Hi all,

I have permission to post.  Mother is 38 years old, infant is 8 weeks old.  Mother also has a 6 year old she struggled to breastfeed, stopping at 1 week.  She's really trying to make it go this time.  She was referred to me by her friend who used to be WIC peer counselor.  Infant with tongue tie clipped by PCP and still with slight restriction.  Infant still only nursed with shield and always with pain so she has since begun pumping only.  She has very large breasts about an H cup on an average size frame. Had mastitis with classic symptoms diagnosed at 2 weeks post partum, then fluconazole for "interductal yeast".  She confesses that she did not finish the antibiotic because she began to feel better.  Nipples are also very problematic-they are wide and with crater-like inversion.  Upon our initial meeting she told me that she has to bite down on something to put the infant to breast and had actually vomitted with pain a few times.  Pumping is not much better.  She also has abundant supply-is only pumping twice daily for 15 oz at a time.

I cultured the milk and it grew enterobacter aerogenes-not sure if that is contaminant.  She is currently on both dicloxacillin and bactrim because her pain increased when we took her off the dicloxacillin.  Her nipples are better after a week of saline soaks, warmth, triamcinalone and bactroban.  Pumping pain is less but she hasn't increased the frequency because of the pain and oversupply.  She had a bleb yesterday that cleared quickly.  This morning she had a fair amount of bright red blood in the pumped milk.

Ongoing is this "excruciating" burning deep breast pain.  It cannot be correlated with any phase of pumping.  It wakes her in sleep and catches her off guard during the day.  Heat and pressure are not relieving.  She is taking ibuprofen regularly.

As you can imagine, this poor woman is nearing the end of her rope.  She had told me last week she eventually hoped to put the baby to breast but is having difficulty seeing an end to this discomfort.  I've seen so many women with deep breast pain before  but never of such intensity or duration.  I realize this may just need more time but I'm posting here to see if any of you have any experience and can advise me.  I did check the archives and think I've given her most of the recommendations I could glean from there.

Thanks in advance.  Sorry for the long post.

Mary Ryngaert ARNP IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome