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It's All About Nipple Cremes And Ointments While Breastfeeding
Human Breastmilk Fat Improves Growth in Premature Infants
Ankyloglossia, Tongue Tie While Breastfeeding
Rheumatoid Arthritis And Breastfeeding
Breastfeeding A Down Syndrome Baby


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It's All About Nipple Cremes And Ointments While Breastfeeding

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     Breastfeeding is best for your baby.  Getting a good latch is important however, sometimes that doesn't always go so well and your nipples crack.  That is when you need to decide whether you should call your doctor, OB/GYN and decide together which creme is right for your situation.
     Cremes that you apply to your nipple while you breastfeed, may get ingested by your baby.  Lanolin creme is safe while breastfeeding.  Lanolin can be applied before and after pumping and after every feeding session if desired.
     If you are in excruciating pain with cracked nipples, they may be infected.  Neosporin, Triple Ointment or Bactracin may help.  Apply these ointments after feeding.  If this does not work after a few days, you need to call your doctor.  
     In my private practice, I see a lot of cracked nipples.  I actually decided to write this blog because I have had a week of patients with lots of cracked nipples.  In my private practice, I see a lot of this.  If your nipples are bleeding, you need a rest from breastfeeding.  You will have to pump a few sessions until your nipples stop bleeding.  Then resume breastfeeding.
     Sometimes, yeast can infest nipple tissues.  When you nipples are cracked, yeast can enter.  You can call a Lactation Consultant to help you figure out what is going on.  As a Lactation Consultant, I do not prescribe medications, therefore, you need to call a doctor if you feel you have a infection.  Your doctor will prescribe an antibacterial creme.  
     Dr. Jack Newman has suggested an all purpose creme for nipples that are cracked and bleeding.  It is a combination of two antifungal ingredients, one antibacterial ointment and one steroid.  Please call your doctor before using this. (I personally feel it is too strong and not healthy to use).
     The simplest and healthiest way to treat cracked nipples is using your own breast milk.  Additionally, you need to let cracked, bleeding nipples air out.  Yesterday, as I was helping one of my patients who had a cracked nipple, we both started singing and made up our own song, It's all about the the tune of ,It's all about the bass song.  This is true.  If you have a good latch, your nipples will not get cracked.
     In conclusion, I am sorry you are suffering.  I know cracked nipples can be painful because I experienced this myself while breastfeeding.  Ask a Lactation Consultant or your doctor which ointment is right for you.  Good luck.  I hope you feel better real soon and enjoy breastfeeding your baby.

