Martha Johnson and I have been having a discussion about the use of heat and cold. She recently wrote me: <I know, most people frown on the use of heat for relief of engorgement. But is the current 'taboo' on heat evidence-based? Are there studies dealing not just with lymphatic drainage in general, but with the BREAST specifically, which show that heat worsens engorgement? If you know about any research, please direct me to it, for I too am eager to further my understanding on this topic. And what about all the moms who are suffering and finally get relief when they hop into a hot shower and their milk lets down? I have seen this happen SO many times that I cannot discount the value of heat in this situation.... haven't we all? I would hazard a guess that most all of our new moms are heating their breasts in a shower every day. Anyhow, I guess I am going on what has worked for me, and the moms I help, rather than on what 'everybody' says. > Oh Martha, I think there is just so much our profession still needs to research about the use of heat and cold, and about how arterial, venous and lymphatic capillaries differ in their anatomical features and physiological responses, to help us to better understand the process of tissue exchange more thoroughly. I think we also need to develop greater insight into assessment of breast swelling. We need to learn to differentiate what part of the current swelling can be attributed to increases in circulatory, interstitial or glandular compartments, in order to choose the most appropriate intervention for that specific moment in time. I agree with your point about MER and warm showers, even if directed mostly on the mother's back. That is a function of both physical stimulation of the chest nerves and of the arterioles delivering oxytocin rapidly to the area. However, it still has to traverse the interstitial fluid to get to the myoepithelial cells. ( I still don't know what accounts for what seems like coordinated, sequential back-to-front nature of the contractions! I read that it doesn't work like the synchronized contractions of the healthy heart.) But once it reaches myoepithelial cells, their contractions around the alveoli and spirally/longitudinally around the ducts can of course relieve pressure, especially in the upper part of the glandular/ductal tree. I also want to go back and learn more about dual layers of lymphatic drainage, both surface, and deep. My curiosity about all this has recently had a boost. I now suspect that the persistent posture problem and low back discomfort I've had in my 70's may be a gift from the Good Lord, because I finally arrived early this year into the competent hands of a young physical therapy assistant whose wife was expecting. Between my learning more about principles of muscle rehab, and he, about new parenthood, we had many an interesting discussion (courtesy of Medicare!) I, of course, proactively supplied him with RPS information, touted the wonders of skin to skin, the MER, off-center latch, breast compression and hindmilk, and posed some of my questions about swelling. Last month, I returned for a second, longer, more intensive course of therapy, and caught up to date with the birth and the early breastfeeding, and the progress of the plans for his RN wife to return to work. Because he will be caring for the baby while she is at work, it was an excellent opportunity to provide some of Diane W.'s excellent handouts on insights about rubber nipples/flow rate habituation/ breast refusal, and several others, including Working and Breastfeeding, and What if I want to Wean (along with some of my brand of advocacy re: pumping vs. AIM, and experiences with working moms through WIC). I've read that there is further PT research being done on cryotherapy (cold), so I asked him for leads in learning more about tissue swelling and the use of heat and cold. He recommended I try www.dogpile.com and search for 'modalities', and specifically, for 'contrast baths'. Of course, much of this is specific to muscle and injuries, but even my first few hits have been thought provoking. I share this with the list so that anyone else who is curious might check these out. As for me, I will soon be over a thousand miles away from my computer for a month, hoping there's no snow in September in Montana, continuing my stretching and exercises, vacationing at the Lewis and Clark museum, and being doula/LC for my granddaughter in the Air Force. I'm enjoying my improved flexibility, and looking forward to a great adventure. Wouldn't it be exciting if my great-grandson were to arrive on my 'Diamond Birthday'!? Jean ***************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html