On Sat, 10 Sep 2005 10:16:07 -0400, Vaishali Kute <[log in to unmask]> wrote:

>Kathy, thanks for your reply.
>
>Mom # 3 had been pumping with small flange for about 7-8 days. She
>switched to larger flange about 8 days ago at which time I noticed
>yellowish crusting on the tips of her nipples and started her on Bactroban
>ointment. The pain did not get any better.
>
>Clindamycin was started 3 days ago and as of yesterday she did not have
>much relief. The pain is worst during pumping and the nipples are
>exquisitely sensitive to touch. The lumps in her breast don't change much
>after pumping.

Is the pain from pumping inhibiting letdown and so she's just not emptying
very well?  Have you been able to watch her pump to see what her nipples
look like during and afterwards, and to make sure that she's not cranking
the pump up to full suction?

A couple things to try:
Lubricate the tunnel part of the flanges with olive oil and avoid putting
*anything else* on the nipples -- friction can cause major irritation and
pain (especially from residue from topicals that increase "drag" when
pumping -- lanolin and then bactroban really tore up my nipples and areolae
before I figured this out).  Many moms who have to pump exclusively wouldn't
even consider pumping without "lubing up" first.  Not all moms find they
need this, though, but it would certainly be worth trying.

I assume this mom is using a hospital-grade pump?  Some full-time pumpers
find that they absolutely need the "gentleness" of a hospital-grade pump or
else they become very sore very quickly.  And many do report that they have
some initial weeks of tenderness as they adjust to using a pump full-time
and figure out what settings work best for them, but this obviously sounds
much worse.

And I echo the suggestions to go ahead and treat for yeast, especially since
this mom has been and is currently on antibiotics.  As I already mentioned,
I'd be very cautious about using topicals when pumping, however, since even
small amounts of residue remaining on the nipple (and you really can't wipe
everything off, nor would it be comfortable to do so if she's in so much
pain) can cause significant irritation and splitting of the skin.

Good luck to this mom.
-Sarah Reece-Stremtan, MD

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