Wednesday, March 13, 2013

The Gift of Nighttime Parenting


I frequently share this story, often teary eyed, when parents ask me if it's OK to sleep with their babies.  Not only is it OK, it's a natural assumption for human infants that they sleep with the mother especially breastfed humans.  I had the pleasure of my children sleeping in my bed as nursing infants and toddlers.  It wasn't until they were ready that I transfered them into their own bed in their own room.  So yes, I was an avid co-sleeper!  Bedtime was not stressful or scary - just my warm, loving  embrace that said,  "NO fear - you are worthy & deserving of  my presence, day & night."   As my children grew, the bed was a common meeting place for fun and conversation, whether it were morning or night.  My door was always open for any joys, fears or concerns.

When I was 47, I was faced with a serious health issue which required surgery. I had a huge mass in my pelvis which led my doctors to believe I possibly had ovarian cancer. The prior year, I underwent bi-lateral mastectomies for breast cancer. Once you have cancer that's pretty much where people go with it :(

Anyway, I decided to go to Johns Hopkins Cancer Center in Baltimore for a full evaluation since they were considered one of the best for this sort of thing.  I'll admit I was really scared, more scared than when I had breast cancer.  From the lay person side of my brain, I felt because it was inside my body and not hanging outside my body like my breast, it was more serious.   Totally irrational, I know.  From the nurse side of my brain, I knew ovarian cancer was one of the most fatal and that since there was a palpable mass, it was probably too late anyway.  That's why I went to John's Hopkins, I figured at least I deserved the best surgery I could get since one surgery is usually all you get.

Johns Hopkins is about 4 hours from my home.  I went down for my evaluation and its was recommended that I have a complete hysterectomy. "Looks suspicious but only until the surgery is  done will we (the doctors) know for sure if you have cancer and what type."   Ugh!  So I scheduled my surgery and informed my family.  Thinking it is unlikely that I could dodge a bullet twice, I expected and prepared for the worst.  Prompted to get my affairs in order, I  redid my will including an attachment letter with my funeral wishes and my "gifted"  belongings.   Listen, I know this sounds morbid but I felt compelled to do it all.   My children were grown by then- 25, 23, and 21 years old respectively. I had been divorced for 6 years by then as well.  So funny thing, when I asked my children what they wanted of mine (jokingly but secretly serious), they couldn't think of anything!  My next thought was, "why am I keeping all this crap?!"- Lol.    I didn't know what the outcome would be but it made me feel much better not leaving confusion and chaos for my children.  Of course, I didn't expect to die during the surgery or shortly thereafter.   But I did know that I would not choose conventional treatment such as chemotherapy and radiation so who knew how long I would live?

To bring her up to speed,  I called my eldest daughter, Nicole who was living and working in NYC.  The main purpose of this call was to let her know that her brother and sister were going to come down to Baltimore to stay overnight the day of my surgery.  Did she want to come down, too?   Well, I could tell by her voice she was anxious and scared (moms know these things) and she responded quickly that she was sure she could not get off work.  Obviously, a knee- jerk reaction due to fear and uncertainty.  I got that.  So, I told her not to worry, that I understood and I would see her when I got home.

M

I am happy to tell you that I did not have cancer just tons of endometriosis- who knew?   I was exhilarated by the great news and felt fantastic (as fantastic as someone who had 4.5 hrs of major surgery could feel).  My parents, two children and sister-in-law were present rejoicing with me. But then guess what happened? To my surprise, my daughter Nicole showed up at the door of my hospital room.  Without a word she proceeded to walk up to my bed and climb in right next to me, laying her head on my chest- right in front of everyone<3.

M
It was truly one of the most tender moments of my life!  I will never forget it.  No words needed.  Just a gesture of pure love and devotion.  Our relationship was right back where we first started, snuggled together in bed. But this time it was,  "NO fear momma, you are worthy and deserving of my presence."  Now, that's the power of nighttime parenting - building bonds that stand the test of time!

Me & my girls, Andrea & Nicole
One year after my surgery


Sunday, February 10, 2013

Benefits of Breastmilk for the Baby/Child with Traumatic Brain Injury

The Benefit of Omega 3's - Fats for brain development.

*Breastmilk also contains some very beneficial fats. Mainly, Omega 3 fats such as DHA and AA. These fats are there to help the baby's brain work, ensure that his immune system is functioning, and helps him take in fat-soluble vitamins. The fats that are found in formula are not digested completely by the infant, and formulas also don't contain DHA.  The fat level in mature breastmilk is approximately 4% and is independent of what mom eats.
http://transcripts.cnn.com/TRANSCRIPTS/1210/20/hcsg.01.html

*Brain injured patients need Omega 3s, not high doses of Omega 6s which is what the Hormel pudding is loaded with! The ratio of 6:3 is what's key and most American diets are overboard on 6's and have zero to limited 3s. http://www.sciencedaily.com/releases/2008/03/080307133659.htm

"Omega 3 fatty acids are important for the baby's developing eyes and brain," says Dr. Sheila Innis, the study's principal investigator, head of the nutrition and metabolism program at the Child & Family Research Institute at BC Children's Hospital, and professor, department of pediatrics, University of British Columbia.
http://www.fastlearner.org/WebsiteFiles/NIX6_Mar15.pdf 

