Hello, it has been a few months since I have written.  I had a mother
with a 3 week old come in to my office today complaining of breast pain.
Today is the first time I have met this family.  It does not exactly fit
anything I have read or seen before and so I seek the breadth of
Lactnetters experience.  A brief history--C/S delivery, was told had
"inverted nipples" in hospital where they used a regular bottle nipple
to "pull them out and "teach the baby how to suck."  The baby did
eventually take all feeds from the breast.  Mom then developed a cracked
nipple.  Mom quit nursing for 24 hours, but then got so engorged that
she wanted to breastfeed to stop that pain.  She went to her WIC office
where they helped her get the baby back on the breast and allow for the
cracked nipple to heal with the use of a nipple shield and L******h.
From the time her milk came in, she says she had a "burning" pain on her
left breast in a wedge area between 1 o'clock and 3 o'clock. She denies
a fire-like or shooting pain.  The pain is 24 hours/day and worsens with
feeding. She has tried different positions with no relief.  5 days ago
she went to her midwife because she was tired of the pain, not because
it had worsened or changed.  The midwife prescribed antibiotics for
mastitis as the pain was localized and one sided, although mom had no
other symptoms:  no redness, no lumps, no fever, no generalized aches.  
        Today, when I saw her, her nipple crack (yes, it's on the same
left breast, between 12 o'clock and 4 o'clock) is now well healed breast
tissue. No relief or worsening of pain with antibiotics. No surface
signs of thrush.  No pain in other breast (she uses nipple shield
bilaterally).  She dreads feeding time as the pain is unbearable.  I
observed the baby feed without the shield and then with the shield as
mom stated the pain was so bad even after readjusting the latch.  After
clarification, I discovered the nipple pain resolved with the
readjusting, it was the other pain that was so bad. She experiences no
pain with the right side, but uses the shield on the right because of
her fear of pain. (we can work on weaning from the shield later).  Mom
boils the shield between feeds but not sides. Any ideas about the pain
and how to help?  I am down to two sources:  1) ductal yeast--but the
pain is worst during feeds or with engorgement, and otherwise constant;
wouldn't she have some surface symptoms during these 2.5 weeks of steady
pain--(also, baby does not have oral thrush symptoms and other breast is
fine even though she uses the same shield)? or 2) "painful letdown" but
the pain is constant and localized. I must admit I have not seen ductal
yeast before.  
I would appreciate direct responses as I have been swamped lately (just
moved into new home) and was nomail.  But I will be checking for posted
responses also.  Thanks in advance...

Judy Rosen, MSN, RNC, CLC, IBCLC
Mom of Kai, who weaned at 2.5 years in January, and ?? (now 21 weeks)
 

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