I need help.  This mother phoned me several days ago because she was
about to go to doctor because the treatment she had been given for her
sore breast wasn't working.  The baby is now 7 weeks old.  At 4 weeks she
started to have severe stabbing pain in her right breast starting five
minutes after the end of the feed and lasting for 1-2 hours.  The doctor
said she had mastitis and prescribed antibiotics.  After a week there was
no improvement.  The doctor then decided that there was no infection, but
there was inflamation and prescribed aspirin.  The aspirin helps the
pain, but there had been no change in the condition.  She told me that
her nipples were slightly red with some burning pain, but she thought
that was because the baby had a very strong suck and stayed on the breast
for a long time.  There was about 10 seconds of pain initially, then the
feeds were comfortable, no pain during the feed. She tried expressing
with a breast pump, but the pain was just as bad after expressing.  There
are no problems with the left breast other than the slightly red nipple.
I went briefly over positioning and attachment just in case, but it
doesn't sound as though there is any problem there.  I also discussed
thrush.  She agreed to let me know what the doctor decided.

This morning she phoned me.  Two doctors said it wasn't thrush.  She went
to hospital for a scan of the breast.  There are no blockages or lumps.
The doctors admit they don't know what is causing the pain and advise
weaning from the breast.  She also saw a surgeon who noticed a scar on
the areola and suggested the pain is caused by the scar tissue
stretching.  I asked why thrush had been ruled out.  This was just on the
symptoms.  I went over the symptoms again and told her that her symptoms
didn't rule out thrush, though it wasn't necessarily thrush, there were
other causes of deep breast pain.  I went through the Candida History
Questionaire in Amir, Hoover and Mulford, Candidiasis and Breastfeeding,
and it isn't obvious, except for the burning nipple and stabbing pain.
She has had an increased amount of dairy and sweets since the baby's
birth.  She rates her pain as 10 on a scale from 0-10.  There don't seem
to be any symptoms in the baby.  We then went through the section on
causes of deep breast pain and nothing else seems relevant. She is
reluctant to go back to her doctor, but weaning isn't an easy option
either as expressing is so painful and she is worried about mastitis if
she stops abruptly.

The mother's main question was how to wean from one breast without
causing more problems.  MIne are:  Could it be scar tissue if the feeding
if pain free?  How likely is it to be thrush if only one breast is
involved?

I forgot more!  On her first call I had told her that I had helped a
mother with ductal cramping with similar symptoms, except that it had
been both breasts, had started early on and was starting to improve after
a couple of months.  One of the doctors also suggested ductal cramping
and prescribed an anti-spasmodic.  She had taken this for a day and there
had been no improvement.  Is that a possibility?

Thank you for your help

Jill Dye, LLLLeader, Goodmayes, Ilford, Essex (Greater London), England

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