I'd appreciate any suggestions for treatment of blocked ducts in a mom of a 
3.5 mos premie (at home) who is exclusively pumping.  I saw her one week ago 
and she had blocked ducts in upper aspect and outer aspect of L breast which 
unplugged after 2 days of heat, massage, gentle use of back massager on affected 
area, castor oil packs and increase in pumping frequency.  Then about 24 hr 
later plugs returned, and did not respond to above tx, so yesterday, ultrasound 
per Jack Newman's protocol given with so far no positive results.  Weather 
permitting (we're in the middle of a snowstorm here), she'll have another 
ultrasound today.

She's on lecithin but I realize that takes time to be effective; also told 
her to inc salt (can someone elaborate on that further, please) dc caffeine, 
rest.  Tried changing pump flange but ineffective in milk removal.  Also 
suggested trying Classic pump which she hasn't yet done.  She's been using Symphony, 
rental from hosp and very "attached to it," as she's been able to increase her 
milk supply over these past months of pumping; this baby, aside from brief use 
of HMF in hospital, has been exclusively breastmilk fed.  And of course, 
breastfeeding is recommended, (at HV unable to initiate breastfeeding, w/wo nipple 
shield) which she stopped doing about a week or two prior to my seeing her 
due to long, ineffective feeds.  Today I suggested she try baby at breast even 
for a few minutes before pumping to try to stimulate more MER's.  I was 
contacted by this mom per her OB's referral specifically for the blocked ducts, so am 
also respecting her intent to pump and feed, and offering help with 
breastfeeding tho not pushing.

Thank you for any insights.  Also discussed lymphatic drainage and 
acupuncture; and she's on phytolocca and hepar, and nipple blebs have been r/o as well 
as thrush. I have searched the archives, too; just looking for something new 
possibly.

Barbara Latterner, BSN, RN, IBCLC


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