Plugged Ducts & Mastitis

Found this at Kellymom

(ni sambil mengepam ni, dok jalan2 carik psl blocked or plugged ducts ni)

Ku rase this article sangat sempoi and senang paham..

Semoga dapat memberi ilmu kepada semua ibu-ibu yang menyusukan..

How do I know if I have a plugged duct or mastitis?

PLUGGED DUCT:
A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (Milk Blister), or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast.

Local symptoms: Mom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift.

A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown.

Systemic symptoms: There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present.


MASTITIS
Per Maureen Minchin (Breastfeeding Matters, Chapter 6), mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is typical. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only one breast.

Local symptoms: Local symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area.

Systemic symptoms: Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu-like aching, malaise and systemic illness.

Common (and not-so-common) side effects of plugged ducts or mastitis

Plugged duct
- Milk supply and pumping output from the affected breast may decrease temporarily. This is normal and extra nursing/pumping generally get things back to normal within a short time.
- Occasionally a mom may express "strings" or grains of thickened milk or fatty-looking milk.
- After a plugged duct or mastitis has resolved, it is common for the area to remain reddened or have a bruised feeling for a week or so afterwards.

Mastitis
Side effects may be the same as for a plugged duct, plus:

- Expressed milk may look lumpy, clumpy, "gelatin-like" or stringy. This milk is fine for baby, but some moms prefer to strain the "lumps" out.
- Milk may take on a saltier taste due to increased sodium and chloride content - some babies may resist/refuse the breast due to this temporary change.
- Milk may occasionally contain mucus, pus or blood.

What are the usual causes of plugged ducts or mastitis?

PLUGGED DUCTS
Milk stasis / restricted milk flow
… may be due to:
* Engorgement or inadequate milk removal
(due to latching problems, ineffective suck, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby's time at the breast, nipple shield use, twins or higher order multiples, blocked nipple pore, etc.).

* Infrequent/skipped feedings
(due to nipple pain, teething, pacifier overuse, busy mom, return to work, baby suddenly sleeping longer, scheduling, supplementing, abrupt weaning, etc.).

* Pressure on the duct
(from fingers, tight bra or clothing, prone sleeping, diaper bag, etc.).
* Inflammation
(from injury, bacterial/yeast infection, or allergy).

* Stress, fatigue, anemia, weakened immunity

MASTITIS
Milk stasis (usually primary cause)
* Same as for blocked duct.

* Blocked duct is also a risk factor.

* Infection

* Sore, cracked or bleeding nipples can offer a point of entry for infection.

* Hospital stay increases mom’s exposure to infectious organisms.

* Obvious infection on the nipple (crack/fissure with pus, pain) is a risk factor.

* Past history of mastitis is a risk factor.

What is the usual treatment for plugged ducts and mastitis?
It's always best to treat a plug immediately and aggressively to avoid escalating into mastitis.

CAUTION: Do NOT decrease or stop nursing when you have a plugged duct or mastitis, as this increases risk of complications (including abscess).

GENERAL SUPPORTIVE MEASURES
Plugged Duct

Rest
Adequate fluids
Nutritious foods will help to strengthen mom's immune system
Mastitis

Bed rest (preferably with baby)
Increase fluids, adequate nutrition
Get help around the house

BREASTFEEDING MANAGEMENT

-- SAME for plugged duct or mastitis
-- important to start treatment promptly
"Heat, Massage, Rest, Empty Breast"

General
- Nurse frequently & empty the breasts thoroughly.
- Aim for nursing at least every 2 hrs. Keep the affected breast as empty as possible, but don’t neglect the other breast.
- When unable to breastfeed, mom should express milk frequently and thoroughly (with a breast pump or by hand).


Before nursing
- Use heat & gentle massage before nursing

- Warm compress. Try using a disposable diaper: fill the diaper with hot water (try the temperature on your wrist first to avoid burns), squeeze the diaper out a bit, then put the inside of the diaper toward the breast. This will stay warm much longer than a wet cloth.

- Basin soak. Fill sink or bowl with hot water and submerge breast in water while massaging the plugged area toward the nipple. Some report better results when epsom salts are added to the water -- add a handful of epsom salts per 2 quarts (2 liters) of water. Rinse with fresh water before nursing, as baby may object to the taste.

- Hot Shower. It can be helpful to massage in the shower with a large-toothed comb. The comb should be drawn through a bar of soap until it is very soapy and then used to gently massage over the affected area in the direction of the nipple.

- Loosen bra & any constrictive clothing to aid milk flow.


While nursing :
- Nurse on the affected breast first; if it hurts too much to do this, switch to the affected breast directly after let-down.

- Ensure good positioning & latch. Use whatever positioning is most comfortable and/or allows the plugged area to be massaged.