Human Breastmilk Fat Improves Growth in Premature Infants

     Premature babies often need special medical attention and care only found in a Newborn Intensive Care Unit, NICU.  Texas Children's Hospital in Houston, Texas cares for 1,000 of babies each year.  In fact, a study has just come out from Texas Children's Hospital doing research on premature infants and breastfeeding. 
     Researchers at the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine and Texas Children's Hospital have put out a report on Human Milk Fat, that it greatly improves growth in premature infants on August 15, 2014, in the Science Daily.
Babies who are born very small 750 to 1250 grams, need extra calories,  (1000 grams is about 2 pounds 2 ounces).  These babies lungs and other organs are still developing after they are born.  If the infant can gain weight and grow at a good rate, this increases and improves their outcome.  Babies will be fed breast milk in a tube and start breastfeeding around 33 to 34 weeks.  My son was born at 32 weeks.  He was feed with a tube for many weeks.  I remember pumping around the clock and bringing my milk to him.  Then when he actually started to breastfeed, many weeks later, it was an exciting moment for the both of us.  I breastfed him well over a year.
A diet for a premature baby may consist of mom's milk and donor milk, if a parent asks for this.  That is why it is important, if you have extra milk, call your local hospital NICU and ask where you can donate your milk.  Furthermore, your body knows that you had a preemie and your breast milk has extra minerals and proteins designed for your baby.  In the fist few weeks, your milk contains more protein fatty calories and calcium, phosphorus, magnesium, zinc, sodium and chloride.  Breast milk also has a laxative effect, which helps your baby pass its first bowel movement, meconium and throughout breastfeeding.  In fact, breast milk is easily digested.  Breast milk helps with brain growth and development.  Breast milk improves your baby's mental health too.
     Human and donor milk have good kinds of fats for these newborns.  However, these babies can only tolerate a certain amount of food in their stomach and intestines.  Please consider donating your breast milk to help save these babies.
     Preemies receive many benefits from breastfeeding including protection against infections, better developmental outcomes and stress.
Large proteins molecules called immunoglobulins cross the placenta and are stored while the fetus is growing inside a mom and during the first three months of life.  They also protect the baby up to 5 months after birth.  Therefore, it is so important to give your breast milk to your baby in the NICU.
     Don't leave milk out longer then 30 to 60 minutes, when your baby is in the NICU.  These little babies are very delicate and it is important to not allow milk to stand outside the refrigerator too long before using it.  Moms who cannot breastfeed their preemies need to pump every 3 to 4 hours.  While traveling to the hospital, put the milk in a cooler for transport.
     Make sure you wash your hands with soap before you pump. Pump 10 to 15 minutes per session.  Use a Hospital Grade Pump. 1-2 ounces is a good start per meal, 1 ounce equals 30cc and 2 ounces equals 60cc.
NICU babies do better with breastfeeding.  They can pace themselves on  how much they are swallowing and therefore they can maintain a good oxygen level.  Breastfeeding also provides these babies the warmth and physical contact they need from their mom.  Skin to skin is really important to do at this time.  Ask a nurse in the NICU or Lactation Consultant to help you with breastfeeding and pumping.  I get called many times to help these moms .
In conclusion, preemies face many challenges in the NICU.  Breastfeeding can really help your baby and it is the best nutrition for your baby.  Try to establish a good milk supply by pumping and breastfeeding.  Bring this milk to the NICU for your baby.   Everyday you give your milk or breastfeed your baby is the best possible nutrients you can give your baby to allow your baby to grow and nourish properly.  I am proud of every new mom out there that attempts breastfeeding.  I know breastfeeding can be hard and challenging however, it is very rewarding.  You are all doing an amazing job.  Enjoy your journey and time breastfeeding your baby.

Ankyloglossia, Tongue Tie While Breastfeeding

     Ankylogglosia is known as a tongue tie.  It is caused by an unusually short, thick lingual frenulum, a membrane connecting under the tongue and the floor of the mouth.  Some are mild and some are more severe.  Tongue ties affect about 4 to 5% of infants.
     Many studies have been done to see if a Lingual Frenotomy, also called Frenectomy, Frenulectomy or Frenuloplasty, a procedure performed to relieve tongue ties while breastfeeding.
     The evidence supports treating tongue ties for breastfeeding problems.  Many feel this is the right thing to do.  In my private practice, I see many babies with tongue ties.  I recommend each baby be seen by a specialist and Ear, Nose, Throat Pediatric Specialist.  Ask your pediatrician for a good referral.  Dentists also specialize in clipping tongues.
     Before the tongue tie procedure, many infants experience poor latch problems.  In many studies, it has been shown overwhelmingly that clipping the tongue and having this procedure, greatly improves the outcome of breastfeeding for the infant. 
Having your infant's tongue tie taken care of, also helps with their word articulation and helps them enunciate words and sounds better later on in life.   This is why, I greatly feel a tongue tie should not be ignored and a specialist should give you their opinion of whether your baby's tongue tie needs immediate attention or whether it can wait.
     In conclusion, there have been many studies done assessing the relationship between Frenotomy and breastfeeding symptoms.  Overall, the conclusion is that you need to have a Frenotomy to help reduce breastfeeding problems.  The baby latches on better onto the mother.  The mother feels less pain.  Breast milk is transferred better.  Make sure if your baby has a tongue tie, you address it as soon as possible.  The soon you address it, the better it is for your baby.  Speak to your pediatrician first.  Then see a specialist.  I have seen many moms breastfeed successfully after a Frenotomy.

