Winnie writes

<I come from the old "warm before, cold after" school,>

In certain cases, I think that still has a lot to recommend it Winnie.
Once again, it's not always a "one size fits all" situation.

< When I point out to a mom that warmth
increases circulation to the area which may aggravate the amount of
swelling, it makes sense to her.>

Maybe. Maybe not.

I guess that's where I came up with the concept of a traffic jam, and
having to make a choice of which lane to relieve congestion in first,
like the traffic cop.

It's the individual LC's judgement call to recommend what she thinks will
give the fastest relief for each mother. (Of course, it's the mother's
prerogative to choose to do otherwise.)

A breast that has a lot of milk in it has a different feel than one that
has so much overall edema you can't feel if the ducts are swollen.

50% of the glandular tissue is said to be in the upper outer quadrant. If
I have the chance to palpate, and detect the presence of full ducts
there, this makes me decide to use RPS and/or massage to trigger the MER
signal.

In that situation, I think the "stimulate that MER, dilate the arterioles
temporarily, and bring in the oxytocin to move that milk" has the
greatest potential to reduce the total volume of the breast the fastest.

If I am certain I can feel full ducts, I think the chance to remove 3 or
so ounces of milk is my best bet. I know for sure I am not going to get
rid of 3 ounces of blood, or 3 ounces of edema in 10 minutes flat.

After that 3 ounces of milk is gone, I "let the other lane go" i.e. put
on the cold for 20-30 minutes max, to constrict the circulation, as well
as numb the discomfort and start getting the edema reabsorbed into the
lymph capillaries to shuttle it away back toward the heart.

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

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