Winnie writes <I come from the old "warm before, cold after" school,> In certain cases, I think that still has a lot to recommend it Winnie. Once again, it's not always a "one size fits all" situation. < When I point out to a mom that warmth increases circulation to the area which may aggravate the amount of swelling, it makes sense to her.> Maybe. Maybe not. I guess that's where I came up with the concept of a traffic jam, and having to make a choice of which lane to relieve congestion in first, like the traffic cop. It's the individual LC's judgement call to recommend what she thinks will give the fastest relief for each mother. (Of course, it's the mother's prerogative to choose to do otherwise.) A breast that has a lot of milk in it has a different feel than one that has so much overall edema you can't feel if the ducts are swollen. 50% of the glandular tissue is said to be in the upper outer quadrant. If I have the chance to palpate, and detect the presence of full ducts there, this makes me decide to use RPS and/or massage to trigger the MER signal. In that situation, I think the "stimulate that MER, dilate the arterioles temporarily, and bring in the oxytocin to move that milk" has the greatest potential to reduce the total volume of the breast the fastest. If I am certain I can feel full ducts, I think the chance to remove 3 or so ounces of milk is my best bet. I know for sure I am not going to get rid of 3 ounces of blood, or 3 ounces of edema in 10 minutes flat. After that 3 ounces of milk is gone, I "let the other lane go" i.e. put on the cold for 20-30 minutes max, to constrict the circulation, as well as numb the discomfort and start getting the edema reabsorbed into the lymph capillaries to shuttle it away back toward the heart. Jean *************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html