Note: Advice to point baby's chin (or nose) toward the plugged area is not necessarily going to be helpful as it is based on the idea that the milk ducts take a nice, direct route to the nipple - recent research tells us that this is not true, and that a particular duct might begin in one area of the breast but can "wander" in many different directions before terminating in any area of the nipple.

- Use breast compressions.

- Massage gently but firmly from the plugged area toward the nipple.

- Try nursing while leaning over baby (sometimes called "dangle feeding") so that gravity aids in dislodging the plug.


After nursing :
- Pump or hand express after nursing to aid milk drainage and speed healing.
- Use cold compresses between feedings for pain & inflammation.

When you have mastitis...

Talk to your DR about starting antibiotics
immediately if:

Mastitis is in both breasts.
Baby is less than 2 weeks old, or you have recently been in the hospital.
You have broken skin
on the nipple with obvious signs of infection.
Blood/pus is present in milk.
Red streaking is present.
Your temperature increases suddenly.
Symptoms are sudden and severe.

yuppp.. ku kena blocked duct, malam td baru ku 'jumpe' lump tu, betul2 behind the n*pple.. susah gile nak massage sbb cracked pon baru je nak baik..

tp ku pulun jugak massage, dah la badan pon rase nak demam.. ohh tidakk.. semoga cepat la baik..

rent a toy

Rent a toy?? Sounds weird kann?? And never know that kinda service exist...

yupp it does -- visit www.rentatoy.com

they have wide selections of toys and baby gadgets eg bouncer, rocker, exersaucer.. kalau beli sendiri sure mahal ratut-ratut punya...

lagipon bende2 tu bukan pakai lama pon.. paling2 pon 2-3 bulan je..
contoh nye cam Faris lah, bouncer dia, pakai pon rasenye 2 bulan je, once dia dh bleh tegak dia dh taknak dok dalam tu.. now dah simpan pon. Sib baik beli 2nd hand :p

tp toys cam tak berapa sesuai lah sbb takut jahanam (utk case anak-anakku yang kreatif lagi ganaz nih)

from the site, diorang ckp leh pick-up service.. okay lah tu tp tambah duit je lah for the service.

hmm kalau sesape pernah try bagitau ye... mana lah tahu, nanti baby akan datang, bleh rent je.. sebulan pon cam RM20-30 takde la rase mahal sangat kan... (Faris ni dh terlewat dah hahaha)

p/s pandai kan orang buat duit??!!

what i learned..

since aku selalu bertamu kat MBW forum, banyak short forms yang aku belaja..

err.. mungkin aku yang ketinggalan zaman, tp just wanna share some

FSOT = for sale or trade --> ni antara yg 1st aku tau, sbb selalu jumpe.. memula tak tau apa, sampai la aku figure out sendiri when they associate it with buy and sell and trade etc

ISO = in search of

HTH = hope that helps

TIA = thanks in advance

IMO = in my opinion

IMHO = in my humble opinion

OT = off-topic -- ni paling lambat aku figured out.. asyik2 jumpa OT nih, pastu baru lah aku tau.. hehehh

LOL = laughing out loud

LMK = let me know

TBH = to be honest

FTR = for the records

banyak lagi sebena nye yang kadang2 aku pon tak sure whether tu short form utk apa hahahha

tp utk sms, aku mmg annoyed dgn short forms err not really short forms but perkataan yang dieja ringkas.. kengkadang aku naik pening baca sms esp kalu sms dari anak2 sedara aku (atau pon bebudak muda sekarang.. i have to admit aku ni dah tak muda sangat hahhahah)..
tapi ada ka baca sms nak kena pikir sume bagai??? kan ke problem kalu orang tu salah anggap?

kalu aku, selalu aku try not to pendekkan perkataan, sbb aku takmoh org salah baca sms aku.. so, lantak pi lah sms aku panjang 2 pages pon, janji msg sampai...

err.. JMTC (= just my two cents -- aku create sendiri ehh ke mmg ada?? hahah)

jangan percaya..

suatu pagi ni aku tertonton sebuah rancangan motivasi tp dah hujung2.. basically aku pon tak sure dia cakap pasal apa.. tapi yang aku tersentap tu bila tiba-tiba statement beliau keluar

"jangan percaya dengan doktor yang cakap mak ayah kita dah takde harapan"
"bahaya ni doktor yang macam ni"
"semua nye kerja Allah..."

err memang betul semua kerja Allah..
kita sebagai manusia patut berusaha selagi mampu. Doktor pon bukan Tuhan.. tapi aku rase lagi BAHAYA kalau carik doktor yang bagi u 'harapan palsu'

doktor ni ada etika kerja sendiri. "Do no harm"

kalau pesakit kritikal, selalunye memang kena bagi family members tahu..

aku sangat la tak kenan kalu doktor yang cakap patient 'stabil' tp sebenar nye tidak. Aku lebih suka kalau family members diberitahu setiap detail/masalah pesakit dan juga pilihan2 treatment/management yang ada..

ini pernah terjadi pada aku sendiri 3-4 tahun lepas.
Abang ipar aku kritikal di ICU (bacterial pneumonia with meliodosis).

