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Maenfayne November 20th, 2013 02:18 AM

Update on meeting with IBCLC
 
It was a wonderful experience. Not only was there an IBCLC there, but she had two students along with her. The three women were so kind to me, and not judgmental at all. (I say this, because my WIC LC was always so quick to tell me how wrong everything was - such as pumping and giving a bottle while out and about.) Anyway, at first they listened to our BFing story and then got a starting weight on Colton. I then fed him, and they helped with some positioning to help my arms get a rest. They also observed his latch and saw how he kept breaking suction and coming off the breast as well as his limited lip flange. After feeding, we weighed him again. He had only consumed an ounce after aprx a 30 min feed. They then did an oral exam and confirmed the upper lip tie, and also felt what may be a tongue tie. She said she felt a small band, but wants an ENT to assess it for sure. I then fed him on the other side and they were able to help me position him in a slightly downward way, so his head is tilted up like drinking from a glass. This cut the pain drastically! I mean seriously... without the shield it usually feels like he's going to slice my left nipple right off. After this adjustment there was hardly any discomfort.

So here's what they said after all the observations. It appears as though his lip tie is impairing his feeding. They suspect the possible tongue tie is also contributing. He is having to work far too hard to get the milk out, and is clearly not getting much out even then. His weight is also on the low end, not worrisome yet, but borderline. Due to this they want me to supplement with pumped milk throughout the day.

BFing plan:
Adjust positioning as shown, breaking suction if latch is painful. Utilizing nipple shield as needed.
Keep using paced bottle feeding method (we have been doing this anyway)
Try giving 0.5-1.0 oz by bottle prior to nursing a few times daily
Try pumping for a few minutes after feedings as many times a day as possible
Set up an assessment with an ENT
Continue with craniosacral therapy

The supplementation with pumped milk is supposed to serve two purposes. One, he'll be getting more milk and therefor gain weight better. Two, it will give him a break from having to work so hard so he'll have more energy for growing and developing. I'm not too worried about him preferring the bottle over breast. Even though he does eat from it faster, he doesn't seem to really want it. He wants the boob. I think it's the closeness and the snuggles that he loves :wub:

I have a follow up next Monday to see how things are going.

mgm78 November 20th, 2013 05:12 AM

Re: Update on meeting with IBCLC
 
glad it went well, when is your ENT visit?

juleeannk November 20th, 2013 06:00 AM

Re: Update on meeting with IBCLC
 
That is fantastic! I am so glad you got some great help!

ThaiSpice November 20th, 2013 07:18 AM

Re: Update on meeting with IBCLC
 
So glad it went well! From what I hear, getting the lip/tongue tie fixed can make a huge difference. I hope things keep getting better!

Maenfayne November 20th, 2013 12:36 PM

Re: Update on meeting with IBCLC
 
We don't have an ent visit set up yet. I have some calls to make since it isn't covered by our insurance. Some accept cash payments and others do a payment plan. The dr I want to see is $150 die the assessment alone. If he does require a revision, it's a $200 deposit and then whatever the cost of procedure is after that.

I want so badly to get care for my little guy. We simply can't afford $150 right now, let alone the cost of procedure. I go back to work 12/6 so that's what I'll be working for.

Rachel November 20th, 2013 02:43 PM

Re: Update on meeting with IBCLC
 
That is wonderful! I'm so glad it went well!

juleeannk November 21st, 2013 07:03 AM

Re: Update on meeting with IBCLC
 
Is it Dr. Ghaheri? And are you sure it's not covered by your insurance? Are they trying to bill medical or dental? It should be done medical. I would encourage you to call your insurance provider and give them to code D7960 to see if it's covered and don't take no for an answer. Still bill for it and appeal it if they wont cover it. It may take some time and effort but to get reimbursed is worth it.

Maenfayne November 21st, 2013 07:28 AM

Re: Update on meeting with IBCLC
 
It is Dr Ghaheri. He comes so highly recommended, does the procedure via laser, and will tell you if LO honestly doesn't need the procedure. I love that! A doctor who cares more about the patient than making an extra dollar. LO's on Care Oregon through Healthy Kids which doesn't cover specialty services. I'll give it a go with that billing code though. I really appreciate your help.

juleeannk November 21st, 2013 07:34 AM

Re: Update on meeting with IBCLC
 
My niece is also covered by the state and she was denied a growth hormone and they appealed it and got it covered.

juleeannk November 21st, 2013 07:48 AM

Re: Update on meeting with IBCLC
 
40819 for maxillary lip tie, 41115 for lingual tongue tie. Medical insurance said these were valid even if performed by a dentist and not necessarily another type of provider.

Maenfayne November 21st, 2013 08:00 AM

Re: Update on meeting with IBCLC
 
Ha! I just asked if it covered both but you answered me first lol Thanks for reading my mind :)

mgm78 November 21st, 2013 08:48 AM

Re: Update on meeting with IBCLC
 
good luck with the insurance and KUP!!

Maenfayne November 21st, 2013 01:51 PM

Re: Update on meeting with IBCLC
 
I just got off the phone with my insurance company and couldn't be happier. I called and asked if they could look up those code, and the rep asked what I was hoping to have done. I told him LO needed to see an ENT and he said, oh well that would be covered under specialty care. I asked him to check and make sure it was covered and it is! My PCP was misinformed, and my member handbook doesn't list specialty care, but it is indeed covered! Dr Ghaheri is also a provider that accepts CareOregon! So now I just need to call his clinic to verify that they still indeed accept the insurance and set up an appointment! I'm SOOOOOOO happy right now. (behind the happiness is a bit of anger towards his PCP for misinforming us. Although I should have called a long time ago myself.)

-erin- November 24th, 2013 05:55 PM

Re: Update on meeting with IBCLC
 
good luck with the lip tie! I'm looking into getting my son's upper lip tie fixed soon


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