Transcript:
*We apologize for any typos, misspellings or incorrect grammar. Our transcript is auto-generated by software that’s trying its best, just like all of us.*
Hey everybody, welcome back to the Milk Minute. Hope you’re having good holidays. Hope everybody’s Christmas was fun and not stressful. Yes, I hope that for you as well, and we really tried to do more, like, experience gifts this year.
Rather than toys, cause I’m just so over it. Like, when we were getting ready for the arrival of Martie. We were just eliminating as many things as possible from the house. Yeah. And the amount of Christmas presents I threw away that the kids never played with from the year before was mind numbing. So, you know, we survived our first year of trying to do less shit and more experience.
So I’ll keep you updated on how that works out because, frankly, even going for a walk can sometimes feel like a stressful experience with my family. Yeah. You know, we’ll see how it goes. Yeah, well, I we had a pretty quiet Christmas at home, which unfortunately does mean more, like, I mean, well, you know, good and bad.
It means more random gifts from relatives who, like, feel bad that they can’t see my kids. And my mother in law, sweet lady that she is, sends just, like, so many things to the kids that, yes, then I end up throwing away or giving away. because they never touch them. And we have a tiny house. So anyway, I’m dealing with that right now, which is fine, but I’m on call for so many people.
So many babies coming. I’m super busy. Yes. It’s never really, you know, when you do birth work, I get busier around the holidays, actually, like not for birth, but lactation because people are. traveling and they end up having so many more issues with lactation or questions about like how to, how to pack for a trip and what do they bring and you know, how to troubleshoot mastitis at, you know, midnight on a Saturday after Christmas when.
Absolutely. No one will be back until January 2nd. Yeah. If I keep my calendar open, like on my auto booking site, it’s amazing how fast those days fill up right before Christmas, right after Christmas, over New Year’s. It’s just, it’s, it’s pretty overwhelming and understandable because, like, You know, especially what I see a lot of is these amazing parents spend so much time preparing to make their children’s Christmas or New Year’s or whatever, a really good experience, and then they forget to prepare themselves.
And then it’s like the day before the flight and they’re like, Oh, how am I supposed to bring breast milk on the plane? You know, I forgot that, you know, or like, how do I store it? Or, you know, they kind of ignored early mastitis symptoms because they were super stressed and they were like, whatever, it’s just a little pain.
And now they have like full blown fevers and chills. And it’s yeah, it can be a disaster. So we always, always encourage people to try to slow down during the holidays. Yes. We also want them to be good for your children, but your children would be happy with a surprisingly small amount of stuff from you and, and effort from you, and they really just want to spend time with you and, you know, They’re not, you know, especially these little kids are just like not going to have super vivid memories of this anyway.
I think one year with Griffin, I almost like skipped Christmas altogether because I was like, he’s three. He doesn’t really know what’s happening and I’m super stressed out. All Marty really wants is to breastfeed. Except right now, because she just popped off and I squirted my laptop with breast milk. Oh my god, here it goes again.
Oh, Jesus. Oh, I’m sorry, I know, that was crazy. Jingle boobs, jingle boobs, jingle all the way. You got me, you got me going, girl. And then I squirted Maureen in the face. Her virtual face. Oh, Marty. Hold on, buddy. Hold on. It’ll be over soon. Honestly, this podcast is never a priority over you taking care of your child, so it’s okay.
And I know y’all out there are totally fine to hear cute little baby noises, so
Alright, well, let’s We hope you enjoy this episode. Again, this is the mastitis protocol for parents. The new one. Hold on. Let me burp this baby real quick. Yes. Part two from our intro to like mastitis research and stuff last week. This is a great one to recommend if somebody has an acute problem, they You know, need to solve it as soon as possible.
Marty, she’s so cute. It gives some really practical how to’s and what not to do, especially. Oh, honey. I know it’s hard to have so much milk shooting at your face. All right, everybody. Well, we will see you next week and reminder that yes, we are still on break to give Heather some time with her baby, but we will be back mid-January with all new episodes.
So please, please, please make sure to tune into that. All right. We’ll see you later. Say bye, Marty. Welcome back to the Milk Minute, everybody. We are in part two of our updated mastitis protocol that the Academy of Breastfeeding Medicine just put out and now we’re going to find out what to do about it.
So if you haven’t heard part one yet from last week and you’re interested in the physiology of what’s actually happening in your breast, please go back and listen to that because it’s not really that it’s plugged up with a fat clog. from your milk, okay? So if you’re still thinking that you have a plug that looks like a chunk of fat, that’s not what’s happening.
And today we’re going to talk about how to fix what actually is happening when you have a hardened red area on your breast that may or may not have fever and malaise associated with it. And also we’re going to speak directly to what you can do about it at home. Yeah, so we’re gonna make sure we go over four things that you need to stop doing immediately and the four things you can do instead.