Rheumatoid Arthritis And Breastfeeding

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     Many women suffer from Rheumatoid Arthritis, RA.  RA is a chronic inflammatory disease, thought to be called a genetically influenced autoimmune response (Riordan, 2005).  During pregnancy, many women with RA symptoms usually get better, even allowing women to go into remission, only for symptoms to return after delivery.  Prolactin, a milk production hormone, has been known to act as an immunostimulator (Brennan and Silman, 1994).
     There are many benefits to breastfeed your baby.  During breastfeeding, a woman needs to look down at her baby, causing a lot of pain in her neck.  There is a whole lot of strain on the neck, because breastfeeding is repeated every 2 to 3 hours around the clock for the first few weeks.  In fact, some women need physical therapy for their RA while they are breastfeeding.
     Moms need to find a good position to help with her baby on her breast.  Finding a comfortable position for her back, neck and hands is important while breastfeeding.  Use extra pillows and blankets if needed.  The cradle hold, cross cradle hold, football hold and side lying hold can be used while breastfeeding.  Ask a Lactation Consultant, I work hard in my private practice, to find the right position for each new mom.
     For the cradle hold, mom supports her baby’s head with the arm on the side as her nursing breast and the cross cradle uses the opposite arm.  For the football hold, the mom holds her baby at the side, with her elbows bent and supports her baby’s head in her arm.  You can use extra pillows or blankets under the baby’s head for additional support.  With lying down on her side, the mom holds the baby with one hand as the other breast helps guide the baby to her breast.
     Women need to talk to the Rheumatologist or Ob/ Gyn, to see what drugs are safe while breastfeeding.  Most medicines that are safe during pregnancy, are usually safe while breastfeeding.  Furthermore, ask your doctor if you need to continue taking your prenatal vitamins while breastfeeding, so you can receive additional vitamins while breastfeeding.
     If you are having a bad RA day, it is flaring up, and you are in constant pain, ask for help.  Have someone else take care of the baby for a while.  They can burp or change the baby’s diaper if needed.  Sometimes, switching breastfeeding positions during the day helps.
     If you cannot breastfeed due to severe pain from RA, you can pump.  Call a Lactation Consultant or your doctor to help you out.  Buy a Hands free pumping bra to help hold the pump bottles in place, so you don’t need to use your hands.
     In conclusion, have a good support system to help after delivery, while you breastfeed.  Speak to your Rheumatologist and Ob/Gyn about breastfeeding. I hope all of you enjoy breastfeeding and this special time bonding with her baby.
The following is a list of drugs you can take while breastfeeding with  RA.
Antitumor necrosis Factor drug
These drugs are NOT good to take while breastfeeding
Warfarin-this drug may be ok
With all the above list, ask your doctor which drug is right for you during breastfeeding.

