Mary, you wrote:

<We are wondering why it is puffy, and since this was the nipple with the
worse crack, wondering about bacteria. . . . .  Yes, we're working on latch
and management of OMER. I wonder if anyone has any insight on causes or
treatment options for her right puffy, painful nipple? I am feeling out of
ideas for this mom, have told her and referred, but no one has come up with
anything else yet....
Thanks!>

Puffiness indicates excess tissue fluid (interstitial fluid).BF Atlas, by
Barbara Wilson-Clay/Kay Hoover has a picture of the measurements of a nipple
before and size increase after pumping. There is dairy research about how
various levels of vacuum change the length (shortens), and widens the
external diameter of the external surface and narrows the interior teat
canal of goats' teats, measurements correlating with the degrees of vacuum.

Although you indicate part of the problem is oversupply/
OMER, is she ever using a pump whatsoever??? Is she of the mistaken opinion
that higher vacuum will remove more milk more rapidly??? Or using such a
small flange tunnel on that side that all vacuum is drawing in and focusing
on just the nipple and not a fair part of the areola to compress the
subareolar ducts (sinuses) against the tunnel?

Reverse pressure softening directly on the nipple itself is effective in
helping excess interstitial fluid move into the dermal lymphatic vessels and
back further toward venous and lymphatic drainage vessels in the deeper
breast, but of course, the pumping aspect must be explored to avoid
re-puffing the nipple.

A small ice bag wrapped in a very warm washcloth to start application (of
less than 20 minutes), can help numb the pain and help reabsorb the excess
tissue fluid. Only problem-if there is a tendency toward Raynaud's this will
tend to set off spasms.

Jean
****
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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