Hello all,

I have a lady that I am working with.  She has had a LOT of breast pain over
the last 9 - 10 months.  I have seen her, another IBCLC (who is IMO, VERY
qualified) has seen her, a Chiropracter has seen her and several doctors
have seen her.  None of us can figure this out.  Please help.  I had her
give me as complete of a history as she could recall, I have reprinted it
below, replacing the other LC's name with VP (I did not ask permission to
use her name on line.)

June 18th, 1996

Dear Linda,

I'll do my best to remember our nursing history for you.  Here it is:

Joey was born July 14th, 1995.  For the first ten days of nursing I had sore
nipples, even some bleeding, and sought advice from my midwives and La Leche
League.  After ten days of nursing frequently and using lots of Lansinoh, I
was fine.  A few weeks later we had a case of thrush, which cleared up
easily with the use of acidophilus on my nipples and orally, and bifidus
given orally to Joey.

Not knowing what to expect, and having a colicky baby, I started to become
very concerned when at 10 or 11 weeks Joey was still nursing every one to
two hours, even through the night, depriving me of any rest at all.  I came
into BESTFed and you suggested that I feed him only on one side per feeding,
to try to fill him up a little more on hind milk.  (He constantly had
terrible gas pains from the colic, and green slimy, smelly stools, which I
think I also mentioned to you at this time.) Unfortunately, at the same time
I spoke with several "friends" who really pressured me not to nurse so
frequently.  They assured me that when they stopped nursing so frequently,
their babies began sleeping through the night.  Desperate for sleep, I tried
other ways to calm Joey, including a pacifier, and they did work, but my
breasts became extremely engorged.  I tried to pump only when the pain
became unbearable, and waited for my milk production to adjust to the new
feeding patterns.  I tried natural remedies for excessive milk production
with no success, even drinking two cups of sage tea a day for five days in a
row, and wearing cabbage leaves in my bra 24 hours a day.  After about three
weeks of everyone from my naturopathic physician to La Leche League Leaders
to you telling me my body would adjust and produce less milk, I ended up
with a breast infection in both breasts, and made an appointment to see VP.
By then I had figured out that I'd better go back to more frequent feeding
and both breasts (at least for a while), and VP thought that that plus the
natural remedies for the infection should clear things up for me. For the
next month I arranged for Joey to come to any music rehearsals and
performances I had with a sitter, so I could nurse him during breaks instead
of using my pump, which wasn't as efficient at emptying my breasts as he
was.  I had been using a Nurture III with great success and satisfaction up
to this point.

I went back to my naturapathic physician and was told my breast infection
was gone (I think this was in late October).  I told her I still had pain,
especially in my nipples, and she suggested treating for thrush again, even
though Joey had no symptoms.  VP agreed that this was the best thing to do.
In the next month I tried acidophilus and bifidus again, with no
improvement.  Then I went to the medical doctor who was covered by my
insurance, and was given a liquid nystatin for both me and Joey.  It was
then suggested by VP that I get a cream for my nipples instead, so it could
be absorbed into the skin better.  My doctor would not prescribe this,
because he thought the liquid was adequate, so I went to the ASU student
health center, where I got the nystatin cream.  This also didn't work, so I
tried gentian violet for about a week (three days on, three days off,
another couple of days on).  Nothing helped!

Near the end of December the doctor at the health center referred me to
another doctor there, a former obstetrician.  He did a blood test to make
sure the infection  was really cleared up, and he said it was.  He said I
just had fair, sensitive skin and a baby with a strong suck, and needed to
toughen up my nipples.  He suggested I get tincture of benzoin to put on my
nipples, but when I got the bottle and it had a skull and crossbones and a
warning about how poisonous it was if taken internally, I decided I couldn't
put that on my nipples and nurse Joey, even after trying to wash it off.  I
checked with someone in La Leche League and was told that the sensitive
nipple idea was an outdated one anyway, and since I had had a period of
successful nursing, that the idea was not valid.

I ended up back at the medical doctor through our insurance, but saw a
different practitioner at that office.  She suggested a different cream for
thrush, sperazole, which also seemed to have no effect.  She then referred
me to a dermatologist (this was early in January), who thought it was
eczema, and prescribed a cortisone cream, which didn't help either.  I
wanted to go back to him, but my husband switched jobs and we were out of
health insurance for three months, and couldn't afford to pay for the visit.
I was also no longer a student, and could not go back to the student health
center.

I turned once again to VP, who watched me nurse to eliminate the possibility
that during the period when my breasts were hard and engorged Joey had
changed something in his nursing habits.  She said he looked great, and so
did a La Leche League leader who checked him a few weeks later.  At this
point I thought I just had to live with the pain.

In the middle of March there were about five days when my breasts felt
almost normal again, but then they became even more painful.  There didn't
seem to be any apparent reason for these changes.

When Joey was almost ten months old, in May, the pain became even worse, and
I began to wean him.  When I spoke to you again about two weeks later, he
was taking about half his feeds from a bottle, but the pain was not
decreasing.  After your encouragement to keep working on the problem (Thank
You!) I went back to exclusive breastfeeding.  About a week later he
suddenly started doing well eating solid food!  Up to this point solids had
given him miserable gas.  This has helped a little bit because when his gums
are hurting or he just wants to nurse because he's bored or cranky, I am
sometimes able to distract him with something else to taste, chew on or just
smoosh in his hands!  This hasn't actually lessened the pain in my breasts,
but it gives me a little more time in between nursings, which are painful.

Anyway, about two weeks ago I went back to the doctor on our insurance,
which we once again have, and we tried a course of antibiotics (I'm sorry, I
don't remember the name - something with a "d" at the beginning - I'll check
when I'm home), in case the infection really hadn't cleared up in the first
place.  (She told me that the blood test to check for an infection in
December wouldn't have done any good because the white blood count only
remains elevated for about two weeks after getting an infection, and then
returns to normal whether or not the infection is gone.)  For about eight
days the breast pain, but not the nipple pain, got a little better.  Then
for the last two days of antibiotics the breast pain got worse again, and
the nipple pain got worse than usual too.  Now we are back to nystatin
liquid for Joey and nystatin cream for me, going once again for the yeast
possibility.  We've been doing the nystatin for about three days now, with
no improvement yet.  She also gave me more sperazole in case the nystatin
doesn't work.

Let me try to describe the pain for you.  The nipples are painful when Joey
nurses, or if anything brushes against them.  The pain feels kind of like
someone rubbing against an open sore on the skin.  There is sometimes a very
mild itching sensation on the areola - its been more frequent in the past
week or so.  The areola looks normal, but the nipple is always a darker pink
than it used to be.  About half the time the tip of the nipple is the same
darker pink, the other half, its purple-ish.  When the tip is purple, its
more painful.

The rest of the breasts are sensitive to the touch, as if someone were
pressing hard on a badly bruised area.  This pain really doesn't get
significantly better or worse under different conditions.  This has become
more annoying now that Joey likes to try to climb me when he's playing.

I am still very committed to nursing Joey until he weans himself, but am not
sure how much longer I can do this.  I am especially concerned because my
husband and I would like to try to have another baby within the next 18
months if possible, and I can't imagine having to nurse a newborn so
frequently with such pain, especially while trying to continue nursing Joey.
It has been especially difficult without 100%  support from my husband and
the rest of my family.  My support has been coming from you, my co-workers,
and friends I have made through La Leche League.

I hope I've remembered everything.  Let me know if you have any questions.

Thanks!

K

Linda Pohl, IBCLC
Phoenix, Arizona USA
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