Asalnye dia hanya suspect demam denggi sbb cek darah memang macam 'dengue fever feature' (dari ujian darah -- low white cell count & low platelet counts). Dia pon memang tak lalu makan/minum & dah sampai tahap dehydrated dah..
Tp H** refused to admit him even for rehydration therapy. Ingat lagi aku masa tu baru balik dari cuti-cuti Msia ke Genting. Balik je terus kitorang visit dia and janji nak bawak gi check up kat H**M keesokan harinye.

Kat A&E, kitorang amik darah dia then 'admitted' him sekejap kat observation ward for IV drip ('masuk air) then plan balik kalu results darah tak teruk sangat.

Tp tup tup masa tu, glucose dia tinggi, cek paru-paru ada signs of infection (padahal dia takde complain batuk apa pon)..
Bila buat CXR -- the chest was quite bad, he was admitted straight away..

next day, kakak aku called cakap abang ipar aku sesak nafas & doktor kena masukkan tiub pernafasan... "masyaAllah, semalam takde la teruk sangat.." terus aku & DH ke hospital. Masa tu dia dah di 'intubate' and transfered to ICU...

masa ni lah aku rase sangat helpless.. memang aku tak boleh buat apa-apa, aku serahkan pada doktor pakar di ICU.. specialist yg treat abang ipar aku masa tu jumpa aku and interview aku sket. Then bagitau aku prognosis abang ipar aku. (which was not good lah kan)
then dia tanya aku "u want to tell ur sister or u want me to tell her??"
"no, u go ahead. You tell her please"

aku memang tak sanggup.. worse cos i know 'it' myself

so dia cerita dengan kakak aku dari A to Z.. what happened, how it happened etc.. then she told my sister what they had done so far and what they were going to do, their prediction as well as the possible outcomes...

bagi aku, itu memang sangat perlu.. ikut psychology, memang kita akan berada dalam 'denial state' masa memula terima berita buruk, tapi kalau berita buruk tu disampaika dgn cara yang betul, insyaAllah kita akan cepat terima keadaan.. tambah plak kita sebagai orang Islam, ada pegangan..

memang kakak aku & family lain sangat sedih!!! Tapi kami redha kalau itu ketentuanNya.. setidak-tidak nye doktor tu dah bagitau kami semua kebarangkalian (let it good or bad)..

tapi alhamdulillah abang ipar aku recovered setelah dekat 2 bulan dok ICU..

bayangkan kalau kami tak diberitahu apa yang jadi..?? atau bakal terjadi??

dan kalau sesuatu yang sebaliknye berlaku?? Tentu kami akan salahkan doktor kan??

well, that's the ugly truth..

bayangkan kami para doktor yang nak menyampaikan berita buruk?? Boleh anda bayangkan betapa dup dap nye jantung kami dalam nak memilih perkataan yang terbaik utk disampaikan?? silap2 ada plak yang kena tumbuk ke?? Tak ke haru??

masa aku keje kat A&E pon gitu gak... sangat la susah nye nak 'pilih' perkataan terbaik nak disampaikan pada family members bila patient passed away. Kalau patient cina, kena guna approach lain, kalu india pulak lain, kalau Melayu/Islam pon lain gaks...

language barrier pon masalah jugak.

Pernah masa memula aku kat A&E, ada satu kes ni, aku bagitau ngan family chinese ni

"sorry, mak you sudah 'takde'"

dia bleh senyum and ckp " oh.. sudah takde apape ye?? good good"

ehh aramak, aku salah pilih word la plak, then aku explain balik bebtul, dari mula mak dia datang A&E tu, masalah yang dia hadapi eg sesak nafas atau tak bernafas, takde degupan jantung etc. Then apa yang kami buat (eg intubate, CPR etc) then apa yang jadik eg no respond after 15-20 minit mencuba etc..

pastu baru lah amoi tu paham.. sorry lah kalu aku salah pilih perkataan terbaik..

sejak tu aku sangat berhati-hati bila nak sampaikan berita buruk.. owhh keje A&E memang banyak kena sampaikan berita buruk.. sungguh ku menci!!

susah wooo nak guna perkataan dan cara yang paling hikmah utk menyampaikan berita buruk tau...

back to the early part of this entry --- aku rase statement yang betul patut nya macam ni:

"carik lah doktor yang berterus terang dan dapat bercerita tentang semua perkara berkaitan penyakit & treatment / management pesakit"

"anda sendiri patut tanya apape saje yang anda nak tahu.. anda ada hak"

Tapi bukan tanya samada pesakit akan matikah? -- semua orang PASTI mati!

