Milking, The Issue

Two weeks down, two to go until the rescheduled surgery date: November 6th.

It goes both too slowly and too quickly.

All around us people are coming down with colds. We wash and sanitize our hands constantly; we don't let sick people (or people who've been around sick people) come near us.

We are the Family in the Bubble.

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I have come across the most astounding thing--courtesy of our good friend Amy Wells, ND who was at a lactation management class all last week.

Apparently, there is no scientific proof, no clinical evidence supporting the mandate that Zoe must not breastfeed during and immediately after her bone marrow transplant.

Amy forwarded me an email thread dating back to 2001 discussing this very fact.

People involved in this thread included two lactation specialists, and an MD in at the University of Texas Medical Branch named Armond Goldman who is an immunologist specializing in the study of breastmilk. (!)

His email in the thread said the following (the highlights are mine):

"Thank you for your inquiry. No controlled studies have been conducted concerning breastfeeding and stem cell transplantation. Because of the lack of information, I have never addressed this issue in any of my writings.

There are theoretical reasons to avoid breastfeeding in such a circumstance if the child has to be immunosuppressed to prepare for the transplantation. The reason stems from cross-fostering experiments conducted by Beer and Billingham some 30 years ago in highly inbred experimental animals. They showed in such animals that ingested T cells from milk colonized the cross fostered infant animals and caused a wasting disease. It is unclear whether maternal T cell engraftment occurs in immunodeficient human infants as a result of breastfeeding. The reason for the uncertainty is that most maternal T cell engraftment occurs during the intrauterine period as a result of T cells colonizing the fetus via the placental.

There are reasons to believe that breastfeeding would be beneficial because of the protection against many types of infectious diseases that affect the gastrointestinal and respiratory tracts. This is particularly important to a child who is immunosuppressed.

It is difficult to make a recommendation when you do not have all of the medical information about the patient. In general, I would encourage such mothers to continue to breastfeed. I would also be obliged to perdiodically make sure that the blood T cells in such children were hers and not her mother's.

I wish I could be of more assistance, but there is little information to provide a more substantial recommendation. If you have any other question, email me or call me.

Dr. Goldman"

I dialed the phone number listed at the end of the email. The woman on the other end of the line explained that yes, Dr. Goldman was still reachable at this number, but they were in the midst of chaos and displacement due to the recent hurricane in Galveston--did I want his cell phone number? Well, sure!

He answered his phone directly. A very pleasant older man with a relaxed Texan drawl. In the next 45 minutes he told me that nothing had changed between 2001 when he wrote the original email and now; there was still no documented proof that breastfeeding was a danger to the transplantation process. But, there was no documented proof that it wasn't either.

Not something that is easy to study through a systematic scientific study, he said.

However, in his years of studying breastmilk, he asserted, nothing has led him to believe that it would be harmful in a situation such as Zoe's. When asked, he said that he would be happy to talk to our oncologist, Dr. Thomas Manley, about this very subject.

Two days after my conversation with Dr. Goldman, I found myself on the phone having an interesting chat with a mother, Beth, who breastfed her baby daughter through a liver transplantation process. Told that her daughter's liver could not process the fat in breastmilk, she did have to supplement with formula (which was less fatty) before and during the transplant process. But, once in recovery, and given larger portions of breastmilk, her baby had what doctors agreed was an astounding recovery.

Beth is convinced that this was due to the healing powers of breastmilk. She told me that the main transplant doctor involved agreed with her assessment.

I have written a long email to Dr. Manley asking him to provide me with the evidence that supports the assertion that breastfeeding Zoe through her bone marrow transplant would be harmful for her.

I don't know if it's irrational hope, or mother's intuition, but I am convinced that nursing her through it will help her fight life threatening infection (a very real and dangerous concern in this process).

It's been a few days, I haven't heard back from him.

Meanwhile, I am continuing to sleuth down other instances where babies have been nursed during transplantation. I have a line on a lactation specialist in Texas who claims that she's observed both stem and bone marrow transplants done in the presence of nursing--without harmful side effects. I am waiting to hear back from her as well.

I'll let you know what turns up.