Breastfeeding A Down Syndrome Baby

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     Down Syndrome is one of the most common genetic birth defects.  Additionally, many of these babies have health problems, with some type of degree of mental retardation and as well as characteristic physical features.
     The most common type is called,Trisomy 21.  These babies have three copies of the 21 chromosome.  A human being has 23 chromosomes, which contain genetic material from your parents, half from your mom and half from your dad.
     Breastfeeding a baby with Down Syndrome can be challenging.  In these past few weeks, I have had the pleasure and honor of working with a beautiful mom and her little angel, who has Down Syndrome.  Both of them have done an amazing job.  I am so proud of this mom because she has tried so hard to breastfeed her daughter.  She knows that breast milk provides her daughter with so many amazing benefits and nutrition.  Furthermore, I have told her to be more patient with her because her baby has a weaker suck and low muscle tone, making it harder to learn to breastfeed.  I watch how patient this mom is with her.  I leave her home saying to myself, how lucky this little girl is because she has such a wonderful mom and extended family who is showering her with so much love.  The mother tells me that when dad comes home from work, he cannot stop hugging his beautiful baby girl enough.
     Breastfeeding improves tongue and mouth coordination for these babies with Down Syndrome.  This can be a real developmental advantage for them.  Therefore, if you can breastfeed your baby, you are really helping them in so many wonderful ways.
     Breastfeeding helps with the protection from infection.  Breast milk contains live cells and antibodies.  Moms passes these along to their babies, while breastfeeding.  These babies immune systems tend to be a little weaker, therefore breastfeeding really helps strengthen them.  Furthermore, breastfeeding helps with digestive problems because, it is easily digested and the best food that you can give to your newborn.  It also helps with skin problems.  Pump to make sure you have extra breast milk, in case your baby needs some more milk.
     I have used a nipple shield for this last baby with Down Syndrome.  It is easier for her to latch onto her mother’s breast.  She also gets sleepy and tires out more easily.  The nipple shield helps her stay focused, while feeding a little better.
      It is best to offer more frequent breastfeeding sessions.  Try to position the baby close to you and use extra pillows if needed.  You may need to support your baby’s chin and jaw by holding your hand under her chin in a, U hold.  This position is also called the, “Dancer Hold.”
     In conclusion, breastfeeding a Down Syndrome baby can be very challenging.  However, breastfeeding offers such a special bond between you and your baby.  It helps your baby grow in strength and muscle tone.  The extra skin to skin, closeness between mom and baby provides comfort therefore, it helps your Down Syndrome baby’s health and well being.  Just try to be patient and slowly breastfeeding will get easier and better for both you and your baby.  You are an amazing mom for breastfeeding your baby.  Keep up the good work.  I am so proud of all the moms in the world who breastfeed their babies.

Breastfeeding And Shingles

      Shingles, also known as the Herpes Zoster Virus or Varicella- Zoster (VZ) causes Shingles.  It is a viral infection that causes a painful rash and blisters.  This is the same virus that causes the Chicken Pox, when the illness is reactivated later on in life, at any age.  The Shingles virus travels along a nerve pathway to your skin.  With Shingles, the rash with blisters contain the virus.  It can appear on your back, neck, stomach, face or neck.  It can also appear  under your armpits, near your breasts.
     Once a breastfeeding mom is diagnosed, the question is can you now breastfeed your baby?  Your baby cannot get Shingles from your breast milk.  However, if you have lesions or blisters on your skin near your breast that are open or oozing fluids, you should not breastfeed.  You do not want your baby to have direct contact with these blisters.  Speak to the pediatrician about further exposure for your newborn.
     Your doctor will decide what medication to put you on.  Tell your doctor that you are breastfeeding.  Lets go over a few drugs that may be good while breastfeeding.  I looked them up in Dr. Thomas Hale's Book,  Medications and Mother's Milk.  Acyclovir- Zovirax, Lipsovir, Apo-Acyclovir, Aviraz can be used and have a minor affect on the newborn baby.  It does transfer in small amounts in breast milk.  Moms with lesions on the areola  or nipple, should not breastfeed.  Famciclovid:  Famvir-  It is probably safe.  At this time, there is no data on transfer into breast milk.  Valacyclovir or Valtrex- this drug transfes into breast milk.  However, it is safe for infants with few reported side effects.
     When can a breastfeeding mom start to breastfeed again?  If the lesions are only on one side of your breast, you can breastfeed on the unaffected area.  Try to cover the lesions just to take extra precautions, on the other side while breastfeeding.
     A newborn has a weakened immune system therefore, has the highest risk of catching the virus.  The virus spreads when the baby is in contact with the lesion.  Wait until it scabs over and you are no longer contagious to breastfeed.  The mother needs to pump her breast milk only when she remains clinically infectious.  The breast milk can be given to the baby only if there are no active lesions on the breast. (Lawrence and Lawrence, 2005)  
     If the doctor tells you that you need to pump and dump while the sores are healing, then you need to temporarily think of an alternative form of nutrition for your child.  Luckily, this will last for a short time.  As soon as the mother becomes noninfectious, it is okay to breastfeed in the United States.(Lawrence and Lawrence, 2005) 
     If you, as a mom, help your daughter while she breastfeeds, come into contact with her lesions, wash your hands well.  Shingles is only contagious if you have not had the chicken pox. It is contagious if the blister is open and oozing.  Wear gloves if you need to help her.  Older people need to think about getting a Shingles shot.  
     In conclusion, Shingles are contagious as long as the lesions, blisters are open and oozing.  Therefore, take precautions while breastfeeding.  Ask your doctor and the pediatrician for advice.  I am so sorry you are going through Shingles.  I have had a family member go through this, so I know the pain one experiences while recovering.  I hope you enjoy breastfeeding your child very soon.

