I have permission to post.  A mother of 10 week old twins came to see me 
today.  She has been followed since I last saw her at discharge by her 
pediatrician and his LC.  She was treated for a yeast infection when the 
babies were 6 weeks old.  it cleared up well but then last week she began to 
experience breast pain again particularly on the right breast.  Thinking that 
the yeast infection had returned they resumed treatment of the mother but 
since the babies showed no sign of infection the pedi did not want to start 
them on meds again.  When her symptoms did not subside with her treatment, 
mom started all of them on gentian violet with no improvement.  Over the past 
48 hours the right nipple has become very painful even to touch never mind 
the nursing! Mom has had Raynaud's in the past but once she was diagnosed 
and treated for Addison's disease, her symptoms subsided. Her nipple does 
occasionally blanche but not consistently.  There is a light raised rash 
surrounding both nipples.  Mother has been using lotrimin.There were no signs 
of redness, inflammation or cracking of the nipple but mother said that the 
pain last night was excruciating.  Mom says that twin b has an extremely 
strong suck and that when this baby nurses it can be very painful.  No signs 
of tongue tie. Baby A has a slight torticollis and is being treated by CST.  I 
suggested CST for twin b as well.  Mom has been feeding twin b exclusively on 
the right breast. When it began to become very painful she did not want to 
risk injury to the left breast from this baby's strong suck.  Today she nursed 
the baby while I observed.  Suddenly the baby came off the breast and 
mother's breast was covered with blood.  we were both shocked as this was 
the first time in over 48 hours that it had not hurt her to feed this baby.  Still 
no signs of cracking.  With handexpression the milk was clear.  Over the next 
few hours mother experienced no further pain but baby did continue to spit up 
blood for about an hour after that morning nursing.  CAn any of you wise 
people tell us what happened?  We thought that perhaps there was an 
irritation of one of the ducts or an intraductal absces that broke.  There was 
no purulent drainage or thick ropey-like milk.  Any ideas?  Is this apt to re-
occur?  Thank you for your thoughts and suggestions.  Bobbie

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