true "Goldsmith situation" the mother can be facing a diagnosis of breast cancer within 5 years. Often the baby is the first to know. Forgive me for being so blunt and so insistant but two of my girlfriends are alive today because I was blunt and insistent.

Please discuss this with your doctor as soon as possible. Believe me, nothing would make me happier than to be wrong about this. But if I said nothing, and something happened I would never be able to forgive myself. So there you have it.

Best,

Don't worry, I'm not panicking. I have enough medical conditions that I have to manage, that I won't freak out until it's time. <img src="/ubbthreads/images/graemlins/wink.gif" alt="" /> I also take what you are saying very seriously. I'm holding with my PCM's office right now. I'll leave a phone consult and ask for a referral to a breast specialist.

Thanks for the info! <img src="/ubbthreads/images/graemlins/smile.gif" alt="" />

Whew! You are most welcome. Delivering this kind of news is always so difficult. I've been sitting on it for a couple of days while probing you for more information. I had my suspicion the minute I heard your babies were suddenly avoiding the breast. If it were mastitis which can also cause an aversion, usually the breast has some redness and you would have a fever and then they would start to fuss because the milk becomes salty. But you're not describing this and so I'm here in Montreal having fits of worry about you because I care about each and every woman on this site.

Note that not all doctors know about Goldsmith's Sign. Most radiologists have heard about it so the mammogram interpreter is probably the best person to discuss it with.

Anyway, fight for the appointment. Don't let this go. And keep on top of it even if everything is fine. It can be microscopic at this point and show up later. Remember this moment because your babies may have just saved your life.

For those of you who wish to know more about Goldsmith's Sign here is the citation: Goldsmith HS. Milk rejection sign of breast cancer.Am J Surg. 1974;127:280-1. 70. Here is the science direct abstract which is all you really need to read: Here is the science direct abstract which is all you really need to read.

For those of you who cannot access it for some reason, this is the direct quote:



The American Journal of Surgery
Volume 127, Issue 3 , March 1974, Pages 280-281

Scientific paper
Milk-rejection sign of breast cancer

Harry S. Goldsmith MD, FACS , 1
, Philadelphia, Pennsylvania, USA
Available online 17 March 2004.

Abstract
A clinical observation has been made in nursing mothers whose infants rejected milk from a breast in which a malignant mass was subsequently discovered.

Corresponding author. Reprint requests should be addressed to Dr Goldsmith, Department of Surgery, Jefferson Medical College, 1025 Walnut Street, Philadelphia, Pennsylvania 19107.

1 From the Department of Surgery, Jefferson Medical College, Philadelphia, Pennsylvania.

So Jamie, if your doctor gives you any grief, bring this citation and the abstract with you.

And lets all give a round of applause to the folks at the Healthy Children's Project who include this information in their lactation program. www.healthychildren.cc

Best,

I really appreciate the passion and work you put into this website, helpinbg us all to nurse our babies. It has been an invaluble experience and gift. Sadly, if a LC hadn't directed me here, and I had believed what the docs, including the birthmom's perinatologist, told me about adoptive breastfeeding, I would likely have been too discouraged to even try with triplets. It is wonderful that you care so much! <img src="/ubbthreads/images/graemlins/smile.gif" alt="" />

I haven't spokne to the nurse yet. hubby is in the military and my PCM is an internist on base. The nurses have 72 hours to return my call. I plan on bringing both the citation, and a printout of this thread with me. Usually docs are very good about giving referrals to specialists, at least from the Internal Medicine clinis, which deals with more complicated patients. But with something obscure like this that most docs won't know, I may have a bit more difficulty.

How far are you from Montreal? By the way, I'm sorry this thread page has become so "out of bounds". It happened when I posted the quote off the internet. I asked our wonderful webmaster Sandy to look into it and see if she can straighten it out.

Best,

I'm not sure how far we are from Montreal. We live in Glendle, AZ, which is right outside of Phoenix, so it's probably pretty far.

Things are a little better today. Jarence seems willing to nurse from the left about half the time, though the other two won't.

I heard back from the nurse. I read her pretty much word for word what you told me, an including the citation, and she said, "well does she [meaning Lenore] have a specialist in mind?" I told her you are in Canada, and she said, "oh, I don't know what a breast specialist would even be called." This worries me a bit. She is going to talk to my internist, and she said she would also talk to the women's health clinic on base. I'm not sure the clinic will be much help, since the lady I spoke to there the other day about bc knew very little about inducing lactation or adoptive breastfeeding. It might take a while, but I'll get what I need eventually.