Bukan tanya 'Berapa lama pesakit boleh hidup?' Itu semua kerja Allah.. doktor mungkin boleh memberi prediction (prognosis) berpandukan penyakit/keadaan semasa pesakit tapi again-- semua terletak di tanganNya...

aku sendiri sangat 'senang' kalau pesakit atau family yang tau apa yang diorang nak tau (maknanye bertanya yang sepatutnya). Dan lagi mudah kalau memang ada 'ilmu' sket (tahu tentang penyakit serba sedikit). Tapi aku tak kenan kalau yang cuba 'challenge' ilmu medik / sains dengan 'myth' atau petua2 yang tak masuk akal atau info2 dari sumber yang ntah hape-hape.

(Sila berhati-hati kalu mencarik maklumat di internet. Pastikan sumber anda boleh dipercayai!)

mungkin kadang2 anda akan berjumpa dengan doktor yang 'menyakitkan hati', tidak sensitif, ataupon 'bolayan' tapi doktor pon manusia.. nobody is perfect! (cuma doktor2 yang macam tu, bukan salah ibu mengandung, tp memang perangai memang dah macam tu, tak dapek den nak nolong!)

malah pesakit mahupon keluarga pesakit pon ada macam2 perangai... earlier said, nobody is perfect.. kita hanya ambil mana yang betul, yang salah jadikan sempadan.

prinsip aku senang, kalau aku tak nak orang buat aku macam tu, aku takkan buat kat orang lain. Atau kalau sebelum aku cakap sesuatu atau buat sesuatu, aku akan cuba meletakkan diriku di tempat pihak yang lagi satu (try to put yourself in their shoes)

kalau aku kurang ajar kat orang, orang lain mungkin akan berlaku kurang ajar balik, tp mungkin bukan pada aku tapi pada mak aku ke abah aku ke family members aku yang lain ke.. sure tak nak kan??

(paham kah?)

so, tepuk dada, tanya selera..

"what u give is what u get"

wallahualam

---

Faris & AGEL

ye.. last Thursday timbang, dia dh 8.7kg..

pastu cucuk 3rd dose DPT Hib, IPV.. tak nangis cam biasa lah hero ai yg sorang nih..

next week kena bawak lagi utk cucuk Hep B plak..


3 hari lagi genap Faris 6 bulan.. hmm pasni bleh pikir nak bagik dia makan plak..

selalu lah buat2 bagik dia or suap dia guna sudu tapi mesti dia tutup mulut hehhehe mesti dia ingat orang nak sumbat ubat kat dia... sebab now dia hari2 kena minum Agel 1 sudu pagi & 1 sudu malam. Tu yang kalau hulur sudu dia tutup mulut hahahhah


ingat tak ari tu bila aku cakap Faris wheezing & kena amik nebs 2x??
tak lama pastu, dia kena balik... plus demam.
Aku cam dah tak sedap hati nak terus bagik dia ventolin syrup, sbb nanti kaki dia akan terketar2..

So finally aku contact Salwa @ibukauthar untuk beli Agel UMI & EXO.. alhamdulillah lepas habis 1 pek, secretions dia berkurang.. (actually aku beli 2 pek each, tapi satu pek EXO & UMI tu Fatini & Haziq telah bedal tanpa pengetahuan aku... so kena roger2 Salwa balik utk get more stock, tp UMI ni memang hotcakes gamaknye, punya lah susah dapat stok ekkk...)

so, now aku still bagi - 1 sudu kecik UMI malam before tido & 1 sudu kecik EXO bangun pagi (before feeding).

Alhamdulillah secretions dia berkurang banyak kalau dulu tu memang berbunyi je tekak tu, tp dia akan wheezing jugak kalau time sejuk cuma takde lah macam dulu... dan sangat jarang lah..

bacalah kisah Agel ni kat sini atau sini atau sini

keberkesanan nye memang ku percaya sebab it contains high vitamins and antioxidants sbb tu ku yakin bagi pada Faris.
cuma, maaf ku terpaksa cakap, harganye agak mahal bagiku.. Untuk Faris, satu pek tu boleh la tahan 4-5 hari.. hmm now dah masuk pek ke-3..


---

Malaysia Boleh!

Semi final football (men) @ 25th Sea Games

Malaysia 3 - Laos 1

CONGRATS!!

First half they were good... we were leading 1-0
2nd half they went sloppy, lost & disorganized - Laos equalized @ 74th minute

haaa barulah gubra..