*Composition of Breastmilk (to combat the argument that Charlotte needed hydration)
Water 88.1%, Fat 3.8% Protein 0.9%
Lactose 7.0% Other 0.2%
Source: Lawrence R. Breastfeeding: A guide for the medical profession. 4th ed. St.Louis: Mosby-YearBook, Inc.1994

*Breastfeeding is best for brain growth and neuromotor development of the babies. Nearly two-third of the brain weight is due to phospholipids and long chain fatty acids. Docosahexaenoic acid (DHA) and arachi-donic acid (AA) are key fatty acids for growth of the brain. Human milk contains 30 times more DHA than cow’s milk. According to WHO, infants should get 20 mg DHA/kg every day. Human milk is rich in choline, taurine and zinc which are required for brain growth. Human milk contains almost double the quantity of lactose compared with milk of other mammals. Lactose is credited to facilitate the synthesis of cerebrosides and myelination of central nervous system (CNS). Breast fed babies have at least 8 points higher intelligence quotient in later life as compared to formula fed babies (6, 7).
There is enough evidence to suggest that the food we eat influence our memory, concentration, comprehension, judgment, intellect, mood and emotions. There are at least 50 brain chemicals or neurotransmitters that are affected by the intake of food and micronutrients (8).

Physiological effects of nutrients on brain growth
A number of amino acids are recognized as precursors of neurotransmitters. Tryptophan is required for production of serotonin which improves the mood and sense of wellbeing. Choline is required for production of acetylcholine which is critical for our memory. Tyrosine helps in motor coordination by elaboration of dopamine. Taurine is required for maturation of retina.

Micronutrients are required for production of several enzymes and co-factors for a number of metabolic pathways. It is known since ages that pellagra (niacin deficiency) leads to reduced cognition and dementia. A number of other B-complex vitamins especially B1, B2, B6, B12, niacin and folic acid are needed for synthesis of several neuro-transmitters. Thiamin deficiency hampers the ability of the brain to utilize glucose. Deficiency of folate, B6, B12 and choline are associated with elevation of plasma homocysteine level which may lead to thromboembolic complications and stroke (9). Iodine is required for synthesis of tri-iodothyronine and thyroxine. Iron deficiency is associated with reduced physical activity, neuromotor incoordination and reduced cognition (10). Cytochrome oxidase in the mitochondria is an iron-dependent enzyme. Oligodendrocytes require iron to synthesize fatty acids and cholesterol for myelin production and its integrity. Iron is also required for functioning of neurotransmission system such as dopamine, serotonin and GABA. Iron deficiency has been shown to adversely affect brain stem auditory activity and visual evoked potentials which may persist even after correction of iron deficiency anemia. There is some evidence to suggest that excessive tissue concentration of iron may lead to Parkinson’s disease in adults. Zinc is an important component of over 200 metalloenzymes and there is high concentration of zinc in the brain (11). Copper is an important component of cytochrome oxidase and superoxide dismutase in the brain. Copper deficiency is associated with Menke’s disease while copper excess is a recognized marker of Wilson’s disease, familial amyotrophic lateral sclerosis and Alzheimer’s disease.

Sea food is eminently brain-friendly food. Fish and fish oils are important sources of omega-3 fatty acids and DHA. Omega-3 fatty acids are credited to reduce cellular and vascular inflammation in the brain, promote vasodilatation and ensure integrity of brain cell membranes to keep them soft and pliable(12,13). DHA constitutes almost one-half of the total fat in the brain cell membranes. DHA is the building material for fabrication of synaptic communication centers in the brain. It increases the level of "feel good" neurotransmitter serotonin and the "memory boosting" chemical acetylcholine.
Unlike adults, infants cannot convert a short chain fatty acid alpha- linoleic acid into DHA and they must be provided with this essential nutrient de novo in the diet. Table I lists the essential nutrients required for the development of CNS (1). Fish is a good source of omega-3 fatty acids, taurine, iodine and zinc. Incidentally, junk food is rich in omega-6 Trans fatty acids which compromise the integrity of the CNS by making cell membranes less pliable and more rigid.

Smart Nutrients for the Brain
• Omega-3 fatty acids, dcosahexaenoic acid (DHA) and arachidonic acid
• Vitamin B complex, folic acid, vitamin C, vitamin E
• Iodine, iron, zinc, selenium
• Essential amino acids including taurine
• Choline
• Antioxidants

Apart from direct adverse effects of nutritional deficiencies on the brain, there are indirect consequences of under nutrition on brain development. Children with under-nutrition are apathetic and listless with poor interest to explore their environment. Because they are small in size, they are treated as "too young" and given inappropriate stimulation by their parents. The altered behavior and mood of the undernourished children often leads to the altered attitude of the caretakers towards them with poor level of interaction and play activity.

 

 

Our Stance Regarding the Value of Breastmilk for Charlotte as Nutrition & Medicine


We are committed that Charlotte gets all of what breastmilk has to offer which includes a heavy infusion of Omega 3s for her brain.   Neurosurgeons are using Omega 3 supplementation as an essential component of their TBI patients with dramatic results. Good nutrition is the basis for Charlotte’s performance meaning when she consumes the ultimate nutrition; it has and will continue to positively impact her therapies.

It's not JUST that breastmilk is high in the "good stuff", it's that formula/sugar laden drinks and foods are high in the bad stuff such as corn syrup and vegetable oils. In other words, it's a win-win for Charlotte to receive BM as her primary fluid along with healthy complementary foods.

