Womanly Art Of Breastfeeding*

Y'all, I like nursing my kiddos.  For some value of 'like.'  But I will harm to the next person who claims it is easier, cheaper, and/or more convenient than formula.  I have been in pain since May.  (MAY!!)  After five months of four different antibiotics, four trips to the local breastfeeding specialist-doctor, and a lot of fluconazole (with bonus periodic liver tests to make sure it's still working!) I've now been prescribed Nasty Drugs Until You Wean, and asked, um, how much longer did I want to nurse?  And this by someone whose specialty is, quite precisely, my exact problem.  Maybe this antibiotic won't give me migraines.**  I hope.

Also, the same thing happened with my first child. Except not quite as bad. 

Anyhow, if you are some other poor soul on the Internet wondering why the blocked duct keeps coming back and it hurts to nurse and yet there's nothing overtly wrong, well, I'm not sure this will make you feel any better.

* Last time I dropped by my LLL meeting someone suggested herbal tinctures.  HA HA HA no.
**I don't mean 'a bad headache'.  I mean 'standing outside the library deciding if I must throw up on a decorative tree or not', with a bonus of that postdrome WTF feeling the next day.  On good days, it's just a bad headache.

(Below: What Is This?  Also: How to create a multi-drug-resistant chronic mastitis infection in several dozen miserable steps.)

FMB: In Which I Complain About Breastfeeding Woes

Okay, I should be in bed, BUT....

With Bug, I had this awful thrush and a low-grade mastitis* that I didn't figure out for three months (what, you mean it's not supposed to hurt so much that you cry your eyes out every time the baby nurses???) and it took forever to get rid of and then we both got thrush again every time he got an ear infection.  And then, of course, he got pneumonia and I quit my job.  Anyhow.

With Tatoe.... it all happened again.  Doctor to me: "When did I see you last time?"  Me: "Exactly 3 years ago in June."  (The thrush is all better now; however, I am reminded to go get some grapefruit seed extract).  And the Mastitis That Won't Die keeps coming back.  The doctor whom I am seeing is actually an expert in this and is great, and she's doing all the right things, but it HURRRRTSSS.  We've been through three antibiotics this way.  And I felt okay for, oh, about a day.  And now I think it's back.  

Apparently I'm just that lucky.

* Did you know you can have mastitis without a fever?  For months?  And it's almost impossible really fucking hard to get rid of?**

** Did you know that taking azithromycin for 6 weeks can give you daily migraines?  ME NEITHER. 

FEEEELINGS About Nursing/ LL

People keep asking me about breastfeeding and then giving me That Look if/when I explain that one round of mastitis = We. Will.  Be.  Done.

People also keep asking if I'm planning to go to LLL meetings.  Maybe?  If things work out okay?  Because I WILL hit the first person who suggests echinacea.  I don't feel like I need support.  (If other people want suggestions about tongue ties, thrush, bad latch, pumping, or multi-drug-resistant mastitis, however, I'm their woman.  Ye gods, what an assortment of bad luck.)

As it happens, I've nursed my children for a combined total of 30 months.  But if I had nursed them for a combined total of 30 minutes, it shouldn't matter.

There's still a part of me, though, that feels that doctors' general lack of breastfeeding knowledge and support is a big obstacle (though not as much as the fact that nursing hurts and is kind of terrible even when it's great).  Just think how little the average MD knows about drug safety in nursing.   If women are getting bad advice, then I'm all for support.  But I'm also all for acknowledging that parents have needs too and sometimes those needs are incompatible with breastfeeding.  This whole ethic of "if you loved your baby enough/ wanted to do the best thing, you'd breastfeed" makes me feel squidgy all over.

Third Time Lucky

Somehow, parenting with Sweetpea around - now that I can sleep some of the time, and have recovered most of my physical health - feels a little like redemption.  I don't remember actually enjoying this stage with either of the other children, but she's just darling.  It's probably all the things:  a much better support network, the knowledge that a little unhappiness won't kill any of my children, and the fact that the oldest child is gone seven hours a day in kindergarten.  It feels more graceful.  It feels easier.