Yes, I love things that have numbers. I know you do. They make me happy and they make me feel organized. But first we would love to thank some of our wonderful patrons. And just so you know, we do batch record. So when we thank our patrons, sometimes you won’t Hear your shout out for a couple of weeks because we record in advance but they are coming and we do have a list to make sure no one is forgotten.
And today we are thanking Amanda from Waterville, Ohio, Nancy B and Mandy G from Morgantown, West Virginia. Thank you so much everybody for supporting the podcast. Really, they make this whole thing possible. It’s true. Let’s take a quick minute to thank a sponsor, and then we’re going to come back and answer a question.
You guys, breastfeeding for busy moms. My little breastfeeding clinic isn’t so little anymore. I’m so excited that not only can people book with you, in person here or virtually, but they can book with the other IBCLCs in your clinic. We also do accept some insurance directly. A lot of insurance will actually pre approve you for a certain amount of visits, even prenatally.
So please head on over to breastfeedingforbusymoms. com and check out the services tab to see if your insurance is approved. Book with IBCLCs and we would love to work with you. You can do prenatal consults. What else can they do, Heather? Well, I often work with people who have supply issues. We’ve got pumping, troubleshooting, we’ve got preparing to go back to work, weaning, starting solids.
We really cover the entire journey. So if you’re struggling, stop struggling and just schedule with me or somebody on my team at Breastfeeding for Busy Moms. Okay. Welcome back. Let’s answer a question. I think I’m going to pull another from TikTok today. Do it. TikTokers have really good questions. They do.
They do. So we got a comment from ADM 3310 asking, would it be bad to dry up my supply with Sudafed? The answer is kind of like no, but It’s not bad to use Sudafed as part of weaning It just depends how much milk you’re actually making right now as to whether or not that’s like the only thing you have to do It’s usually part of a larger process, right?
So Sudafed can be like complementary to, you know, cutting down a few minutes off your pumping or cutting short feeds or replacing feeds with, you know, it’s not the only answer. It’s just part of it. I use Sudafed as a tool in the early days of maybe even bringing down a massive oversupply. I might use it to get like a little kickstart over the hill to get people moved in the right direction.
And with weaning, you know, whenever you start cutting down. pump times, especially when you’re eliminating pumps completely at work, but you can’t take Benadryl during the day because, you know, you have to work. I’ll use like a single Sudafed in the morning on the day that it’s like the hardest because your body down regulates pretty quickly.
Usually within three days you’re kind of coming down, but that first 24 hours can be a real doozy and be very uncomfortable if you’re needing to wean quickly. Yeah. And it shows that it really works in studies. I mean, in, in some studies, Just a single dose has been enough to reduce supply by 25%. And it’s safe to take Sudafed pretty often.
And for a number of days, you know, we all do it when we’re really sick. So you could take Sudafed like every day for a week while you, if you’re like kind of aggressively trying to wean down, and that would be a really great compliment. And as we’re moving into cold and flu season, we’re going to link that episode in our show notes because I’ve had a lot of people that had COVID that had to go to the emergency room and the.
Dumbass residents don’t know anything about breastfeeding and they load them up with all kinds of decongestants. And I’ve had the breastfeeding parents be like sorry, I can’t have that. And then the residents are like, oh, yeah, you’re right. Yeah, and then they’re like, shoot, we don’t have anything else to do.
Yeah, so be sure to check out that episode if you’re looking for a quick, you know, refresher of what you can take when you’re breastfeeding to help cope with the uncomfortable symptoms of respiratory illness. Absolutely. Okay, so if you tuned in last week, you know all about this, but I’m just going to give a very small summary again.
We now know mastitis is a spectrum of inflammation, beginning with dysbiosis, so an imbalance of bacteria, and or oversupply. And then it’s just like, how the heck your body’s responding to it. As you said earlier, there are no clogs in your ducts, just swollen ducts. And when you pump out a clog, it’s actually a biofilm, folks.
Cool and gross. Biofilm. Yum. It kind of looks like something I’d want to take a Q tip and like roll it up in it, like, and then set it on fire and make it one of those tiny little fire sticks that you bring into a cake. Weirdly satisfying. Very. Yeah. But don’t would just kind of want to like smush it between my fingers.
But don’t do it, you guys. Yeah, anyway, okay. So we went on a big journey of new information and understanding. And honestly, it’s hard as healthcare providers to admit that you’ve been doing the wrong thing. And that’s what we’re admitting now is that our other episodes are not the correct information.