We have attempted to understand your explanation of the food "challenge". Reason being if Charlotte could take in the "calories" by solid foods and liquid then she would not need a PEG put in to go home. We understand that many children "drink their calories" and have no room left for food.  This would understandably be a concern if we were talking about anything other than breastmilk which is easily digested and 99% bio-available. It doesn't sit in the stomach for 4-6 hrs. like commercial formulas do. Also water is "filling" as well and can discourage eating plus it contains no nutritional or medicinal value. Shouldn't we be concerned where the calories are coming from- not just counting calories?   I implore you to produce the studies that show water and high calorie supplements are healthy.

It is clear to us that Charlotte may not be able to take in orally the required fluid amount thus requiring a PEG to go home - so be it. We are very pleased with her eating and drinking of nectars including the amount she can eat now. Progress is expected. But we feel strongly that breastmilk remain a main staple of her diet - any way she can get it. And discontinuing it would only compromise her health & well-being. We have come too far to allow that to happen.

Yes, Charlotte has a traumatic brain injury - we are not denying that. But you act like the TBI child is so different that "normal" anything doesn't apply. She is still a human baby so human milk is what she needs.

Side note: An influential mainstream nonprofit focused on protecting healthy infants is in the process of writing a story about Charlotte's journey through JDCH.  A similar story was done from her stay at St. Mary's. Much of it will be about the courage and camaraderie it took on your part to open up to new ideas, let down your guards, and get Charlotte where she was to where she is now. The goal here is not for her merely to survive, but to THRIVE. She needs live nutrient dense specialized food to do that. Human Milk is a Super Food! And you are Super Heroes for breaking with the past and making it happen.

We appreciate your cooperation.

Maria Parlapiano RN IBCLC

* here is another heartwarming story of a child who was adopted by a couple when she was near death and is alive today because of donated breastmilk  
 http://www.candgnews.com/news/journey-save-j

Saving Our Miracle

This blog was supposed to be called “Sharing A Miracle- Part 2”,  a follow up essay about my recent weekend visit with Charlotte.  I had hoped to bask in the glow of her amazing recovery as well as the success of her miracle milk. The night before, I barely slept.  Reading prayers and asking for God’s blessing consumed most the night.  I eagerly anticipated holding her in my arms for the first time.  And the nurse- in- me could hardly wait to evaluate for myself how well she was doing.

My prayer focus was to ask God for the ability to connect with Charlotte on an intimate level.  You see, we were told based on the results of her CAT scan that she probably won’t be able to show emotion.  I refuse to believe that.  After all, she is part Italian!  But seriously, it was my fervent prayer that this not be so.  Also, I wanted to be able to follow and read her wants and needs so she would feel listened to and understood.  Very important as well, my visit was intended give my sister a worry free, much needed rest. These were my prayers and intentions.

Unfortunately, the situation was not exactly what I expected.  I arrived at the hospital at 1:30 am after a long flight delay.  Charlotte was a cranky, fussy, crying mess, teething horribly and clearly overstimulated -pretty much inconsolable. .  Then I see a bag of water hanging attached to her NG tube (stomach tube) and many empty Emfamil sterile water bottles as well as Nestle Pure Life water bottles- UGH!   What’s going on?!  Where’s the breastmilk?! When I learned that her banked breastmilk was completely stopped 36 hours earlier, I immediately went into save and protect mode.  Which means “Jerzee” was in the house and ready for action!   

I was told that the nutritionist weaned Charlotte off the breastmilk as a “challenge” to see if she would eat more solids. Apparently, it was her belief that the breastmilk might be filling her up too much.  Better that she eats more calories in food so her tube can come out, even though Charlotte has yet to master drinking fluids.  So the nutritionists and PEDS doctor agreed to give Charlotte only water down her NG tube -water continuously all night (1/2 liter) and 3 ounce boluses of just water 4x/day.  Cram in as many high-calorie pureed “fake-foods” and sugar nectars throughout the day instead.  This is what they called a good nutrition plan. And they drove my sister crazy measuring, force-feeding and counting the calories – where these calories came from did not matter, just calories. 

Sadly, this plan did nothing but set everyone up for failure especially our little Charlotte.  This “challenge” was compromising her health, basically pulling the rug right out from under her, nutritionally and medically.  My sister was simply scared by the looming threat of Charlotte needing a stomach tube surgically implanted. So she tried to follow the plan feeding Charlotte as much food as humanly possible.  But as you can imagine, the stress and anxiety to perform on her part as well as Charlotte’s was overwhelming. They were crashing and burning.

Needless to say, GrAuntie Maria was fit to be tied and brought on the “Post-Storm Jerzee Fresh” once again.  After getting a brief orientation to Charlotte’s schedule and care, I sent my sister home.  Then I began the hard task of correcting this nutritional travesty.  `As with the first hospital she was in, I had nothing but praise for the medical care.  Same here and in addition, I was quite impressed with her various therapists.   But again, the nutritional aspect of her care was severely lacking.  And again, there was little to no knowledge about breastmilk  and its appreciation, as an integral part of Charlotte’s care.   So the first thing to go is the breastmilk?!  Oh, I don’t think so ;)

This was a very long night as well since I needed to wait until the day shift to address the issue and fix it.   I pulled together my citations and strategized my approach as I felt a pressing urgency to get that breastmilk back up.  I held Charlotte a lot that night, neither of us slept much.  I was sick with worry and prayed hard for God to help me once again advocate on her behalf.

