Vasospasm - what can I do?

[HeatherB]

My 9.5mo DD is EBF - she eats almost nothing (well, except for all the crumbs she finds as she chases her brothers!). She has had occult blood in her stools and I'm on an elimination diet - DF/SF - to try to help her. She also had a tongue tie clipped several months ago (though I've never been 100% sure it was fully resolved).

Anyway, the problem at this point is I'm having an increasing degree of vasospasms. I've always been prone to them (though it wasn't until DS2 that I found out what they were - they were horrible with him) and it seems that my chronic Lyme disease could be a factor there. But I know I've read about things that can help, and now I *need* to know. In the last few days, they've been increasing in frequency, coming now in both nipples (it's primarily been just one, all these years), and cycling for hours on end. The relief as it goes away almost reminds me of breaks between contractions!

Any help appreciated! I've got very little memory left these days, but I know I've heard of things that can help.

Thanks!

[CheriK]

Yes, definitely there are things that can help!  First off, you mentioned that your DD had a TT clipped, but you're not sure it was done completely.  Nipple compression is one of the main contributors to vasospasm.  Can you have her evaluated by someone who has experience with TT (a local IBCLC might know of an ENT or Dr. who treats TT and type 2 TT)?  Might also consider chiro or cranial-sacral treatment for her to see if it helps with latch and compression.

Avoiding some situations can help avoid attacks: cold, cigarette smoking, caffeine, and alcohol.  Some medications, specifically beta blockers can also be a trigger. 

Pain medication, such as ibuprofen or Tylenol, can help.  Applying warmth to the nipples after feeding can help speed the return of normal blood flow.  You might have success using a heating pad on your breasts after nursing, a warm compress such as a microwaveable rice sock, or a hair dryer set on warm.  There are also some medications that may be helpful if other techniques don't provide relief.  Nitrogylcerine ointment or spray (2%) applied sparingly after every feeding during the first 24 hours and thereafter only when blanching occurs, or Nifedipine at a dose of one-two long-acting 30mg tablet per day for at least two weeks.  You may want to discuss a trial of medication with your doctor if home remedies aren't helping.

[HeatherB]

Thank you, Cheri! I didn't see an email for your response so missed it until now...

She is definitely compressing both nipples and causing a lot more pain these days. I will need to see if I can find someone else to evaluate her tongue. The person who did so most thoroughly, before, was a pedi dentist who didn't think she could do the clip and sent us to an oral surgeon who said, "Oh, she's fine! No problems!" after I described all of our issues. Hers was definitely posterior, and a MW eventually clipped it for us. I have thought of going back to the pedi dentist (I need to take my boys, anyway) because I'm not really sure whom else to go to.

She was just (last week) adjusted again by my chiro. She clearly needed it, too, though the pain of the last few days makes me think it didn't fix her latch. We've never done craniosacral, though I've thought about it for her. Rotten insurance is the problem, there.

I did realize, after posting, that I have been having more caffeine of late, where I often have none at all. It also occurred to me that when I was having major problems with my 2nd son, I was also in a time and place where I began drinking caffeine quite regularly. So I'm considering that that may be a very strong factor for me. Of course, her poor latch habits are hurting even withOUT the vasospasm!! So I need to figure out how to fix that. I do know she's teething and has just gotten her fifth tooth. I'm not sure if that's creating more trouble at this point or not.

I am also sometimes getting a very deep throbbing, which makes me think yeast but I don't believe it is. I believe I've read that vasospasm can mimic yeast in that regard, and it certainly comes and goes much like the spasms.

Seems like I need to pick up all my research on TT experts, again, and see if I can get some help with her latch issues and try to save my poor nips! I do not look forward to nursing these days because it's uncomfortable and painful no matter what.

[CheriK]

Hi Heather,

I wonder also about oversupply.  Does she clamp always or at letdown?  Other OS signs (gagging, choking, popping off at letdown, dislike of comfort nursing. . .TT can also contribute to this. . . high weight gain)?  You noted occult blood; sometimes OS can mimic food sensitivities with green, mucosy stools & irritation from the high lactose causing bacterial imbalance; not sure if this could cause microbleeds w/ occult blood, but it seems likely to me. 