Foods That Fight Breast Cancer

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     October is breast cancer awareness month.  So, it is a good idea to learn how you as a woman can lower your chances of breast cancer.
     What causes breast cancer?  Family history plays a large part of getting breast cancer.  Furthermore, breast cancer risk is elevated for woman who have had no children.  Estrogen exposure also plays a role in the development of breast cancer.
     Lifestyle plays an important role in developing breast cancer.  Maintaining a healthy weight is important.  Regular physical activity can reduce the risk of breast cancer.  In fact, eating right is important.  Choosing hormone free dairy and animal products, is a good place to start.  Try to avoid alcohol.  You should also avoid long term hormone replacement therapy.  In fact, long term exposure to our environmental carcinogens may play a role in getting cancer.
     Can what you eat protect you against breast cancer?  Eat less saturated fat and eat less red meat, butter and dairy products.  Use olive oil for cooking.  It happens to taste great in all foods and salads.  Watching your diet carefully, may help lower your risk for breast cancer. 
     Another good group of foods to eat are omega 3 fats, found in fish, especially salmon and sardines.  Choose chicken without the skin or fish over red meat.  Eat foods containing calcium, such as dairy products, yogurt and bony fish.  A diet high in antioxidants can lower your risk of cancer such as beta carotene, Vitamin C and Vitamin E foods. 
     Fruits and vegetables are a great source of antioxidant.  Best sources of beta carotene are sweet potatos, carrots, cantaloupe, pumpkins, butternut and winter squash, spinach, broccoli, mango and papaya.
     Here are a list of some anti cancer vegetables:  broccoli, brussel sprouts, cabbage, carrots, cauliflower, eggplant, green beans, kale, red onions, radishes, soy, squash, sweet potato, tomato and yam.  Carrots, red tomatoes and green spinach are loaded with carotenoids. By the way, the American Cancer Society concluded that moderate consumption of soy foods appears to be safe for all women.
     Here are a list of fruits that are anti cancer fruits:  apricots, blueberries, grapefruit, grapes, lemons, mangos, persimmons, strawberries and tangerines.
      A high fiber diet is good.  The best anti cancer fiber sources are:  wheat bran, kidney beans, garbanzo beans, navy beans, whole wheat, whole grains, legumes and prunes. A diet high in antioxidants can lower your risk of breast cancer.  Vitamin C and Vitamin E foods are also good to eat. Additionally, try to drink green tea. Eat foods containing calcium such as dairy products, yogurts and bony fish.   Ask your doctor if you need to take a vitamin supplement. 
     Vitamin D exposure to the sun or fortified milk and other foods are good for a woman's diet.  Woman who have a diet high in Vitamin D may have a lower risk of breast cancer.
     Selenium is good for your diet, such as red snapper, lobster, shrimp, whole grains and vegetables, brown rice, cottage cheese, lamp chops, chicken, sunflower seeds and garlic.  Acidophilus, garlic and green tea are also good.
     In conclusion,studies show that certain foods play a role in breast cancer prevention and others in breast cancer.  Keep your diet low in total fat and very low in saturated fat.  Increase your fiber intake to lower cancer risk.  Use whole grains breads instead of white bread.  Eat beans, such as kidney and garbanzo beans.  Eat vegetable and fruits, full of nutrients colors and vitamins.  Eating healthy helps keep the cancer causing estrogen from promoting the growth of malignant calls, cancerous cells.  Learn to love yourself by finding time to take care of your health and your body.  You are all worth it.

