armet distinguishes between a 'plugged duct' and a filled duct.  The
filled duct usually presents with a white spot on the nipple, and the duct is
literally filled with congealed milk which when it comes out looks like a
piece of spaghetti or rubber, and once the congealed milk is out, fresh milk
comes squirting out.  This is generally very painful, until resolved.  I've
had several clients with this problem.  Massage of the breast seems to be the
only really effective method of resolving the problem.  Pumping &/ or having
the baby nurse in different positions sometimes helps, but I've never had a
mom clear the duct with out massage.  And we are talking about prolonged,
deep massage.  I've had one mother with repeat occurences who spends several
hours massaging them out.  Using a lubricant is helpful, during the massage,
and sometimes a father's hands are better able to do prolonged massage.  The
pain is generally constant, and is more intense during feeding.  The clients
I've had with this problem have usually ended up being diagnosed with either
a yeast problem or cow's milk allergy.  We've also looked at  saturated fat
intake, and using lecithin, etc.  I have had mother express some of the
congealed milk out and then 'hooked' the milk thread with a safety pin and
pull the rest out!  (the pin came no where near her skin)

These mom's have frequently presented complaining of a 'milk blister'.  But I
don't know if this would be related to the milk blister Lisa Amir was
referring to.

I remember knowing someone many years ago who did get literal blisters filled
with milk and she used warm, moist heat to soften the skin, which would then
spontaneously burst during nursing.  She would use the old method of putting
an empty glass jar under  hot running water letting it heat the jar up and
then placing the hot empty jar over the nipple/areola area.

Re:  Shooting pains in the breast unrelated to MER.  I used to experience
this starting when my daughter was about 9 months old.  I was one of those
who never 'felt' the MER/let-down so when they first appeared I thought there
was something physically wrong, but exams were normal.  These 'shooting
pains' continued on a sporadic basis throughtout over 5 years of lactation.
 After Brooke had weaned a fellow LLLL/LC Bonnie Durkitt (famous as the
originator of the "Dr, it's none of your business who I'm sleeping with' re:
the family bed quote) shared with me an article by Sheila Kippley concerning
caffeine causing sharp shooting pains in the breast.  I was stunned as I
realized my 'shooting pains' had diminished greatly when I switched from
caffeinated to decaffeinated coffee.  And I still get 'shooting pains' in the
breast if I happen to overindulge in caffeine products.  I've worked with a
number of moms who have found a similar connection.
I've wondered over the years if this could also be yeast connected.  By the
way, neither myself or the mothers with this problem have had any other
symptoms or dx of fibrocystic disease.

Has anyone else ever observed this caffeine/pain connection?  I think it
would be an interesting study area.

Kathe Catone, IBCLC,  LLLL    ([log in to unmask])