Alhamdulillah they quickly woke up from daydreaming and had another goal and another 10 minutes before time..

hmm.. aku memang layan bola.. in fact any games/sports...
cuma aku pelik naper Sukan SEA kali ni takde coverage
ni pon sebab masuk semi final ke baru ada live cast??! Ke sebab Menteri Belia & Sukan masuk campur??

aku rase ramai je orang Malaysia ni yang masih nak sokong team kita.. janji main jangan poyo... biar kalah tapi semangat melawan tu ada...

tp ku kesian tengok players Malaysia -- kurus kering cam tak cukup makan.. owhh mana otot-otot kental kalian hahahha

anyway, GOOD LUCK in the final game -- lawan Vietnam.. hmm.. kalu main poyo memang lunyai la kena ganyang... pape pon, with the spirit Malaysia Boleh!, i know Malaysia Boleh!!

ole ole ole...


mode: happy / semangat Malaysia Boleh hahha poyo kan... (lama haku tak layan bola.. dulu tengok gak EPL, World Cup tetengah malam etc tp ni sejak beranak pinak memang dah tak layan esp bila games selalu nye pepagi buta.. owhh baik ku tido hehhe)
---

MY HAPPY WHEEZER

HAPPY WHEEZERS = happy baby, but having wheeze

what it is exactly??

This is a condition in which a child, usually under 1 year old, has a chronic, persistent or intermittent wheeze, heard without a stethoscope, but is happy and smiling, not at all distressed.

It is thought that inflammation and oedema account for a more significant part of the airway obstruction in the very young child and hence bronchodilators are less effective.

The diagnosis "Happy wheezer" is thus for the most part a psychological reassurance, both for the parents and the physician. However, there is debate as to what the smiling actually means and whether is important to monitor oxygen levels in this apparently benign condition.

this happened to Faris since Monday.. but monday evening, he had wheeze but not really a happy one lah.. he looked 'uncomfortable' with the wheezing.. i'd partly blame the cold weather and rain in Cheras since morning and partly the 'secretions' that he had since God-knows-when..

i gave him syrup Ventolin, partly resolved but still wheezing..
when i listened to the chest -- wallahhh.. prolonged expiratory phase, rhonchi (wheezing) and also crepitations... temp - normal.. chest - subcostal recession but no laboured breathing..

i just watch an eye on him..
thank Allah, feeding OK, sleeping also OK. He was not cranky but i knew he was uncomfortable..
around 9.30pm, the wheezing almost gone.. and he slept soundly through the night.. alhamdulillah

but yesterday around 10am, my maid called up and
told me "Faris bernafas macam semalam la kak"

alamak.. my DH had a class in UM, and i stucked 'carless' (we carpooled today and he had the car keys)..
but later maid said, he slept ok after had his EBM.

@ 2pm, after DH finished his class we brought him to A&E..
his lungs had generalized rhonchi & creps.. so he had a nebuliser...
alamak.. payah nye nak bagi... he cried all the way.. cian nengok!!
then when the MO reviewed, lungs were clear, so he was discharged.

But then @5pm, when we were just about to leave the hospital ground, he wheezing again... huwarghh i'd blame the air-cond (in the car) this time (cos i left him with daddy in the car for 10 mins before i managed to 'cabut lari ' from bosses who were having discussion in front of the pintu jabatan)


so we went back to the A&E.. when examined, he still have the rhonchi and creps... (owh my poor baby...)
but no respiratory distress..
and he is the most happiest patient in the ER at that time.. ( I thanked Allah for that)

he had another nebs -- this time no crying at all.. the trick was -- i let him 'take' the mask voluntarily.. and being mummy's good boy, he was 95% compliant with the nebs.. (fuuhhh lega, at least i can guarantee he gets most of the medication)

after review, still generalized wheeze and creps.. so another nebs after half an hour.. (huwarghh kena tunggu lagi...)
so we waited, whilst i breastfed him.. then he slept..
this time much easier, with him soundly asleep, the nebs gets directly into his nostrils.. luckily the 'sound' of the gas did not scare him (or woke him up)..
after that, the lungs were clear.. alhamdulillah we went home.. cian kakak & abang (who cried gila-gila when we left the home with Faris)

last night, he was OK -- no more wheezing but he is still a HAPPY baby like always...

this morning, before i left -- i listened to his chest, alhamdulillah clear... creps also gone..
"hope that was our last visit to the asthma bay ok my dear Faris... "

so, the bottomline is:

if u are worried, just bring ur child to the nearest hospital... among the signs of respiratory distress (which necessitate emergency or immediate treatment) are:

- difficulty in breathing

- increased respiratory rate (normal : 20-40 per minute (infants), 20-30 per minute for preschool children)

- cyanosis (blue discoloration of face/extremities)

- fever, fits

- wheezing (not a happy one)
- use of accessory muscles eg neck muscles

- nasal flaring (idung kembang kempis bukan kerana dipuji )

- subcostal recession, intercostal recession

- chest indrawing


errr.. these are among the signs that i can still remember... uhh.. i tak buat Paeds rotation, so my knowledge agak kureng.. sorryyyyy.....

