Re: Breast feeding s/p VG (5 yrs)

[Guest guest]

I have a Pt who is 5 yrs s/p VG, due with 2nd child in a month (1st was pre sx).

She has been successful/maintained wl pre sx, gained 12# w/ her pregnancy and

baby is healthy ~5.6# now. She is concerned if she will be able to breastfeed.

From what I have read of previous posts it is recommended that she work with a

lactation consultant to monitor her baby's growth and if her milk production is

sufficient or if she needs supplement with formula. It was also mentioned that

research has shown diets below 1400-1500 calories can result in insufficient

production/lowered milk production. Does anyone have any additional information

or experience with similar pt's s/p VG? What Calorie/PRO/CHO recommendations do

you give? Thanks, Alisha

>

>

> Hi all,

> A big big thank you for all your responses and help. Specilly to Jeanne for

your input - much apprecietd.

> We wiol add this to the information seminar: do not come to see us if you are

pregnant !! or breast feeding ..

>

> After receiving emails from experts and reading on the subject........this was

my plan:

> After assessment, I found out that this lady had already started supplementing

her milk with formula as well as started solids ! She has 7 children and said

she has not seen a lactation consultant.

> For her baby: I referred her to see a lactation consultant re appropriate

fortification and appropriate introduction of solids. I think she can still

breast feed but as the quantity may reduce and the quality is poor at this stage

post op (lack of variety, does not physically fit the necessary food groups in

the acute post op pouch - nor do we want her to as we focus on protein at this

stage)

> For her, as she is breast feeding: She is to supplement with a VLED (as a

protein supplement - for her fluid/puree phase) to ensure 60-70 grams of

protein.

> In addition to a chewable multivitamin, I have asked her to add calcium

(soluble 100 mg), DHA 300 mg, AA, Vit D daily (she had pre op mild vitamin D

deficiency) as well as Elevite.

>

> I will see her in 2 weeks.

> Thanks everyone and please feel free to contact me for further discussion and

advice.

> Regards

> nazy

>

>

>

> Nazy Zarshenas

>

> Senior Clinical Dietitian

> The Nutrition and Dietetics Department

> The St Hospital

> Kogarah NSW 2217

> ph: 02 9113 2752

> Fax: 02 9113 2847

>

> Email: Nazy.Zarshenas@...

>

>

>

> ________________________________

> From:

[mailto: ] On Behalf Of Jeanne

Blankenship

> Sent: Wednesday, 2 December 2009 17:02

>

> Subject: Re: Breast feeding post Sleeve

gastrectomy (immediate post op phase)

>

>

>

> I agree that this was a bit premature given the age of the infant and the

undisputable benefits of breastfeeding and protection against obesity. I can't

imagine why she couldn't wait another 9 months to have the surgery. Having said

that, research by Dewey et al. has shown that most women have decreased milk

production at caloric levels less than about 1500 to 1600 kcals. Although milk

quality has be suggested to be unaffected by this, it may not be the case with

surgical weight loss patients. Specifically, maternal vitamin D levels are

reflective of milk levels. Thiamin and B12 deficiencies in mom also lead to low

levels in milk.

>

> A sleeve has more capacity than other procedures, but at this point, it seems

as though her decision was to place weight loss over the needs of her infant. I

would not suggest complete weaning, some breastmilk is better than none, for as

long as she can feed. But she will need to supplement with artifical milk

sooner rather than later (which she is likely already doing since she probably

didn't feed perioperatively) . I would recommend that she see a lactation

consultant to come up with a plan to address monitoring (elimination patterns

and growth). Since supplementation negatively affects milk production due to

decreased suckling, she will likely gradually produce even less milk.

>

> I would recommend a prenatal vitamin be continued, correct any deficiencies

that were/are present (esp. Iron post partum), and she should consider a DHA

supplement for lactation.

>

> Let us know how this plays out.

>

> Jeanne Blankenship, MS RD

> ADA Representative to the United States Breastfeeding Committee

> Secretary, USBC Board of Directors

>

> Breast feeding post Sleeve gastrectomy

(immediate post op phase)

>

>

>

>

> Hi everyone

> I have a new patients 2 days post Sleeve gastrectomy - however she has a 3

months old baby, whom she is breastfeeding.

> The diet prescribed and tolerated post op is: 500-600 Kcal/d and ~ 60 grams of

protein with an adult multivitamin...

> I do not have much experience in paediatrics and maternity .. But after some

quick readings today I know that the requirements increase by 500 Kcal/d and

more protein is needed.

> Personally I think mom and the surgeon should have waited before having the

surgery ... so I think I have to get her to change to formula?

> Has anyone had similar cases?

> I would appreciate if you shared your experience

> Regards

> Nazy

>

> Nazy Zarshenas

>

> Senior Clinical Dietitian

> The Nutrition and Dietetics Department

> The St Hospital

> Kogarah NSW 2217

> ph: 02 9113 2752

> Fax: 02 9113 2847

>

> Email: Nazy.Zarshenas@...

>

>

>

--------------------------------------------------------------------------------\

-------------

>

> SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE

>

> This email, and the files transmitted with it, are confidential and intended

solely for the use of the individual or entity to whom they are addressed. If

you are not the intended recipient, you are not permitted to distribute or use

this email or any of its attachments in any way. We also request that you advise

the sender of the incorrect addressing.

>

> This email message has been virus-scanned. Although no computer viruses were

detected, South Eastern Sydney and Illawarra Area Health Service accept no

liability for any consequential damage resulting from email containing any

computer viruses.

>

>

>

>

>

>

--------------------------------------------------------------------------------\

-------------

>

> SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE

>

> This email, and the files transmitted with it, are confidential and intended

solely for the use of the individual or entity to whom they are addressed. If

you are not the intended recipient, you are not permitted to distribute or use

this email or any of its attachments in any way. We also request that you advise

the sender of the incorrect addressing.

>

> This email message has been virus-scanned. Although no computer viruses were

detected, South Eastern Sydney and Illawarra Area Health Service accept no

liability for any consequential damage resulting from email containing any

computer viruses.

>