We’ve been giving the, what we thought was correct at the time, treatment protocol to people. But now we have to change that. Well, and also I think we did some things right. Sure. You know, like when people had clogged ducts and they’d come to us, I’m always looking for oversupply. Mm hmm. Because we did know that that was a precursor to clogged ducts, quote unquote, and mastitis.
And also just correct fitting. For flanges and breast pumping. So like how, making sure that we’re breast pumping. Okay. Yeah. And that’s going, so, you know, we’re trying to fix the root of the problem always, but it’s really, really good to know how we can tweak this and make it better so we don’t end up with chronic plug ducts.
Yeah. So. In the protocol from the Academy of Breastfeeding Medicine, before they even talked about treatment, they gave broad recommendations that are kind of like preconditioned things that we should be doing for everybody. And honestly, it’s like things that we do a lot, but as we’ve talked about in other episodes there’s not a lot of time for education when you see an obstetrician in a big practice, so we’ll have to figure out how to implement this stuff.
But let me just kind of go down the list a little bit, and I feel like I would like to sing these from the top of the hills, please. Okay. Are these the four things? No. Oh, that’s next. This is more than four. Okay. So this is not even about treatment. This is before you have mastitis. What we should be doing for everybody.
Oh, okay. We should be telling everybody what to expect if they feel a clog or they have mastitis coming on and what the early symptoms mean. We should be educating everybody who’s going to breastfeed on that. We should tell them what educational resources are nearby, like us! Woohoo! We should educate all patients who have glands on their chest about normal breast anatomy and normal postpartum physiology of feeding.
So like, telling people that glandular tissue feels lumpy, you know, so it’s not alarming. Telling people that they’re gonna feel full and their breasts are going to feel warm after they have a baby. Telling them what normal engorgement feels like. Preparing them, you know, like Childbirth education.
Breastfeeding education. This seems like I shouldn’t have to say this. But obviously I do, if this is part of like a groundbreaking new protocol. We should be teaching infant feeding on demand and telling patients to try and avoid emptying their breasts every time. Emptying the breasts should not be the goal.
Because they’re never really empty. Right, and, and just like as part of normal feeding, right? That’s not the goal. We should minimize breast pump usage because pumping may predispose you to dysbiosis. Because it interrupts the exchange from mother to baby, which is interesting. If it’s necessary, which obviously it is sometimes, we need to make sure pumps are well fitted, they’re used correctly, we need to avoid nipple trauma, and your pumping schedule should reflect normal milk removal, and not more.
Right, because pumping often leads to oversupply. We should be avoiding nipple shields, which we’ve been saying over and over and over again, and it’s nice to say one more time, and we should be wearing bras that fit. We do have an episode on nipple shields, and we are not anti-nipple shield. We will use them To get us back to the breast.
The goal is always to be direct breastfeeding. We think about nipple shields like epidurals. If it’s going to get you closer to a vaginal delivery, we’re going to use it. If it gets you back to breastfeeding as opposed to exclusive pumping, we’re going to use it. Yeah, and the thing about that is, you know, we’re advocating for judicious use.
Because there are still places that you can have a baby that you just get handed one. Oh yeah. And they’re like, Yep, use this. Okay. And you’re like, Oh, okay, then I use this and no education about it. So we’re not doing that anymore, folks. And all of those things you just listed definitely should have been happening already.
Yeah. And they’re definitely not. And I think most people when they’re pregnant, they are so worried about the birth that Preparing for breastfeeding in this way that’s so thorough in such a short amount of time is too overwhelming. Honestly, I was like, kind of, I was kind of exasperated about it typing it out because I was like, ugh, these aren’t happening.
Oh, they’re definitely not happening, but it really should be like in a special topics health class in high school at the very least. Yeah. We 40 weeks while we’re also worrying about how we’re going to get the baby out of our bodies. Absolutely. Absolutely. I mean, and, you know, ideally, right, we’ve got, we should.
Be encouraging people to educate their friends and family and their kids and to present Normal infant feeding as like a public thing that we do and we talk about okay, okay So I do have your four things now. I’m ready. I’m ready to receive them Okay, everybody. Are you ready? I’m gonna blow your minds.
You might feel defensive. Try not to feel defensive at home If you’ve been doing these, like, there’s nothing wrong with you, this was the recommendation, okay? Yeah, and, and, if you see recommendations that are old on the internet, feel free to comment and send them directly to the new ABM protocol, which we will link in the show notes, okay?
Okay. Number one. Avoid deep massage. Why? No more toothbrushes that vibrate. No more vibrators. No more digging into your boob. Not even gentle vibration? They say no vibration. None. But I will get there. Because deep massage increases inflammation and basically damages tissue. Yeah. It’s not a muscle that we’re massaging here.