- -

T.H.R.U.S.H

ingatkan ari tu pas raya ku komplen pasal cracked nipple kan...





rentetan dari itu ----





i'm suffering from nipple thrush!!





Faris pon ada oral thrush...

THRUSH is aka candidiasis or fungal infection usually caused by a fungus known as Candida sp.

sakit and gatal nye na'uzubillah....


Allah je yg tau betapa sakit & seksanye...





SAKIT memang sampai ku rase kaki kejang2 cam tahan sakit contraction tau... sakit time Faris isap and kadang2 berdenyut2 bila-bila masa





GATAL nye masyaAllah.... kalau tak tahan ku garuk jugak!!! esp malam!!





how do i treat it???





ku guna Nystatin suspension utk sapu mulut Faris





and ku sapu gaks Nystatin susp tu around my areolar & nipples -- since i dont want to use other creams that maybe harmful if Faris accidentally ingest 'em (kalu aku tak cuci betul2)





and ultimately, i've started taking Fluconazole tablet -- an antifungal to treat candidiasis (or aka thrush). BUT Fluconazole is not recommended for baby below 6 months old.


Since it can also be excreted into breastmilk, i have to stop BF... yessss... ini yang paling mencabar..





BM yang ku pam di siang hari telah selamat DIBUANG begitu saje uhuk uhuk... at least 20oz terbuang hasil pumping kat tpt keje :(





tp ku teruskan direct BF waktu mlm, if possible selewat yg mungkin. Since fluconazole is a daily dose, ku mkn kul 6 pg and hoping by malam the level excreted in breastmilk will be lesser



why i only b'feed at night???

sebab:

ada site cakap tak kisah leh continue b'feeding since the antifungal can be used to treat the baby as well.

but pharmacist (read: my SIL) ckp takleh bagi kat baby below 6mo.

tapi ada je newborn/premie babies been treated successfully with this antifungal.

ada study done stated that fluconazole level in BM is less than level in plasma. So this level is considered safe for babies based on the dose used to treat the newborns.



so, taking all the above 'statements' and the fact that Faris always direct BF at night, so ku hanya BF him at night.

i would try to delay the time if possible.

For eg, 1st day, i only BF him after 12mn. He tolerated the bottles..

but 2nd day, he only accepted bottle in the evening, pastu refused... pas dapat nenen direct, dia refused to let go... bergantung sepanjang malam huwarggghhh...

hari seterusnya, gitu jugak.. kalu dia ngamok sgt and tak isap langsung botol, baru ku direct BF



actually Fluconazole should be taken for 7 to 14 days... tp ku hanya dapat amik 3 hari... owhhh sangat tak aci!!!!! bukan sbb ku tak compliant, tp ku tak tahan tengok Faris kemaruk mencarik... tambah lak ni weekend!!



now -- much much improved. His thrush dh takde. Ku still apply the nystatin suspension -- to prevent relapse.

gatal2 sudah manyak kurang!!! tp dia gatal2 tu kat tepi2 areolar tu taw.. siap kering2 lagi area kulit situ..

sakit?? owwhhh masih ada... masih kejang2 kaki menahan bila Faris isap. Tp sakit tu tak selama dulu meaning bila BF is established, the pain goes away (denyut sikit2 tu ada lah...) kalau memula dulu sakit sepjg feeding tau...

sakit dia kan, kalu nak describe -- it's deep pain.. sakit ya amat!! bayagkan nk pam pon guna suction level 2 je, tp sakit bila pam hanyalah 2/10 sakit ketika dirct BF ye....





nway, ku hanya berdoa moga ku cepat2 baik.. x syok tau BF dlm kesakitan.. uhuk uhuk...

sorry ku tak dapat nak attach any articles on this matter.. masa ku terhad. InsyaAllah kalu ada masa ku tolong C&P articles abt thrush ni ye.. buat masa ni, kalu anda berminat nak tau lebih psl ni -- go google lah... manyak je articles psl ni TAPI kalu anda mengalami problem ini atau tak sure sila consult your clinician ye.. jangan amik bulat2 apa yang ada di internet. Tak semua info betul.... sekian terima kasih

H1N1 -- what we should know

Salam,

Sahabat-sahabat ku..
Ye wabak influenza A H1N1 makin merebak, and mungkin ada yang kata makin teruk..
Rata-rata nye sume orang jadi panic and risau, tidak terkecuali yours truly ni, but when we are well-equipped with the facts and knowledge, insyaAllah yang susah akan jadi mudah apa yang penting??? KERJAAASAMAAA

Diriku sangat2 la sedih bila membaca blog2 yang memberi tanggapan negative bila berlakunye wabak ini…
but I cannot blame other peoples’ opinion.. some are based on experience(s), so I’ll try to let everyone know about some facts on this pandemic flu..

there are few facts that we all should and MUST know..

