Dear Diane,

The longest I have had a mom hang in there with really horrible nipples
was a remarkable woman who I worked with quite a few years ago, soon
after I was certified the first time around.  She was a beautiful Italian
lady who had had breast cancer with a subsequent radical mastectomy on
the left side.  After giving birth ( long and difficult including pit and
3 hours of pushing with  one shot of demerol in the middle at around 5
cm.) to a lovely little girl, she proceeded to develop severe damage on
the remaining rt. nipple.  When I saw her first on Day 10 where was
tissue missing from the middle of the nipple, eventually forming a
permanent little crater.  We tried quite a few things (baby had a high
palate), but with no other breast to use for relief, the pain continued.
She couldn't take the pain anymore and on Day 16 D/Cd bf and began
pumping.  She didn't like the idea of finger-feeding, spoons, etc. and
decided to use a bottle to give EHM.  Eventually she had to also
supplement with ABM.  The nipple improved dramatically the first week,
but then did not see much progress - the doctor and I convinced her
finally that the purple tissue in the middle of her nipple was scar
tisssue, evidence of healing.  The trick then was to get the baby back to
breast, which didn't turn out to be hard at all.  The real problem was
the mom's overwhelming fear of re-damaging the nipple.  She went very
slowly, just a few minutes a day at first.  By Day 33 the nipple was
looking almost normal again and mom was a little less apprehensive about
nursing, but still going slowly.(meanwhile we are closely watching wet
diapers, wgt. gain).  On Day 50 she took a 2 week vacation in Italy(with
baby) and continued pumping. By Day 60 mom was nursing baby every 2-4
hours, for 10-15 minutes.  Doctor gave the go-ahead to D/C ABM.  Mom went
on to nurse this one for over a year.  She developed a sore nipple with
the next child, pumped for about a week until it healed (didn't wait for
the damage to get so severe that time) and went on to nurse her son also
for over a year.  I have lost touch with this special couple and still
say a prayer now and then for her, hoping that she has remained healthy
and able to raise her children in the wonderful way that I know she
would.
Other moms have hung in for longer periods with off-again, on-again sore
nipples, but none experienced the total maceration of the tip that I saw
with this one, and none had only one breast to work with.  She remains my
most memorable case.
Sorry this ended up so long.  Dug out my notes on her case and it really
took my back to my first days as an LC.  Good luck.

Sharon Knorr
Lactation Consultant Services
Rochester, New York
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