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Breastfeeding And Shingles
Foods That Fight Breast Cancer
Some Amazing Facts About Breast Cancer
Breastfeeding Report Card By State
Breastfeeding A Baby With Hypotonia

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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.

References: 

Cancer.Net-Breast Cancer
(This website has over 120 different cancer types and information).

www.asco.org/guidelines/breasttm.
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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               BREASTFEEDING RATES BY STATE

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.

What Is A Certified Breastfeeding Educator (CBE) ?

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     Certified Breastfeeding Educators help breastfeeding families in many ways. Many of them are nurses on the health care team promoting and assisting new moms with breastfeeding problems. In 1987, Dr. Debi Leslie Bocar, created the Breastfeeding Educator Program.  It has been revised through the years over 120 times.
   
Certified Breastfeeding Educators take a very short five day course.
In fact, Certified Breastfeeding Educators are not qualified to represent themselves as lactation consultants. Therefore, there is a big difference when a person represents themselves as a Lactation Consultant or as a Certified Breastfeeding Educator.
The title Certified Breastfeeding Educator means that you have attended and participated in a Breastfeeding Educator Program.
Additionally, you have role play activities which may
include positioning, latch-on and mom breastfeeding, and oral discussion of the management of selected breastfeeding challenges during the week you are at your conference.
There is a 50 question exam that you need to get an 80% in order to pass.
Participants are awarded a certificate documenting their successful completion of the certification process and will be entitled to use the designation Certified Breastfeeding Educator™ for a period of five years.
Recertification is needed every five years.

     There are different pathways to become an International Board Certified Lactation Consultant or IBCLC.  This is the real degree in the field of Lactation Consulting. For me, it took six and a half years to become an IBCLC.   I am an International Board Certified Lactation Consultant.  I hold a Bachelors Degree in the field of Maternal and Child Health/ Lactation.  I also interned for many hours, months, years to qualify to sit for my boards in 2010. 
     A Certified Breastfeeding Educator has only finished a one week course.  Therefore, you need to be careful who you choose to be your Lactation Consultant.  Ask for our Board Certified Number.  An IBCLC has much more extensive training, and more techniques to better serve you and help you with your breastfeeding problems.  By using someone else, they miss something and you are not going to be guided correctly.  Furthermore, someone may say and represent themselves as Lactation Consultant when in reality, they are not.  Many states are trying to put legislation through to protect new moms.  I feel that it will take a while before this happens in your state or place you live.
     In conclusion, if you can find someone with an IBCLC, behind their name, then we are the real International Board Certified Lactation Consultant.  If you use anyone else, including nurses with the less degree, they will not know all the techniques to help you and your baby.  Choose wisely and carefully.