Some Amazing Facts About Breast Cancer

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     Breast Cancer is a form of cancer that affects and starts in the cells of a woman's breast.  A malignant tumor is a group of cancer cells that can grow into nourishing tissues or metastasize, spread to areas around the breast, such as your lymph nodes.  The majority of cases are women, however men get it too.
     Family history is one factor that determines your risk for the disease of breast cancer.  Therefore, it is important for a woman to increase their awareness about their personal risk of breast cancer.  In fact, many older women, older then 50, are diagnosed with breast cancer. 
     Ethnicity plays a part in developing breast cancer.  Asian, Native American, Hispanic women have a lower change of getting cancer.  While Caucasian women are more likely to get diagnosed.   African American women have a greater risk of dying from breast cancer.  Furthermore,  if a mother, sister or daughter has breast cancer, your risk doubles.
     The American Cancer Society has put out statistics on breast cancer as follows:  about 1 in 8 women, 12%, will develop invasive breast cancer during their lifetime.  Statistics for 2014 are as follows:  232,670  new cases if invasive breast cancer is diagnosed in women.
62,570  new cases in carcinoma in situ (CIS) will be diagnosed, which is the earlier form of breast cancer.  40,000 women will die.     
      Breast cancer is the second leading cause of death in women, next to lung cancer.  Early detection, breast cancer awareness and screening have helped with catching breast cancer earlier.  We are now seeing since 2000, a decreasing rate of breast cancer survivors today in the United States.
     There are several types of breast cancer.  Here are the more common types.  Ductal Carcinoma in situ (DCIS) Intraductal Carcinoma is considered non invasive.  Cancer has not spread.  Lobular Carcinoma (LCIS) grow in the lobules of the milk producing glands of the breasts.  This is not a true cancer.     Invasive Ductal Carcinoma (IDC) starts in the milk duct, goes through the wall and grow into the fatty tissues of the breast.  It may spread.  Invasive Lobular Carcinoma (ILC) starts in the milk production glands. It can spread.  Less common forms of breast cancer is Inflammatory Breast Cancer (IBC).
      Here are some basic knowledge about a females breasts:  The female breast is made up of lobules, milk producing glands and ducts, tiny tubes that carry milk from the lobules to the nipple, the stroma, which are fatty and connective tissues surrounding the ducts and lobules, blood vessels as well as lymphatic vessels.  Some cancers begin in the cells that line the duct, ductal cancers.  While others begin in the cells that line the lobules, lobular cancer.  Other cancers start in the tissues of a women's breast.  Breast cancer can spread through lymph nodes.  Lymph nodes are part of our immune system cell that is connected to the lymphatic vessels.  Some lymph nodes are nearby under the arm while others are above or below the collarbone, near the breasts.  Breast cancer spreads through these lymph nodes.
     Your genes play an important part with breast cancer.  If you have BRCA1 or BRCA2 gene mutations, you have a higher risk for breast cancer.  Therefore, monthly self exams, mammography, clinical breast exams when doctors request them, are important.  The earlier mutations are detected, the better the survival outcome for a woman.  A simple blood test of saliva test is needed.  Additionally, genetic testing may be recommended.  Afterwards, your doctor can recommend medications to reduce your risk of cancer, diagnose and even so preventative surgery.
     The American Society of Clinical Oncology (ASCO), developed clinical practice guidelines about tumor markers for breast cancer.  What is a tumor marker?  Tumor Markers is a substance produced by a tumor.  Tumor Markers are found in the person's blood, urine or tumor itself.  It is produced by the tumor in a person's body in response to cancer.  When Tumor Markers are used with other tests, they can be very helpful.  The next four paragraphs talk about Tumor Markers.
     Estrogen receptor(ER) and progesterone receptor (PR) -Breast cancer cells with ER  and PR depend on estrogen and progesterone to grow.  Successful treatment with hormone therapy is tamoxifen (Nolvadex).
     Human epidermal growth factor receptor 2 (HER2)- This protein is present in large amounts in 20 to 25% of breast cancers.  Testing for HER2 helps doctors know if cancer can be treated with anti HER2 treatments.
     Cancer antigen 15-3 (CA15-3) cancer antigen- 27.29 (CA 27..29) and carcinoembryonic antigen (CEA).  These Tumor Markers are found in 50 to 90% of patients with metastatic breast cancer, which is cancer that has spread outside the area of the breast.
     Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1)- higher then normal levels of them, Tumor Markers mean the cancer is more aggressive and faster growing.  The Tumor Markers will probably help doctors decide what treatment to do such as chemotherapy after surgery.  Additionally, the patient lymph nodes will also be checked.
      In conclusion, it is important to be a well informed patient on breast cancer.  Remember knowledge is power when it comes to your health and dealing with breast cancer. In addition, Tumor Markers are used to monitor, treat, help plan, guide and diagnosis breast cancer.  They also predict the testing response to hormone therapy after surgery.  Patients that have no cancer spread to their lymph nodes, may not need chemotherapy.  Many cancer patients are now going on Tamoxifen for many years after breast cancer.  Always ask your doctor for advice and don't be afraid to come with a list of questions.  I know I did when I had a family member diagnosed with cancer.  Remember, your doctor is here to help you and be a part of your treatment plan and recovery.  Good luck and I hope everyone who goes through breast cancer and any form of cancer will come out stronger and be a survivor.