First thing in the morning, Danielle Rigg, cofounder of BestforBabes.org, reached out to see how things were going as she was writing a blog about Charlotte and her miracle milk.  It was truly a “God thing”.  As I was brought to tears, Danielle listened as I told her how disgusted I was, that once again I had to rescue and justify our use of banked breastmilk for Charlotte.  Exhausted and depressed, I dreaded confronting the nutritionist and doctor as I know the way these conversations go but it must be done.  My commitment is to none other than Charlotte Rose and her well-being.

Danielle reassured me and supported me with the words I needed.  She helped me re-group and focus. Our angle would be Charlotte’s urgent need for the potent Omega 3 fatty acids in breastmilk to help heal and nourish her brain.  She sent me the citations and told me her husband who is a traumatic brain injury doctor gives huge doses of Omega 3’s to his patients with amazing results.  So I felt a renewed energy and confident in my approach to reclaim the breastmilk for Charlotte- today!
Another “God thing”, the nurse who worked the weekend was still breastfeeding her one year old and nursed her first child long term.  Natalie was a friend, not a foe in my quest that day, eager to learn and help.  She was instrumental in contacting the key people and obtaining the orders to start the miracle milk once again.  I will be forever grateful to her as well.
After Charlotte started back on the banked breastmilk she was much happier.  Imagine just getting water and small amounts of food, broke my heart just thinking about it.  Now she was restored again.  I mashed up whole foods instead of feeding her the processed foods.  We had fun at mealtime as I placed the food on her fingers and hand so she could feed herself.  

I also addressed the issue of having a gastrostomy tube (GT) put in temporarily (3mo) and having the NG finally taken out. A gastrostomy tube (also called a G-tube) is a tube inserted through the abdomen that delivers nutrition directly to the stomach. It's one way of make sure kids with trouble eating get the fluid and calories they need to grow.  I reassured my sister that this is a good idea for Charlotte right now and that the tube is very small and easy to care for, nothing to be afraid of.  Charlotte will be able to do much more activity wise since it is more comfortable and out of the way.  The GT will enable her to go home and take her time when mastering her swallowing skills.   Most importantly, the GT will allow her to continue to receive the correct amount of her miracle milk!    
Since Charlotte was teething and had a day full of various therapies, I made sure not to overstimulate her.  I followed her when we were alone and engaged her gently and quietly with lots of physical contact through holding, rocking and massaging her.  When she was "into it", I would carry her down the hallway to visit everyone and take her for rides in her chair.  I also went to all her therapy sessions and cheered her on.  It was quite busy and I admit I was really tired, my back and neck ached and my arms were sore -  it was quite a workout.  But so worth it- we were together again, that’s all that mattered.

The last day and a half that I took care of Charlotte, she didn’t require any pain medication for her teething or Benadryl for sleep.  She barely cried, slept soundly, cooed and chatted and was on the verge of several smiles. (I threw my best jokes at her-Lol)   She was like "butter" ;)
Obviously, the Lord placed me in the right place at the right time, once again.  I happened to be there just in time, when she needed me the most – a little ‘rescue mission”. 

I pray the Lord will continue to use me as an advocate for her, as she is my angel on earth.  As expected, God answered my prayers for the weekend.  Charlotte and I did connect on an intimate level.  I was able to successfully read her and follow her needs.  Many of the staff commented on the special bond we have.  I know it, she knows it but it was nice to have that feedback.  Natalie, her nurse, cried the day I left saying, “You are amazing together.”  The time we spent together was an amazing gift.

Our sweet baby, Charlotte Rose continues to challenge me as a person.   Prompting me to dig deep, venture out of my comfort zone and fiercely persist when it’s easy to give up.   After all, she didn’t give up.   And as far as emotion is concerned, Charlotte elicits pure emotion from everyone she meets.   In my heart of hearts, I know she will return the gesture soon…….because my faith tells me so ;)   

Link to our position paper for use of breastmilk for Charlotte
http://wwmdwhatwouldmariado.blogspot.com/2013/02/our-stance-regarding-value-of.html

Link to citations for the above position paper
http://wwmdwhatwouldmariado.blogspot.com/2013/02/benefits-of-breastmilk-for-babychild.html

Best for Babes is Helping to Spread the Word !  Thanks Danielle
http://www.bestforbabes.org/miracle-milk-helps-heal-brain-injured-formula-fed-baby#comments

Saturday, January 19, 2013

Sharing A Miracle


 I willfully submit that my faith and resolve in who I am and what I stand for, were put to the ultimate test by none other than a small, injured child.  It was this extraordinary baby that compelled me to fiercely answer the call to advocate and protect for her ultimate good and in turn, for the greater good of all babies and      children.    Following is the remarkable account of my experience as “health guardian” of a baby called Charlotte Rose, the miracle bestowed upon her and the unexpected journey she took me on that changed my life forever. 

In December, my grandniece Charlotte Rose suffered a massive, traumatic brain injury. She was eleven months old. Airlifted to a Level 1 Pediatric Trauma Center, Charlotte endured emergency brain surgery in an attempt to relieve severe swelling. She was availed every possible life-saving intervention including being placed in a medically induced coma.  I immediately boarded a plane   to be by her side and so our journey began.

