Monday 31 March 2014

Milk Overproduction and Prolactinomas

While most moms of preemies have undersupply issues, few talk about the downfalls of having too much. I know what you're thinking - how can this mom possibly be complaining? Breastmilk is worth its weight in gold, surely there can be no such thing as too much milk... I assure you there is.

First a bit of background. One of the main reasons I have an overly active milk supply is that I have a prolactinoma. A prolactinoma is essentially a non cancerous growth that can be either teeny tiny or quite large that grows in the pituitary, a gland pretty much in the middle of your brain. Luckily mine is teeny tiny. Prolactinomas secrete prolactin, one of the hormones involved in milk production. I discovered I had a prolactinoma because one day before ever getting pregnant, I noticed a tiny amount of milk on my nipple. Upon further inspection I was able to express a couple milkly drops. One blood test later (looking at my prolactin levels), imaging of my brain (an MRI) and a visit to the endocrinologist (hormone specialist) and I was diagnosed with a prolactinoma. What does that mean for me? A yearly blood test and the occasional MRI to make sure the little bugger doesn't grow. It also means that I have an overabundant milk supply!

The last bit that they were worried about was that the extra prolactin would make getting pregnant more difficult. Luckily for us, that was not an issue!

A few hours after an semi emergency delivery of my little 29 week old darling, for my HELLP syndrome, my nurse asks me if I'm interested in breastfeeding. Still on magnesium and a bit in chock from everything that happened so quickly, I nonetheless was quite keen to give pumping a try. She brings me a pump amd explains the basics and leaves me to it. Twenty minutes later she comes back to see how I am doing, and I show her, a little disappointed, my 70mL of colostrum. She could not believe her eyes! She told me usually moms get less than 5mL on their first pump. I was pretty proud at this point, but little did I know it was a blessing and a curse.

The pros :

1) My little sweetheart luckily never ran out of breastmilk to eat. I realized how fortunate I was in that regard seeing lots of other moms in the NICU struggling and ultimately being unable to produce enough milk.

2) I was able to donate most of my stash that I had accumulated during sweet V's hospital stay to another preemie. It was all the more special that I knew how unpleasant a stay in the NICU can be, I really felt like I helped out a family in a pretty crappy and stressful time in their life.

The cons :

1) My multiple high flow let downs made teaching my sweetheart how to breastfeed more difficult that it otherwise would have been. At first, it was terrifying, she would go into fits of choking, have bradys and the desaturate. It made me feel terrible to think that I was the reason that she was choking! Still now at 10 weeks corrected age, she regularly chokes while breastfeeding, something she does not do when bottle-feeding. For a while it looked like I would not be able to breastfeed her at all!

2) At first, due to the intense let downs, miss V. had to learn how to breastfeed with a nipple shield (I used the Medela nipple shield). While it was a huge pain to have to sterilize it before every feed, it was really the only way I could get her to feed without choking. To get around having to constantly wash it, I bought 3 and sterilized them every 3 times. Having that many coupled with the 2 enriched bottles per day meant that I only had to clean them twice per day. After about 2 months, I was able to completely wean Miss V. off of the nipple shield. I guess a minor positive with the nipple shield was that while Miss V. was learning how to breastfeed, she sometimes had a bit of a shallow latch, which meant mega sore nipple for me, unless I wore the nipple shield. Lucky for me, she grew out of that bad habit too!

3) To help better control my high flow, I continue to pump off a little bit of milk prior to breastfeeding. Initally, I had to pump off 40-60mL before each nursing session. Now I only have to do that twice per day. I've tried a few times to completely eliminate the pre-pumps, however we just get right back into the chocking fest, so I guess she is just not ready yet. I use a manual pump, I find it is less of a hassle to use, and I can just quickly pump one breast prior to feeding and still hold and comfort my sweetie in a pinch. I use this one, but I'm sure any manual pump would work well.

4) Over supply means lots and lots of nipple leaking! Kangaroo care was made a bit more difficult with my very leaky nipples - I had to have 4 towels on hand to keep it in check, otherwise it looked like I had been on the losing end of a water balloon fight!

There you have it, while having an overflowing milk supply has some obvious benefits, it can also add additional difficulties when teaching a preemie how to feed, an already complicated task!

xo
C

Saturday 22 March 2014

100 Happy Days - Day 4

Slowly working on a baby quilt for a friend. I just love visualizing my progress!

Friday 21 March 2014

Two Months Old!! (Corrected Age)

Happy two months my little sweetheart!


Some sweet friends sent you a second month care package - apparently Red is Best was one of their childhood favourites and really shaped them (and I believe it, their wedding color was red!). The jumper will be the perfect size for this summer and you LOVE the book, I think it must be the high contrast of red against white, you stared at the pictures the whole time we read it to you!

I thought it might be nice to write down what your world is like these days.

Oh how far you have come! You are such a joy to wake up to in the morning, after a sleep you always have the most beautiful smiles! I think you might be a morning baby. You especially smile when we say "mamama", "agoooo" or "gaaaaa" the latter two being sounds you tend to coo at us a few times per day. You have great little chitchats with your Mina, she has a knack for making you smile and laugh! 

You like to stare into our eyes and sometimes follow us around the room. I think you still prefer black and white to colors because you like looking at Rodrigo the butterflies black and white side better than his colourful tummy. I think Rodrigo is your favourite toy, although recently you seem quite fond of the barnyard animals that make noises.

