Archive for January 2011
Candida albicans is a commensal organism that usually lives in harmony with the human body. In some instance this symbiotic relationship become disturbed and the balance between the fungus and host is lost. There are several reasons why this balance may be disrupted. The best most likely example is the use of antibiotics. Antibiotics are often administered to treat bacterial infections. They are designed to destroy all bacteria in the gastrointestinal tract. Unfortunately, they also kill all of the beneficial bacteria in the body. The result is usually a vaginal and gastrointestinal overgrowth of Candida which is the most common cause of thrush in the oral cavity of a baby and the superficial and ductal infection of the breast.
A cluster of obvious symptoms is usually sought out to determine a diagnosis of mammary thrush. These signs and symptoms can be found on the mother and baby. The baby may have no visible symptoms or a white plaque coating on the tongue, buccal mucosa, soft palate, gums or tonsils. The baby may also have a diaper rash with red patches that can result in scaly and peeling skin. The mother may have an infected nipple that appears red, shiny or have sloughing skin. The mother may complain of burning, stinging or itching in the nipples. These sensations can last for several days. Burning and shooting pains may also be experienced in the breasts. If this type of pain is present a physician should rule out possible bacterial infection or nipple vasospasm, which can also present the same symptoms.
Both mother and baby will need to be treated at the same time even if the baby shows no signs of symptoms.
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Dermatitis can affect any area of skin and may affect the breasts. Most dermatitis is caused by contact with allergens, viral dermatitis may be caused by herpes simples infection, and bacterial dermatitis may occur with impetigo or staphylococcus infection.
Nipple eczema can be identified by redness, crusting, oozing, scales, fissures, blisters or slits on the nipples. There may be a burning or itching sensation on or around the areola. Topical steroids are often administered to treat nipple eczema, which can occur on both nipples. A physician should be consulted to determine if Paget’s disease is the cause of the eczema, if only one nipple appears to be affected by eczema.
Allergic contact dermatitis can have all of the same signs and symptoms as nipple eczema and may be caused by the use of lanolin or emollients on the breast area. Often the addition of beeswax or chamomile in the emollients or ointments causes an allergic reaction. Whenever contact dermatitis is suspected careful review of whatever items come into contact with the breast should be carefully considered for potential allergic reaction.
Psoriasis can also affect any area of the breast. This skin condition can appear as a moist pink plaque with minimal or no scale. Seborrheic dermatitis is also a possible type of dermatitis that most commonly occurs in the mammary folds. It can be identified by a greasy white or yellow scale on a reddened base. Seborrheic dermatitis is usually treated topically with ketoconazole, zinc, or selenium sulfide.
If the eczema is due to Herpes simplex active oozing lesions on the nipple or areola may be present. Immediate treatment should be given and breastfeeding should be discontinued on the infected side until the lesions are healed.
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Lactation Consultant: Breast Feeding and Breast Augmentation
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Women under go breast augmentation for a number of reasons, such as asymmetric breasts, hypoplastic breasts, breast reconstruction from surgery, or commonly for breast enlargement. Regardless of the reason, breast augmentation may cause dysfunctional breast tissue which can impact breastfeeding. When studying how to become a lactation consultant, this is a subject you will learn more about.
Any breastfeeding success following breast augmentation will depend on the surgical technique used for the augmentation and whether or not sufficient functional breast tissue remains. An infasubmammary procedure is when the incision is made under the breast. A periareolar procedure is when the incision goes around the areola. An axillary incision is near the armpit. Women who undergo breast augmentation via a periareolar incision are at the highest risk for not being able to make enough milk. All women who have had augmentation surgery can have milk insufficiency due to nerve disruption and pressure from the implant on the breast structure.
Women with silicone implants may be concerned about the potential leakage of silicone into their breast milk. Several studies have shown that silicone implants posts little hazard to breastfed babies. Interestingly, infants that drink artificial baby milks have higher amounts of silicone in their bodies compared to infants who are breastfed by women with silicone implants.
Mothers who have undergone breast augmentation should pay close attention to their engorgement and their infant’s weight gain. This is because mothers with insufficient glandular tissue may not be able to produce sufficient amounts of milk. In this case, supplementation may be necessary. It is always best to consult with a lactation specialist during pregnancy and after delivery to discuss any questions or concerns about breastfeeding, if you have undergone breast augmentation.
