Hi, Susan.
       I've worked with numerous moms who have a white bleb on the nipple.  
Many times, they would open it (sterile needle, or soak in warm water and let 
baby's suction pull it open), have baby nurse, and then the nipple would look 
fine.  But a few feedings later, the white spot would be back.
       Sometimes, I think the "bleb" was never truly gone.  My suspicion is 
that, in many cases, the milk got stuck behind the epidermal layer that covered 
the nipple pore.  That milk then got thick as the water was reabsorbed as it 
sat in the duct.  So when baby nursed after the skin was initially opened, he 
pulled out the thickened milk at the very front of the duct, so the nipple 
*looked* better.  But I think the thickened milk actually filled a large portion 
of the duct, and does not move down and out the duct very well, because it is 
so thick.  As baby nurses during the next few feeds, he gradually moves the 
thickened milk that was farther back in the duct down to the nipple opening 
where it can be seen, so now mom thinks "it's back," but in reality it was never 
really all gone!  Because the milk is thick and slow-moving, the milk that 
forms behind it also cannot get out easily, so it begins to thicken as well, and 
we end up with a vicious cycle.
       I have had good luck in many of these instances by suggesting that, 
after she has opened the skin and the baby has removed the white part she can 
see at the front of the duct, (this is often best done when dad or someone else 
is around to watch the baby and any other children), she get in the tub. Have 
her fill the tub with enough warm water so that she can sort of comfortably 
lean over and submerge her breasts.  She should soak the breasts for 3-4 minutes 
to let the heat widen the ductwork as much as possible.  Then she should 
start just behind the nipple, and massage and try to express out a strip about an 
inch wide (from base of nipple back one inch, and all the way around the 
breast).  She may get out some more stringy thick milk.  Then she should move back 
another inch and massage and express that strip.  She may or may not see any 
thickened milk come out while she is in the tub.  Warn the mother that she may 
see this thickened milk, so she doesn't freak out if she sees it.  But 
reassure her that if she doesn't see it, but her massaging loosens it so it might 
come out the next time the baby nurses, it won't harm her baby.  It's just milk 
that has lost some of its water, but still has all its nutrients, antibodies, 
etc.  After I started suggesting this procedure to moms with "blebs," I have 
seen much fewer recurrences.
       On the other hand, it hasn't resolved all cases.  Sometimes it really 
has been thrush.  One mother in particular, had no other symptoms of thrush 
but the blebs on her nipples.  They would come and go, but nursing was quite 
painful whenever they were there.  With her first baby, I didn't yet know that 
thrush could cause nipple blisters, so she just struggled through for several 
months, until she couldn't stand the pain anymore.  The second time around, I 
knew about the relationship between thrush and some nipple blisters.  I 
explained it to her.  She was not really willing to ask her dr. for Diflucan, so I 
suggested the over-the-counter version of Dr. Newman's all purpose nipple 
ointment (APNO) that Barbara Wilson-Clay has developed.  She used this for several 
months.  Each time the bleb would resolve (more quickly than with baby #1, since 
she was using the APNO), but it kept coming back.  She finally decided she 
was tired of the recurring pain and asked her dr. for Diflucan.  That medicine 
resolved her pain permanently.
       When I was pregnant with my children, I craved chocolate with the 
first and orange juice with the second.  I have read that cravings often indicate 
some nutrient your body needs more of.  I figured with the orange juice, it 
was probably vitamin C that I needed.  But I think someone told me that craving 
chocolate could be a sign of vitamin B deficiency (don't remember which vit. 
B, but I've read several times that it's usually a good idea to keep the B 
vitamins in balance, so take a B-complex supplement rather than a single-B vitamin 
supplement).  I don't know how true this is, and I have no idea if coffee 
also contains vitamin B.  Perhaps someone on the list who is a dietician or 
nutritionist could let us know if there is/are any nutrient/s common to both coffee 
and chocolate.
       Dee


Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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