Heather, Your client's case makes me think of a few things. In my experience, pain free bf followed by painful bf often means a case of thrush. I am definitely of the mindset that thrush is greatly overdiagnosed and treated. I live in hot, humid New Orleans and rarely see or get a case of thrush but it does happen. Usually there is antibiotic use associated with this, and often concomitant vaginal yeast, baby thrush, diaper thrush etc. Thrush does usually seem to be bilateral in its presentation. In the mother you present, there is a history of sore, cracked nipples in the first days. This would be a red flag, to me, of possible anatomical concerns like ankyloglossia, very poor latching (even though you say he is thriving I would still look for this), and a risk for bacterial mastitis. If the nipples resolved easily and one month later the soreness occurred I would think of thrush. But if the nipple cracks resolved, but there was ongoing pain, I would think mastitis, continued trauma of some degree (though less severe than early days), and nerve pain due to the ongoing trauma. Mastitis is *usually* unilateral in its presentation, but can be bilateral and one tends to think of strep bacteria (vs the *usual* staph) when bilateral. Hope this helps in your client's case. <<Her symptoms are on both breasts, and she feels pain 'radiating' between feeds, often if she is going over a speed bump in the car, she says. It is also painful to feed, though the sore cracked nipples she had in the first days are now ok. Baby is fine, thriving, no issues with him.>> Laurie Wheeler, IBCLC, MN, RN New Orleans Louisiana, s.e. USA _________________________________________________________________ Find a broadband plan that fits. Great local deals on high-speed Internet access. http://click.atdmt.com/AVE/go/onm00200360ave/direct/01/ *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html