It’s a gland. So It might actually reduce pain in the short term, but it’s so easy to cause trauma. They mention in the protocol that, like, you can do massage with proper training technique, but that we should tell people not to do it, so I think that’s BS, so I’m gonna tell you how to do it. Lymphatic drainage massage is what they recommend.
So essentially, the way that you do that is you make Your hand flat, and you use the edge of your hand, so like your pinky and the outside of your hand, and you sweep down, whooshoo, towards your armpit. You can sweep up and down. You can sweep either way. No, because you’re, the lymphatic drainage, they drain in your armpit, right?
The breast drains into the armpit. It’s light sweeping. You can sweep in any direction because we just have a million lymph nodes and while some of them drain up into your axillary, into your armpit, others drain like down to the side and really what we want more than anything is just some movement there.
So we’re going to do gentle sweeping, right? No deep tissue massage. And you can have your partner do this if you have a supportive partner with some coconut oil, just to make it real slickery. And make sure they’re doing it very gently. You control the pressure by telling them what’s too much. We need it super light.
And they’re just going to have a better angle than you will. Yeah, I actually think of this more on, on the spectrum of massage. We’re looking more at like the sensual pressure. Effleurage. Versus like you know, you, you had like a hard workout, now you need a massage. Like, more, more like the sensual side.
And then they did note that breast compression during milk expression is actually still recommended but it needs to be pretty gentle. It shouldn’t, you shouldn’t be like squashing your breast like you’re getting a mammogram. Okay number two. Are you ready? I’m ready. No more saline soaks, castor oil, or any other topical treatments.
Can I be honest? I never bought into the saline soaks anyway. I didn’t understand it. Honestly, I kind of feel conflicted about this one a little bit. I do understand that, like, sometimes the Epsom salt haka thing can macerate the skin, but Their reasoning was basically that, like, it’s inside your tissue and not topical, so anything you do topically, like, doesn’t work.
But our skin also, like, absorbs things and circulates it, like, as a semi permeable barrier. So I could see possibly some things being helpful, but things like castor oil are only going to increase circulation, and you don’t want more fluids there. Things like Epsom salts. Yeah, they might actually damage your skin.
Again. It’s going to like increase circulation and we want to kind of have the opposite happening. We’re like, no, thanks. And I think people really like the Epsom salt haka situation because they’ve seen videos of the biofilm clog getting sucked out into the haka and they want that relief so badly. And I think the HACA being placed on creating that negative pressure is a manual pump.
Yeah. And so that’s just potentially, you know, wreaking havoc on oversupply, which might already be the reason that we have this inflammation in the first place, or it’s just basically poking the inflammation by sucking, you know, creating the vacuum suction on it unnecessarily. Although A baby’s mouth.
Yeah, it’s, it’s an interesting one. I guess with all of these, the way I look at it is, okay, this is not our first go to anymore. Yeah. And if we use these things, we’re going to be very careful and we’re going to use them differently. Right. Number three is to avoid routine sterilization of pumps and household items.
So especially with things like thrush, but even often with bacterial mastitis, especially with nipple wounds, people tell you to like make sure you sterilize your bras. I mean like clean everything because that bacteria is going to get in there. Sterilize your pump parts. That doesn’t do anything and it dysbiosis.
I have questions. Yeah. So current recommendation by the CDC is sanitizing pump parts every 24 hours. Yeah, ABM says no. So What about if you do have a yeast infection, which I know they’re saying that it’s very unlikely that it is actually yeast but if you’ve seen thrush in your baby’s mouth and they actually have the white patches and you’ve got the red shiny bits on your skin the White vinegar the cup of white vinegar in your washer with your breast pads is supposed to kill the yeast spores Are we not supposed to be the yeast spores are sons of bitches like they’re so hard to get rid of I think what they’re saying Now though, is that the nipple and breast pain associated is not because of candida.
It’s because of staph Even if your baby has candida, so are they saying like sanitize your pump parts as usual, but don’t over sanitize them to fix No routine sterilization Because it doesn’t decrease the incidence of mastitis. But does it help anything else? Like preventing your baby from getting ill?
I mean, as we went over in the storage and pump parts protocol and everything, the milk storage protocol, No, unless you have a preemie or like a medically complex baby, it doesn’t make a difference. It’s not better than just washing your parts in hot water and soap. You know, the only time they do recommend that is if like Regular washing is not possible.
Right, like say you’re on the road and you have to do like steam sterilization. Great. But also, I don’t think, you know, maybe sanitizing your pump parts is not making it, it’s not decreasing the incidence of mastitis, but it’s also not increasing mastitis. Yeah, but it’s just another thing to do that you don’t have to.