Cancer.Net-Breast Cancer
(This website has over 120 different cancer types and information).
1.  Guide To Breast Cancer
2.  What To Know:  ASCO's Guideleines on follow up care for breast cancer
3.  Understanding Tumor Makers

Breastfeeding Report Card By State

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Here is the latest statistics on breastfeeding and exclusively
breastfeeding by state.  This list was compiled by The Center For Disease Control And Prevention National Immunization Survey.(2011)  Statistics.  It is based on phone calls, land line and telephone samples, dual frame sample.

The World Health Organization says that babies should be breastfed for at least six months.  The American Academy of Pediatrics also believe that babies should be breastfed exclusively for the first six months.  Then food should be introduced and breastfeeding continued up to 12 months old.

Vermont is the best state for good breastfeeding rates.

States          Breastfeeding 6 months       Breastfeeding 12 months
Alabama      32.1                                     11.8
Alaska         64.3                                     42.5
Arizona        47.8                                     23.9
Arkansas     32.3                                     13.5
California     63.1                                     38.4
Colorado     55.2                                     29.3
Connecticut   51.4                                    27.5
Delaware       34.4                                   16.8
District of Columbia     53.1                     30.0
Florida                         48.7                     26.9
Georgia                        40.1                     20.7
Hawaii                         61.5                     36.5
Idaho                           56.8                     30.5
Illinois                           47.0                    26.1
Indiana                          38.6                    21.5
Iowa                             51.6                    28.9
Kansas                          40.3                    22.5
Kentucky                       31.5                    22.8
Louisiana                       30.3                    12.6
Maine                             50.5                   29.2
Maryland                        60.1                   29.4
Massachusetts                 53.7                  24.9
Michigan                         46.6                  23.3
Minnesota                       59.2                  34.6
Mississippi                       28.9                 10.0
Missouri                          42.1                  20.2
Montana                         50.7                   25.5
Nebraska                        46.1                   25.8
Nevada                           45.3                   22.7
New Hampshire              57.6                   30.9
New Jersey                     56.2                   28.3
New York                       55.8                   31.3
North Carolina                48.3                   24.5
Ohio                                42.1                  21.6
Oklahoma                       38.4                   22.6
Oregon                           64.4                   40.2
Pennsylvania                   45.7                   26.1
Rhode Island                  47.0                   22.2
South Carolina               56.2                    30.9
South Dakota                 45.6                    18.3
Tennessee                       40.7                    20.9
Texas                              42.9                    20.9
Utah                               63.1                    40.7
Vermont                          66.5                    45.3
Virginia                           53.7                    27.4
Washington                     64.2                    35.3
West Virginia                   29.3                   15.9
Wisconsin                        54.9                   26.2
Wyoming                         56.6                   30.0

