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35 year old primip with 12 week old, History of early hyperlactation.
Mother developed symptoms of plugged ducts 5 weeks ago in left breast.  Did rest, heat, massage and increased pumping/breastfeeding without a significant difference.  Plugged ducts occurred in right breast shortly afterward but resolved with above treatment.  Left breast remained uncomfortable.
Mother had already returned to work part time and had baby on a schedule of 6 feedings daily, 2 at breast and 4 at bottle of EBM, partly because baby was very uncomfortable at breast (probably because of hyperlactation.)  Mother had full freezer of milk.
Sent to physical therapist for plugged duct ultrasound treatment which patient said was extremely painful and resulted in more pain thereafter.
Symptoms continued for 3 more weeks with subsequent reduction in milk production.  No fever, no chills, no body aches.  Mother has mild nipple soreness from pumping. Encouraged to let baby to breast more often and explained about biological norms for feeding frequency.
Mother given script for antibiotics to start if she felt it was not improving so she began taking it 10 days ago.  Some improvement but not significant.  Considered switching antibiotic but client declined.  No signs of yeast in mom or baby.
Now on last day of antibiotics and has suppressed lactation (just used last bottle of EBM) and still has an uncomfortable left breast.  Baby is going to breast more often now but still takes milk in bottle while mom is working and sometimes after breastfeeding.  Mom's pumping sessions are less productive (2oz several times daily) and she is stressed.  Has been on mothers milk tea and doing hand expression after pumping but not seeing an increase in production.
Exam shows fullness and tenderness but no distinct masses.  Has been taking advil on and off for inflammation which helps but not curative.
My next step would be to send for an ultrasound but I don't expect to find anything.
Thoughts from the collective wisdom of this wonderful lactation community?
Annie Brown, FNP, IBCLC
Greenwich CT
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