Greetings!

I have enjoyed reading Lactnet for the past couple of months but have never
posted.   To share a little information about myself, my name is Carolyn
Zara. I started out as an elementary school teacher and have been a LLL
leader for almost 25 years, IBCLC since 1985 (just recertified by exam), RN
since 1990 and I am currently working on completion of my MSN in Parent Child
Health with Advanced Practice Nurse certification in Peds and Women's Health
at Kent State Univ.

I attended the first ILCA conference/meeting in Georgetown in 1985 and then
returned home to establish our own organization and become the founding
president of Ohio Lactation Consultant Assn. from 1985-1988.

I am currently working part-time in private practice as an LC and teaching
childbirth and breastfeeding classes in a small local hospital while going to
school full-time.  I have worked as an LC in a variety of sites: hospitals,
clinics, physician's offices, and WIC.

I have 2 children ages 26 yrs and 24 yrs.  Last year my husband was diagnosed
with Chronic Lyme Disease.

I would like to share a breastfeeding situation with you.

This morning at 7 AM I received a very frantic call from a young woman
breastfeeding a 4 month old (who normally feeds about every 2 hrs.) She said
she is an RN and her husband is a Radiologist.

Her question seemed similar to a question on the IBCLE exam last Monday.
She said she has had a plugged duct on the lateral side of her left breast
for about one month now that has been very painful.  One physician ordered
antibiotics even though she did not have mastitis.  (She did report she had
had several bouts of mastitis from a plugged duct in the same vicinity with
her two-year old child whom she nursed 15 months.)  As you might expect, she
found that the antibiotic did nothing to resolve the plugged duct.  She said
her breast gets better and then it get worse but currently is very painful
and sensitive even to the touch of her clothing.  She has spoken to her
family doctor and her OB.  One told her, since it's not mastitis, there is
nothing he can do.  She will either have to live with it or wean. The other
doctor referred her to an LC at the hospital who suggested she use massage,
hot soaks and different breastfeeding positional holds to drain that
particular part of the breast.

Early on, she says she noticed what looked like a white head on the nipple
(sounds like a clogged nipple pore?) but she is uncertain if that nipple pore
is draining; yesterday she poked it with a pin, made it bleed and pulled some
outer tissue off of the nipple but cannot tell if the nipple is draining in
that area. She has tried double pumping with the Lactina for 10 minutes
several times but says she gets nothing from either breast.

Her husband, the Radiologist, has several times aspirated fluid by needle
from this area of the breast which continued to drain through the skin after
the needle was removed.  She said her breast felt better for a couple of days
and then the nodule and terrible pain returned so he apirated again with
relief for several days but again there was return of these bothersome
symptoms. Her husband performed an ultrasound on her breast which she
decribed as "showing some big dark cavernous holes, one of which was
particularly large."  She had no other information about the ultrasound.

I told her I would need to meet with her to do an assessment.  We would need
to know what we were dealing with before I could proceed with any suggestions
however my thoughts were that there were at least 3 things I would be looking
for: 1) a stubborn plugged duct,  2) a clogged nipple pore,  or 3)  a
lactocele (which seems to be a possibility).  So we made an appointment for
an office visit for today.

Two hours later she called me back and cancelled our appointment stating that
she had discussed these possiblities with her husband who had talked with
other Radiologists, OBs and surgeons and decided to treat her himself and
would be inserting a drain in her breast to drain the "plugged duct" and
running a wire up the "clogged nipple pore" like an angio procedure.  She
said all of the doctors he had spoken with suggested she stop nursing on that
breast temporarily and perhaps permanently.  I warned her that this may lead
to engorgement and mastitis in other areas of the breast since only a small
area would be draining.

I never got a chance to see her, to make an assessment.  What do you think?

Carolyn Zara, RN, BSN, IBCLC