Is this a case of vasospasm?   I saw this mom 6 wks p.p.  She had been
complaining for the past 5 wks of sore nipples, blistering, cracking and
blanching.  The nipples were pink with a blister on one.  Baby had good latch
but jaw not tight, using football hold, baby was in a good pos.  Mom
complaining from latch of severe pain untill letdown, very active letdown but
baby appeared to be handling well.  Then baby would seem to bite at nipple
5-6 min. into feed then mom had another let down.  When baby was removed from
br. nipple was blanched and flatened.  Baby would be agitated at times just
prior to latch and some times during a feed also with clinched fists. Mom
also c/o burning after nrsg.
Tx. with Nistatin cr and nistatinsusp for baby.---- No relief
Tx. with warmth & ellicit letdown prior to latch.---- sl relief
Tx. with more freq fds or pump occ. -----sl relief

I am an RN IBCLC that works as a LC for a large HMO.  Any ideas or
sugestions?