< She has been
> experiencing "breast pain" for about the last 2 weeks.  Her baby is 4
> weeks old.  It occurs in both breasts, but not at the same time.  It
> hurts for a second, then goes away, only to reccur a short time later
in
> a different place, and this goes on for an hour.  Some days it doesn't
> happen at all, she says it's "random' regarding when it will occur.

This does not sound like the typical severe, pathological pain of thrush
to me. It sounds as if it is related to the occasional occurrence of
overexpansion of the ducts. The MER will often cause momentary pain in
such a situation.

Have you investigated the possibility of oversupply? It is very common
for the MER to be especially strong if this is the case.

A few interesting factoids about MER and myoepithelial cells:

* They are not true muscle cells per se. (Muscle cells are connected
directly to and stimulated by nerves.)

* They are specialized epithelial cells that share some contractile
characteristics with muscle cells, but respond to the purely hormonal
stimulus of oxytocin bursts to produce the MER.

* While myoepithelial cells surrounding the alveoli have a basket like
configuration, those that surround the ducts, all the way down to and
including the milk sinuses, are arranged more longitudinally and
spirally.

* In this way, their contraction brings about simultaneous slight
shortening of the length and expansion of the diameter of the ducts
during MER.

Regulating the volume in the ducts at any one time, might reduce the
sensation of discomfort at the moment when this shortening and expansion
of the ducts takes place.

Have her try feeding a little oftener, rather than waiting till the baby
outright "demands" if the baby is going 3-4+ hours between several or
more feedings/24 hours.

Also suggest that she let the baby remove as much as possible from the
first breast first. In this way, he will probably cut back on whether he
takes the second breast every time, or as much of it each time he takes
it, fine-tuning any oversupply.

This could relieve the signs of discomfort within 48 hours or so instead
of putting up with it for months waiting for the ducts to adjust.

I think both of these slight changes would tend to regulate more evenly
the volume that is dilating the ducts at any one time throughout the 24
hours. Yet, the baby will probably get the same total volume of milk per
24 hours simply by reducing the volume in the ducts a little oftener.

Jean
*************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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