However, I got a blocked duct this week.  Actually, I've had a somewhat-blocked duct for weeks, and it finally went into full-on OH FUCK.  Not only does it hurt like the dickens, it's a herald of possible mastitis.... which, in turn, sent me into a full-on weeping breakdown.  I kept saying that if I got mastitis, I'd wean the baby, but it turns out I'm bargaining with myself in my head.  (Because that turned out SO well last time.)  And... the doctor I see here, I don't actually trust to deal with this.  Actually, on reflection, I don't really trust anyone to make it better, on the grounds that even an expert failed rather.  So, fuck.

"Will You Have Another?"

First, why does anyone think this is okay to ask?  I think I asked my dear friend R once - but she's one of my closest friends and we've known each other for fifteen years.  Also, she had pre-eclampsia both times and I was afraid someone might, God forbid, die a third time.  Aside from that, I may wonder, but I sure as hell don't ask.

Will I have another child?  (I am fortunate enough to have no fertility issues that might prevent this; it's pretty much just up to me.)  Probably not.  A year ago, I would have said maybe.  After the last six months of Continuous Bug Meltdown (he tried to head-butt me this week!  And he slapped me across the face!), and after a year and a half of what I could only characterize as pregnancy/breastfeeding-related poor health*, I'm honestly not sure I'm willing to go through any part of that again.  It would be very hard on my spouse, and I would be not-really-there for the children, and... well, I'm never taking that many antibiotics again unless the alternative is death or serious injury.

It seems ridiculous to put us all through that again, when I already have two healthy children and, more to the point, no burning desire for a third.

* In pregnancy: Migraines, 30 weeks of nausea, and strange sparkly visual stuff.  Afterwards: mastitis, more migraines from antibiotics, chronic sinus infections eventually requiring surgery, more mastitis, FUCKING THRUSH, and, oh yes, the ridiculous food-allergy stuff probably resulting from all the antibiotics.  This all happened the first time too.  

still alive

But trapped in the basement with the baby all the time.  Also, much gardening.

Mastitis is improving, maybe gone.  Nice lactation consultant came by with useful and helpful suggestions.  Cracked nipple (AIEEE!!!) also improving.

Digging many holes and planting things for our large shared vegetable garden, and for my flower garden that is so far a hole in the ground, and round one of the fruit trees, and rooting willows to shore up the banks.  Did I tell you there's a creek in my front yard?  There is.  Also, trying to root several dozen blackberry cuttings from emergency spring pruning of twelve foot escaping canes.  More fun than mastitis for sure.

Hoping this can be the last round of stuffed-up-baby nursing all night for a while.

ETA:  encore performance from blocked duct.  Gaaaaaaaaaah.

TB: Nobody is more surprised than me ...

 ...that applying lavender essential oil to my nipples* actually appears to be getting rid of my recurrent blocked duct/ mastitis from hell that has lasted two months.  Things I tried that didn't work: heat, massage, antibiotics, more antibiotics, antibiotics and fluconazole together, pumping, moist compresses; and all those things at once plus echinacea, lanolin, all purpose nipple ointment, crying, and visiting the breastfeeding clinic in University Town.  But (knock on wood) two days of applying this have made the white spot go away by 80% and the pain by 90%.  I am still taking Antibiotic #2 so it could be the combo, but it was getting worse all week.

Now, I would normally regard this as crackpottery of the worst kind.  However, I tried everything else to no effect, so.... why not?  Also it was free because I cook with coconut oil a lot** and a friend donated 16 drops of lavender oil.  

This extremely unscientific treatment brought to you courtesy of the excellent Nicole, who posits that the oil penetrates the biofilm and kills it dead (hand wave, hand wave).  Just think how hard it would be to organize a RCT of primarily-nipple-involvement mastitis/blocked ducts with lavender oil.  I find that for once, I couldn't even care less about there being a plausible mechanism.

I still draw the line at homoeopathy, though.  A girl has to have some standards.

* 8 drops per tsp coconut oil; I have no idea if the carrier oil matters.  Probably anything semisolid would work.

