>She contacted me a few days later to give me an update. 
>Breastfeeding on her left breast was pain free but she was still 
>having a lot of pain after feeding as the right nipple was still 
>blanching(there were no cracks). I observed her feeding on the right 
>breast and noted the flow was quite fast and the baby was struggling 
>to cope at the beginning of the feed.

I wonder if perhaps the explanation is as simple as, vasospasm 
secondary to pinching/clamping/defensive tongue position of the baby 
due to an oversupply and/or OAMER on the right side only.  We know 
that it's very common for the right breast to produce more than the 
left, and we know that vasospasm may be triggered initially by nipple 
trauma such as biting or clamping.  The suboptimal positioning and 
latch may have simply compounded the problem on the right side, 
whereas they *were* the problem on the left side.

Good on you for helping this doctor-mother to a happy resolution!

Margaret
Longmont, CO

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