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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html