12 months old, Breastfeeding Pain Worsening. At Wit's End!

[equilibrium]

Let me first explain that Ds is my second son bf and he just turned 1. My first son nursed for 2 years and it was not without pain and issues, mostly resolved after the first few months. This past year has been full of issues-clamp down, nipple cracks and bleeding, vasospasms/Raynaud's, engorgement, gential violet, high palate, blebs, etc etc etc. I have a strong attachment to nursing and I am at my wit's end. I am in Canada thus I have my GP and that's it. I don't have 4 months to wait for a referral to a OB GYN. No breastfeeding docs here, no LC's that have experience with issues. Seen many health nurses, etc in the past year that leave with their heads being scratched...I have had to figure out all my issues on my own. And they are ongoing...

The current problems have been going on for a few weeks. My right breast starts with shooting pains (15mins-1hr after feeding), lumps and bumps, pains, sore and sensitive. Stinging pain deep into one side of my breast, and centre of breastbone. The pain wakes me from my sleep, is toe curling painful, and feels like razors on and off inside my breast. There is no associated fevers, or redness except for very pinky inflammed-slightly looking montgomery glands. 

The pain is so bad sometimes it goes on for 4-6 hours! I end up taking Tylenol and it helps a  little. Now I wonder if this could be thrush in the ducts? (No pain whatsoever in the other breast).

Any suggestions?

[PatioGardener]

Strangely, nipple blebs gave me that kind of pain when the clog backed up into the breast. Any blebs you could pop?

So sorry you don't have access to good support where you are.

[gemasita]

I have the same pains!  Yet to figure it out WITH great LC and doc.  Tested neg for thrush but pos for staph but have treated that.

[Heba]

Hmm, I was under the impression there was no reliable test for thrush.

The pains you describe do sound as if they could be thrush, although it could well be other things as well (bacterial infection, even problem with positioning and attachment which can change as baby grows).  Reliable info on thrush here: http://www.breastfeedingnetwork.org.uk/pdfs/BfN_Thrush_leaflet_Feb_2009.pdf  It's a UK source, but might be helpful to use to discuss diagnosis and treatment with your GP?

Hope you both feel better soon!

xx

[gemasita]

I had a fungal skin culture done at a dermatologist (bf'ing-friendly, btw) and she said it was neg.  I hope that was right because we stopped boiling everything!

[CheriK]

Fungal cultures are not a reliable way to diagnose thrush.  A positive culture means thrush but a negative culture simply means. . . a negative culture.  It's hard to culture.  Thrush is usually diagnosed based on symptoms, but docs are often unfamiliar with thrush in bf moms & want a diagnostic test.  Thrush is also almost universally bilateral.  It's a normal skin fungus and when it overgrows due to whatever is throwing your system out of whack, it's going to overgrow in both breasts, not just one.

You already mentioned Raynauds, but I also though Raynauds was bilateral.  Have you tried taking Nifedipine at a dose of one long-acting 30mg tablet per day for two weeks?  Worth a try.

Another thought would be a bacterial infection, which can be diagnosed with culture of your milk and baby's mouth.  A staph infection can cause shooting duct pain as you describe.

What about oversupply?  Raynauds/vasospasm & plugged ducts/mastitis are more common in moms with oversupply.  Do you have other symptoms of oversupply?  Working on that might help.  With my toddler, I've mostly found the oversupply to not be an issue any more, but when she suddenly ups her nursing frequency for whatever reason (teething, illness, whatever), then goes back to normal, I have about a week of issues.  Does your DS frequently only nurse on one side?  Is the pain worse when he skips nursing on that side?

I also wonder about referred pain.  Started any new exercise routines recently, or anything else that could be causing back/arm strain?  How about the way you sleep (putting pressure on that arm or breast)?  Do you carry your DS on that side?

Have you tried ibuprofen?  Might be more effective for pain if there is inflammation involved as it is an antiinflammatory while tylenol is not.  Also lasts longer!

Sort of a last resort, but what are your thoughts about weaning from that breast?  It's certainly a better option than suffering without resolution or complete weaning.

As far as getting help, are you anywhere near Dr. Jack Newman's breastfeeding centre in Toronto (https://nbci.ca/appt-request.php)?  You have to pay out of pocket (oh, the horror for you Canadians with universal health care - sorry, couldn't resist ;-) but I would think worth it for some answers and experienced help.

[Heba]

Gemasita, I wouldn't rule out thrush simply because of a negative test.  If you're still suffering, then I would expect your HCP to consider thrush along with other possiblilities.  If the staph treatment doesn't work, then I would think that thrush is back on the table.  Please don't give up!  I know it can be hard pushing for answers - and sometimes you have to try several things until you get there.  But if you really would like to continue nursing, then sometimes it's worth it.  Do let us know how you get on.

xx

[Heba]

Load of excellent suggestions from Cheri.  If it came down to stopping feeding from one side, but you didn't want to completely wean from that breast, you could perhaps consider expressing from this side while continuing to feed directly from the other side.  This would mean that you wouldn't be burning any bridges as you would be maintaining supply on that side.  (How does it feel to express from that side?)  Just throwing another suggestion out there.

Please let us know how you get on.

xx
 

Originally Posted by CheriK 

Sort of a last resort, but what are your thoughts about weaning from that breast?  It's certainly a better option than suffering without resolution or complete weaning.

[equilibrium]

I appreciate all this discussion. I went to my GP today and since it's still very sore even to the touch, he is putting me on Keflex 4x500mg a day for 7 days. And I have to return in 7 days, and sooner if get's worse. He said he doesn't suspect thrush because of the lack of symptoms (white spots, lol) around the nipple. I think he's wrong with assuming a certain symptom must be present (visual) to diagnose but this is a trial thing. SO, basically not sure what it is but treat blind first to see if there is relief. The issue with the meds though is I had to take Keflex after a uterine infection after my c-section and it totally wipes my digestive track out of all good bacteria. I thought I got C Difficile or something from it/hospital stays last time (nope, lol). Probiotics here I come!

[CheriK]

He's got you on a nice high dose of the keflex.  Good for treating mastitis, not so good for your body's flora.  Definitely probiotics.  Some folks believe probiotics don't do any good while you're on the antibiotics, so keep them up for a couple of weeks after treatment, at least.  You might want to consider rinsing your nipples with vinegar water post-feeding, and/or using grapefruit seed extract to reduce the change of thrush. 

Some things to watch for - if you notice improvement but not 100% by the end of the course, ask to continue for at least 10 days.  If it's a resistant Staph bacteria, cephalexin won't resolve it.  So if no improvement in 3 days or so, ask about switching to an antibiotic that is effective against MRSA (methicillin resistant staph aureus).  It sounds like you have a fairly proactive doc, though, if he wants to see you again before stopping treatment and asked to know if no improvement.  Hope this does the trick for you!

[equilibrium]

Thanks for the tips! The keflex totally irritates my tummy so I have to take with food and will keep up the probiotics. Good pt about keeping it going for a few weeks. Besides the tummy issues I got last time (and ahem, the bathroom issues I got) I also get yeast infections after taking antibiotics so I am hoping this time I don't. Thanks everyone!

[PatioGardener]

I really hope this does it for you! I was on antibiotics for a postpartum complication and ended up getting thrush. Fortunately gentian violet for a week completely took care of it. I hope you manage to avoid thrush and have a huge reduction in pain!