Rachel, besides the other suggestions that are coming in - is an 
anti-inflammatory part of the treatment? Ibuprofen, as per package insert, 
should help with both the pain and the inflammation. Pain seems to me to  be 
the most pressing issue at the moment, and pain isn't nice. It affects 
everything. This poor mother. I really feel for her. I assume she has a 
repeat on her anti-biotic script so that she has 10-14 days of treatment.

This may be one occasion when cold packs could be judiciously used - trial 
and error, with your own clinical judgment and long experience - if she 
doesn't have a history of Raynaud's phenomemon. On one occasion years ago 
with a mother in distress with nearly bursting breasts, I reversed the usual 
and tried a cold pack before feeding. The rationale was to do something 
about the inflammation, as nothing would flow unless that was addressed. The 
cold helped. I can't recall all the details, except that I was really 
concerned and had to think on my feet, and that this strategy led to 
improvement. It took several days to clear completely.

The deep burning pain - have you investigated yeast, or are you associating 
it with the bacterial infection?

Virginia
in Brisbane, QLD, Australia

----- Original Message ----- 
From: "Rachel Myr" <>
To: <[log in to unmask]>
Sent: Wednesday, January 08, 2014 5:35 PM
Subject: need help with difficult oversupply case


> I'm trying to help a mother who since her second baby was born 3 weeks ago
> has been struggling with oversupply. Full drainage gave immediate relief
> but she was already very sore as baby was tongue-tied and holidays delayed
> getting that fixed. Baby gained well despite ineffective feeding because
> mother was producing buckets from day 3; after frenotomy baby feeds well
> and sores are healed. At one week she had ramoant mastitis, started
> antibiotic treatment as clinically she was very ill. Cultures from sores
> and from milk were positive for S.aureus and Group B strep, but antibiotic
> covered both. During mastitis she drained both breasts at least 8 times/24
> hours. Drinking sage tea, one cup per day divided in three doses, have not
> seen any noticeable effect but we don't know how much she would be
> producing without it.
>
> Throughout this time, she has had deep burning pain in both breasts,
> worsening immediately after feeds, and peaking an hour or two later, not
> totally subsiding in time for next feed or expression. Heat applied to
> breasts after feeding/expressing gives little relief. The only time she 
> was
> pain-free was the first time she tried full drainage and block feeding,
> when baby was five days old. Normally I don't recommend this method so
> early but her history of extreme oversupply with first baby made us think
> there was little to lose. Now I am not sure.
>
> The mastitis has been treated, but she still has the pain, and the
> oversupply. We are trying block feeding again, cautiously, but after less
> than 24 hours her breasts are tense, overfilled - and PAINFUL. She is
> exhausted besides. Wants very much to continue breastfeeding but also 
> wants
> this long drawn-out painful stuff to stop.
>
> I am not sure what to try next. We are open to all suggestions.
>
> Rachel Myr
> Norway
>
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