Sudden Onset Breast Pain???

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Need your help wise ones.... Permission to post of course

29 y.o. mom, hx of luteal phase defect, PCOS, infertility, gastric sleeve, depression, anxiety, ADHD, induced difficult vag birth. Minor breast changes in pregnancy.

Baby had seizures on day 2, in NICU for 7days, was NPO at first then formula fed, now getting both formula and Bm. No reason was ever found for seizures. Baby is on phenobarbitol. Oral exam normal except for strong suction. Visually baby appears completely normal.

Prior to seeing me in late Feb, mom had taken fenugreek, Reglan and power pumped but after poor start and w/ hormonal hx, still was not getting good results. After seeing me, went back on Metformin, started taking goat's rue and domperidone (no more reglan!). Also started a much more rigorous pumping schedule with different pump flanges in addition to putting baby to breast regularly. Paced bottlefeeding and lots of work on latch.

3 weeks after starting new plan, breasts had become more full and she had doubled her output but still was not making enough to wean from formula (with both test weights and pumping, mom hovers at about 1.2-1.3oz total per feeding).

At that point (mid-March), she said her breasts, "ache on and off that I can only assume is growing pains that you normally get during pregnancy when your breasts are developing" She described the pain as very mild and intermittent. No other S/S.

She called me a couple of days ago, stating she had sudden onset breast pain on Friday. Hurts less when pumping then feeding. I have questioned her about latch changes, teething, baby illness, yeast symptoms, plugged duct symptoms. Mom says no external signs of trauma, no redness, bruising, nipple wounds, blanching, etc. This is her story...

I'm having an issue. It suddenly started hurting when I'm breastfeeding my daughter. I went to the dr and they sent me home and said call back in 2 days if it's still happening. On friday we were in the car all day, Rowan didn't want to eat in the car very well, my breasts weren't very emptied, I forgot to bring the breast pump. It felt slightly uncomfortable like when your just a bit full.Friday evening we got into the hotel. I fed her as much as I could, expressed as much as I could, got in the hot tub at the hotel and then tried to breastfeed, and they got much more empty.Both were hurting my left more (but it creates more milk)We got home Sunday night I started using that nipple ointment and it helped a bit I think. Went to dr 9:40am Tuesday. suppose to call back in 2 days if no change. nurse practitioner did not think it was yeast, but thought it was a duct problem. if it doesn't feel better in 2 days, suppose to have an ultra sound to see what's going on.So the pain. It hurts when they are full of milk. The smaller the amount of milk in them, the less they hurt when you touch them. When you touch them, the nipple does not hurt it hurts inside somewhere, behind the nipple.When I am feeding Rowan, it hurts when she first starts, then toward the end, not as much, as soon as she stops, pain is gone. But it hurts REALLY bad when she first starts. Not crying bad, but where you might set your jaw and struggle through until the pain lets up. Which usually doesn't take a really long time.If I pump, it doesn't hurt very much, maybe I can feel a little pinch or so inside, but nothing I think isn't ordinary.The pain feels like... deep inside. where you can "feel" the let down. When your really full and it starts getting empty it kinda feels good, but if you made that feeling more intense it would hurt. That's the kind of hurt it is.So, what I am doing now pumping or feeding her very often, trying to use heat to relax the breast tissue to help with the letdown, and using that nipple ointment the dr office gave me a while back.Suggestions, ideas? Any idea what this might be or what to look for?

Can your let down reflex suddenly become extremely painful due to the goats rue or the domperidone raising your prolactin levels?I'm sitting here going to power pump, just pumped to empty my breast and waiting my 10 min or so before going a bit longer and I'm feeling in my left side what almost feels like my breast filling up again or releasing some milk like let down reflex so it can fill up better. The only other question I have is can something mildly irritate the ducts inside. Just enough I can feel it since my let down reflex is pretty strong, just I never considered it painful. Perhaps a mild irritation is just making me feel it worse.

She just told me tonight that she feels like her breasts have at least doubled in size since I saw her (still at 1.2oz/pump or feed though). She also just disclosed tonight that she is taking Vyvanse (L3) as well as more milk plus with goat's rue, extra fenugreek, metoformin, probiotics, domperidone 60mg divided into 3 doses/24 hr, and the mini pill (month 3 of this). She is on so much stuff and is such a complex case that I have no clue what could be causing her breast pain. Yikes!

Any ideas would be appreciated. Thanks so much!

Carroll