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Caroline
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| Posted: Jan 01 2008 at 11:54pm | IP Logged
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I need help! I have had a plugged duct on my left side for 6 days. It is much smaller now than it first was, and in fact I thought it was gone at one point, but is 6 day too long? When I saw the doc on Friday she mentioned having a surgeon drain it if it didn't go away, but I'd rather not if I don't have to.
My other, more frustrating, issue is cracked nipples. One is quite injured and the other slightly. I'm slathering Lanolin on them, but I want to speed this up. Nursing is just excruciating. My just-turned-one-year-old is growing up too fast as it is. I want to enjoy our nursing. 
Advice, suggestions? Please?
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Mary Chris
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| Posted: Jan 02 2008 at 6:23am | IP Logged
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This is the advice I got 12 years ago when my oldest was a newborn, to soak my nipple in a solution of warm salt water. The warm water should help the plugged duct also. Heat is really good to help plugged ducts, and massage. Make sure you are drinking plenty of water and resting some (ha, I know you have two boys) just try to put your feet up every now and then. Also even though your little guy is one really check your positioning.
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KackyK
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| Posted: Jan 02 2008 at 6:56am | IP Logged
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What you are doing so far sounds good for the cracked nipple. I can't really offer anything else...but prayers. I had cracked nipples terribly with my first 4 children (so much so the first child would spit up blood  the pediatrician said "not to worry, it's just your blood"...gross!). Unfortunately I never discovered lanolin until the 4th child! I just cried during every nursing session. Eventually they toughened up and it went away.
I will pray for you...because that pain is awful!!!!!!
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Mackfam
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| Posted: Jan 02 2008 at 8:31am | IP Logged
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Oh dear! Prayers here too! Check your positioning like Mary Chris suggested - sometimes shifting the position of the baby's lower jaw will help with that plugged duct. Try hot, hot showers while gently massaging your breast to relieve the plug - but slather that lanolin on first or the water will be excruciating. I don't know what to say about the cracks other than keep the lanolin on. The salt water idea sounded hopeful.
Lots of prayers for your relief!
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MaryM
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| Posted: Jan 02 2008 at 11:27am | IP Logged
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Caroline,
I tried to post last night but my computer froze up and had to be turned off. I lost a post but I'll try to recreate.
First, don't let anyone near you with a lance. . Surgical drainage is NOT an appropriate treatment for a plugged duct - even a persisent one. Surgical drainage is used when there is an abcess (which can develop around the milk gland where it is blocked) or a milk cyst/galactocoele. A good diagnostic step would be to have an ultrasound (by someone familiar with the lactating breast) to make sure that it isn't one of those conditions that might warrant a surgical drainage. One treatment for recurrent or persistent plugs is low-dose therapeutic ultrasound to the affected area. I can get you specific info if needed. Treament of a possilbe underlying bacterial or fungal component should be explored as well.
Yes, persistent plugged ducts could go on for 6 days. You mention it seemed to get better but isn't now. If it seemed to almost be gone but now isn't, it is likely that whatever is impeding flow in that duct has not been resolved completely though there was movement for awhile. I will also post some information on a technique for what is called stripping the breast, to clear a blockage. Not as drastic as it sounds - it's a massage and compression technique.
It was mentioned by Jennifer to change position to get little one's chin/lower jaw in the area of the plug. That is a very helpful suggestion. Where is the plug located - which quadrant? We can suggest the positions to go with the area of blockage.
It would be helpful to know when the nipple cracking developed. Did they develop after the duct plugged or was it before? If before has if been on-going for awhile or just recent? With a year old baby, cracking is more unusual, unlike when a baby is newborn and there are usually latch issues causing cracking. Now that being said - with an older baby or toddler it still can be latch issues. Like Mary Chris said, check your positioning. Toddlers are often active and mobile nursers. They may not be in close enough or taking in enough breast tissue any longer. Making the baby take a deeper latch and keeping chin firmly in the breast tissue again and holding closer can make a difference. Make sure there are no acrobatics  .
Cracking and painful nipples in later breastfeeding can also be a reaction to something in contact with the nipples - like food in toddler's mouth, change in laundry detergent or soap, etc.
Cracks that won't heal likely have a bacterial component. It could be that the plugged duct and area of milk statis provided a breeding ground for bacteria which are contributing to slow wound healing or conversely the cracked nipple provided an entry point for bacteria contibuting to the plugged duct. Use of an antibiotic oinment (like Bactroban or something similar) on the nipples will help address that. Cracks can come from fungal infections also - any other symptoms of thrush present?
