Dear Everyone,
Well, that got a bit of activity going, didn't it?!
Judy H. Knopf, when are you likely to visit us in Oz? You ask as many
questions as we do!
There was an article on the use of ultrasound for blocked ducts in lactating
breasts in Breastfeeding Review No 1 or 2, in about 1983, reprinted from the
original article in the Australian Journal of Physiotherapy. It was written
by a physio, Margaret Shellshear (?spelling). My BRs are all at home, so I
can't check them here at Anne's.
Mothers do not need to be referred to a physio by a doctor - they can just
take themselves along to one without any health care provider's referral if
they wish. (In Australia, anyway! We are considerably more free to self-
refer to hcp's here than you may be elsewhere in the world.) All
physiotherapists are trained in the use of ultrasound for therapeutic rather
than diagnostic purposes. I am not happy about doctors using ultrasound
equipment unless they have been trained to do so. The dosage level used on
breasts is fairly low, and has been reduced further on what it was in 1983.
It is important that the practitioner using ultrasound knows the usage
criteria because it is possible to damage delicate body tissues with too
high a dosage level of ultrasound treatment. There are also cautions issued
about the use of ultrasound on infected tissues because of the risk of
spreading the infection further. This is not generally regarded as a
significant risk when treating breasts because the recommended dosage levels
are low, and in fact one of the case histories in the BR article was of a
breast that was infected so badly that it was just at the early abscess
stage, and the ultrasound treatment resolved it within hours. I can report
similar outcomes with many other women in this situation in the 12 years
since. (It seems to work if the abscess has not encapsulated - if it has,
surgical drainage is more appropriate treatment.)
Ultrasound works by the effect of very fast vibration of the molecules in
the body tissues being treated. This causes local friction of those
molecules and therefore local heat production. It is very effective for
breaking up lumps of cheesy milk residues such as in blocked ducts (the
Americans call them plugged ducts). Ultrasound is a form of sound waves, but
at a frequency the human ear can't hear.
The advantages of using ultrasound on these breast conditions are that
physios are easily accessible in most local communities (here anyway!), it's
a fairly cheap, non-invasive and pain-free treatment that takes only about
10-15 minutes, that provides very fast resolution of the problem. (Within 8
hours.)
The 1993 article in BR was a study that looked at the effectiveness of
ultrasound on breast engorgement. The findings were that this was not an
effective way of resolving engorgement. This does not surprise me, and the
other methods we are more familiar with are more helpful in these cases.
(And soaking breasts in very warm solutions of Epsom's Salts (Magnesium
Sulphate) is magic for those really intractable cases! It works by simple
osmosis to unload excess fluid from body tissues - but needs to be washed
off breasts before feeding/expressing, to avoid exposing the baby to the
magnesium which is a heavy metal.)
Other than "caked breast", the extreme form of blocked ducts (where the milk
would all be "spaghetti milk" ), which I mentioned in my previous letter,
these are the only situations where ultrasound will be appropriate
treatment. We can't see any virtue at all in attempting to express a mother
who has these extreme problems until some hours after the ultrasound
(usually 4-8 hours, depending on severity) when hopefully her baby will be
interested in helping her to drain the breasts! And it becomes much more
like her normal pleasant experience of breastfeeding.
Robyn Noble and Anne Bovey, Brisbane, Australia
(More 4 year olds with endless questions!!)
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