Breastfeeding With Fibromyalgia, Yes It's Possible

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     Breast milk is best for your baby.  Therefore, every woman should consider breastfeeding.  However, sometimes medical problems may arise and prevent a mom from breastfeeding.  Some women experience breastfeeding and Fibromyaligia.  It becomes a little more challenging where these moms experience constant fatigue, chronic pain, joint disorders and other kinds on medical problems.  Some women with Fibromyalgia feel great during their pregnancy, only to feel worse afterwards while breastfeeding.  Therefore, this makes it hard for women to breastfeed.
     What is Fibromyalgia?  It is a syndrome that is associated with pain all over your body for a long period of time.  It has no age limit therefore, children, men and women can suffer from it.  Possible causes may include:  physical, emotional and mental trauma, abdominal pain response, sleep disturbances, anxiety, depression, injury to the body, sensitivity of light, sound or odors, stiffness when you wake up and get out of bed, sexual dysfunction, muscle trauma, chronic neck or back pain, infectious illness, chronic fatigue, hypothyroid or under active thyroid, or illnesses such as Lyme Disease, Hepititis C or Epstein- Barr Virus.  Additionally, if you have an overactive immune system, this may cause muscle trauma and injury.  Last of all, genetics may play a part in triggering Fibromyalgia. 
     Sometimes, stress can cause Fibromyalgia to flare up.  When that happens, try to find a calm and stress free room to breastfeed.  Use pillows to help support your body during breastfeeding.
     Unfortunately, people with Fibromyalgia experience pain day and night.  Some people seek medications for their symptoms.  At this time, the Food and Drug Administration has approved Lyrica (Pregabalin), to be used for Fibromyalgia patients.  Dr Thomas W. Hale, an expert in the field of medications and breastfeeding, recommends that you watch your baby for sedation, constipation etc…   Furthermore, he continues saying that nursing moms should use precaution when taking this drug. 
     Alternative therapies such as massages, acupuncture or seeing a Chiropractor may help.  Yoga may also be good for you.  These alternative therapies may help mange your Fibromyalgia symptoms better.
     Other symptoms of Fibromyalgia may include:  irritable bowel syndrome, (IBS), having memory loss or having a hard time to concentrate in your daily life, numbness or tingling in your hands or feet.  You may also have a limited ability to perform exercises.  One can even get migraines or tension headaches.  Speak with your doctor if you experience these problems so you can get a proper diagnosis swiftly.
      Fibromyalcia can be debilitating.  These conditions can come in a wide range of symptoms affecting each individual differently.  At the present time, there is no cure.  Doctors focus and concentrate on relieving symptoms and improving your functions.
     In conclusion, breastfeeding should be pain free and enjoyable.  If you have Fibromyalgia, ask your doctor how you can successfully breastfeed.  Position yourself on your bed or in a chair properly.  Try to have a little bit of patients to deal with your problem.  Consult a Lactation Consultant, such as myself, a specialist in the field of breastfeeding for additional assistance.  Speak to your doctor and use prescription medication to help reduce pain if needed.  Try to use alternative therapies for additional comfort.  Try to get as much rest as possible, reduce your stress level, exercise moderately and listen to your body if you are tired, practice methods of relaxation, and improve your diet and overall nutrition.  All these things can help minimize symptoms and help improve your quality of life.
    

Amyotrophic Lateral Sclerosis (ALS) And Breastfeeding

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       What is Amyotrophic Lateral Sclerosis or ALS?   Amyotrophic gets its name as follows:  A stands for no, Myo refers to muscle and Trophic means nourishment., therefore, no muscle nourishment.  When a muscle has no nourishment, it atrophies or wastes away.  Lateral identifies the area in the human’s body, their spinal cord, where a portion of the nerve cells that signals and controls the muscles are located.  As this area degenerates, it starts to scar and harden, sclerosis, in the region.  Sometimes ALS is called Lou Gehrig’s Disease. Unfortunately, it is a rapidly progressive disease, a fatal neurological disease that attacks the neurons or nerve cells which are responsible for controlling our voluntary muscles movement.  These muscles may include the arms, legs, or face.  In fact, it can gradually destroy our motor neurons and can be fatal.  That is why The Ice Bucket Challenge is a blessing to many who suffer or who have family members who are suffering from this disease because from all this money has come awareness of this disease and a possible road to a cure.
     The drug Riluzole (Rilutek) is the only drug approved by the FDA for ALS.  It slows the disease down.  Speak to your doctor if you are breastfeeding because this drug passes through into the human milk.  Additionally, this drug can lower your white blood cells and increase your chances of getting an infection.  Additionally, animals, especially rodents, treated with this drug, have shown significant improvement in their motor scores.
     There are no adequate studies at this time done on Riluzole and breastfeeding. Together with your doctor, you can make an informed decision weighing the benefits of taking this drug as opposed to the potential risks it may have on you and your baby while breastfeeding.  Many feel that a mom should not breastfeed while taking this drug.
     There are side affects to this drug Riluzole.  Some of the side effects are:  pneumonia, abdominal pain, drowsiness, dizziness, decreased liver function, nausea, rash, itching, swelling, vertigo, vomiting and diarrhea.  There are many clinical trials underway testing new drugs and hoping to find a way for people to live a better quality life.  There are tests being done on especially rodents to test drug like compounds, gene therapy, antibodies and cell based therapies.  Clinical trials offer hope for people to help further our study on ALS. 
     In conclusion, always contact your doctor when you want to breastfeed and you are taking medications. Discuss with your doctor the risk and benefit of the drug, Riluzole.  It is unknown if this drug passes into breast milk.  Therefore, consult with your doctor before breastfeeding.  I hope in our lifetime we will see a cure for ALS and be able to figure out what causes this disease and how we can prevent and help people live a more productive life with it.  I am happy we have had The Ice Bucket Challenge and now the world is more aware of ALS.  I hope with the money received, we will find a cure.
Where can I get information?
ALS Association
1275 K Street, N.W.
Suite 1050
Washington, D.C. 20005
tel:  202-407-8580
fax:  202-289-6801

