Bonnie mentioned that the mom "was using hydrogel at first".  Why
did she stop?  I have moms use these when they have major injury to
the nipple or severe soreness without obvious injury (in addition to
working on correcting whatever caused the soreness in the first
place).  Most find them very helpful and some come back for more if
it takes more than a couple of days to heal completely.  I think the
more severe the injury, the longer she will experience "residual"
discomfort from the existing damage until it heals.  I would also
wonder if there is a bacterial infection going on now.  If there is
any exudate, she might ask her HCP about culturing it.
Regarding the "never coming off"- is she using breast compressions?
Any relaxation techniques which work for her might enhance the
amount she is getting by expression.  She is bound to have a lot of
tension both from the situation and the anticipation of pain.
Anything she can do to reduce this should lead to greater amounts
being expressed.
I really admire this mom.  So many would throw in the towel long
before this.  Please keep giving her lost of positive reinforcement
for what she is doing for her baby.
Winnie

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