I always equated flying with a happy event like a vacation or destination wedding.  This time, I cried during the whole flight promising myself I would never make that assumption again.  I was overwhelmed with compassion for those suffering like me: confined in a plane, cut off from communication, trapped in my own thoughts, distraught, enduring what seemed like the longest flight of my life.
I did not know then that my arrival at Children's Hospital marked the beginning of what was to become a 16 day, 24/7 bedside vigil over the crib of Baby Charlotte Rose.  All my life experiences, both personal and professional, seemed to reach a most urgent crescendo at this urgent moment in time.  Raising  three children to adulthood through some difficult times, surviving breast cancer and navigating through life-threatening illnesses, training and working as a nurse in emergency medicine centers, and my business as a lactation consultant devoting my life to the health and well-being of mothers and babies.  This varied history would serve as a deep well to draw from and provide me with the essential tools for the vital work that lied ahead.

By instinct, the first thing I did was cast the widest net possible for support and spiritual guidance for the family, as well as myself. I knew we could not walk this alone and my faith told me, we would not walk this alone.  So out went the net.  Using the vast world of technology at our fingertips, we emailed, posted, texted and phoned everyone we knew to summon their support and ask for their prayers and good intentions for Charlotte.
Personally, I held tight to my friends' compassionate words and selected scripture verses, leaned on my colleagues for guidance and encouragement. I reached out to my employees and clients for love and strength, my grown children for their dedication and devotion to our family.  Everyone was in place, loyal and steadfast. 
From that platform, we faced a series of events that would bring us to our knees, break us to our core.  Two days after surviving the brain surgery, Charlotte's condition took a drastic turn for the worse. Her brain swelling accelerated out of control. Her major organs were failing -we were losing our little girl.
After review of her head CAT scan, Charlotte's condition was deemed fatal - physicians informed our family that there was no hope of recovery. We were informed that even when she is eased out of her medically-induced coma, Charlotte would be brain dead.  Devastated beyond words, we grappled with disbelief and deep sadness. Multitudes of believers were holding us up with their prayers and intentions, refusing to give up hope.  It was in deep faith that we handed the fate of our baby girl entirely over to God's grace and will.
Our family was resolute that Charlotte's death not be in vain.  That her short life not be wasted but used as an instrument for good.  She was an excellent candidate for organ donation.  So we had our initial meeting with the organ donor team leader. Charlotte would be a hero, so young yet so noble, leaving a legacy of hope and new life.  As soon as Charlotte was weaned off all medications, which the doctors estimated would take about 24 hours, then the two day protocol for the establishment of legal brain death prior to organ donation would begin.  
We would use this time to prepare ourselves to let go and hand over our precious one.   Her mom was assisted in the creation of a Memory Box which contained a lock of Charlotte's hair and a casting of her hand and foot prints.   Agonizing plans were started for Baby Charlotte's funeral service. We reach out to our Christian folk for special bible verses and songs. Family members and friends planned their pilgrimage to offer their condolences and celebrate Charlotte's short but joyful life.  Prayers and devotions continued as Charlotte’s mom refused to give up on her girl, no matter what anyone said, she still hoped for a miracle.
By then, I was sleeping in Charlotte's room most every night.  I truly cherished that time - quiet and private. There was definitely a strong spiritual presence – it was a sacred space.  Routinely, I would sing her favorite bedtime song and tuck her in around 12:30 am and then try to get some sleep. Frequently, I would wake and check on her.  On the fifth day after her injury, I woke up at 4 am and went over to her crib as usual.   This time though, she looked dramatically different. Now mind you, just four hours earlier when I said good night she looked awful, her head was so swollen it even scared me and I remember thinking, how could she live another hour, let alone, another few days?
Now, I was staring at a baby, whose brain swelling decreased dramatically and she was sucking on her breathing tube!  Needless to say, I was speechless which if you know me, is hard to believe.  I tried to explain it away and rationalize it.   I told myself that what I saw was most likely a result of a diuretic medication or aberrant spinal cord conduction.  I tried to convince myself that it was meaningless, nothing to get excited about or get your hopes up over.  After all, it is impossible for anyone to survive this. That is what the experts said.
I was anxious and riddled with self-doubt when the PICU team entered.  Curious to see what they thought but with no expectation of good news, my niece and I stood patiently by while they examined Charlotte.  Then the doctor turned to me when she was done and said, "This baby is not brain dead".  My chest felt like it was going to explode!  My niece nearly jumped out of her skin!  After taking a deep breath, I asked the doctor to repeat what she said.  After another deep breath, I asked her to clarify.  The doctor proceeded to tell us that Charlotte's cough and gag reflexes had returned, her pupils were now reactive, she responded appropriately to painful stimuli and her bodily functions were kicking in - we got our baby back!  We were overwhelmed with emotion and pure joy!   From that moment on, we would believe and bear witness to Baby Charlotte's miraculous recovery.
So changing gears in my head, I prepared for Charlotte's life, not death.   After a day or so after her awakening, I noticed a nurse bringing in a container of powdered Nutramigen (hydrolysate baby formula).  Charlotte had been receiving only intravenous nutrition at that point and had a naso-gastric tube in place to avoid abdominal distension. When I asked the nurse, she informed me there was an order to start feeding her this formula via the feeding tube.  Taken by surprise, I did what came naturally and laid on, what I refer to as, the "Post-Storm, Jerzee-Fresh Body Block!"  I politely told her, (as only one from New Jersey can do-Ha!), to hold off what she was doing and asked if I could speak to the doctor.
This is where it really gets interesting.  I announced to the PICU doctor with the nurse present, "Instead of infant formula, I want Charlotte to have pasteurized banked breastmilk."  Well, they looked at me like I had two breasts coming out of my head! The following is a series of statements and counter statements, detailing the debate that they would not win.  The doctor said, "She wasn't breastfed". I said, "doesn't matter, now she needs the most optimal nutrition and breastmilk is a potent medicinal as well."  The nurse said, "But she's 11 months old."  I said, "The benefits of breastmilk have no expiration date, Charlotte deserves every advantage possible." The doctor said, "Nutramigen is a very specialized formula” I said, "Nutramigen is 46% corn syrup and 25 % vegetable oil - I wouldn't call that special or nutrition."1  I went on to say that since Charlotte is going to survive, proper nutrition and support is vital to healing and avoiding complications thus ensuring a faster recovery.   Even though it made perfect sense to me, they appeared annoyed and frustrated suggesting I speak to the nutritionist about it in the morning.
Immediately, I reach out to my lactation colleagues on-line for help (via my iPhone 4, - LOL) I was beyond exhausted and summoned them for the citations, numbers and names for what I needed. As expected, they did not disappoint.   I prepared all night for morning rounds and I was ready.  In comes the PICU team including the nutritionist.  Again, I pitch my plan. The PICU doctor immediately deferred to the nutritionist who admitted she had no idea that human milk banks even existed.  Then she attempted to convince me that the formula they use is "specialized".  Well, we know where that went! 