Sometimes when we know a lot we think we know everything and tend to impose our knowledge on others. This imposition can be threatening and unwelcomed. Always keep in mind that it is impossible to know everything. Cooperating and collaborating with other professionals can provide needed and unexpected insight. Cooperation can also help to grow your business. As you build relationships with other healthcare providers, they will likely refer their own patients to you. When looking to become a midwife or looking for midwife jobs, these relationships and refferals will be a huge asset.
Our understanding of the human body continues to grow. This is why it is important to continue to learn, attend seminars and conferences, read articles and journals, participate in local coalitions and remain open minded to the new and evolving techniques arising in this field. The moment you stop learning, you start losing important opportunities to hone your skills and help your clients. Science is continuously discovering new and amazing things about the human body. There will be new ideas and suggestions that can be useful tools for you. Just as there is more than one position to use when breast feeding an infant, there will be more than one way to help a mother overcome another type of problem or concern. A continuous desire to learn and improve in your profession will be appreciated by your clients. Keep yourself open to the possibilities and you will become a valuable and highly sought after consultant.
If you love working with people, adore babies and are passionate about health and nutrition, you may want to seriously consider becoming a lactation consultant. Here are a few things you should know about this field, and what it takes to make it your career.
The road to becoming a lactation consultant will require perseverance and dedication. In order to be considered a lactation consultant, also known as an International Board Certified Lactation Consultant (IBCLC), a person needs to obtain certification through the International Board of Lactation Consultant Examiners (IBCLC). Certification from this board is the highest form of credential in this field and no other “title” provides the same degree of public protection.
There are three requirements for certification. A person must have received a degree preferably in a medical field, additional education in lactation, and real world experience helping breast feeding mothers. Most people who are currently lactation consultants have degrees in health related professions such as nutrition, physical therapy or anything in the allied health fields. A majority of consultants are registered nurses or midwives. If the bachelor’s degree was not in a medical field, it is likely that additional courses in physical science, nutrition, counseling, research, anatomy and physiology, child and human development will need to be taken. Enrolling in a professional nursing or midwifery program is an excellent way of obtaining the experience needed for the foundation of education required for this career. A baccalaureate or master’s degree program is ideal. A two-or-three year RN program is the minimum requirement if you have some college experience in a non medical field.
Specific education in lactation is of course required. Several documented clock hours in lactation must be obtained within three years of taking the certification examination. Gaining real world experience by working in clinics and with other lactation consultants can help provide the experience you need for your application to take the board certification examination.
Although lactation consultants are a wealth of information and can provide helpful tips and techniques, it is important to remember that the main role of a lactation consultant is to support the mother. Support, understanding, encouraging, empowering and validating a mother can end up being more important in the long run than “fixing” a specific breast feeding issue. If you, as a lactation consultant, can help the mother to feel good about her self as a mother, caregiver and provider to her child, you will be able to strengthen and build bonds that can last for a lifetime. All of you knowledge and experience is worthless if the mother feels inadequate.
Rule: It’s Her Baby…Not Yours.
It is important to remember when helping mothers that it is their baby and their body. You shouldn’t make them do anything they do not feel comfortable about and you shouldn’t make them feel bad for not following a suggestion you may have given. Do not take anything personally. It is sometimes easy to become frustrated or offended if someone does not follow your suggestions or advice. Always remember that every client and situation is different even though there may be similar problems or concerns. How a mother processes information and acts upon that information will be unique. Sometimes there are cultural, religious or personal sensitivities that challenge the way you will consult with a client. In the end, it is important to remember that it is her baby, her body and her choice. All you can do is provide information and support the mother in whatever she decides to do for her baby.
Lactation consultants have the important job of helping mother’s to become successful at breastfeeding. Although breastfeeding seems as though it should be easy, there are many complications, stresses and difficulties that can arise for new and experienced mothers. The help and guidance of a lactation consultant can help a concerned or challenged mother to hopefully overcome any of her concerns or problems with breastfeeding.
There are five things a good lactation consultant should remember when working with mothers. These five rules can help create a successful practice as well as help mothers to feel confident and willing to listen to your suggestions and tips for effective breastfeeding tips and techniques. Today we will talk about the first, and most important rule. We will look over the next four rules in our blogs this week. If you are interested in lactation consultant training, this week may be helpful in your exploration.