Well, I know. I’m just trying to speak to the people that are out there currently sanitizing every 24 hours. Yeah, and You’re not giving yourself mastitis. No, but they do mention that it might be contributing to dysbiosis to have just this routine sterilization of everything. But that’s not like the definitive reason why I’m pretty sure mostly But aren’t they also saying that Yeah.
Sorry to play devil’s advocate, I’m just, it’s a very complicated protocol. It is. So, but they’re also saying that topical stuff on the nipple is not traveling back in the ducts to create mastitis either. But, our microbiome also exists on our skin. Right. Right. So I don’t know. It’s interesting. That, I need closure on eventually.
But that’s good to know. Well, you know, I didn’t have time to read every single study cited because there were about like 85 of them. Usually I try to go through a bunch of them, but there was a very long list of studies cited because this is a very long protocol. So unfortunately, I Like, usually I like to really dig in deeper on these, I just didn’t have the time this time.
Well, and it also says, avoid routine sterilization of pumps. And household items. So that might just be like, stop scrubbing your house top to bottom with Clorox. You know, that is creating dysbiosis in every Sure. tract of your body, I’m sure. Yeah. So be dirtier. I’m fine with that. Okay. Number four? You ready?
I’m ready. No more heat. We’re done with heat. Pretty much, yeah. They say avoid hot compresses because heat increases inflammation. We used to be like, hot showers, hot compresses, so now they’re saying no hot compresses and even just like standing under the hot shower is not necessarily going to help. It may provide immediate pain relief.
Like, something like a hot shower isn’t going to make it worse, but the repeated application of hot compresses definitely can make it worse. Even for engorgement? Because that is, like, part of that inflammatory mastitis. But, there is a difference between the primary engorgement and inflammatory mastitis.
Oh, sure. Yeah. But either way, the tissue is probably more friable and more Delicate because it’s being stretched. Same thing with hyperlactation. Those tissues are just working extra hard at those times and we have to treat them more like injured tissue. But, you know, that’s funny because if we have injured tissue and we’re a physical therapist, we’re going to do some heat.
Depending on what it is, we’re going to do heat or cold or maybe both, right? True. But, this isn’t Like, with, say, a physical therapist, we’re talking about injured muscle, or tendons, or whatever, but this is a gland. Okay, but if I had, for example, a, you know, my Bartholin’s gland on my honeymoon in my vagina that’s swelled up, they’re gonna doubt me to do an Epsom salt hot bath.
And maybe they shouldn’t. Not anymore? I don’t know. They probably will still tell you to do that. And what they noted in this is that often that hot compress provides immediate pain relief, but it doesn’t help with the root cause. It doesn’t release anything. Yeah. Okay. Okay, I do actually have more than four things that we’re doing.
Sorry. It’s like seven. I thought it was four. Okay, so now we told you what you’re not allowed to do anymore. No, just kidding. You do whatever you want. But here’s the real up to date recommendations. Now what? Okay. Our aim, now that we have all this knowledge in our brains, is to decrease inflammation. So what do you think we should do?
Well, this part, I feel like I’m actually doing well with my patients. It’s the other ones that I need to stop doing. We’re going to do ice and NSAIDs. Yep. So, lots of ibuprofen. And they, they’re actually giving recommendations for big doses. People do not go hard enough on this. Like, we’re treating an acute inflammatory issue, so they want us taking 800 milligrams of ibuprofen every 8 hours.
And possibly, in addition, a thousand milligrams of acetaminophen every eight hours if there’s a lot of pain. Mm hmm. And this is kind of shocking. Ice hourly or more often as needed? Yeah. That I can see for people that have an oversupply, but I can’t imagine that ice is gonna be good for a milk ejection reflex in someone who’s just dysbiotic but doesn’t have an oversupply.
Yeah, and I think we’re gonna You know, and, and what they said basically as needed, like what I read into that is this is a case by case basis, but they’re saying ice is preferable over heat in most cases, and they are still saying, this is interesting to me, they’re still saying sunflower or soy lecithin, 5 to 10 grams daily by mouth.
I know why I looked this part up. Yeah. So it’s actually. We’re trying to pinpoint what it is about the lecithin that makes it anti-inflammatory, and it’s the choline in it. Right. And so, actually, a lot of lactation consultants are like, Can we skip the soy? Yeah. And can we just get the choline? And we can actually get choline from a lot of foods, like egg yolks and kale.
Organ meats, peanuts, things like that, which a lot of people are eating anyway. But you can also just get a choline supplement and you can get a choline supplement. I’ve also found recently there’s a lot of like B complex vitamins that have a hefty dose of choline in it and B is not bad for anything, right?
You know, so it’s, and it’s water soluble. It’s gonna make you pee a funny color. It’s gonna make your pee a little bit neon. So, I’ve had some good luck with that. And just kind of skipping the soy bit altogether. Yeah, one, and there’s been a lot of noise recently from lactation professionals and like holistically minded practitioners being like the soy and sunflower lecithin is so pro inflammatory.