You managed to sleep 6 and 7 hours straight around Dada's birthday, but because your weight gain slowed down a bit, we've been told to wake you up every 4 hours at night. I don't know how you do it, but it seems like you breastfeed while completely asleep. Those nighttime moments are really precious, you are so cuddly and calm.

Feeding in general is going well, you eat 7-9 times per day with 1-2 bottle feeds. We have restarted enriching one bottle per day again because of you slight slowing in weight. You don't seem to mind the enrichment, but you definitely prefer the breast to the bottle! You definitely hate your iron, but we seem to have you tricked by giving it to you when you have your pacifier. If we give it to you in a bottle you spit it all out, so now most of your onesies and pyjamas have yellow stains! I spoke to the Nutritionist today and we can let you sleep 6 hours between night feeds! Yay! Sometes you get Mama to dance around the room when you are feeding, you seem to prefer the constant movement to the rocking. You like grabbing my hair when you feed and sometimes you tickle my sides! 

You are a little snuggle bug, you love being held nice and close! When you cry and it is not time for feeding or a diaper change, usually holding you nice and close and doing little squats with you does the trick! Or playing a sweet Justin Bieber teddybear .

Physio wise, we carry you around pretty much in feral position and need to stimulate your pects because you tend to pop like a popcorn otherwise. We do lots of tummy time which you don't really like, but recently you've started to use your arms to push down when you lift your head. This is a great improvement! You seem to prefer looking towards the right when you are on your tummy and to the left when you are on your back, but we are working on it. You also keep your hands more open than you did just a few weeks ago. You regularly bring your hands to your face when you are held in a hood position. On your back you still mostly have your hands in the air, but sometimes you bring them down or to your mouth yourself, especially if you have a soother!

Your Dadada and I are so proud of you! You are such a sweet and happy baby even when we ask you to do so many exhausting physio exercises! You are the love of our lives, thank you for being sweet little perfect you!

Xo
Mamama


Thursday 20 March 2014

Safe Visits and The Great Lock In

Preemies need to be protected from the winter cold and flu season which leads to what some people call "The Great Lock In". This is because preemies often have lung issues like bronchopulmonary dysplasia (BPD) and are more susceptible  to need hospitalization from viruses, especially the dreaded RSV!! To avoid infection, from November till April, preemies are recommended to be kept far away from crouds and people who are sick. 

For us, because we live in the city (also no great air quality for BPD), we have stayed mostly indoors since Miss V's discharge. So visitors are a really welcome change in our routine, although we take quite a few precautions before inviting them over. With nearly 50% of preemies rehospitalized in their first year of life, many due to infections, we don't want to take any chances! 

We ask that every visitor:
  • Not be sick (obviously)
  • If they have been sick, be asymptomatic for 2 weeks before visiting.
  • Have no close contact with sick people in the past 7 days.
  • Not wear perfume, cologne, hairspay, other strong smelling stuff.
  • Wash their hands when they arrive and before they hold Miss V. 

This has made it impossible for Miss V. To meet her aunt and uncle because they have kids in daycare, which of course means that there has not been a two week period when no one has been sick in their household. Something to look forward to when daycare starts I guess...

Just a few weeks left of lockdown, but in the meantime, we'll safely enjoy germ free visits from our friends! Happy day #2 of 100 happy days. A healthy preemie is a happy preemie (and a happy mom and dad - hospitalizations are awful!)



What do you do to keep your little sweethearts safe?

xo
C

Wednesday 19 March 2014

Signed Up!


Day one of the 100 happy day challenge is of course really easy: here is my beautiful, happy 8 week old (corrected age) preemie. She cracked this gorgeous smile while I was saying "mamamamama"

<3

Bonus happy event:

Miss V had a ginormous poop this morning! If you don't have a preemie, this may be no big deal to you, or TMI. But when your little sweetheart is on daily iron poops are few and far between! 

Happy tummy = happy preemie!

xo
C

Tuesday 18 March 2014

100 Happy Days

This past year has been a little crazy :


Pregnant ..............................................................Elation

Bleeding...............................................................Scary

Morphological abnormalities on ultrasounds........Devastating

...that turned out to be variations of normal...........Relief

Diagnosed with preeclampsia...............................Disbelief

...that turned out to be HELLP.............................Extreme bloating

C-section at only 29 weeks gestation...................Terrifying

Meeting our daughter for the first time.................Blissful

3 months of NICU................................................Frustrating

Finally home.........................................................Amazing, Stressful, Worrisome, etc!


While I am extremely thankful and happy that our little sweetheart survived this incredible journey, it has been difficult to cope with stress of the many unknowns, the multiple doctors appointments, physio exercises that she does not always enjoy and staying sheltered from everyone during the terrible cold and flu season. Also, this never ending winter has not been helpful in the mood departments.

So, in an attempt to return to my previously rose-colored glasses totting self, I have decided to sign up tomorrow for 100 happy days. The idea is that each day, you take a picture of something (or in my case, I'm sure it will often be a tiny little someone) that makes you happy. I think it will be a nice reminder of everything I have to be thankful for and pull my attention away from my multiple new found worries. Oh, and if I complete the 100 days, I get a little booklet with all the pictures, which will double as a little reminder of the happy things that happened to be during my maternity leave, as I start back to work in about 100 days!

Wish me luck!

xo
C