Re: Fw: I: frequent blebs and engorgments

[Guest guest]

OK, parts of her response are directed to comments I wrote, so I'll try to address them here.

Dee Kassing

Here's what I suggest for a "recurring" nipple bleb. Personally, I think that it often really isn't "recurring", but more likely "never quite cleared up in the first place."I think that when that milk sits at the front of the nipple pore, thickened, so it can't get out, then the milk behind it in that particular duct also thickens as it sits there unable to move out. Then, eventually, the mother finds a way to get the white spot at the nipple pore to go away, and she temporarily feels better. I think she took the pressure off the tissue at the nipple pore. But that other milk that thickened as it couldn't get out, is still there, just back farther in the breast where it can't be seen. Then as baby

nurses a few more times, or another day or two, he gradually pulls that toothpaste-thick milk down to the front of the duct, and that thick milk puts pressure on the tissue around the nipple pore again, and mom is in pain again. But it's not a "new" bleb (at least, this is my conjecture), but just more stuck milk finally making its way down the duct.All of this make perfect sense, but it brings to my mind two questions: 1) what is the difference between a bleb and a plugged duct? 2) According with all of the above, how would you explain the fact that, after the bleb has been pierced by a doctor, I managed to fully drain an engorgement that had been there (getting better and worse) for 48 hours and the bleb didn't reform for 5

whole days?

**Dee here: We aren't exactly sure what a bleb is, so I don't think we can specifically say what the difference is between a bleb and a plugged duct. But at the very least, they seem "related" in that they block milk behind them, causing painful pressure, and they at least appear to both be thickened milk.

As to how it was gone for 5 days after being pierced and drained, we just don't know everything there is to know about breastfeeding yet. One of the things we don't know is why blebs form. So I can't really say why yours came back in 5 days. Although I am convinced many "recurrences" are different portions of thick milk moving gradually down the duct toward the nipple, I am just as sure that this explanation won't fit every situation of having a recurring bleb.

I suggest that moms take a pain reliever (like acetominphen or ibuprofen) right before they nurse the baby, preferably when there is another adult in the house to take care of the baby after they've finished nursing. Otherwise, if she is alone, she can try to do this when she expects baby to take a long nap after nursing. She takes the pain reliever, so that it has time to get into her system, and I warn her that what I'm suggesting will not feel good. (So she isn't thinking harshly of me while she's in the tub, thinking I'm a complete idiot.) I promise I won't think harshly of you, but if it works I'll consider you my saviour forever and ever.

**Dee here: <grin>She breastfeeds, so there's the least amount of milk/pressure in the breast as possible. Then she gets in the tub, with the water high enough that she can comfortably lean over and submerge her breasts. She soaks them for 3-4 minutes, to let the heat help to widen the ductwork. Then she starts at the nipple and massages and expresses the nipple to move out any thickened milk she can. Then she moves back to the areola and massages and expresses a strip about an inch wide, all the way around the breast. Then she moves back about an inch toward the chest wall, and again massages and expresses any milk she can out the front of the breast. She continues to move back on the breast, inch by inch, constantly moving the milk towards the nipple. (If she starts back at the chest wall, she's just running milk into the blockage and increasing the pressure.) I warn her that if she manages to express any thickened milk, it is likely to feel unpleasant or even painful, but that if she manages to get it out, she will feel much better afterwards.How intense should the massage be and how much should I insist on the nipple, or any other area if I can't express anything? Wouldn't be easier before doing it in a different moment rather than just after having breastfed on that breast, what I mean is, wouldn't the greater pressure help to express the thinckened milk? **Dee here: The massage should be firm, but not so firm that you cause bruising. Bruising would increase pressure because blood would then be leaked into the tissues instead of staying in the capillaries where it belongs.

If you can see a bleb on the nipple, or feel a lump in the breast (depending on "bleb" or "plugged duct", you should definitely spend extra time there even if it seems nothing is happening. I think you loosen up the congestion by manipulating it, thereby making it easier for it to move out of the breast over the next several feedings, even if it doesn't disappear immediately while you are working on it.

I find that it is usually less painful to do this with the least amount of milk in the breast. But I also know there is an exception to every rule! So you can certainly try this technique with milk in the breast, if you can tolerate the pressure on a full breast. If it works better for you that way, please do let us know that!

Subject: I: frequent blebs and engorgmentsDate: Thursday, January 12, 2012, 2:43 PM

Hi all and happy new year! Here some update from the mom (she writes in black) , for the ones of you that asked about it J Many thanks for your wisdom Hugs a

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[Guest guest]

how do i add someone to this group?

Subject: I: frequent blebs and engorgmentsDate: Thursday, January 12, 2012, 2:43 PM

Hi all and happy new year! Here some update from the mom (she writes in black) , for the ones of you that asked about it J Many thanks for your wisdom Hugs a

..

[Guest guest]

You can't add someone, Lizz. They have to sign themselves up. Give her this link and she can easily request membership with this group:

http://health.groups.yahoo.com/group//

Dee Kassing

Subject: I: frequent blebs and engorgmentsDate: Thursday, January 12, 2012, 2:43 PM

Hi all and happy new year! Here some update from the mom (she writes in black) , for the ones of you that asked about it J Many thanks for your wisdom Hugs a

..