Antipileptic Drugs and Breastfeeding

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     Can breastfeeding moms use of Antiepileptic Drugs (AEDs)? Now that you have given birth, you probably have concerns whether you can breastfeed while taking epilepsy drugs.  It is important to  encourage breastfeeding moms to  take  careful precautions and evaluate possible side-effects on their baby caused by the indirect exposure to AEDs via breast milk.
     In this blog, I have tried to explain how safe each drug is while breastfeeding In fact,  for each AEDs, I collected all retrievable data from Hale’s “Medications and Mother Milk” (2012).  I will summarize each drug according to Dr. Thomas W. Hale’s opinion.  Additionally, older AEDs, such as Carbamazepine, Valproic Acid, Phenytoin, Phenobarbital, Primidone are considered to have a good level of safety during lactation. However, there are fewer data available on the use of the new AEDs on the market today.   Therefore, Gabapentin, Lamotrigine, Oxcarbazepine, Vigabatrin, Tiagabine, Pregabalin, Leviracetam and Topiramate are compatible with breastfeeding with a less documented safety profile. Ethosuximide, Zonisamide and the continue use of Clonazepam and Diazepam are contraindicated during breastfeeding. More testing is needed on these drugs and hopefully in the near future, more doctors, healthcare professionals and scientists will take interest in this subject and future their studies on these drugs,

Carbamazepine -Moms treated with Carbamazepine (CBZ), should be carefully monitored during breastfeeding.  Probably this drug is safe to use.
Ethosuximide-A large amount of this drug is transferred into the baby.  Watch your baby for sedation, poor sucking and excitability. This not the preferred choice.

Gabapentin- Levels are low in milk.
 
Lamotrigine- lamotrigine is considered moderately safe during breastfeeding .

Levetiracetam- Levetiracetam is a new AED;  keppra, is usually added to other drugs in case of inadequate control of seizures. It passes into breast milk however, it is still thought to be safe levels.  It is the growing choice of a drug to use.

Oxcarbazepine- Oxcarbazepine (OXC) or  Trileptal is used to treat partial seizures.   Reports of its use while breastfeeding are limited. Phenobarbital-  Phenobarbital or Laminal or Barbilixir, is widely used in both adults and children.  The main, yet rare, side-effect attributed to phenobarbital is sedation, In premature babies or in infants with drowsiness, difficulty in sucking or poor weight gain, it is recommended to monitor its plasma levels.

Phenytoin or Dilantin or Nova-Phenytoin At this time, there is no study on the passage of pregabalin into human milk. The absence of binding to plasma proteins and its excellent oral bioavailability suggest that it can pass into the mother’s milk and into the circulation of the breastfeeding baby. Numerous side effects such as dizziness, drowsiness, impaired vision have been observed in adults. It is rated as moderately safe during breastfeeding  

Primidone- Mysoline, Apo-Primidone, Sertan, These types of drugs have a significant affect and causes sedation in a baby. It should be used with caution during breastfeeding Tiagabine- Tiagabine oral absorption is almost complete and it is highly bound to plasma proteins. There are no studies on its use during breastfeeding, leading to possibly prefer other antiepileptic drugs. If this drug is taken by the breastfeeding mother, the baby should be monitored.

Topiramate or Topamax is increasingly prescribed, being effective and well-tolerated by epileptic patients. It is rapidly absorbed, it has a low plasma protein binding, a relatively long half-life and a significant excretion into breast milk.  Close observation for sedation is advised.

Valproate- Patients taking valproate may develop hepatotoxicity, thrombocytopenia and anemia. The limited passage of valproate into breast milk (the drug is almost completely bound to plasma proteins) make it safe in lactation.

