Re the mom with extremely inverted/invaginated nipples.  Her engorgement was
a wonder to behold yesterday morning when I went to see her, despite wearing
cabbage all night, periodic icy cold compresses, and pumping.  I worked with
her doing very gentle breast massage as did one of the other LCs at the
hospital.  The pain, as you can imagine, was tremendous.  She was switched
over to an SMB which she found much more gentle than the Lactina, but she
still could not get it above medium without a lot of pain.  It caused a
terrific amount of edema in the tissue surrounding the nipple, so we switched
back to the smaller flange.  However, the upshot of the whole thing was that
both of us concluded that this lady probably only has one, or at the most,
two patent ducts on the left side, and probably only one on the right side.
Four days of pumping religiously and hand expression (when breasts were
comfortably full, not horrendously engorged), RPS -- the whole nine yards,
only yielded a total of two teaspoons of milk, one drop at a time.

By yesterday afternoon the engorgement was in her armpits, the breasts were
red & hot to the touch.   She was on Vicodan for the pain.

Continuing to pump seemed to be the wrong way to go, as it continues to send
messages to the brain to produce more and more, without any egress from the
breast.  So she's stopping all together -- that can't be more painful that
what she is doing now.  She's using peppermint oil/lotion on her breasts to
soothe them, cabbage, icy cold compresses, and Sudafed to flatten prolactin
levels.  And inbetween times, she's gonna eat peppermint altoids.

If anyone is interested in hearing the rest of the story which I'll find out
today, please let me know.  But -- do I believe/am I convinced that there can
be blind ducts in a breast?  That there can be nipples with such an anomaly
that milk can't be released because of no patent nipple pores?  You betcha!
It's a first for me, and Lord willing, it will be a last.

Jan Barger, RN, MA, IBCLC -- Wheaton IL
Lactation Education Consultants
www.lactationeducationconsultants.com

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