Then I was informed that their hospital has no policy for the use of banked donor breastmilk.  My answer to that was,"Frankly, I am shocked as it is used all over the country.  But, there's a first time for everything and I am proud that Charlotte will be that first one.  What a wonderful learning opportunity for everyone!"  Finally the lack of anything better to say, the nutritionist shared her opinion that most parents wouldn't be able to afford it anyway.  My response to that was, "They should be given all options and then decide for themselves what they can afford. We can't afford it alone but we will raise the money.  I do not view this as a luxury. I view this as a necessity for Charlotte's sake."  End of conversation.  The nutritionist exits the room and proceeds to call her supervisor.  To my surprise, she returns and says, "You buy it, you ship it, we'll hang it."   She also agreed to provide a refrigerator in Charlotte's room to store her daily requirement of milk.
Unfortunately for her, I wasn't done yet and
took the opportunity to educate the entire PICU staff on the risks of using powdered infant formula, mixed at the bedside with sterile water and hung for hours.  This practice is highly inappropriate as powder formula is not sterile like the liquid formulations.  In order to kill the bacteria that may be present in the powder, it must be mixed with boiled water not below 70 degrees C,  then cooled to room temperature and consumed immediately. 2  No doubt, children in their unit are highly compromised and cannot afford a life-threatening infection.  Continuing to practice in this way, places their patients at increased risk as well as jeopardizing their own professional licenses. (Jerzee-Fresh, coming on again)  Great way to make friends, right?  Not.
As expected, down came the "fallout" from the staff which pummeled me like a torrential rain storm.  I was the brunt of many backhanded jokes and received the "cold shoulder" from quite a few nurses - (this was especially disturbing as I am a nurse) Personal opinions were flying high and judgment was plentiful.  One nurse was bold enough to share that she was "grossed out" by breastmilk.  Another accused me of putting undue financial pressure on our family.  Our decision to use banked donor milk as part of Charlotte's care plan, as you can imagine, sparked highly spirited conversations among the nurses and doctors about breastfeeding. 
This prevailing attitude of disapproval brought a new concern- the negative impact it would have on Charlotte's care and I could not have that.  So how was I going to turn the tables to our favor?  Obviously, lots of TLC and “behind the scenes” staff education.   It was a teaching hospital, so during morning rounds there was an entourage of minds I could influence in a positive way.  I knew the doctors were my avenue to the nurses so that would be my approach.  If I could convince them then the nurses would surely follow suit. A solid strategy, I thought.   Little did I know that Charlotte Rose would be the one to turn them around and make them believers...?  Sweet Baby Charlotte, who wasn't supposed to survive at all, was charting a course to defy all odds!  With prayers and the miracle of mother’s milk, she began progressing at such a rate - it was simply astounding! 
 The neurosurgeon said he had never seen a baby so responsive.  "Every time I come in here, I just can't help but smile." he said.  The trauma doctor would go through his checklist with the nurse, "What cardiac meds is she on?" None.  "What GI meds?" None.  "Urine output?" Perfect. "Lungs?" Clear. “Labs?” Good. "Oh…OK" - Ha!  Every morning before the PICU team would make rounds, I would whisper to Charlotte, "Go ahead little girl, show'em what you can do" and she would.  They would discuss at the bedside what Charlotte's capabilities were.  "Well, she's not tracking with her eyes."  Yes, she is.  "She most likely can't hear."  Yeah, it appears she can hear, according to the audiologist.  "She doesn't move her left side, arm or leg, right?  Wrong!  As Charlotte proceeded to almost kick him in the groin! - LOL
Little by little, the staff began embracing our Charlotte Rose.  The energy changed completely for the better as our miracle girl transformed the hearts and minds of those around her.  Believe it or not, they even embraced me in the end.  There were lots of tears shed and hugs given when I left to go back home.  Especially difficult, was saying "goodbye for now" to Charlotte, my angel on earth.  Filled with awe and gratitude, I reflected on the journey she took me on...... one of personal enlightenment and reaffirming faith.
I attest to you that Baby Charlotte Rose is a living miracle, touched by divine intervention. I further attest that the donor breastmilk has played a critical part in the fulfillment of that miracle.  It is truly magical beyond our comprehension.
My mission is to offer hope by sharing Charlotte's Miracle and spread the truth about the healing power of breastmilk.  Most people in the US are not familiar with breastfeeding let alone, the medicinal use of breastmilk and donor milk.   “Why breastmilk for Charlotte?” people asked me.  The evidence is overwhelming that human milk is absolutely the best nutrition a human baby can have - it’s species specific.  Premature, injured and sick children seriously require and deserve this unique advantage!
Research has shown that feeding medically challenged babies this nutrient-rich milk also eases digestion, promotes growth and development, and helps to prevent infection. Breastmilk provides important vitamins and minerals for children including the brain-cell builder taurine. While taurine is not an essential amino acid, its high concentration in breast milk does seem to indicate a need that cannot be met by the child's own body. But how much taurine is in formula or cow's milk? None! Yet extremely high levels of this "smart" substance are found in the brains of children, indicating that it is an important aid to brain growth. Ninety-six per cent of brain growth occurs by the age of five years. Disease resistance is another benefit of breast milk, which contains 37 known immune components and can be divided into the following categories: protective bacteria, enzyme "attackers," protein binders, antiviral agents, and antibody "defenders." It is the job of these "fierce" mechanism groups to find and destroy any viruses or bacteria that may harm the babies, while also making sure they get enough protein and nutrients. 3
I was also asked what the difference is between breastmilk from a human milk bank and donor milk directly from moms who are breastfeeding, commonly called, milk sharing.  This issue comes up frequently as many people are confused and concerned that milk from the human milk bank is "so expensive."  ”Why pay for it when you can get it for free?” a common statement.   There is a big difference between shared donor milk and pasteurized banked breastmilk. In a case of extreme compromise, like very ill or injured children and premature babies, rigorous screening of donors and pasteurization of their milk, eliminates any chance of virus or bacterial transmission.  Because in those cases, even the smallest infection, whether viral or bacterial could prove life-threatening. So the screening process for donors is rigorous, strict protocol for expression is observed and the milk is pooled and pasteurized to kill any viral or bacterial load.  This is done with extreme care as the milk banks are able to retain 97% of the quality of the milk. It is this vital protection that you are paying for.4  We chose to work with the Mothers Milk Bank of Austin, Texas, a member of the Human Milk Bank Association of North America. 5 HMBANA is a non-profit entity with eleven human milk banks in operation across the US and two in Canada.6
Am I glad they exist? Yeah! Is it worth the money? Hell, yeah! Charlotte has been thriving on it as many other lucky babies do!  No major infections to report and no gastro-intestinal issues to speak of - these are just two of the many benefits Charlotte has enjoyed.   So, next time you ponder breastfeeding or breastmilk – remember, it’s not just the best nutrition, it’s also the best medicine. Baby Charlotte Rose is living proof of that!
On behalf of Charlotte and my entire family,
I would like to thank all those who rallied to our cause by contributing to Charlotte’s Miracle Milk Fund.  Lastly, a special thank you and to all the moms who generously share their miracle milk with those in need.  Bless each and every one of you.
Maria Parlapiano RN, IBCLC,  AKA  “GrAuntie Maria”
To follow and share in the miraculous recovery of this very special child go to:















