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Subject:
From:
Cindy Curtis <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 27 Apr 1999 22:05:47 -0400
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Hoping someone can help........

I have just searched the archives and didn't find what I need.

I am working with a mom who has had nipple pain for almost 2 months since
her daughter was born. First she had cracked nipples and positioning fixed
that, then she began to have yeast symptoms and was treated with Nystatin
ointment for her and suspension for the baby, followed by the whole 2 week
course of Diflucan,and following of Pat Gimas yeast tx plan, all of which
made NO improvements.  I am wondering if I should do a breast/nipple/milk
culture to look for strep  or staph infections.  Does this sound reasonable?
Exactly how do you culture a nipple? What type of swab is used? Should the
milk be cultured as well?

This is this womans 4 th baby, she fully breastfeed the first 2 for a long
time, the third she didn't breastfeed because she was discovered to have
cancer and had radiation/chemo after he was born. Not breast cancer.  Could
this cancer treatment effected her nipples in any way?


After a 2 hour visit with her today I gained some new info: please read on
if interested:

History: G5P5 mom who breastfed the first 3 children well over a year or 2
depending on the child without any complications.
Was diagnosed with Hodgkin's Lymphoma during the 4 th pregnancy and could
only breastfed that baby for one week because she had to start chemotherapy.
Took 18 months chemo, then had an  bone marrow transplant (5 years ago) then
a month of radiation to the mass which was located in the center chest area
above the breasts. Oncologist reports her to still have a mass there which
is believed to be scar tissue because it hasn't changed in years. Has had
close follow-up.

Delivered a healthy baby girl Feb 17, 1999, had initial bilateral sever
nipple pain and nipple cracking, positioning corrected most of this, had
nipple thrush and was treated with Nystatin Cream to the nipples, nystatin
Solution to the babies mouth and a 2 week course of oral Diflucan.  Right
breast is now fine, no pain in breast or nipple.  Left breast has been
experiencing severe shooting,stabbing pains almost since milk came in.  Pain
starts in the 12 o'clock position about 1-2 inches above the upper breast
edge and radiates towards the nipple. Mom applying direct pressure to the
area helps the pain, does not relieve it, pain is worse when breasts are
more full, pain is constant, always a dull pain with intermittent sharp
shooting pains throughout out the day at random times.  No correlation to
feeding, actually feels a little better during most feedings.

About 1 -2 inches above where the pain starts , patient had a Pherosis
catheter in for about a year during her treatment. Pt had a Grosong above
the other breast.  We have been in contact with her
radiologist,oncologist,OB/GYN,midwife,other Lactation Consultants, LLL  and
Physical Therapy to try and figures out the cause of this pain.

Our question to you, do you think that the catheter above the breast could
of damaged nerves,ducts or scar tissue something else that would cause this
type of pain in a breastfeeding mother? If so, what tests could we perform
to rule a problem in or out?  If there is a nerve,duct damage, what could be
done to repair it?

I emailed the above to Dr. Susan Love......well actually to her secretary ,
so hopefully she will reply.

Any advice still appreciated.  Started mom an Jacks APNO for the left nipple
today (4-27) and am getting her fitted with a good bra this week.

Cindy Curtis,RN,IBCLC
mailto:[log in to unmask]
http://www.erols.com/cindyrn

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