Breastfeeding A Baby With Hypotonia

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     Breastfeeding is best for your body.  It has all the nutritious ingredients needed to keep your baby healthy.  In fact, any breast milk you give your baby is better then none.  However, sometimes special care is needed to help breastfeed a baby with special needs. 
     Hypotonia babies have a weak muscle tone movement, which may involve the brain, nerves, muscles and spinal cord.  Causes may include:  brain damage, encephalopathy due to lack of Oxygen.  Sometimes disorders affect the nerves that supply muscle to our body.  In rare cases, an infant can’t process food into energy.
     How can a mom help breastfeed a baby with Hypotonia?  A baby with Hypotonia has a weak suck, and ineffective tongue.  Therefore, the baby needs help positioning on mom’s breast for breastfeeding.  Many Hypotonia babies have a hard time with the coordination of sucking, swallowing and breathing.  Therefore, a baby with Hypotonia needs additional support. 
     The Dancer Position is used, where a mom rounds her hand underneath her breast while stabilizing her baby’s jaw.  Sometimes, the Hypotonia baby, does not have a sucking reflex or has a decreased one. In fact, some of these babies facial muscles are also weak, therefore making it hard to suck well.  Occasionally, a nipple shield is needed for this baby. You need to make sure your baby gets a deep and good latch.  If these signs are not recognized early on, these babies can lose too much weight.  However, it has been noted that, after working with these babies, their sucking efficiency continues to improve over the first year.  Some of these babies may require a little intervention such as supplementation, pumping, more frequent nursing etc……  Take short breaks in between breastfeeding.  Use a supplemental feeding system at your breast if needed. 
     One example of Hypotonia is Down Syndrome.  Down Syndrome is a disorder caused by Trisomy of Chromosome 21.  Breastfeeding may actually help with normal mouth and tongue coordination.  Additionally, many Hypotonia babies suffer from Cleft Palates. Other Hypotonia babies may suffer from Pierre Robin Sequence, where a baby has a smaller then normal jaw, high arched palate, a jaw that is far back close to the throat and the tongue is large.  Sometimes, teeth even appear at birth.  Other babies may suffer from Choanal Atresia, where the anterior skull has a blockage which narrows the nasal airway.  Sometimes surgery is required to correct this situation. 
     It is a good idea for a  Lactation Consultant to help assess your baby’s ability to latch, suck and transfer milk.  In fact, a Lactation Consultant will recommend you to hold your baby skin to skin because this helps with increasing you milk supply.  Ask your pediatrician to refer you to a Specialist, who can help you with your baby’s sucking coordination, probably a pediatric Occupational Therapist.  I have seen many come to the NICU to help preemies. 
      Ankloglossia or Tongue Tie is very common in babies suffering from Hypotonia.  They may have a short Ligual Frenulum, difficulty lifting their tongue and going to side to side with their tongue.  These babies need to see a special Ear Nose and Throat, ENT, Doctor.  I send many of my patients to ENT, for a proper evaluation. A Frenotomy, Tongue Clip may be preformed by the ENT, if necessary.
     You can use a hospital grade pump to double pump your breast.  It’s important to continue to evaluate and monitor your infant.  You can go to a pediatric neurologist, a geneticists for more testing, you can get diagnostic testing done and evaluate your baby’s decreased muscle tone and floppyness of your baby’s body and head.
     In conclusion, I am so proud of each new mom that attempts to breastfeed a baby.  Having a baby with Hypotonia is an even bigger challenge.  However, with patience and love, you will learn to breastfeed your baby well.  Remember, human milk is the best for your baby.  Keep your baby skin to skin when possible.  Breastfeed as often as you can.  This will help improve coordination associated with Hypotonia.  Support your baby’s mouth and jaw with your hand if needed. Take extra care when lifting your baby up. Good luck.  I hope breastfeeding works out for all of you.  It is a special bond that will last forever.  If you know someone who has a child with Hypotonia, encourage them and be supportive of their choice to breastfeed.  Keep telling them what a wonderful job they are doing.