Ok, so what is chylothorax? It is a condition that results in fluid building up in the space around the lungs because of leaking lymphatic ducts or drains. The lymphatic system has hair-like structures that run all around the heart area and carry fats to where they need to go in the body. During Teagan's surgery, those drains were challenged by both the Turner Syndrome she has and the surgery itself. That means she has leaking into her chest around her lungs when she eats milk with fat in it. It is like a garden hose with a bunch of holes poked in it. Turn the water on, the water leaks out. Same concept. Put fats into her body, they will leak out and in her chest space. The solution? To turn the hose off, or stop giving her fat in her diet. Say what? How can you even do that? Don't we need fat? The simple answer is yes. We spin the breastmilk to remove the type of fat that travels through the lymphatic channels and replace it with other fats that can be absorbed through the blood.
Teagan is battling chylothorax for her second time, the first being after her first open heart surgery. We knew to watch for it because she is at high risk for developing it, and when it came we were quick to treat it. Treatment is a standard 6-8 weeks of fat-free diet, whether skimmed milk, fat-free formula, or TPN. Teagan has yet to tolerate any formula, even the hypoallergenic types, and TPN is not a super optimal choice. So that leaves us with skimmed breastmilk. I wasn't ready to give up giving her the best otion in nutrition, either, which is breastmilk if at all feasible.
So there's the "why". Like I said, there may be other reasons to do it, but this is ours. Next is the "how". When we were inpatient, the hospital used a centrifuge to spin my breastmilk to less than 1% milk fat. Because Teagan struggled so badly the first go around with chylothorax (even the oils that shouldn't cause issues did!), we need the lowest fat % possible to ensure she heals. So it was time to go home, but we needed to figure out how to skim the fat out of the milk. The hospital has a centrifuge they aren't using but after trying hard to borrow it for the 6-8 weeks needed, they emphatically said no for liability reasons. So where did that leave us? We thought of buying a centrifuge but they are expensive and that was money we just didn't have. I had heard of using a washing machine to spin it, and our incredible lactation consultant had as well. She had taken the time to learn and try the method out lined here. She had drawn up step-by-step by step instructions on how to do it, sewed tube-like sleeves, and encouraged me as I learned the process over many tears. I was ready to give it a go. I didn't have a choice and my back was against a wall. Teagan is worth it. But wait. I didn't own a top loader washing machine, the type you need to do this. God provided, twice over. :) I was now the proud owner of two washing machines parked in my homeschool room for the sole purpose of spinning milk. The hospital was ready to discharge us.
WHOA! Say what?! I quickly reminded them that I had never done it this way, only using the centrifuge, and through tears poured my heart out to the cardiologist with my fears that I would screw up and kill my sweet girl. So we waited a day and I worked on it overnight. I had it down, and the test confirmed that I was spinning the milk to the same levels or close to what the hospital was spinning it to. We took our baby girl home and I spun away.
Let me tell you up front...this is not for the faint of heart. Even 8 kids deep and two open heart surgeries under our belt and by day 2 I wanted out, BAD. It took me literally all day to spin enough milk for Teagan. I couldn't spend that much time on it and still care for my family, much less keep up with the demands of Teagan's care. Long story short, I have gotten better at it and while it is still time consuming (about 3 hours a day) it is a lot easier and quicker than it was. As of today we are just over 3 weeks deep of spinning milk at home.
So here is the meat. The "how".
Start with a top-loading washing machine. It has to have an agitator and it has to load from the top so as to keep the milk separated when the agitator stops spinning. These are ours.
Next, take a 60mL syringe (we also use 35mL) to draw up cold breastmilk to be spun. I have found that my machine allows me to use about 33mL per syringe. I fill all of the syringes at the same time and cap them with the orange caps that come with them.
Place one syringe into each end of the sleeves. Make sure that the orange capped end is loaded pointing toward the opening. Otherwise you will not be able to skim the milk correctly. These are cloth tubes that our lactation consultant had sewn for us for this purpose. I tied them in a knot in the middle and can put one syringe on each side of the sleeves. I secured them at the bottom with a safety pin. I have also seen pantyhose used instead of sewn sleeves.
We removed the agitator from the washing machine. The washing machine we use is designated for spinning milk and we do not use it for our clothes, so we had this luxury. You can do it with the agitator left on, as well. It MUST be a top loading machine. A front loader doesn't typically have an agitator, anyway. I tied the loops I had created in the middle of the sleeves over the agitator and tighten them. Set your washing machine to the spin cycle ONLY. I found that I needed to run our spin cycle twice, for a total of 16 minutes, to get the milk adequately separated.
This is what the milk will look like when you take it out of the washing machine. The milk will be closest to the plunger, the skimmed milk will be closest to the bottom. At this point you can put the syringes in the refrigerator standing straight up and down to firm the fat. I didn't find it to make much of a difference in the end. Slowly push the plunger down until to get very close to the creamy fat line. This will be the skimmed milk. I then pushed the fat into a separate bottle and froze it to use for later.
You do need to supplement the spun breastmilk with other fats for health reasons and for proper braing development. Teagan gets 3mL of walnut oil three times a day, as well as 3mL MCT oil three times a day.