Dear wise ones,

I've been working for more than 2 weeks now with a mom with a complex of
problems and she agreed to turn to the collective wisdom for help. She has been
(and is yet finishing) treated for thrush in baby's mouth and on nipples with
nystatine and once took fluconazole. Visable yeast symptons are gone in both mom
and child. Nipple skin has been cultured for bacteria and found negative. Doc
didn't see need for milk culture.
Mom experiences deep breastpain during feeds (not always), easing away very
slowly afterwards in what feels like a kind of lumpy ''chain'' from the nipple
towards the armpit. On the same breast there is a milkblister on the 6 o'clock
position (so almost to the opposit of this lump-chain). Only towards the end of
a feed, the milk in that area starts flowing, causing pain, described by mom: as
if the milk has to be drawn from my back. This blister comes up, hurts, rest of
nipple painfull too, keeps the milk from flowing and needs to be opened with a
needle. Then it heals, but reappears within days (used to be within a day or 2,
now takes about 4 days).
Also in the same breast ''moving lumps'' (one day here, other day there, other
day none). This breast fills very quickly after feeds and is easily engorged.
Baby is doing more than well,. growing and thriving. He is a noisy nursing and
sometimes does strange things with his tongue while on the breast. He tends to
slip his lowerlip in, but corrects that immediately. He nurses more relaxed on
the problemless breast, but that one produces less and the milk flows slower. No
significant hx of allergies in near family.
I've tried the usual oversupply, engorgment and mastitis treatments, including
as well expressing to empty as far as possible as pumping just to get the
pressure off, massaging while feeding, other positions, etc.

Who as any suggestions to try and solve this problem?
Thanks for thinking with me.

Gonneke van Veldhuizen, IBCLC, living in Maaseik, Belgium
http://www.users.skynet.be/eurolac
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