friction blisters - teething?

[spiceoflife]

DD is 22 weeks. For the past 8, I have had two proper white spots with blocked duct/mastitis (on each side, at different times) and several other 'milk blisters' on my nipples (both also have reacted to the trauma with vasospasm). I've been treating these as white spots for 6.5 weeks now, on advice from my LC. But while the original side seems clear, it still hurts, and the later affected side is still suffering.

Part of the difficulty is that I'm not sure whether this is skin 'healed' over with a build up of milk behind it, or something related to friction. (DD started pulling hard on my nipples back when all this began. It seems a bit of a habit now).

I would really welcome any information or advice about nipple changes that start after 3.5mths of good feeding. I don't want to stop but pain is such a dealbreaker.
Anyone?

[spiceoflife]

*bump*

[onthefly]

Hi - that sounds pretty uncomfortable!
What has you LC said and what have you been trying?
Did you have any attachment/feeding issues early on?
So the white spot has cleared on one side, but it's still painful, and you still have sore white spot on the other?
It is possible there's some other sort of trauma as well as the white spots, I guess. What do you do when she starts pulling on your nipples?
Sorry, just lots of questions for you

[spiceoflife]

Thanks for responding, MadB

LC #1: not thrush; pulling behaviour is likely due to white spot (i.e. trying to increase the flow); may have been a long-standing low-grade infection (now eliminated with oral and topical abx); may also be friction, not unlike a corn; may be connected with teething issues??
LC #2 (locum for LC #1): not thrush; not classic or at least not acute white spot
LC #3 (public hospital, originally seen for attachment-related nipple trauma at 8 days): not thrush; not classic or at least not acute white spot

Treatment for white spot: rub olive oil into nipple at the end of each feed, pare away at spot with fingernail, massage milk duct; dab 2% salicylic acid cream on white spot 3 times daily; soften the nipple with olive oil and/or warm wet facewasher and/or epsom salts solution, break the skin of the white spot with a sterilised needle, feed/express immediately after, soothe with olive oil on cotton wool inside nipple guards or use hydrogel pads.
Treatment for staph infection on nipple: bactroban cream
Treatment for mastitis: oral abx, rest, warmth, frequent feeding, massage
Treatment for vasospasm: warmth, EPO, calcium & magnesium supplements

Yes, midwife-led attachment resulted in yucky grazed nipples on both sides in the first couple of weeks but went on to painlessly feed from then until 14wks.

When she pulls, I push her in to me! (Wrist-breaking work with a 5 monther). She also pushes away with her hand, so if I can manage it, I will try to hold her hand or distract with a hoodie cord or something so she doesn't get as much leverage in the pull back. Occasionally, I have broken her off when she pulls but this has not in any way stopped the behaviour. Because I thought she might be trying to clear the duct, I wasn't consistent with breaking her off. Sometimes I lean over her with her in my lap so she can't pull as easily.

I know of only one other person, a friend, who said that 2 of her 3 boys did this exact thing when they were teething, and she believes the pulling creates the white spots!?!?

The only other thing I can think is that I have red hair and fair skin and perhaps I just have the kind of nipple tissue that blisters or grows easily??

[*beannaithe*]

I had problems with recurrent milk blebs which hurt like hell when bf, as in fist clenching, toe curling pain. How long did you try with the sterile needle? I found that I usually had to pierce the skin on several occasions and it would still take a good week to heal following this. If you are experiencing blebs, introducing some lecithin into your diet will help prevent them from recurring. HTH

[spiceoflife]

as in fist clenching, toe curling pain...

That's the one

I did forget to say that I started adding 1tbsp lecithin to my breakfast about 6 weeks ago. I have been indulging in butter since DD was born so I have tried to cut back on that. I only drink decaf tea and coffee, but hot cocoa (with just a splash of milk) has been another daily comfort. Could chocolate cause a problem?

[*beannaithe*]

Chocolate is a staple for me and I have been bleb-free for about 8 months now! Stupid question but when you saw your LC about this, did she look at the latch? Because surely, if it is a latching problem causing this, until the latch is sorted, you would carry on having problems? Kellymom talks about grapeseed extract for healing, maybe worth a shot?

[onthefly]

Oh yeah, I've had one too. yowch.

OK, I know with blebs it can take quite a while to clear them. A lot of mums find soaking in warm water also helps to soften the skin on top so that they can clear them, and it can take quite a bit of massage, along with feeding/expressing, to clear the whole blockage (they're often like really long strings of toothpaste).

How's she going? Feeding seems ok otherwise and all signs of good intake? I wonder also if there's an underlying attachment issue? Is the pain generalised or only on those spots?

The pulling may be due to her problems latching (if any). It may also be her response to slow letdown. Have you tried triggering letdown before feeds? Does she pull on both sides the same? Is it any different if she's sleepy/in different feeding positions?

I can't say about diet - not aware of any connections there. Also doubt it has anything to do with your complexion.

[spiceoflife]

LC #1 did look at positioning and attachment. Told me to ditch the pillow I was using, concentrate on nose to nipple, chin into breast, head tilted back. So I"ve been trying to do that, but big babies move around a lot and I'm not sure that DD maintains ideal latch for the duration of any feed.
It's been so long, but now that I look again, when it's dry, I think the nipple does look a bit like it did when grazed in those early days!
This was why I went to see LC #3 last week, to check positioning and attachment. Of course, DD was majorly distracted and did not feed well at all during the appointment. LC #3 recommended mixing up positions to relieve constant wear on one spot. Must say I haven't done much of that, mostly coz I'm too comfy with our cradle hold, and again, big babies are harder to move around.
How do you correct attachment in a 5-monther?

[onthefly]

You could try laid-back nursing - lie back, make yourself comfortable and put her on your tummy and let her go for it - it's worth a shot.

[spiceoflife]

That even sounds good
I haven't had much practice or success with lying on my side to feed so maybe once we've done a bit of baby-led stuff I'll roll over and try that too?

Still going with the sterilised needle. As you say, it could be quite a long string that takes ages to clear.

Thanks so much for your input, ladies. More to think about when it's been such a puzzle.