This weekend

I have been questioning the use of a fortifier in my expressed breast milk from the very beginning. Because she is on fluid restrictions, the nutritionist wanted to increase Rebekah's calories per ounce. At first, while she was still in the NICU, they used HMF and then they transitioned to Enfamil. Both of these are bovine milk based. I had originally told them that I had gone off of all dairy in order to help her reflux and it had worked. Then they did this. I asked about the base for these fortifiers and they led me to believe that it was not cow's milk based. They lied! I just happened to pass by it in an attempt to figure out how to increase the calories in my own breast milk so that I would not have to use the fortifier at home. I was so irate that I immediately talked to the nurse practioner on call and he took her off until the morning. After the second feeding of straight breast milk, she was no longer refluxing. The next morning, they talked to me and suggested Elecare as a fortifier because it was already broken down into amino acids and is hypoallergenic and easier on the tummy. I agreed. By the time we left the hospital the next day she was refluxing at every meal again. I thought perhaps she would adjust and she had gained weight in the 3 weeks. However, seeing her struggle and then refuse the bottle that she seemed to want before made me question whether it was doing more harm than good. I understand, more than most, the nutritional side that their formula say she requires 318.5 cal in a day and that they calculate breast milk to be 20 cal/oz which would equal her getting 266.6 cal per day on her current feeds if she gets straight breast milk. According to her cardiologist, I can take her up on her fluids to where she gets 293.3 cal in a day. Now, what they don't realize is that she expends a great deal of energy refluxing and then throws up around 5-10 mL/feeding which means that for every feeding she gets with the fortifier, she is actually losing 36-72 cal/day. That would take her down to only getting between 246.5-282.5 cal that she keeps on days she gets fortifier. This is not counting the extra expended calories involved in the refluxing process itself. So, I took command and made the executive decision, which as Rebekah's medical advocate I have the right to do, and took her off the fortifier. Once again, no reflux on straight breast milk. Of course, she is still on Prevacid 2x/day which also plays a role. We see a nutritionist, for the first time since leaving the NICU, tomorrow. We will see what she says and hope that she agrees with me.