** Because dairy is as poison unto me.

FMB: While The Children Mostly Sleep

Extremely Randomly Assorted Thoughts:

• DEER.  Death to the little f!@%ers.  They keep eating my plants.  My plants are now enclosed in wire cages all across my yard.  I live in the city limits (barely) and cannot shoot them.  Despite being a pacifist, I would make an exception for these deer (besides, I eat meat).
• Sweetpea is going through A Phase.  A sleeping-on-boob phase.  She does not want to nap, or fall asleep at night, or do anything but be on or near boobs.  This is extremely frustrating and I am very tired.
• Tatoe is kind of learning to go in the f!@%ing potty.  We tied his rewards to the light fixture and told him he had to do his business in the potty to earn N stickers to get THIS THING RIGHT HERE.  Also there is enforced post-meal potty time.  It's... better?
• Speaking of better my mastitis thing seems to be mainly gone, though it still hurts.  I continue to give Sweetpea a bottle every day, on the grounds of why mess with success.  She likes it.  She's also eating a little people food (I didn't exclusively nurse her six months!  OH NO! Whatever.  Note Norway's numbers; as Alice points out, most places give a little food before six months.  Screw you, AAP and your dumb recommendations).
• Instead of mastitis I now have a round of this, which comes with a my-ear's-exploding headache for the last three weeks.
• My middle sister's wedding continues to increase in intolerability.  My youngest sister's childish avoidance of pretty much everything continues to make me both sad and irritated. (She needs a new nickname.) I am still annoyed that I have to go to TWO of my middle sister's awful weddings and she had to go to ZERO of mine.  And possibly Sister 3 will not be there?  I can only hope.

FMB: Assorted Updates

• I stepped on one of our hazelnut twigs (tree-to-be) and another died in the exceptionally cold winter.  BAH.  
• The mastitis is maybe... mostly gone?  Something is still not quite right in the nipple area but overall, a big improvement.  I took a third week of antibiotics that I had laying around (not even expired!) without arguing with the doctor about it, because I am officially the World's Worst Patient.
• I know that many people are not into sleep training but I am counting down the days until this child is old enough that I do NOT have to nurse her all night.
• That said, she is still sweet and adorable and a complete chub ball and she laughs and cuddles and loves to eat.  Also she thinks her brothers are hilarious, which they find charming.  
• Today I took a nap.  I kicked everyone else out of the house and SLEPT.
• Fatigue makes me deeply unsympathetic to my spouse, which I realize is unkind, but... I haven't slept more than a few hours in a row in SIX MONTHS.  So, you lose.
• Gardening!  So much gardening.  Every afternoon I go work on my flower garden.  Every weekend I go do things at the vegetable garden.
• Eventually planting season will be over and I will be forced to do housework again.
• Re: this last, the washer sprung a leak and now requires repair.  You know who really needs a washer?  Three small children and two adults.
• I have just now restrained myself from late night fruit tree buying.  See my superhuman restraint?
• I almost never have access to a computer-with-keyboard because the above, plus the kids, suck up all my time.  
• I must harass the Chem department head about how surely he would like to hire me again in the fall. SURELY.  
• Because it is amazing to be paid for time away from my children.  

Five Minute Blogging: Feelings on Professional Work, and on Breastfeeding

1)  I can't quite articulate why, but it's like a giant weight has lifted, simply because I have work for which I receive both respect and money.  My education is actually useful for something!  I can stop worrying that I'll never work again!  (I still worry that I may end up adjuncting for almost-forever.  Still.)

2) Someone asked if I was planning on going to the local LLL meeting, like, ever.  Errrrrrgh.  I tried to tactfully explain that, in fact, I had some serious medical problems last time, and treating them led to permanent serious medical problems.  And that a doctor/lactation consultant, whose specialty is serious medical problems in breastfeeding, told me that I both could and should stop.  Also that I don't want well-meaning people running through "Did you try heat?  How about probiotics?  Pumping?  Fenugreek?  ECHINACEA?"  I tried all of those for which there was any evidence whatsoever, I ended up really, really sick as a result of not weaning my child, which in retrospect was the correct choice; too late now - and I have NO INTENTION of going through that again.  When I say that if I get mastitis even once, I'm done, this is based on years of painful experiences and consultation with three specialist MDs and every piece of scientific literature ever published on the subject.  And I don't want to try echinacea/ acupuncture/ traditional Chinese medicine/ homeopathy/ whatever.  NO.

(Yes, I get a little annoyed about this one.)

FOUR(!) Years Of Boobs

Or, the ups and downs of breastfeeding, from my point of view (looking down at a fuzzy noggin while little fingers investigate my nostrils and try to yank out the headphones).

