H
​i Karen,

I just reviewed this topic to prepare a webinar, so here are my 2 cents:

Things that you should go thru in chronic mastalgia (chronic meaning more
than 1 week, mastalgia meaning breast pain):

1. Latch/suck issues - you´ve done this and apparently it´s not the cause.

2. Inadequate draining of the breast: you can try having this mum feed more
often on the mastalgic breast, although if she has issues with oversupply
it will then requiere a tapering down. Often, burning pain will dissapear
with frequent, effcient draining of the breat. It´s always worth a try.

3. Muscular issues, usually from unergonomic breastfeeding positions,
sometimes but less likely from old spinal injuries. If this mother´s pain
is worse at night, it could be simply because pain during the night usually
always seems worse, but it could be beause of a worse position in bed, or
maybe more little children in the bed that make it even harder for mom to
find a decent position to breastfeed in, much less sleep. ALso ask this mom
what she usually does during the feeds with the arm/hand of the painful
breast´s side. I have seen quite a few mastalgias of the right breast in
right-handed moms who are texting during the feeds, or using their right
hands/arms to help other siblings, cook or whatever.

4. If you have ruled all these out, the next step is to do a milk culture.
The thrush/candida infection hypothesis is currently pretty much outdated.
In the latest studies, with more modern techniques (last one published two
months ago) there is just no Candida growth. Most studies on chronic breast
pain now seem to agree that, if the nature is infectious, the most likely
culprit is S aureus. So for this mom, before giving her diflucan I would
culture her milk and look for bacterial pathogens.

Finally, it is usually not this simple and you will find a few of these all
mashed together, in a mom who is probably already afraid to nurse on the
painful breast and therefore might have anticipatory pain, fear, flinching
reflex, etc.

Hope that helps
Kika in Madrid

Dra. Carmela Baeza
Médico de Familia
Consultora Certificada en Lactancia Materna IBCLC
www.centroraices.com
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Autora de "Amar con los Brazos Abiertos"
http://www.amazon.es/Amar-con-los-brazos-abiertos/dp/8426904688/ref=sr_1_1?s=books&ie=UTF8&qid=1420813499&sr=1-1&keywords=amar+con+los+brazos+abiertos
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