breast pain

I am still nursing my 14 month old mostly b/c I want to keep up my milk supply for a baby we are adopting in 3 months.

- Over the past month I have been having a shooting pain in my left breast only. It has become progressively worse with the past 3 days being unbearable.
- When I wake in the morning there is no pain. When I nurse there is barely pain but a little. AFTER nursing (I mean hours afterward until 3 ibuprofen kick in) there is horrible shooting pain.
- Currently there is no visible difference in my left breast, other than supply reducing.
- when i hand express milk only comes out of two spots.
- About two weeks ago I did have white spots on my nipple and then a scab but now they are not present.
- No signs of thrush in the baby.
- I did just get my period back for the first time.

My primary care doc wants to put me on antibiotics over the weekend to see if it helps and an ultrasound on Tuesday. I do not think my doc is experienced in breast feeding issues. My fear with antibiotics is if the issue is yeast related, seems like antibiotics would jsut bake it worse.

What are your impressions on what this could be? and (obviously not medical advice b/c you aren't seeing me directly) What is your suggested plan of action? Who should I be seeing directly for this? a lactation consultant? my OB? try the antibiotics first or ask doc. to prescribe something for yeast first?

Thank you for your time.

Answer from the lactation consultant
What an awesome thing to adopt AND breastfeed.

It could be your cycle BUT if it were it would likely be both breasts so,
The shooting pain sounds like vasospasms (also known as raynaud's syndrome or phenomenon). Usually they occur from an infection, shallow latch/tongue tie or some kind of breast injury (I have even seen this happen from mom's getting bitten by teething babies). Did you have thrush or mastitis at some point? I know you said no now, but in the past????


Anyway, vasospasms are blood vessel/nerve pain. So they are indeed sharp shooting (like being stabbed with a knife) kinda pain.
There are several treatment options:
1. Make sure you do not have a current infection, if you do this must be addressed first before going any further.
2. You can try applying a cold back to the breast after the feeds and when you are having the spasms to see if it provides some relief. Cold usually works BUT I have had moms who found more relief from warm heat. Either can be done by filling a disposable diaper with cold or warm water and applying to the breast.
3. Apply some mild pressure to the nipple immediately after the feed.
4. Avoid nicotene and caffeine. They cause vasoconstriction, which worsens the pain.
5. Take calcium, magnesium and B6 supplements.
5..Arginine (an amino acid) you can find at a health food store will often provide relief. It will help to dilate the blood vessels and help to reduce the spasms.
6. If all that does not work, see your primary care doctor and discuss possible treatment with Nifedipine. It is a calcium channel blocker and works by relaxing blood vessels. It is usually prescribed for people with high blood pressure and may only be prescribed by a doctor.

Your gut is exactly right. It does not sound like an infection at all. The signs of a breast infection would be warmth at the site, red streaks, tenderness and body fever. And yes, I feel antibiotics would make matters worse.

If you try some of the above for the next few days and do not see any improvement, I would call your local lactation consultant and ask her for a referral to a breastfeeding friendly breast surgeon.

I hope this helps,
Liz Pevytoe, Rn, IBCLC