Tuesday, November 20, 2012

Open Letter to Director PAHO/WHO

 
Open Letter To: Mirta Roses Periago, Director, The Pan American Health Office
                       Regional Office for the Americas of the World Health Organization

Dear Ms. Periago,

I was deeply disheartened to learn that your organization has accepted a $150,000 contribution from Nestlé, 1 the major violator of the WHO International Code of Marketing of Breast-milk Substitutes.
2

First of all, your alliance with Nestlé is a direct contradiction to your own Mission Statement : "To lead strategic collaborative efforts among Member States and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen, the lives of the peoples of the Americas."3  I contend that Nestlé is a major contributor to inequity of health by their predatory marketing practices.4
Also, they increase world-wide disease by methodically sabotaging breastfeeding efforts which can only result in the quality and length of lives being greatly diminished, not improved.  

This absurd affiliation can be further clarified by referring to your very own Health Agenda for the Americas 2007-2017 which states, "In accordance with the quest for equity, the Health Authority should prioritize and emphasize specific actions to reduce maternal, neonatal, and child mortality in all segments of society. Breastfeeding should be promoted, and actions taken to prevent infections, dehydration, respiratory diseases, and malnutrition and obesity among children as part of the problems of childhood nutrition."5   One must ask why an organization who publishes the above statement would align themselves with Nestlé, the largest purveyor of infant formula and junk food on the planet, infamously boycotted for their callous, aggressive marketing tactics.6

In addition, Nestlé products for babies and children are made from modified cow’s milk, genetically engineered soy, high-fructose corn syrup, added sugars, a variety of fats (palm, soybean and coconut oils), plus a long list of chemicals to adjust nutrient levels and enhance product appearance. Bottlefeeding artificial baby milks often leads to large volume, parent-controlled meals leading to overfeeding which contributes to childhood obesity in the Americas.7

Also, I noticed on your website the PAHO Core Values which include,
"Integrity - Assuring transparent, ethical, and accountable performance".8  Accepting funds from Nestlé is far from honorable. Instead, it clearly demonstrates the grave conflict of interest that exists between health organizations and the junk food industry. Not to mention, a clear and all too common, example of Nestlé’s false benevolence.