Good:

• They always eat.  My breastfed babies only stopped eating when they were really, really sick.  
• They have a great sleep cue.  They both nursed before bedtime, though Tatoe gets put down awake at 9:30 so help me it's bedtime now, kiddo.  
• It's very comforting.  Fall down?  Sad about life?  Have some boob, little one.
• It's always there. Hungry on the go?  Have some boob, little one.
• It's cheap.  Well, cheaper than formula.  In theory, free.  (HA!  Ha, ha ha ha ha.)
• Doctors recommend it! It'll prevent the common cold, cure cancer, and cause world peace.

Bad:

• When they won't eat, they won't eat anything.  No, really, not anything.  Because my kids both hated/hate bottles with a fiery passion. 
• It's the only sleep cue.  Ever try to put a nursed-to-sleep baby to sleep without nursing him at all?  Takes a lot of retraining.  (I've done it.  Then I learned to put the second one down awake.)
• It's the only comforting thing.  Tatoe wants Mama.  Accept no substitutes.
• I'm always there.  I couldn't leave the damn house for FOREVER without hours of pitiful screaming, even with Dr. S, who looked after Bug for three months while I worked part-time.  Yep.  That was awesome. 
• It's not actually cheap.  Between the two of them, I have had FUCKING THRUSH for a total of six months, and chronic mastitis for a year, and we're still counting until Tatoe is weaned.  (Probably another 6 months at least.)  In total, I have had sixteen doctor visits, twenty-nine separate prescriptions, seven sets of labwork, an 'outpatient surgical procedure' to snip Bug's tongue tie, six visits to the baby OT, and, I estimate, a grand total of around $7000... so far.  Granted, I didn't pay most of it, but I'm pretty sure formula would have been waaaay cheaper.
• Doctors are ignorant and give idiotic advice. The IgGs in breastmilk mostly stay in the gut and prevent fatal diarrhea.  They don't shorten the duration of a cold, they don't prevent my baby from getting sick, except for dehydration, and they don't make him smarter.  Also, sure, my EBF dehydrated infant won't nurse, but he'll drink Pedialyte.  Riiiiight.  (No.  He will scream.)  See also: wrong growth chart, 'How much does he drink?', etc.

"Have You Tried Herbal Remedies?"

- a question asked me by a well-meaning person regarding the whole allergic-to-everything fiasco.

Here is what I think happened (note that this is not subject to proof): I was allergic to some pollens (skin-prick and IgE confirmed).  I eventually developed an intolerance to celery and walnut.  This was in about 2006.  At length, I had a couple kids, got mastitis both times, and took antibiotics for a total of two years.  (With the accompaniment of all kinds of vegetable, probiotic, and vitamin goodness, on the advice of my physician.)  The antibiotics eventually damaged my intestinal structure in some way that let a larger percentage of partially-hydrolyzed proteins through (hand-wave, hand-wave, or something). My B cells (they make IgE, remember) responded by multiplying.  When they multiply, their IgE chain DNA is  more susceptible to mutation (white blood cells already have a high degree of controlled rearrangement), or so my spouse tells me; so I ended up with a pseudo-clonal population that had gone all haywire all over everything that looks even a tiny bit like birch pollen.  (I already had a latex contact reaction and - rare in adults! - a true, wheezing-and-hives, IgE mediated dairy allergy.  And asthma.  So basically my immune system sucks.)  Then everything went all pear-shaped.

This is a long way of saying that, even if I thought 'herbal remedies' were a good choice for 'turn down that immune system there', I'm probably allergic to them.

WHAT NO

Bitey teething baby has given me the milk blister/blocked duct again.  If I weep and bargain with the universe, can I NOT have mastitis again?  Pretty please?

Grapefruit Seed Extract and Thrush: Evidence

So I have this persistent kind-of-awful thrush and mastitis, right?  (Note: Please do not suggest anything else.  If it involves sugar, or anything available at a pharmacy, I have already tried it.  My immune system is screwed up, and is not playing nicely.)

I started wondering about grapefruit seed extract.  (One of my favorite blogs had an excellent piece on "How to judge good science."  Anyone?)  I was willing to believe that it had a topical effect - lots of things are bacteria-preventing; for example, a salt-and-vinegar solution will not grow bacteria easily, but drinking it won't help you with your infection - but skeptical of the take-a-capsule claims.  So, I looked it up on Pubmed.

