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From:
Virginia Thorley <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 19 Jun 2014 09:06:22 +1000
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Mary, you are doing a great job working with this mother. She is fortunate to have you. Yes, nipple pain can have multiple factors and we are wise to look for more than one. I try to check for 7 or 8, if only for the process of eliminating those that don’t apply. If a mother asks when booking a consult, "What do you know about thrush?", as some do, I look at the other possibilities as well.
Useful references include:
Amir LH. Aust Fam Phys Sept 2011 (Sept); vol 40.
Heller et al. Int J Dermatology 2012; 52: 1149-61.
The Heller et al article has excellent pictures, including of nipple psoriasis.

Virginia
In Brisbane, QLD, Aust

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Mary Jozwiak BS, IBCLC, RLC
Sent: Thursday, 19 June 2014 8:12 AM
To: [log in to unmask]
Subject: Re: Resistant TT and Labial Frenulum case

Sorry to take so long to get back. Lots of tongue ties to see, er, I mean lots of consultations. :D 

At my last visit with this mother, I did strongly stress (as gently as I could, as we all know, pushing someone will result in them pushing back even harder and becoming resistant to any further suggestions) about body work. Mom said she would take the names I gave her (we have some wonderful CSTs and Chiros and other body work clinicians in the Chicago area) but that she was burnt out and didn't know what she was going to do. You can lead a horse to water.... we can only suggest. And, I've found through more than 20 years of practice that using too much "force" (even when well intentioned) causes a loss of trust and breaks the intimacy and dialogue we both worked so hard to develop.  

I sat with her through an other feeding, baby was engaging and cooing and smiling and trying to get my attention while supposed to be latching, normal for this age. The mom kept talking about how much "burning" in her nipples she had after showers, yet appeared to have no signs of symptoms of thrush. I had explored possible Raynaud's Syndrome on the first visit because of nipple blanching and pain. Mom was not absorbing information at that point a few weeks earlier, so I gently approached the situation again. 

"Yeah, it blanches, you can watch the whiteness spread after the baby unlatches." The same light bulb went off again in my head.  *spreading blanching* Baby de-latched with NO crushing, no squashing, no "lip stick tip" no clicking, great feeding and no blanching. Mom said, "Watch." I watched as over a period of a minute or two in the middle of the nipple a white blanched mark occurred, then it spread over the entire tip of the nipple. This is vascular, and happening even when the latch is greatly improving. The warmth of the baby's mouth, the pressure, even if improving, was enough to set off the possible Raynaud's in her nipples. 

I asked her, again, if she had problems with her fingers and toes in cold weather or after showers. Yes, she did. (She was so exhausted on that first visit that I think she may have not been absorbing much of what was being said after a while.) Blanching and pain in fingers and toes when exposed to cold and then warmed or when exiting the shower. This has happened her entire life. No hx of migraine.

So, in addition to posterior ankologlossia, Maxillary Tight Labial Frenulum, and definite OER, Mom also appears to have Raynaud's Syndrome. Referred to an MD who may use meds to treat Raynaud's, until then, using warmed, wet washcloths or heat immediately after de-latching seems to help a lot. 

At this visit, I did a lot more listening than talking. What we learn when we do this is amazing. Things are not yet 100% perfect, a fairly complex case. But, progress is being made. Thank you all for your input. Mom feels confident to carry on, and will contact me if the problem persists. It's been a few weeks with no additional problems. 

Warmly,

Mary Jozwiak, IBCLC, RLC
Board Certified Lactation Consultant, Post Partum Doula Birthwaysinc. labor support, lactation support and post partum support Chicago IL. 

 

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