Feel free to PM me.
Praying for your healing as well.
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MaryM
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| Posted: Jan 02 2008 at 11:32am | IP Logged
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If a blocked duct and/or early mastitis begins, strip after each nursing until the blocked area is clear. This can often interrupt an episode of mastitis early in its development.
How to strip blocked duct(s):
1. Generously apply KY jelly, or other breastfeeding friendly lubricant, around and over the sore area.
2. Using thumbs of both hands, start above the sore area and press down from above the sore area, sweeping slowly but firmly right down to the very tip of the nipple. (Pretend the duct(s) in the sore area have toothpaste in them and you're slowly squishing it along and out.)
3. Watch the nipple for the duct opening(s) that don't spray milk.
4. Repeat the slow sweep from above the sore area to the very tip of the nipple. Each time, press a little more firmly. The first sweeps will be quite sore, so you want to start with lighter pressure and work up slowly. The duct(s) that didn't spray milk should, after a while, begin to empty of pus. Pus can be lightly colored - creamy, green/yellowish - or can be normal milk color, but it is thicker than milk. It forms a dollop then drops as a blob, as opposed to milk, which sheets off the nipple.
5. Keep stripping until the ducts that had pus have cleared and are producing milk. At this point, you'll be surprised how much better your breast will feel.
6. Repeat this stripping procedure after each nursing until you don't get pus at all.
Stripping helps antibiotics work faster, too.
Reference:
Cantlie H. Treatment of Acute Puerperal Mastitis and Breast Abscess. Canadian Family Physician Oct 1988; 34:2221-2226
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Caroline
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| Posted: Jan 02 2008 at 7:51pm | IP Logged
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Thank you all so much! I did go to the surgeon today. He doesn't think it's a plugged duct. He thinks it's a fibroid adenoma. I have an ultrasound on Friday to confirm. He's not concerned about it, fortunately.
Thank you also for the cracked nipple advice. I really want this to heal. It's been going on for a couple of weeks and I'm fed up with it.
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Zeliemum
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| Posted: Jan 03 2008 at 3:44pm | IP Logged
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I have saved all this information even though I am not currently dealing with this particular problem. Mine is attachment. (I've post a new thread in 'From Diapers to Driver's Ed') Just for the future if ever I need it.
Thank you so much Mary. You are a wealth of knowledge.
God Bless
Chemai
Good Luck Caroline, I'll keep you in my prayers for successful feeding. 
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Caroline
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| Posted: Jan 04 2008 at 1:22pm | IP Logged
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Mary, thank you again for all of your helpful information. I rushed through my last post and I didn't articulate how grateful I am for all your wonderful knowledge. And I didn't answer some of your questions about the cracked nipple. The cause isn't latch, it's that he pulls off suddenly--and with teeth -- when he is distracted by noise, big brother, etc... I'm doing my best to nurse him away from distractions, but big brother is only 3 and not trustworthy. 
thank you again for your advice!
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MaryM
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| Posted: Jan 04 2008 at 1:38pm | IP Logged
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Those are helpful details to know, Caroline. I'll say again that a triple antibiotic ointment would be useful to help deal with possible bacterial component keeping it from healing.
Ideas to keep him from pulling off suddenly:
-Maintain eye contact during feeding and watch body language/muscle tone in face. When he changes sucking behavior or has that look of "I'm done" be ready to direct appropriate un-latch behavior. Have finger ready to insert and break suction when his tone changes.
-You can condition him to open mouth wide. Have him mimic opening wide and say "open" when you do. Play games with that and offer praise. Give positive reinforcement when he detaches correctly.
-If he starts to pull back, pull his face into the breast - opening mouth is quick reflex in response.
-Nurse him in an upright position (facing you straddling on lap). In the upright position a toddler has a better awareness of what is going on around him and can see more without thinking he has to pull off the breast. It can help minimize distractability.
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Mary M. in Denver
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Caroline
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| Posted: Jan 04 2008 at 2:38pm | IP Logged
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MaryM wrote:
I'll say again that a triple antibiotic ointment would be useful to help deal with possible bacterial component keeping it from healing.
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I did pick Bacitracin after I read your original post (I couldn't find Bactran, but kellymom said that Bacitracin is fine too). I do think it's helping. I have a ways to heal still, but I do think things are getting better.
Thank you for all your help Mary!
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Topic: Plugged duct and cracked nipple
