Carol writes:
<which brings me to jean's description of treating 'nipple edema' by
moving
the water out of the nipple. i thought this was really good approach to
solving the problem, but now that i have just had all this info about the
lymphatic system, i would like to point out that i think that simply
moving
the excess fluid out of the nipple into the surrounding tissues might
either
not work or only work temporarily. of course, temporarily might be
enough.
but why does this work or how?>
To reemphasize:
I use reverse pressure softening on the areola adjacent to the nipple,
not the nipple itself. The results are admittedly temporary as far as
interstitial fluid goes. But it also temporarily displaces milk as well
as interstitial fluid. It often then allows for painless digital
extraction in an areola where it was impossible, or too painful to use
the Marmet technique to soften the areola. And it invariably triggers a
MER.
It is a way I have found to use approximately 3 minutes or less to alter
the compressibility of the edematous areola long enough for the baby to
get a fighting chance at a good latch. I personally think it is less
traumatic to tissues, and often more effective than the application of a
pump.
I too found the description of the course fascinating. (Too many courses,
too little time and money to take them all in one year!) I hope it is
presented again in the future.
I have had to content myself with further reading in my faithful old
edition of Guyton, about the presence of numerous small lymphatic vessels
in the dermal lymphatic plexus surrounding the areola and the fact that
the cells of the lymphatic vessels overlap. This allows pressure to open
the junction of the cells inward, so that excess interstitial fluid can
be moved into the lumen.
But due to the overlapping, the presence of lymph inside the vessel
pressing outward makes adjacent cells close the junction, preventing the
fluid from getting back out of the vessel once it is inside. At that
time, it is then properly called "lymph", and is on its way back to dump
into the general circulation in the chest.
So the reverse pressure, in addition to moving the excess tissue fluid
from around those cells into some other interstitial area, may also press
some into nearby lymphatic vessels.
The points you made about working on the total edema situation have
merit. But my suggestion is designed as a simple, quick intervention to
facilitate latching, and buying time till natural diuresis can bring
better balance of tissue fluids (or till someone with the time and
expertise performs the technique you describe.)
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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