Why are we using it then with this new protocol? And they’re pushing just for the isolated choline. I don’t know how strong the evidence is that this lecithin is a pro inflammatory food. You know, like, I think there’s maybe like one study or something. It’s, it’s not something we have like 10 studies on though, so.
Well, this makes sense to me also, to have a little bit of an emulsifier. On board because, you know, if you have that inflammation and the ductal narrowing and you’ve got a biofilm clunking everything up, then our milk will get, then our milk is going to thicken up around there too. It’s not because your milk is high in fat, but it’s going to, it is going to congeal around that biofilm.
Yeah, and if the opening is smaller, it makes more sense than to have like slightly thinned milk. But that’s an interesting one. And I know they said like they for all this stuff, they provided like a level of evidence, you know, the level for that wasn’t like as high as, you know, ibuprofen. And five to 10 grams is a lot.
So a lot. Yeah, I did not say milligrams. Yeah. So I’ve actually I’ll have to change what I’m doing because I tell people if they have an active area that’s, you know, of concern, we’re doing 1200 milligrams three times a day. That’s not enough, I guess, three to four grams a day. So I’ll have to change that too.
Yeah. Okay. Well, we’re changing people. It’s a key to change. Yeah. Okay. So we’re also Making sure that we pay attention to nipple blebs. We don’t tell people that they’ll just go away. We still are avoiding unroofing or picking at them or poking them with a needle. However we’re treating them like we treat everything else because they are part of the same inflammatory process.
We’re doing the oralecithin and this recommends topical steroid cream, which In the last episode, we mentioned that the blebs are essentially an overgrowth of skin in response to the inflammation and steroid cream thins out your skin. Over time. Yes, over time. So it might be something where that is another kind of like perk to using that in this case is that it’s gonna possibly thin out those epithelial cells.
And reduce inflammation, so. Mm hmm. You know, something to think about. They didn’t really explain in detail why they recommended all of this. Well, what’s going through my head as a provider is like, Okay, well, can I skip the compounded cream, the all-purpose nipple ointment, and can I just order beta methazone Yeah, they gave a specific recommendation for the kind of steroid and the percentage.
I just didn’t write it right here. Oh, okay. Well, I will go dig it out. I was trying to keep this brief and accessible. I’ll stop asking questions. Okay, next we’re treating oversupply. Come on, people. This happens all the time where people go in for mastitis, they get antibiotics, and then that’s it. End of story.
It’s usually caused by oversupply. We need to treat the oversupply. If it’s causing a pathological problem. Yeah, please don’t be pathological.
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Enjoy.
This next one I’m so excited to see. It says, Utilize Therapeutic Ultrasound. How is that different from vibration? I don’t know. It’s different. TUS uses thermal energy to reduce inflammation and relieve edema. It can be effective for all conditions on the mastitis spectrum. It can be used on a daily basis until symptoms are relieved.
So we’re not going once a week. You’re going to go every single day. You know, to whomever is providing this to you and they said they wanted like one megahertz intensity of, I don’t know, I don’t know what this measurement is, a certain intensity for five minutes at a time. So, short little bursts of this therapeutic ultrasound.
And if you provide therapeutic ultrasound services, or you think you can or you want to, check out this protocol and it gives you exactly what you need to use for that. I want one of those little Ultrasound machines for my office, like one of those little handheld ones, like the butterfly or something.
Can you do therapeutic ultrasound with those? I don’t know, but I will find out. Like, I know with my, like, Doppler, you have to change the probe if you want to change the megahertz. So, like, some of those fancy ultrasound machines just, like, the probe is the whole thing. So, I don’t know if you can adjust or not, but I will look into it.
Yeah, look into it, because that would be awesome to have in your office. Yes, it would. I wonder how you go billing for that as a lactation professional. I don’t know. I have so many questions about How to do anything. Maybe you could bill for that as a CNM? Yes, well there’s actually, that’s very complicated actually.
I’m sure it is. Insurance companies barely know what to do with midwives anyway, and then if you’re like, no I’m a midwife lactation consultant and I can do ultrasound. You’re like, I used an ultrasound on a boob! And they’re like, weird, you don’t fit in a box. Five dollars. Yeah, I, maybe that would have to be cash pay only for a little bit.
Flat rejection. Until you figure it out. Yeah, no doubt. Yeah, I promise you guys we do not ever want to be cash pay only providers. It is only out of necessity when that happens, like for the most part, because working with insurance companies is soul sucking. Yeah. It’s a lot, but we’re willing to figure it out.
