I have been working with a mom at the hospital and I thought I'd ask for some
input. She has a six-month old baby and has recently developed three white
spots on one nipple that are very painful, to the point where for awhile she
couldn't nurse on that side and was manually expressing. I told her I
thought they were probably plugged ducts at the nipple openings (milk
"blebs"). Her doctor had told her they were blisters and she shouldn't nurse
on that side. When I saw her, she had some evidence of plugged ducts under
the area, which she said were not as bad as they had been; and the spots on
the nipple were no longer white, in fact were barely visible. She had been
doing all the recommended things - warm soaks, gentle manipulation, massage,
etc. She had also developed what looked like bruises, probably from too
aggressive manipulation of the plugged area. She said that although it
looked better, the spots on the nipple were still extremely painful. It
looked to me that, although milk was coming abudantly from surrounding pores,
it was not coming from the affected ones. I suggested she go to her doctor
and see if she would open them with a sterile needle. The doctor declined to
do so, feeling that at the time she saw them, they were draining milk; and
she had never done that and thought it would introduce bacteria. She put her
on dicloxicillin, which she has now been on for a week. The mom feels that
the affected ducts are partially draining, but not entirely, and they are
still very painful. Also, she says that the underlying lumpy duct area has
resolved. It sounds to me like this is gradually resolving, but the pain is
not improving. Any ideas or suggestions? It does not sound to me like
ductal yeast, and the mom has no history of yeast. Please e-mail me
privately since I will soon be going nomail. Miriam Levitt RN, IBCLC,
Berkeley, CA
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