The main 'active ingredient' in a lot of GSEs is 'Citricidal', which is produced by proprietary reaction of actual GSE with ammonium chloride.  A large number of studies have found that benzalkonium chloride and similar compounds, including triclosan, are the active ingredient.  This makes sense: phenolic (aromatic-ring-containing) substances in the seeds are reacting with the ammonium chloride. 

One of those linked studies shows that the only GSE product that didn't have benzalkonium chloride also didn't have any antimicrobial activity.  In other words, natural extract of grapefruit seeds doesn't do anything.

Additionally, GSE taken internally can have serious side effects - largely due to the benzalkonium chloride.

(Benzalkonium chloride is a topical irritant as well.)

(Here is an excellent example of a crap article on the subject. Pro tip: "Natural products" papers out of Africa, Asia, and China - and especially out of India- purporting to show that TURMERIC!  will prevent DIABETES!!  are almost always crap.)

So am I going to apply this to my nipples?  Oh, hell, no. On the other hand, I am seriously considering begging for some APNO.


[Note to the reader: Comments on how GSE cured your thrush (great, but not the point here) or how natural products papers from India are totally awesome (also great, for you, but I have literally read over a hundred of them) will be deleted.]

To Wean (v):

1) To forcibly deprive my precious baby* of his most favorite thing in the whole world;
2) To put an end to the chronic mastitis and FUCKING THRUSH which I have endured for ten months;
3) Both of the above, simultaneously.

The time has come, Dear Readers, to start weaning Tatoe.  (Perhaps you would think some previous time would also have qualified; you would be correct.) 

Even I don't know why I am still nursing, other than what my Nanna, may she rest in peace, would have called "sheer cussedness."  Actually, there is one good reason: despite being constantly ill, Tatoe has had only one ear infection, after riding on a plane.  At this point Bug had had EIGHT.  My theory is that the constant suction of breastfeeding clears it all out a bit.  Also that he doesn't get as dehydrated because he loves BOOOOB more than things-in-cups. (Don't even mention bottles; he throws them on the floor and screeches MAAAAH!)

My immune system has gone completely haywire.  In addition to all the other things I can't eat, I have also reacted to: brandy, white wine, peanut butter, soy, and some spice (probably nutmeg or cloves).   This has necessitated a startling array of antihistamines, a large amount of misery, and a high chance of surgery due to The MDR Sinus Infection That Won't Die.  

In consequence of all of the above, the rest of my body seems to also be freaking out.  My digestion and lady parts are both registering complaints, and I am deeply tired of dealing with it. 

So as soon as it gets above freezing, the kiddo is getting (slowly) cut off.  Bonus?  I can leave him with my parents after we move!  And go somewhere ALONE!  I haven't been ALONE in FOUR YEARS!!!! Do you have any idea how excited I am about this?  SO excited.

*Currently 17 months old, sporting ten teeth, and drinking from a straw cup.  He'll be fine, once he gets over the tragic disappointment at NO MORE BOOB.

State of the Self, 10:30 PM, With Wine

HEADACHE: Mostly gone.  Hearing probably also 5% reduced, but I'll take that over a perpetual knife in the ear.  Let's say a 2.

F@#$ING MASTITIS: Persists as milk blister.  Imagine a blister in a sensitive area and, well, it's about as fun as that.  3.5.

WORK FRUSTRATION:  A solid 6 for reasons I will not discuss, owing to my desire to stay employed.  Also frustrating: the fact that I do not enjoy or value most of my daily work of cooking, cleaning, and general contracting secondary to subsidizing my spouse's career.  This Too Is A Phase.

CHILDREN: Continue to injure each other in appalling ways (no, I do not let them bully each other, but I cannot be constantly physically present with three children).  Latest: head slammed in door.  Ranging from 2 to 'It goes to  eleven. "

BABY: Sweet, endearing, and yet SO high maintenance.  I wonder if I will ever adapt to the reality of having a third child.  Maybe when she can walk and talk?  (Current words: DA- dog/cat/squirrel; NA NA- milk/mommy/feed me, peons).  The baby year is just so darn hard, people.

FUCKING DEPRESSED: Enjoying a renaissance thanks to Where Are My Real Friends Here, I Want R and N, WAAAAAH.  Prescription: more exercise, more free time (HA), more gardening (double ha).

