I probably see several people each month who have wasted lots of time
treating breast pain (deep or shallow) with thrush medications in the
absence of direct contact with someone who has observed a feeding. The
observation part of lactation consulting is too critical to minimize.
Generally, with good history taking, observation of mother's nursing
position and baby's latch, one can come up with a real clue as to what is
going on with deep breast pain. Sometimes it is a result of fungal
infection. But many times I have observed a pinched up nipple after the
feed, with nipple blanching. This is very traumatic -- like slamming the
door repeatedly on your finger. This can make your whole hand hurt, and
repeated compression trauma can make your whole breast hurt. Residual,
poorly draining milk can trigger inflammatory mastitis (afebrile but painful
and persistant).
There are other reasons besides candida for deep breast pain, and in my
opinion thrush treatment should not be initiated over the phone unless there
is some visible evidence of thrush in infant's mouth, or some other tip-off
(ie vaginal yeast, nipple discoloration, etc.) Even then, you can miss
secondary problems or confounding issues. Allergic dermatitis and bacterial
infection of the nipple are frequently mis-treated as candida, and unless
dealt with as well can delay improvement and prolong suffering. See Lisa
Amir's wonderful article in JHL on nipple eczema. In the same issue (Sept.
1993) Kathleen Huggins reports on 20 cases of persistent sore nipples (about
a collaboration between dermatologist and LC). Also in this issue is a short
case report called "Post-feed Breast Pain" by D. Ellis. She describes a
case similiar to one Judy Hopkinson described in and earlier JHL (1992) on
the subject of deep breast pain. These are quite useful articles to review,
and remind us not to get stuck in one frame of reference (ie Thrush Mode)
for every case of breast pain.
Ellis's article, which I found very interesting, described a stategy where
some relief was gained from a massage therapist who worked on the mother's
tight trapezius muscle. I personally get a bursitis in my left shoulder
from bending over and reaching around mothers while working. It creates
such muscle stress and girdles my back and reaches around to pull over my
left breast. Until I began to employ massage therapy (Traeger massage) I
was convinced I had breast cancer. My breast hurt constantly. I did, of
course, also get a mammogram.
Barbara
Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html
Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html
|
