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From:
Chris Mulford <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 20 May 2002 01:14:32 EDT
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To: Jayne Charlamb, M.D.
Breast Care Center, Syracuse, New York

Dear Jayne,
Here's what I know about breast duct stones.  (It's not much.)

1. I spoke on the phone once with a woman who was, I think, an experienced
nursing mother.  She had at least one plugged duct that she was treating with
massage and hand expression in a warm shower, and described expressing more
than once a small, hard stone "like a diamond."

2. I asked a dairy scientist from Penn State whether cows get milk duct
stones, and he said yes, it happens sometimes.

3. Just by analogy (not very scientific, I know), it makes sense that it's
possible for stones to form in milk ducts the way people can have stones in
bile ducts, ureters...and did I read once about stones in salivary ducts?
Basically lots of body processes involve fluids moving through tubes, and
lots of pathology involves things happening to block the tubes that carry
fluids. Sometimes even the fluid itself that is supposed to be flowing
through the tube can cause a blockage, if it gets too thick or too
solid--blood clots, mucus, impacted stool--or if minerals precipitate out of
the fluid to form stones, crystals, whatever.  All of these blockages would
be indications of less-than-ideally-healthy function of the body part
involved.  All of them would be painful.  Some would be life-threatening.

4. So health involves the proper flow of fluids in their respective tubes,
and physical assessment could involve checking all the fluids to see whether
they were "just rollin' along" the way they're supposed to be.  The breast is
such a fascinating organ because its fluids flow only at certain periods in
the reproductive cycle, unlike air and blood and GI tract contents, that are
moving every day.

Maybe my ideas are colored at the moment because I just came back from a
month in Malaysia.  (Hi, everybody!  I'm home!)  One knee developed pain and
swelling in the last couple of weeks, and my friends took me to see a Chinese
chiropractor, who gave me great short-term relief with massage, lumbo-sacral
adjustments, and accupuncture.  I know that a lot of Chinese medicine is
based on theories about the flow of energy through the body--that viewpoint
takes my conception of health as the flow of physical fluids through tubes
several steps further.

.....Well, let me get back to Western reality and welcome you to Lactnet.  I
bet you can be a wonderful resource for this network, too, because of your
work at a "Breast Care Center."  Tell us more about what you do.  I'm always
looking for a lactation-attuned breast expert to help me figure unusual
things out.

Here's the strangest phenomenon I ever saw in a lactating woman.  Excuse me
for telling this story from memory and not trying to find my notes.  A woman
with a young baby---under two months, as I recall, was having what she
described as repeated painful plugged ducts.  She may have been entirely
pumping and bottle feeding--I'm a bit unclear on the details.  When I did a
home visit, what I observed was that when an area of the breast was
developing a painful spot, the contour of the breast also changed, as if half
a ping pong ball was under the skin---there was that much deformation of her
normal breast shape.  There was a lot of pain, and nothing we tried (nursing,
pumping, heat and cold were the likely options then) seemed to help, but
inside a 15-30 minute period the shape change and the pain went away.  Then
another ping pong ball showed up elsewhere, either in the same breast or in
the other one.  In a two-hour visit there were at least three bumps that came
and went.  I was totally baffled, and I don't think we came up with either an
answer or a way to make her more comfortable.  The only other thing I
remember was that she was a person I would describe as "nervous," so I
wondered whether this could be a psychosomatic phenomenon, but I had no
theory to explain what was going on in the breast to make it change shape
that quickly.  Fluid must have been blocked and then released, and the most
likely fluid is milk, but I have no clue what could be blocking it
intermittently like that, or why the blocked area would look so round instead
of wedge-shaped.

Well, Lactnet buddies, what do you think?

Chris Mulford, RN, IBCLC
Swarthmore  PA
Eastern USA

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