1) Influenza A H1N1 is a new/novel virus derived from mutation of the earlier virus. They (the researchers) believed it derived from the H1N1 virus from the pandemic 1918 (Spanish flu) [source: Morens DM et al, The persistent Legacy of the 1918 Influenza Virus; NEMJ 361;3] hahahha aku pon lom abis baca artikel nih!!

2) We are in the mitigation phase, so we cant cope to screen everyone or admit everyone with symptoms of flu. Rase-rase nye semua orang ada symptoms flu eg demam, batuk and selsema.. jadi tidak cost-effective utk screen semua orang.

3) Bukan hospitals atau A&E menolak kes-kes demam selsema anda, tp MEMBERI PRIORITI kepada yang lebih kritikal… tolong lah kasihani doktor2 dan staff2 yang bekerja bertungkus lumus di A&E tu.. jangan lah maki2 mereka bila anda tidak dilayan… (bayangkan anda bekerja bagai nak rak menolong orang tp bukan ucapan terima kasih yg dapat, tp dimaki hamun!!) Saya merupakan bekas staf A&E dan saya paham perasaan tu, sbb tu saya merajuk dan lari berurusan dengan kuman-kuman je di lab, diorang tak pandai maki saya, tp saya maki diorang kalau tak nak tumbuh hahahhaha

4) Pesakit2 yang dilihat di A&E akan di’screen’ betul2 supaya hanya mereka yang betul2 memerlukan admission akan dimasukkan ke dalam wad contoh mereka yang mengalami komplikasi respiratori (pernafasan), jantung, neurological etc ataupon mereka yang berisiko tinggi eg wanita mengandung, pesakit2 kronik (jantung, asthma, COAD etc).. mereka akan di’assess’ menggunakan CLINICAL ASSESSMENT TOOLS (CAT) (rujuk bawah)

5) Jika anda disuruh balik rumah and kuarantin kan diri, SILA lah kuarantin kan diri anda.. kalau nak bersosial dgn ahli keluarga, sila pakai mask. Tak salah kalau duduk sama2 tengok TV atau berbual, tp PAKAI LAH MASK! Kerana virus ni merebak melalui respiratori droplets (batuk, bersin dan bercakap tersembur2 ayaq liuq nye ). And pls adhere to PATIENT HOME ASSESSMENT TOOLS yang diberi kepada anda (rujuk bawah).

6) Jika anda rase anda ada flu, sila KUARANTIN kan diri selama 7 hari dari onset of symptoms dan amalkan HAND HYGIENE & COUGH ETIQUETTE… tidak perlu ke hospital jika symptoms anda tidak teruk (refer PHAT di bawah). Kerana kalau pergi hospital, silap2 anda yang takde H1N1 akan dijangkiti plak H1N1 kerana sedia maklum hospital ramai orang yang sakit… kalau pegi hospital, jangan bawak budak kecik esp less than 2 year old..

7) Tidak semua orang suspected to have flu memerlukan antiviral (Tamiflu). Most of the cases hanya memerlukan supportive treatment. Jangan la plak marah doctor tu kalau dia suruh anda balik & bagi anda panadol and ubat batuk je.. kerana mmg itulah ubatnya. Viral infection is self-limiting. Except in severe cases, we have to ‘intervene’ with antiviral (esp when an individual cant fight the virus alone). So Tamiflu is RESERVED for admitted cases and those yang highly suspected of H1N1 tp kena home-quarantine.

8) Tapi jika anda diberi ubat Tamiflu, TOLONG lah makan, kerana anda adalah orang ‘terpilih’ yang diberi antiviral tersebut. Walaupon anda makan supplements, antiviral has their own activity against viruses. Supplement food only to strengthen ur body defense..

9) Jika anda takde flu, jangan la plak saje suka-suka makan antiviral kerana ini akan menyebabkan ‘resistance to the antiviral’..