Babies are expected to double their birth weight in the first four to six months of their life. This can be especially challenging for a baby that has not yet mastered nursing. It is vital that the child always gets enough to eat. If a bottle must be used to supplement feedings, reassure the mother that with practice the baby can become very proficient at breast feeding. Bottle feeding with breast milk is the best supplement until the baby has learned to nurse more proficiently. Your ultimate goal is to help the mother learn how to feed her baby. Human breast milk is the best for infants but can be challenging, painful and exhausting for new mothers. Both the mother and the baby will need to learn how to make this process successful. It can take time. However, no matter how long it takes the baby should always have all of his or her nutritional needs met.
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Lactation Consultant: Risky Drugs While Breast Feeding
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There are five potential risk factors that can be assigned to a drug depending on the level of risk the drug may have on the fetus. The five risk factors are A, B, C, D, X and are designed to make it easier for someone to determine if a drug is appropriate to be used during pregnancy. These risk factors, however, should not be used to determine if the drug is safe for breast feeding.
Category A: Drugs in this category have been tested and determined that they do not pose a risk to the fetus in the first trimester or any trimester. These types of drugs are not likely to cause fetal harm.
Category B: Drugs in this category have not demonstrated a fetal risk in animals; however, very few tests have been done on pregnant women. It is possible that drugs in this category have caused adverse effects on animals but these effects could not be confirmed in controlled studies in women during the 1st trimester.
Category C: Either adverse effects on the fetus have been observed in animals, there are no controlled studies in women or studies in women and animals are not available. Drugs in this category are usually not prescribed unless the potential benefit outweighs the potential risk to the developing fetus.
Category D: Drugs in this category have been found to risk fetal development. These drugs are usually only prescribed in a life-threatening situation or for a serious diseases where safer drugs are not a considered ineffective.
Category X: Drugs in this category are considered extremely dangerous to the fetus and have been found to cause fetal abnormalities. These drugs should not be prescribed to women who are or may become pregnant.
The liver plays an essential role in the digestion of food through the small intestine. Without the aid of bile secretions from the liver and digestive enzymes from the pancreas, digestion would be incomplete. The bile duct, delivers bile from the liver. If the bile ducts become dilated due to obstruction the area must usually be fixed surgically. As an ultrasound technician this will be something you might have to diagnose in your allied health field.
When bile secretion is blocked many other serum levels become elevated. Urine and serum bilirubin, serum cholesterol, and serum alkaline phosphate all become elevated. Another possible cause for these elevations is severe nonobstructive liver disease.
There are several common causes of bile duct obstruction. Most obstructions are due to gallstones, choledocholithiasis, pancreatic tumors or tumors in the bile ducts. A common bile duct tumor is a Klatskin tumor. Primary sclerosing cholangitis and biliary stinctures will also cause bile duct obstruction. There are two other important and possible causes of obstruction in infants and small children that can occur. The most common biliary obstructive disease affecting this age group is biliary artesia. Biliary artesia causes the progressive destruction of the extrahepatic bile ducts and gall bladder. In some instances the proximal aspects of the intrahepatic bile ducts may be also be involved. The symptoms of these conditions usually present between 2 and 6 weeks after birth. If the problem is due to extrahepatic bile destruction, then surgery is necessary to create drainage into the intestine. If the problem is due to an intrahepatic bile obstruction, the only treatment option is a liver transplant.
Normally, only the common hepatic duct of the biliary tree can be seen with an ultrasound. Sonorgraphically, the common hepatic duct lies within the porta hepatis, anterior to the right hepatic artery and the undivided right portal vein.
When I was pregnant with my third child I went in for the typical 5 month ultra sound where most parents are eager to see the first real pictures of their baby. This is also an exciting visit because the doctor is often able to determine the baby’s gender. This is an important visit because the doctor is able to see how well the baby is developing and any potential problems. During this visit my doctor determined that I was having a baby girl and that I also had a condition called placenta privia.
Placenta privia is a condition that is caused when the placenta is close to or covers the lower portion of the uterus. Normally, the placenta attaches in the upper part of the uterus. However, in some instances and for reasons that have yet to be determined, the placenta is lower than usual. Placenta previa can be a problem because it often covers the cervix (the opening of the uterus into the vagina). When this happens the baby is unable to get through the cervix during delivery and could possibly bleed to death.
My doctor had me do several more ultrasound exams during the last several months of my pregnancy because he wanted keep an eye on my condition and was hopeful that the placenta would move out of the way of the cervix before it was time for delivery. If the placenta did not move in time then my only option was to deliver by C-section as soon as the baby was mature enough to survive outside of the womb. Fortunately my placenta moved out of the way before it was too late and a C-section was not necessary. However, had it been necessary, C-sections are routinely safe and are the only option for delivering a baby in this situation.