Contacting your local LLL or a local IBCLC might be a good start w/ TT.  I'd want someone to evaluate her who is experienced w/ posterior TT as this is sometimes not clipped enough & unrecognized even by those who acknowledge TT is a breastfeeding challenge that needs correction.  At her age, though, clipping is not likely to be a cure-all without some support on suck training.  She's learned what works for her and is likely to continue.  Also might be hard to find someone who will clip at her age. . .  Ugh, not fair that it's so hard to find good supportive BF health care professionals.

Yes, vasospasm can mimic yeast w/ deep pain, but nipple trauma also puts you at increased risk of bacterial and fungal infections.  Some studies indicate that moms w/ staph infections have increased vasospasm and deep breast pain (and some breastfeeding experts believe that bacterial infections are as likely as thrush to cause deep breast pain).  Might be worth asking for a culture of your milk/nipples to check for staph and treat w/ abs if necessary. 

Good luck!

Cheri

[HeatherB]

She had a lot of symptoms of oversupply at about 2 months, which is when we started investigating tongue tie, as well. The pulling off, letting milk run off, etc., decreased or went away after the tongue clipping. I can't say for sure that was directly related to the clip versus simple maturity, but it did stop, at least. She does gulp fast occasionally, and here and there I'll leak from one side while she's nursing on the other - but that's not common anymore (I never wear nursing pads, for instance). I'm not dealing with what feels like a huge supply - not a lot of fullness, etc.

Back when she was 2 months, I did try block feeding and pumping off foremilk. I also cut out dairy at that point (I'm off dairy, again, now, as well as soy). Her intestinal symptoms, which caused concern both for allergies as well as oversupply, improved in the week of doing those things - though the mucous returned before I reintro'd dairy, and she gained NOTHING that week, so I ditched it all. (I later realized I'd eaten edamame and that's what caused the major mucousy stools, not just dairy.) I haven't done anything else significant to address any possibly oversupply or over-active letdown issues, since then.

Oh, and she's got very, very slow weight gain, which is the biggest issue of all (though everyone agrees that she seems entirely healthy, so unless the digestive issues are a problem, we just think she's more petite than my boys). She's 7th percentile on CDC charts; just under 25th on WHO charts. She's 10mo and comfortably wearing 3-6m clothes.

I've tried to contact an LC that had tongue tie expertise (or so I read somewhere) in my area, but haven't heard back. I need to look again at who is around here and could be an option. I may have to drive to the other side of town, about an hour away, to find someone who can evaluate and give oral exercises. At least I've talked to those folks by phone and found them very helpful. Ah! They'll likely be at a baby/birth fair next week, so I will chat with them there, to start with.

Who would generally do a test of BM for staph? A GP? Pedi? LC? I'd never heard of a link with staph. Would it pose any risk for the baby?

Thanks for all your insight!

Heather

[CheriK]

No, a staph infection in your ducts or on your nipples doesn't pose any risk to your baby.  It's actually one of the most common microorganisms to cause mastitis; the antibodies & anti-inflammatory factors in your milk protect your LO.  Your GP should be able to culture your milk or your pedi can take a culture of your baby's throat; this isn't anything particularly exotic or special, docs culture material for infectious agents all the time (think a strep throat swab or a urine culture to detect UTI).  Some docs will simply treat based on symptoms, and a negative culture doesn't mean no infection (it just means that no infectious material was collected).  But a positive culture is the definitive way to diagnose infection and has the added benefit of allowing the lab to determine the exact infectious agent, and determine what antibiotics it's sensitive to, so you get treated with the right antibiotic to actually kill the bug you have.  Wow, probably more info than you wanted ;-)

As a mom of 3 slow-growing children, I can definitely say we've BTDT with the slow growth (including 2 who are "off the charts" - one when only the CDC charts existed, one now w/ the WHO charts).  As you've already noted, if she's healthy and developing normally, then slow gain is probably perfectly normal for her.  Is she growing consistently in both length and head circum?  Often these measurements are ignored as if weight is the only indicator of growth. 

It does seem suspicious that perhaps the symptoms of oversupply you noted early on were in fact more to do with her difficulty managing milk flow due to latch issues (i.e. TT).  It seems especially likely since when you tried block feedings, her weight gain stopped.  Exploring the food allery issues is probably a good idea, too, since allergies/intolerance can affect absorption of nutrients and growth.  And it's really common for babies w/ food sensitivities to be slow to show interest in solids (wonderful how our kids bodies know how to protect themselves if we just follow their leads!).