Hi Karyn-Grace

You sound VERY frustrated!  And I can certainly see why. When I 
worked in private practice I used to find that breast and 
breastfeeding problems used to come in bouts - a series of difficult 
non-latching babies, a slew of moms with mastitis, a succession of 
sore/damaged nipples that wouldn't heal. It was inexplicable, 
really.  Maybe you're in the middle of one of those periods ...

However, as to the current mystifying situation, lots of moms with 
on-going sore nipples that just wont heal .... I've had some of those 
too.  Often the mothers had been experiencing really badly damaged 
nipples for weeks before seeing me, and/or there would simply be 
extreme pain without damage -the nipples would look mildly pink.  The 
mothers had often tried everything with no success, eg adjusting 
positioning, trying all sorts of creams and ointments, and treating 
for Thrush - to no avail.  Often I was the only person who really 
believed that the mom felt such terrible pain or had coped with 
wounded nipples for so long.  Sometimes there would also be breast 
pain and/or mastitis.   I eventually learned - as a first option, 
rather than a last resort -  to send these mothers into their doctors 
with a request for a culture of the milk or a nipple swab. Nearly 
always, the the lab confirmed that there was infection with Staph 
Pyogenes, and they would sent back a list of appropriate antibiotics 
that the infection would respond to, and the doctors would 
prescribe.  I would follow up really closely and send the mother back 
to the doctor just before the end of the course if symptoms 
persisted.   Sometimes the course of antibiotics needed to be 
repeated over three weeks or even longer before the nipples would 
completely heal and/or all of the pain resolved.  But afterwards the 
mother would always say that the difference was like a "miracle".

IMHO I think we often try to fix chronic sore nipples by trying 
everything else first - when underneath everything, the main culprit 
is a bacterial infection.  I found I could save weeks of 
experimentation, pain and suffering by ensuring that bacterial causes 
were investigated - and ruled out - first.

Jaye, your case history would seem to be relevant to this situation too.

Pamela Morrison IBCLC
Rustington, England
--------------------------------
Date:    Thu, 18 Mar 2010 22:08:30 -0700
From:    Karyn-grace <[log in to unmask]>
Subject: Why don't nipples heal anymore?

Hello, wise ones.

I am wondering if anyone else out there is struggling as I am with what to
do about VERY wounded nipples that won't heal?  To clarify:

I am seeing clients at 1, 2, and even 3 months post partum presenting with
long-term chronic situations because clients are being referred to me as a
last resort (thanks, people!) and by the time I begin working with the
mother, I honestly have no CLUE what is going on with her nipple tissue.
Not too long ago, it all seemed to just be yeast, and mom would respond well
to appropriate treatment.  Then, we started to realize that it wasn't only
yeast, it was also bacteria or maybe just bacteria, but if we caught it soon
enough, Dr. Jack's APNO would work wonders.

Then, of course there things like tongue tie, palate abnormalities,
prematurity, damage from in correct pump uses, etc. etc. and bottles were
introduced and shields were introduced and then there are the moms who are
allergic to wool who react to the lanolin, and moms who develop dermatitis
because of all the activity at their breasts, and, of course plugged ducts
and mastitis and, and, and, and...

Now, it seems like all my clients are dealing with ALL of these problems and
I have no idea how to help them.  Long gone is the dyad who had one or two
issues that *I* understood, now I am dealing with clients who have so many
layers of complexity, that *MY* mind is drawing a blank.

Am I the only one out there who is dealing with this?

And, mostly, I need to know how the heck do I get those nipples healed?

Karyn-grace Clarke, IBCLC
Happy Tribe Consulting
"For Milk Makers, Drinkers, and Those Who Love Them"
Nanaimo, BC, Canada
250-739-3146

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