A quick reintroduction...I've posted once before. I am an RN, IBCLC (hospital
based) working at Packard Children's Hospital at Stanford in Palo Alto, CA.
I have an interesting and challenging case I would appreciate some collective
wisdom on.
Baby is thriving, 9 weeks old, and  exclusively breastfed.  Wish I could say
mother was doing as well.  At about one week post partum she developed
mastitis of right breast and presented at a local ER with a temp of 106.  She
was treated with IV antibiotics and sent home 3 hr. later with oral
antibiotics. Several days later she was called back to the ER for a further
injection of antibiotics for possible (my interpretation) positive blood
culture.  This did not occur at the hosp. where I work so I don't have access
to her chart.  Mastitis resolved on the right and within several weeks she
developed symptoms of mastitis on the left treated by pediatrician with 1/2
the proper dosage of antibiotics (according to mother). Of course, mastitis
recurred on that side and this time she was hospitalized for a 3 day course
of IV antibiotics. Ultrasound at that time ruled out abscess. Through all
this she breastfed her baby which brings me to the current issue.  I saw her
several days ago for the first time. with severe burning pain of left nipple
radiating to her back along nerve pathways. She has seen a breastfeeding
savvy dermatologist who treated her with Diflucan for 2 weeks and then
cultured nipples and milk and reassured her that yeast had resolved.  Nipples
are pink but pain occurs only on left side.  I watched infant feed on that
side and as with 9 week old babies she latched her own  way.  Mother reported
a low level of pain .  Infant then nursed on right...mother had no pain on
that side.  She began to experience the burning shooting pains in the other
nipple (left) at this time and i watched it blanch and then turn pink again
as the pain subsided.  This happened at least 4 times.  I sent her home with
explanation of vasospasm and recommended warmth and Ibuprofen to get through
the weekend.  My suspicion is that the 2 episodes of severe mastitis on that
side may have heightened nerve sensitivity in that nipple.  So to my
questions.
1.  She does not have this pain  when she pumps.  Would it be a good idea for
her to pump for a while in hopes that this nerve sensitivity gets
better...she has no history of Reynaud's.   2. In searching the archives
there was a review of the JHL article on Staph aureus nipple infection
leading to mastitis.  Five women in the study developed deep, radiating,
burning breast pain and vasospasm of the nipple. 12% of infants had
significant retrognathia (receding chin).  Coincidentally, or mabe not, the
first thing I noticed about this infant was her receding chin.  So...this
mother has pink nipples but no cracking...do they warrant any kind of topical
treatment? and is there a way to position this infant so receding chin and
underbite does not traumatize that left nipple...mother used cradle hold.  3.
What are your experiences with NIfedipine.?..I've had several mothers get
severe headaches so am reluctant to recommend it but will if we can't fix
this mom some other way...she has been very brave. 4. Barbara Wilson Clay,
this sounds a lot like your mothers with persistent breast pain...anything
I'm missing?  Thanks all for bearing with this long history.  Looking forward
to your feedback.

Kathy Boggs, RNC, IBCLC

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