If the babies go back to nursing from the left side normally does that mean everything is likely to be ok? If there is something wrong, is it safe for them to nurse from that side? (I know that's probably a silly question.)

Hi Jamie,

A breast specialist is anyone who specializes in diseases of the breast. You're a bit far from Montreal (we're an hour by plane from NYC) but you're not too far from MD Anderson which is one of the best cancer facilities in the world. It's located in Houston, Texas.

If your baby is willing to breastfeed from that side it's fine to do so.

With your permission, I would like to ask Dr. Jack Newman if he knows anyone in Glendle, AZ who can assist you.

Best,

This seems like a serious thread and I'm sorry to invade it with a trivial question. As I was reading this thread, I saw a posting about caffeine and does it help. How could caffeine help? Does it affect the baby? I love coffee, but stopped drinking it due to producing breast milk. I sure wouldn't mind drinking it again. <img src="/ubbthreads/images/graemlins/smile.gif" alt="" />
Punky

Punky, Jaime has a medical issue that causes her to fall asleep suddenly. Here is what Lenore said "you can drink 2-3 cups of coffee or other caffeinated drinks per day while breastfeeding?" She was hoping it would help her to stay awake.
If you like coffee you can drink up to 2-3 cups daily. Just make sure you are well hydrated with other fluids through out the day

Hi Jamie,

I discussed all of this with Dr. Newman and according to his experience, the most common reason for breast refusal is diminished milk supply. He doesn't want us to jump to the wrong conclusions which can cause all kinds of anxiety without going through the usual steps first.

So before we get ahead of ourselves please arrange for a visit by an international board certified lactation consultant to see what's going on with you. You can find one here: www.ilca.org Just click on "find a lactation consultant" if you can't contact the ones you know.

Once you've seen the IBCLC she can direct you to a breastfeeding friendly doctor who can investigate further.

Best,

Hi Punky,

You can have 2-3 caffeinated beverages per 24 hours.

Best,

I'll call Tuesday (after the holiday on Mon.) <img src="/ubbthreads/images/graemlins/smile.gif" alt="" /> I'm not especially worried, just irked that my PCM's office seemed unwilling to listen to what I was saying.

I almost forgot-- I spoke to my Rheumatologist on the phone today. I told him all about who you are, this website, etc. I told him that Dr. Hale recommended Ritalin might be a reasonable option, because milk levels are low. He said, "I don't know where you're getting this information, but no one knows if it is safe or not. I called the manufacturer myself and they told me they just don't know." He knows who Dr. Hale is, but he either disbelieved that I had gotten the information from him, or disbelieved the information itself.

He is very anti-breastfeeding anyway. He has told me often that even biological mothers nurising one baby rarely produce enough milk to breastfeed exclusively. He also says that while breastfeeding is important the first few days of life, after that it is really just personal preference, and not usually worth it, especially for me. (I guess he disbelieves the AAP and WHO too?) He concedes that breastmilk is better nutritionally, but I could not possibly have enough for all of my babies. This in spite of my telling him I've been taking the babies to the pediatrician monthly for weight checks just to make sure their weight is fine, and she (the ped) is perfectly satisfied with their growth and their breastfeeding.

I sort of felt like he was witholding medication as leverage to convince me to stop nursing. (I must be mistaken, though. surely that's not ethical?) He knows that when I have a flare up my inability to stay awake is a definite safety risk for my children. I even told him I would be willing to "pump and dump" on those days I take it, since I only need it once in a while, for maybe a week or so at a time. I would of course prefer to keep breastfeeding, but I would be willing to make this concession. I even said I would take the Provigil (the one he gave me samples of ) if he felt more comfortable with that, since he knows the halflife is 24 hours and it would be out of my system the next day. I was hoping that it wouldn't affect my supply if I took it rarely. He said this is an unacceptable alternative. He said "Until the day you tell me you are done breastfeeding for good, I won't give you anything." He is so against my nursing at all. <img src="/ubbthreads/images/graemlins/frown.gif" alt="" />

My plan is to talk to the ped first and get her approval for Ritalin, then go to my PCM and discuss it with him. I am just so surprised at the bias many physicians seem to have against breastfeeding. Thankfully, the ped is extremely supportive.

Sorry this post is so long. I just feel a bit flabbergasted, and a teensy beat up.

