Dear Chris,

Just a few quick thoughts.  Cut down on heat and increase cold therapy -
cabbage may help, but mainly you need to apply cold for more than just a
couple of minutes.  Use warm compresses on the back of the neck in
combination with massage to aid MER.  Be careful with pumping - if it is
done too vigorously it may increase edema and decrease the ability to
extract milk from the breasts.  Use RPS to encourage MER. You might also
want to try using nasal oxytocin to see if it will help with MER, in
conjunction with other strategies already being employed. Although I have
not had occasion to use it, lymphatic massage by a qualified therapist can
also be of help in cases of severe, unremitting engorgement. 

Good luck with this mom.  Sounds like she really needs your help.

Warmly,
Sharon Knorr, BSMT, IBCLC

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