And like these new protocols are helpful to have on hand so we can be like, all right, well, who is able to use it? Yeah. I think they specifically mentioned that it’s common at like physiotherapy offices, but it’s not the only place. A lot of chiropractors have them too. Mm hmm. Stay tuned, everyone. Okay, so what else are we doing?
Okay, we are not prescribing antibiotics as often. Basically we have known for a really long time that we should stop over prescribing antibiotics. Prophylactic antibiotics have not shown to be effective to prevent mastitis. Right? But, we have to note that some antibiotics and antifungals are also anti-inflammatory, so that’s often why they seem to work, even if we’ve been dealing with inflammatory mastitis and not bacterial mastitis.
Yeah, but when I read this protocol, they did make a good point. The minute you give antibiotics, you’re putting them into dysbiosis. Yes. Which sets them up for future mastitis episodes. Yeah, and you’re possibly setting them up to then have You know, if they had a very small bacterial infection or something to have a resistant strain crop up later.
And now we have an abscess with a gravity drain. Well, the next one I’m really excited about. So the next one is consider probiotics. Yes. And they actually gave us strains for once. I feel like usually I look at these and they’re like, try probiotics. Maybe they’ll work. End of story. They told us which ones.
Yeah. So they told us the strains and the goal. is always to find a probiotic that has the strain in it with the highest number of CFUs that you can afford for your budget. And, you know, refrigerated is also going to be the best way to go because it’ll preserve the most bacteria, the most live bacteria.
Yeah. So, probiotics Do you want to give these names? So You want me to read them? These used to both be Lactobacillus genus named, but now they’ve changed to much longer. You try one, I’ll try the other. Alright, so we’ve got Lymosilactobacillus fermentum, formerly Lactobacillus, or And then preferably they want you to use Ligilactobacillus salivaris.
Oof, yeah, so, Probably Lactobacillus. Yeah, which is also good for your vagina. Yeah. Which is great. Absolutely. So hopefully not too hard to find, but I have to say I did not troll Amazon last night to see if I could find it. So I have looked so Clare Labs is usually what I like, but they’ve been out of it.
And so I’ve seen some on Amazon there’s one called And of course, I can’t promote any of these brands, really, because I don’t, we don’t have one that’s best or better than the others which is part of the hard thing about probiotics. Yeah, and I think one of the big thing is you don’t want to just get one that has Like every lactobacillus strain in it, you want to really target it with just one or two.
And that is harder to find, right, because a lot of these probiotics kind of sell like what you might think of as like broad spectrum to deal with a number of different issues and then they don’t really work well for any of them. Mm hmm. So if you can find that, that’s what we should be recommending to people.
That’s what you should be doing as part of your at home treatment. So I also, when I give people the recommendation to do these probiotics, I also say pick up some of that like Kevita probiotic drink like kombucha. You know, drink lots of kombucha, lots of fermented foods. You can really think about your diet in this case.
Like, if you can get six servings of a fermented food in every day. Lots of good yogurt if you can find, like, lacto fermented pickles. Sauerkraut. Lots of stuff like that. It’s going to be very good for the situation. And what these do is really help with that biofilm. So it helps break down that biofilm and get everything moving again and flowing.
And then additionally, I will tell people, if they can tolerate it, to make a ginger, turmeric, honey, lemon tea, and make it really strong and take a few shots of it every day. Just throw it in the fridge and take a few shots of it, because turmeric is very anti-inflammatory, and so is ginger, and ginger is good for your tummy in general, just kind of makes it easier.
Yeah, and with those things, like, you could take pretty massive doses without harming yourself. Exactly. And usually things are a lot more bioavailable to us when we eat them and digest them, as opposed to, like, What am I trying to say? Like taking pills and capsules and stuff. Right. Because, you know, okay.
So, love that the probiotics are in there and we’re actually, like, a big organization is giving a nod to the fact that they might work. Yeah, so this last one is A note for health care providers who are seeing people who need to have their mastitis treated is that we need to be evaluating all mastitis patients for perinatal mood and anxiety disorders because people with those PMADs have much higher rates of mastitis.
Oh weird, how the gut and the brain are connected. And, and it’s just like. It makes sense if you’re having some issues with oversupply in feeding and you’re stressed and you probably have something disrupting like normal physiological feeding of your infant, maybe your baby was in the NICU, like shocker, you’re probably going to have some issues.
So This mentioned that many patients are going to feel defeated by breastfeeding, afraid of mastitis, and supply issues and might be unable to stop pumping despite your recommendations because of anxiety. And how many times have we seen that? A thousand. A thousand times, and this is possibly the first time I’ve ever seen it mentioned in a scientific paper.