Vigabatrin- Vigabatrin is commonly used for multi-resistant epilepsy.  There are no precise data about its passage into breast milk. Since no information is available about its use during lactation, the breastfeeding infants should be monitored.

Zonisamide-  Zonisamide –It is a sulfonamide. It easily passes into breast milk.  Caution is recommended with this drug.


         When evaluating a drug, certain things should be taken into considerations.  Discussion toxicity in breastfed infants is reported. AEDs are expected to determine in the breastfeeding baby  a series of symptoms related to their pharmacological effects on the central nervous system, sleep patterns, poor sucking and possibly poor growth.  Another variable is how well an infant and mom metabolizes the drug in their systems.
        Breastfeeding mothers should be provided with concise and clear information on the lactation risk on every prescribed medications they take. Nevertheless, breastfeeding mothers taking AEDs happen to receive inconsistent and sometimes conflicting advices on whether or not to breastfeed from different clinicians (general physician, neurologist, pediatrician, obstetrician, etc.).  Therefore, don’t be afraid to ask questions when you are in doubt of what medications you are on and how will it affect your baby.
        In conclusion,  breastfeed babies should be carefully monitored and, if required, the infant drug plasma-level should be tested.  Although the current available advice on the use of AEDs during breastfeeding present some contradictions, most AEDs can be considered safe according to our review.  We need to keep encouraging women to breastfeed.  Moms taking epileptic drugs need to be well informed and speak directly to their doctor and together make an informed decision to breastfeed her baby. Good luck and I hope you all have a successfully and enjoyable breastfeeding journey.

How Critically IIl Babies Benefit Most From Breastfeeding

To everyone around the world, after you read this, please like my facebook page, Breastfeeding With Love.  I hope you enjoy this blog.

     Breast milk is the most nutritional food you can feed your baby in the NICU.  It is filled with nutrients, vitamins and antibodies that can help a NICU baby get stronger and healthier.  “The immunological and anti inflammatory properties of human milk are especially important for the critically ill, infants in our intensive care units,”  said Diane L. Spitz, nurse researcher and director of the Lactation Program at the Children’s Hospital of Philadelphia, CHOP.  Some babies will be able to breastfeed during their stay in the NICU while other babies will need breast milk fed to them through their feeding tubes or bottle.  I have had the experience of having two sons who were in the NICU. 
     I remember going home and pumping my breast milk every three hours at home and sending the bottles with my husband for our baby in the NICU and they fed it to him through his feeding tube.  One of our sons spent four weeks in the NICU.  I had to teach him how to breastfeed when I came home. 
     If you need to pump for a while for your NICU baby, I highly recommend a hospital grade pump or a good electric pump.  Many insurance companies are now paying for you to get a pump through the Affordable Care Act.  After you give birth, call your insurance company and see if you can get one.  Some of them are worth close to three hundred dollars, well worth the call.
     Try to pump in a comfortable place, eat and drink well, find time to rest.  This will all help your milk production.  What ever you pump for your baby is so important to bring to the hospital because this breast milk is especially designed for babies in the NICU.  It has more infection fighting substances in the milk.
     Ask a Lactation Consultant for help in the hospital while your baby is in the NICU.  Once you come home, you may want to call a Lactation Consultant, such as myself, at least one time to help you breastfeed.  A Lactation Consultant may recommend you use a nipple shield, a soft silicone nipple placed over the mother’s nipple sometimes used to help premature babies.  Additionally, a Lactation Consultant can help weigh your baby before and after to see how much your baby is eating.  Your pediatrician may recommend supplementation for a while.  As the baby gets stronger and bigger, supplementation will be decreased and possibly be discontinued. 
     A Lactation Consultant can also go over Kangaroo Care, placing your baby on your chest skin to skin.  This will help warm the baby and be comfortable by hearing mom’s familiar heartbeat and breathing.
     In conclusion, don’t expect breastfeeding to be perfect at first.  Your baby has spent time in the NICU and there needs to be a period of adjustment for both of you when the baby comes home.  Your baby will benefit from any amount of breast milk you can produce.  Breastfeeding is a personal decision.  You need to make the right decision for you and your baby.