I am hoping to pick the brains of all you thousands of LC's out there...
I am working with a woman who has a six month old baby. I saw her for the
first time five days ago. She has been struggling with plugged ducts in her left
breast since the begining of nursing, though she has never had any problem of
any kind in her right breast. She has been taking Lecithin since the first month
which has been helpful in warding off the plugged ducts.
Except for occasional plugs from the time the baby was one month old until
now, she has been nursing without pain or problems. She returned to work in
October and pumped every 3 to 4 hours at work and brought the milk home for
the baby and nursed the baby at night and on the weekends.
Within the last month she has developed two blisters on her left nipple which
may be blebs from her description. When I saw them one was crusted over
and one was a red spot, but she says at times they have been filled with
white fluid. Her left breast has been "cloggy" for three weeks, often not
draining well with pumping or feeding, leaving her with a "cottage cheesey"
feeling, as she puts it, to the whole lower half of her breast. She can
sometimes get it to drain well and then the lumps go away, but she is left with
a residual soreness, which is constant.Sometimes she has an extremely painful
burning sensation in the lower half of the breast, to the point where she
thinks she may have to wean. As I said, she had been plagued with plugged
ducts in this breast, but this feels different to her. It seems like she has a
good day and then a bad day and then a good day, but she is never pain-free.
My recommendations were to start on an antibiotic in case there was some
sort of subclinical bacterial mastitis. She did start 4 days ago on Keflex with
no relief. She started on APNO for the blisters at the same time, with no relief.
I also recommended frequent emptying of the breast, she had been allowing it
to fill for up to 7 hours at a time since baby is a single side nurser. Emptying
frequently does seem to help somewhat, but has not cleared up the situation.
She does not have a seat belt or handbag or anything that restricts flow on
that side. She carries the baby in a Baby Bjorn, which distributes the weight
evenly over both shoulders.
I suggested to her OB that they consider a culture of her nipple, possible
treatment with fluconazole (though it seems so atypical of yeast to me that it
is hard for me believe that is the problem) and imaging of the breast to take a
look at whether there are abscesses or cysts causing problems.Perhaps an
ultrasound might give us some answers. They don't seem too enthusiastic
about any of these suggestions.
I also suggesting decreasing the size of her pump flange since she had been
using a size 27 and she has small nipples and breasts and was having a painful
pullling sensation when she pumped. I thought perhaps too much breast tissue
was being pulled into the pump.
Has anybody had a situation pop up like this well into a fairly uneventful
nursing course - burning, not draining, "cottage cheesey" feeling to half of
the breast, constant soreness even when the breast is empty,for three
weeks? If you have had this situation, what did it turn out to be? I am going
to talk to the OB tomorrow hopefully, so if anyone has any great ideas for me
to pass on to him that would be great.Thanks mucho!!!
Kathy Lilleskov RN IBCLC
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