July 10, 2015 at 7:18 pm #5271Vanessa PrinzIBCLC
Hi all, Here’s another topic from Lactnet around which it would be great to get some discussion going!
Date: Wed, 8 Jul 2015 10:34:04 -0400
From: Wendy Jordan
Subject: Persistent sore nipples
PTP: I have a client who has had persistent sore nipples. At 2 months treatment for thrush included 2 rounds of diflucan, APNO for 3 weeks, and she tried grape seed extract but it irritated her skin. The soreness significantly decreased but never went away completely. She has returned to work and the pain level is about 4-5 (scale to 10). Assessed for both ULT and PTT neither are an issue and latch is fantastic. She doesn’t tend to be sensitive to environmental agents or have eczema. She hasn’t changed detergents or soap and doesn’t use creams. I have suggested decreasing pressure while pumping and using different flanges but there has to be another underlying cause because she has been sore prior to pumping while at work. The nipples are always red and sometimes the right nipple blanches slightly, though she doesn’t feel any throbbing. She also mentioned achiness in the breast during pumping. Any ideas? All suggestions greatly appreciated.
Wendy Jordan, BS, IBCLC
Private Practice LC
http://www.seacoastlactation.comJuly 16, 2015 at 3:47 pm #5301Sonya MylesIBCLC
I have to admit, I am not a fan of APNO. I find that it slows down healing and increases pain. If I have a mom whose nipples aren’t healing, I always get her to stop APNO and things always improve. I have no research to back this up, but then, interestingly enough, there is no research on the use of APNO either. Maybe just some coconut oil (again, all anecdotal) on only the nipples, where the pain is. Is she using breast pads, and if so, are they disposable or washable ones? Perhaps her nipples are being irritated by those? Pumping should never hurt, if it does, mom needs to turn down the vacuum. Also, sometimes lubricating the flanges will help. The blanching makes me wonder about vaso-spasm, can she use some warmth on her nipples before and after pumping? It can be as easy as a warmed hand over her nipples. I am curious as to when exactly she is feeling this pain, is it with pumping, with breastfeeding, or always? Have there been swabs done on her nipples to see if anything is growing on them? The achiness in her breasts could just be milk moving, I know my breasts ached for most of my breastfeeding years, and I still get occasional shooting pains, all duct related, not thrush at all. Ductal thrush is a rare beast, and Tom Hale would say that it doesn’t exist, as for thrush to be systemic like that, an immune system would need to be severely compromised. Doing some pectoral stretching can help release any tightness in nerves and muscles that might be causing pain and discomfort (Edith Kennerman describes it as mammary constriction syndrome, and has some basic stretches that help, but any stretches that get in to those shoulder muscles work well). Hope this mom finds relief soon.
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