Furthermore, this action proclaims a blatant breach of trust with the very mothers and children you protect, not to mention, the health advocates, such as myself, who have devoted their lives tirelessly to promoting the WHO International Code for Marketing Breastmilk Substitutes.
 
Lastly, linking with Nestlé seriously undermines the credibility of your organization and WHO as a whole. WHO is known as the global guardian for public health. When your organization accepts money from Nestlé, it sets a bad precedent and the wrong tone for the future. Many rely on WHO for protection from industry self-interest, do you want the legacy of opening that predacious door?

I strongly urge you to reconsider your decision to accept Nestlé funding, in turn reaffirming your commitment to the WHO Code and those it protects. I implore you to join WHO and publicly call for Nestlé executives to end their unethical promotion of infant formula and unhealthy foods and to stop lobbying against regulations that safeguard global health.
 
Sincerely,
Maria Parlapiano RN IBCLC
Chatham, NJ









 

1. http://www.reuters.com/article/2012/10/19/us-obesity-who-industry-idUSBRE89I0K620121019
2. http://www.who.int/nutrition/publications/code_english.pdf.
3. http://new.paho.org/usa/index.php?option=com_content&amp;task=view&amp;id=36&amp;Itemid=163
4. www.babymilkaction.org
5. www.paho.org/english/gov/ce/od328-strategy-e.pdf
6. http://online.wsj.com/article/SB10001424052702303592404577361070078
7. http://www.dailymail.co.uk/health/article-1316395/Baby-milk-formula-make-child-obese-5.html
8. http://new.paho.org/usa/index.php?option=com_content&amp;task=view&amp;id=36&amp;Itemid=163

Friday, November 16, 2012

WHO the Heck, Did What?!



You're probably thinking- Not again! Didn't Maria just finish a similar campaign?!http://www.mothering.com/community/a/newark-and-nestl-partnership-there-s-nothing-sweet-about-it
Now I know what Michael Corleone from the Godfather meant when he said,
 "Just when I thought I was out....they keep pulling me back in." -Lol




 


Around the world, civic and non-profit organizations have been gloming "donated" Nestle money,
 like kids in a candy shop! http://newarknj.patch.com/articles/new-pilot-program-will-target-childhood-obesity-in-newark

Ironic, right? That money "earmarked for healthy causes" actually comes from Nestle - the worlds biggest "candy shop"!  Add to that, the fact that Nestle is the  largest manufacturer of processed, high-fat foods and high-calorie beverages including their infamous infant formula and baby food products.  I would also be amiss not to mention their notorious bottled water business- saving that for a future blogwww.bottledlifefilm.com/index.php/home-en.html
http://online.wsj.com/article/SB10001424052702303592404577361070078138812.html

Complacency surrounding this issue runs rampid which I will never get used to.  But more disturbing is the warm embrace Nestle receives from the the very programs and  organizations that are working tirelessly to reverse the damage that Nestle itself causes to our population and planet! 

By now, many of us who follow the trail of chocolate wrappers one by one, are rarely surprised.  False benevolence is one of Nestle's trademark tactics. Eying the long list of names of those who fall prey via gifts, donations, sponsorships, scholarships, interships, partnerships, research, promotions and educational conferences is merely a daily routine now.

But recently, even I- Ms.Cynical herself, was literally shaken to the core when news broke that PACH/WHO accepted $150,000 from Nestle to fight obesity and non-communicable diseases!   I almost choked on my Hot Pocket - NOT!
Akin to Eve's partaking of the forbidden fruit, are we to believe that WHO may now fall from grace?  Just like the others- corruptible?

If so, then who can we trust if we can't trust WHO anymore- (can't believe I just wrote that!)  Historically they were our "agents" for global health concerns and guidance.
 
Even with their attempt to guard us from commercial exploitation and promote, support and protect breastfeeding via the Code of Marketing Breastmilk Substitutes -it appears they have now allowed political and financial pressure to trump reason and responsibility. 
Perhaps we overestimated the power and ability of WHO to protect us from harm, as well as police itself and resist temptation from corporate parias like Nestle.

Perhaps WHO underestimated their own need for self-monitoring, as well as, our need for urgency and stewardship when our health is threatened by Nestle and other global food giants.

These are shortfalls that may likely haunt us for years to come.

Starting now, there will be a vast effort put forth by breastfeeding and child health advocates in an all-out, grass-roots, multi-media campaign to inform, educate and act to empower change and flip this situation to our advantage.

Our goal is to influence PAHO/WHO to the extent that they will reverse their decision and mis-align themselves with Nestle.

But we need your help to mobilize this campaign to the largest scale possible so
PAHO/WHO hears us LOUD &CLEAR! Cause, trust me, Nestle is always listening.........:(

Join & Share Friends of the WHO Code Today !https://www.facebook.com/#!/groups/friendsofthewhocode/

Sign the petition today!
http://www.thepetitionsite.com/569/157/115/urge-the-world-health-organization-to-cut-ties-with-nestle-our-mothers-and-babies-are-worth-it/

Open Letter to Director of PAHO/WHO-
http://wwmdwhatwouldmariado.blogspot.com/2012/11/open-letter-to-director-pahowho.html