Dear Denise,
Thankyou so much for your clarification and indepth answer.
When used as a last ditch attempt to relieve engorgement, we have only 
used luke warm to cool water with the epsom salts. One mother requested 
ice in her bowl and loved it, much like cows who go down and immerse in 
the local creek for relief of their engorgement! Cool with engorgement and 
heat with mastitis. Yes, thankyou for that. When used we have had good 
success in both situations. 
It was recently(last week) pointed out that the treatment is not actually 
research based so we may need to delve further or ditch the treatment.
The whole issue of heat versus cold is divisive and many articles quote 
use of moist warmth and hot showers but my experience has also found 
immediate relief with that but subsequent massive throbbing=increased 
vasodilation and all the things you wrote about.
I like a Marsha Walker article including findings by Barnes(relating to 
ice and sports injury) about vaso constriction within 9 to 16 minutes of 
ice application followed by reflex vasodilation thereafter ie use the cold 
then the body takes care of the warmth itself.
[from Breastfeeding Abstracts,November 2000, Volume 20,Number 2,pp.11-12]. 

Use of cold with Reverse Pressure Softening and unrestricted feeding or 
pumping with breast compression and massage therefore sounds like a good 
group of offerings for engorgement.

It is still amazing to have 2 incredibly diverse/ contradictory treatments 
for the one situation - Some LC's are adament about use of heat first and 
others the use of cold.(Aside from the use of Epsom Salts and a soak.)

Thanks
Cath Williams :)

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