Jaime ((hug)) I am so sorry he acted like that. Going to your pediatrician sounds like a good idea. Maybe she can put a call into him directly. He is being ridiculous and in my opinion if he is unwilling to work with you I would either find another doctor or report him to the AMA etc or both. He isn't even basing what he is telling you on fact as far as exclusive breastfeeding goes. Women take Ritalin to stop premature labor. If it is safe during pregnancy crossing the blood brain barrier then seems it would be safe with nursing. I know that isn't always the case but I trust what Doctor Hale says. Besides you are willing to pump and dump as you stated so really there is no reason he couldn't give it to you.

Just an update-- the babies seem completely fine with the left side again. I don''t know what the deal was, but I'm relieved that everything seems to be back to normal. I am still going to talk to the LC when she calls me back, and my doc about Goldsmith, just to be safe. I am also going to talk to the ped about Ritalin and then see my internist if the ped approves it. And, I am requesting to be assigned to a different Rheumatologist. I just don't feel comfortable with someone who is so fundamentally opposed to nursing in general.

Good for you Jamie. I am so glad the babues are doing fine with that side now.

Hi Jamie,

Congratulations on your succes with getting your babies back to the affected breast and on your standing your ground against a health care professional who took an oath to do no harm and should be helping you.

I'm so sorry for the delay in getting back to you. I've had a horrendous week. A dear friend has had a heart attack and has been in the ER of my hospital. I've been spending night and day helping to care for her. Another dear friend had a heart attack the day before. Her funeral was Wednesday and I've been running from the hospital to the funeral to the home to be with the family and back to the hospital to care for my friend. This is my first opportunity online.

Ok, having said that... the rhumatologist is not providing you with evidenced-based information and is contavening the recommendations by the World Health Organization, the American Academy of Pediatrics, and a host of other respected heath care associations.

The bit about the babies not needing anything but a few days of breastmilk is rediculous since breastmilk only comes in after a few days for a birth mother. The first few days produces only collostrom...if that is what he meant. Lars Hanson has spent his life researching the immune benefits of breastmilk which he and others say can benefit a child the most up to the age of 5. Adult liver transplant patients receive breastmilk to help their immune systems. Breastmilk contains interferon and so babies who are exclusively formula fed are eight times more likely to develop lymphoma than breastfed babies.

From what you describe, this guy is not competent to discuss breastfeeding matters in any real sense and is using his position to bully you. You should report him. Here is a link to a literature review that contains numerous reference articles regarding the outcomes of breastfeeding VS formula feeding: http://www.lalecheleague.org/cbi/Biospec.htm

Also, please visit this webpage for additional links: http://www.promom.org/101/j

If you email me at Lenore@asklenore.info I'll be happy to email you Dr. Hale's original email to me.

And I'm not just Lenore from Ask Lenore. I'm also the executive director of the Canadian Breastfeeding Foundation www.canadianbreastfeedingfoundation.org and the founder of the Goldfarb Breastfeeding Program which includes the breastfeeding clinic at the Jewish General Hospital in Montreal. The government was so impressed with our efforts, they agreed to provide funding for our clinic. And we're moving to a much larger space in 2007.

Just a basic check of the IBLCE website provides proof that I'm board certified. Go to this link: http://www.iblce.org/international%20registry.htm
Look for Canada and click on Quebec. Then scrolll down to Goldfarb, Lenore Esther. That's me.

If this doctor bothered to check out our website and my credentials, he'd know this. All of this is easy to verify. In fact if he telephoned the Jewish General Hospital foundation or the breastfeeding clinic and asked about me and my work, he'd have egg all over his face in no time.

I should mention that I'm on temporary leave from the breastfeeding clinic while I finish up my Ph.D. but that I attend all relevant meetings and come in for special cases on request. I'm also providing research assistance upon request. When the clinic moves to our new space I'll be moving into a new position: Board Certified Lactation Consultant/Researcher.

Best,

Thank you for the support and the links! I was afraid I was just overreacting to the rheumatologist's statements and actions. It gets under my skin to no end that women have so much against us when it comes to breastfeeding, in terms of the attitudes of others, even some physicians.I do think I need to report him.

You go girl!!! Someone has to stop him.

Regarding my friend who had the heart attack, she's been released from the hospital and is on the mend at home. Regarding the horrible incident at Dawson College that by now has been all over the news, my friends and relatives, several of whom either teach at or attend Dawson, are accounted for and safe. None were injured.

My thoughts and prayers are with those less fortunate.

Best,