>
Even without the blanching, it might be useful as a first run to treat this as vasospasm, and it doesn't hurt to throw in some of the measures suggested for Edith Kerneman's idea of "mammary constriction syndrome," because that also focuses on opening up bloodflow. (check the Lactnet archives). With an infection, the pain may peak and recede at times, but there's usually some ongoing level of irritation or tenderness. But with nerve pain or muscle spasm, it's excruciating at times, and then the nerve stops firing and everything feels fine.
I explain it this way -- the breast is packed with nerves, and (often initially in response to a baby pinching or clamping) a nerve pathway is firing, which shoots through the whole breast. Each time that nerve arc fires, it reinforces that pathway, and it fires more easily, and sometimes in response to cold, sometimes randomly. So the home care treatment is staying in preventative maintenance mode -- keeping the circulation high, with the breasts toasty warm, to head off triggering. Measures could include dry warmth and massage immediately after feeds, a big soft flannel or wool breast pads on the breast all the time, calcium/magnesium/B6 supplements, hot drinks and soups, lifting the breast and massaging on the pectoral muscles with the flat of the hand, doing some pectoral stretches in the doorway several times a day. (One client's deep breast pain went away when she started working out in the gym again). If we can keep that pathway from firing for a while, the body forgets about it, and it breaks the cycle of pain. Nifedipine is a prescription vasodilator that is next step to try. Diane Wiessinger has a good handout on vasospasm on her very useful CD of materials, but I don't see it on her website (which is under reconstruction http://www.normalfed.com/help/).
And it's good that you're helping her fine-tune the dug-on latch --the fit between a mother and baby is subtle, and everyone is dealing with microns of difference, and you're right at as a second time mom, she may have a baby who is backing off a bit from the generous flow. The fact that the latch feels ok on the other side makes it less likely that there are huge anatomical issues, though the one-sided pain does suggest looking for any subtle asymmetries. If the mother does a slide-over position/football hold on the unhappy breast, so the baby is nursing laying on the same side as she does when nursing on the pain-free breast, does that make a difference? If she just pumps the painful side for a couple days, does the pain go away?
Another hypothesis could be a muscle pull, even around to the back, that's causing referred pain..
You could also check the Lactnet archives (which are a professional treasure being lost with the discussion moving to Facebook) for posts by Anne Eglash on "deep breast pain" which has some other ideas to explore, including an ongoing low-level mastitis that's not progressing to visible inflammation and fever,
Good luck in the detective work.
Margaret Wills, IBCLC, Maryland, USA
> Date: Sun, 27 Sep 2015 20:34:30 -0400
> From: Karen Lavergne <[log in to unmask]>
> Subject: burning in one breast after feeds
>
> Hello, I have permission from mom to post, and I would really like your input on this one, because I am stumped. Thinking maybe I should see mom and baby again, maybe I missed something the first time.
>
> Mom is a G4 P4, her baby is 4 weeks old. She is having burning pain in her breast on one side, mostly after feeds. She says this has been going on since baby was 1.5 wks. I looked at baby's mouth, no visible restrictions noted in tongue or lip, although I am not an expert with TT, LP, but I have seen my share. Baby did have a little milk on the back of tongue, that seemed to wipe off easily. I know this can be a sign of post. TT. No visible signs of yeast in mouth.
>
> Mom has a history of oversupply with each child, but feels it is under control with this child at this time. Observed baby feeding, had mom do a laid back position, thinking it would help with deeper latch and milk flow if fast. Mom latched baby well, tips given on getting a deep latch, mom verbalized a comfortable latch. Baby did cough/choke once during feeding, maybe still a little oversupply, or tongue issues? No nipple creasing noted after baby came off of breast. No redness, skin irritation, or white noted on nipple.
>
> Mom latched baby on other side, after done with first side, and said, it is always perfectly comfortable, and she never has any pain during or after feeding on this side.
>
> Mom complained 3-4 times of burning pain on the side baby had just finished nursing on, while nursing on the non-painful side, and after baby was completely done. We looked quickly at that side (nipple) to see if white/discolored, but it was not. I showed mom how to compress at the base of nipple to encourage blood flow to nipple, it did get a darker color of pink. The burning goes away, but comes back again and again. Mom describes as a burning shooting pain, in nipple and radiating throughout breast.
>
> Baby did spit up after feeding. Mom says baby is a happy spitter, but has discussed a script for zantac with baby's pedi, in case baby starts to show signs of pain with the reflux. Wondering if baby is backing off of the nipple a little d/t reflux, causing some compression?
>
> We discussed continuing to practice a deep latch in a laid back position, using cloth breast pads, as they may be warmer than disposable. I mentioned chiropractor care for both mom and baby, not sure if she is open to this. She denies any neck of back problems. I encouraged her to watch for signs of yeast in baby's mouth, and any signs on her breast. We discussed maybe treating for yeast even though not sure if this, with so few symptoms in mom/baby.
>
> Mom called me a couple of days after I saw them and said the burning pain was worse, especially at night and she had gotten a script from her OB to start diflucan. She asked her pedi to treat baby too, but he said he would not, since baby had no symptoms. Mom also got a script for APNO.
>
> I really want to help this mom, but I am puzzled by what is going on. Your thoughts/suggestions on this one would be appreciated. Thanks in advance!
>
> Karen
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