10) Lab test adalah dgn mengambil ‘throat swab’… dan ujian rapid test dan PCR akan dijalankan utk confirm kan virus H1N1.. satu test takde la sampai beribu RM (tak tau la kalau ada yang charge sampai 1K) – tp PCR mmg MAHAL.. tp di PPUKM dalam RM250.. that’s why kita hanya buat test utk kes-kes yang masuk wad sahaja…

11) Kebanyakan kematian merupakan mereka yang muda dan apparently sihat. Jadi kita masih tak paham VIRULENCE of this virus… ada yang hari ni demam selsema, esok sihat lusa tiba-tiba tenat dan na’uzubillah meninggal.. kita (read the researchers bukan saya :p) masih buat research and study on this virus…

12) JADI, kita kena fahami situasi kita supaya kita bleh tangani wabak ini.. wallahualam… semua orang mainkan peranan masing2… GO FIGHT WIN yeayyy…

PATIENT HOME ASSESSMENT TOOL (PHAT) –
adults
- designed to detect moderate to severe influenza , can be used to guide the patient on the need to seek professional medical attention
- patients with ILI (influenza-like illness) are advised to seek medical care should they develop any of the symptoms and signs listed below:-

i) respiratory difficulties : shortness of breath, rapid breathing or purple or blue discoloration of lips

ii) coughing out blood or blood-streaked sputum
iii) persistent chest pain
iv) persistent diarrhea and / or vomiting
v) fever persisting beyond 3 days or recurring after 3 days
vi) abnormal behaviour, confusion, less responsive, fits
vii) dizziness when standing and / or reduced urine production

PATIENT HOME ASSESSMENT TOOL (PHAT) – children
(paediatrics)
- children should be brought to the nearest hospital for further assessment if they developed the following signs and symptoms:-

i) lethargy or poor oral intake
ii) change in mental status or behaviour eg drowsiness, irritability
iii) signs of dehydration : sunken eyes, dry tongue, absence of tears during crying or poor urine output
iv) increasing respiratory rate : fast breathing, noisy breathing, presence of chest recession
v) fits
vi) cyanosis (purple discoloration)
vii) persistent fever

CLINICAL ASSESSMENT TOOL (CAT) –
adults

1) respiratory impairment
2) evidence of clinical dehydration or clinical shock
3) altered conscious level (esp in extremes of age)
4) other clinical concerns : rapidly progressive (esp high fever >3days )or serious atypical illness OR severe and persistent vomiting / diarrhoea

CLINICAL ASSESSMENT TOOL (CAT) – children

- severe respiratory distress – lower chest wall in-drawing, sternal recession, grunting or noisy breathing when calm à anda akan tahu jika anak anda susah bernafas, dada nye berombak2 dan pernafasannye berbunyi
- increased respiratory rate - >50 breaths/min if under 1 year old; or >40 breaths/min if > 1 year old
- oxygen saturation <92% -- ni kena pakai special machine
- respiratory exhaustion or apnoeic episode (tiba-tiba tidak bernafas ie >20 seconds pause in breathing)
- evidence of severe clinical dehydration
- altered conscious level

** itu adalah antara tanda2 yang akan di ‘assess’ oleh doktor2 utk melayakkan anak kita masuk wad atau tidak… tp jangan takut, kalau ada sikit2 tanda macam tu pon insyaAllah akan masuk wad, sbb kanak2 esp bwh umo 2 tahun lebih berisiko tinggi… (bunyi macam dah teruk baru nak masuk wad kan???

Bukan begitu, itu hanya panduan, tp by experience, kita para doctor tau siapa
yang layak masuk wad and siapa yang tidak. Kalau kira macam ‘borderline’ case,
kita akan masukkan jugak utk pemantauan…

Last but not least (seperti pesanan cikgu mentor ku saya )
** SILA CUCI TANGAN ANDA….
** amalkan kebersihan diri… cuci tangan, cough etiquette – tutup mulut jika bersin atau batuk, buang tisu yang telah digunakan ke dalam tong sampah bukan main campak merata-rata
** jika ada symptoms flu atau ILI, pakai la mask kalau nak berjumpa / berkawan dgn orang lain….


Pesanan saya:

anak2 yang demam atau suspected ada ILI, jangan anta nursery atau sekolah, kuarantin kan mereka.. kesian la anak2 saya yg di nursery itu… uhuk uhuk

Jika anda pon demam selsema, jangan pegi keje tp jgn saje2 ponteng keje shopping raya – ohh saya ada plan nak buat camtu aci kah?? hehhehe

Elakkan membawa anak2 pergi ke tempat2 yang ramai orang atau bersesak-sesak.. ohhh mana lah saya nak bawa anak2 saya jalan2 weekend ni ye??



abah saya plak selalu pesan, kalau bersin masa tgh mengadap makanan, pergi basuh tangan, memula dulu saya musykil kenapa… sekarang baru saya paham….



Sebarang kemusykilan, jangan malu-malu kucing untuk bertanya….
Atau rujuk website MOH (www.moh.gov.my/ ) atau CDC (www.cdc.gov/h1n1flu )

Lagi sekali… APA YANG PENTING???? “KERJAAASAMAAA….”

---