NO F@#%ING STOVE: Have I mentioned I've had no stove for TWO months?  Yes.  It's kind of like going to the post office: anything involving more than a certain number of steps rapidly becomes asymptotic to 'impossible'.  Now I must visit a metal shop during business hours, procure a 36 x 2 5/8" strip, sand it, and paint it black.  This makes three stove tops, four trips to the hardware store, and three electricians.

In Which I Discover I Didn't Really Mean It

Dear Readers, I DO have mastitis!  (That is an exclamation point of WOE.)  I went and saw the smart lady doctor (my spouse teaches her son but this is a small town so we get used to this stuff.  For reference, the total 'city' land area is 2.5 square miles.)   And I am taking antibiotics (again!).  And fluconazole.  It turns out I really, really didn't want to wean the baby, no matter what I told myself.

So far, it got better, and now it feels a little worse (t=3.5 days).  I may have forgotten a dose in my sleep-deprived haze.  I keep telling myself it will be okay either way - and it will- but every time it gets a little worse I am basically sitting with a hot pack on my nipple, sobbing.  I'm not entirely sure the antibiotics are working.  I am trying to not succumb to despair.  She's only twelve weeks old.  I'm really, really not ready to wean her, and I feel terrible about having her lip tie clipped if it's going to be for nothing (even though she was totally fine by that afternoon).  WAAAAAAAH.

FMB: Various Kinds of Woe

• FIRE has not killed my mastitis/ recurrent blocked duct/ milk blister/ painful everything that gets better with antibiotics.  
• Urgent Care in Next Town Over is very willing to dispense antibiotics, though! (Mountain Town does not have an urgent care, which would cost me $15.  The emergency room costs $300 and up.  It is worth $285 to me to drive 45 minutes, plus we have friends in Next Town Over, whom we visit.)
• I have an appointment at Big University's breastfeeding medicine program on Wednesday.  It is an hour and a half away.
• I have a cunning plan, which includes never talking to my mother about this again.  She told me I was 'acting crazy'. And here I thought I was dealing with severe pain from a recurring and ongoing medical problem!  And was upset largely in proportion to how much it sucks!  
• The rest of my cunning plan involves my pal who runs a state-licensed, inspected goat dairy.  I could buy goat milk!  (Pasteurized goat milk.)  And give it to the baby! (With appropriate vitamins and additives.)  
• If I can nurse her ten more weeks, she'll be six months old, and I will feel less terrible about weaning her, antibiotics or not.  
• I realize I could wean her now but I don't want to for all kinds of perverse and emotional reasons.  Also, because my family is Allergic To Everything (TM), I have serious concerns about dairy or soy before six months.  (This week, my sister Prudence ended up in the emergency room, post Epi-Pen, after eating something with a tiny amount of dairy in it.)  
• My neighbor just had her baby - at a hospital with a 25% primary C-section rate - by C-section.  Guess whether all those people really need a C-section?  Yeah.  Nope.
• They apparently also suck at breastfeeding advice.  Helpful hint: telling someone to supplement with formula at two days postpartum is usually inappropriate and completely counterproductive.

Tablet Blogging*: a lesson in humility

Dear Readers, I am mildly horrified to tell you that I am taking echinacea.  A well meaning friend here offered me some and.... I honestly don't think it can make the situation any WORSE.  (I appear to be non-allergic to it.  Bionic pointed out that I am only allergic to things that taste good.  Readers, I regret to tell you that it tastes exactly like you would imagine.)  That sound is me having a hearty serving of humble pie, made entirely of anecdotes, with a crust tasting of ground up roots.

The mastitis continues to afflict me- though I am pleased to say my ability to convince randomly selected urgent care docs to do what I want remains intact.  I have driven to Research U, 90 minutes away, where they basically said HMMMMMM.  But they are willing to continue dealing with it long distance, including prescribing and cultures, and they understand that I have a legitimate reason to be concerned.  (I become stroppy when I feel I am not being taken seriously.)  On the other hand, two experienced clinicians find that there's no underlying reason or thing I am doing wrong, so I've eliminated some possible causes.  HMMMM and I will update you when it inevitably comes back next week.

* i.e. brief and subject to typos and bizarre auto corrections.