Yep, I’m really excited about it. Yeah, if someone is exclusively pumping, And they have an oversupply, but they won’t stop. I’m like, listen, man, we got to talk about this. Yeah, we’re having a problem. You are creating a pathological problem or at least preventing your body from healing itself. You know, like we got to intervene at some point.
Yeah. They also mentioned that if they’re coming in for an exam, folks with a PMAD might show an extreme pain response that is out of proportion to the exam. Hmm. That also makes me think big T trauma. Yeah. Which, of course, we’re gonna have higher rates of postpartum, like, mood and anxiety disorders, if we’ve experienced that in the past, maybe are currently experiencing it.
It also mentioned to consider D-MER as a possibility, not really explaining why they linked it, but I think they’re just throwing it in there being like, we need to talk about this more. So. Good. We do need to talk about it more. Thanks, ABM. Yeah, absolutely. So, the further details that I just want to mention First of all, if you are a healthcare provider who can prescribe and treat mastitis, you have to go check this out.
They provide very clear protocols for new Antibiotic dosing, all of that. What we’re telling folks now is all that stuff that we mentioned above with the ice and the gentle massage and normal feeding and anti inflammatories, if you have mastitis forming, do all of that for 24 hours. If nothing improves, that’s when you need an exam and possibly antibiotics.
Providers, then, if you have someone who has been on those antibiotics for mastitis for 48 hours and nothing is improving, you should consider doing a milk culture. You might not be using the right antibiotics. You might have a resistant strain. So, that’s really important to do soon. And not make people suffer.
Okay, so we have some new recommendations for draining galactoceles, abscesses, and phlegmins. And I don’t want to bog you down in the details, but I just have to mention them, because they all kind of relate. The flagmans may or may not need to be drained, but just think about them while I’m talking about this.
Okay. So, for abscesses and galactoceles, right, if they need to be drained with a needle aspiration, if you’re already doing that, please do a fluid culture. Okay, you already have the fluid. Do a culture. Repeated aspirations of those significantly increase the rates of early weaning. Shocker, if we’re stabbing you with a needle over and over because you’re breastfeeding, you’re gonna wean.
So, what’s recommended is that drain placement should be done as part of the initial intervention often. And, and that should be part of your consideration for the definitive management, right? When you do that first aspiration with a gravity drain, rather than suction, no vacuum assisted devices. Probably for doing that, we need an antibiotic as well, we’re feeding normally and we’re gonna have intermittent exams as well as part of that ongoing treatment.
And we’re going to do imaging at the end to ensure resolution. And then you take the drain out. Yes. Okay. So that is not what the recommendation was before. Before we were doing lots of repeated needle aspirations and really needlessly putting people in pain. Well, and also they were unroofing blubs with needles, which was also uncool.
And also, I think the recommendation to do aggressive massage and lots of vibration and lots of heat was creating more. Flegman and abscesses that had to be drained. Yeah. And you know, this protocol is really encouraging the use of radiology as a guide for how to treat and when to stop treating, and I definitely appreciate that.
It’s also mentioned it now as part of the treatment for recurrent mastitis is to use imaging to evaluate what’s going on under there. Is there an underlying mass? Is there some kind of anatomical anomaly, like do we have like some kind of granulomas or something? You know, like what’s going on? Is there something there?
Structurally? I’m glad they put that in there. Yeah. Can I just tell you that I have sent people to breast. centers before, and they refuse to ultrasound them because they’re like, Oh, well, if they’re lactating, there’s so much going on in the breast. We won’t be able to see anything anyway. And I’m like, it’s your job time to get good at it.
Like I’m, I’m done with that. I’m so done with it. And I’ve, I’ve definitely had people refused for ultrasounds before because they, and because they were lactating or they come in and they’re like, Oh, I drained my breast. And they’re like, no, you were supposed to come in full. And we’re like, well, you should tell people that.
Yeah. Like, I’m sorry. Okay, be clear. We should be doing ultrasounds on breasts when we have issues with abscesses, galactoceles, etc. Okay? Yeah. Thank you. Okay. So, you ready for the summary? I’m ready. ICE. NSAIDs. Physiologically Normal Breastfeeding. are ideal for broad spectrum treatment. Do not ignore oversupply.
Refer to a lactation specialist if you don’t know how to deal with oversupply. Do not underestimate the importance of the microbiome and supporting that. Avoid deep tissue massage and too much heat and avoid overstimulation of the breasts. Extra pumping, extra milk removal. Okay. Okay. Well, everyone take a deep breath.
Understand that change is hard. You know, we’re not losing our practice, okay? We’re gaining a new way to practice. True. And we are always going to try to get better. In 50 years, this will be different also. But you know what I did lose? What? My bathroom birds. They’re gone! Oh my god! Susan. Susan is gone. Do you guys remember, I don’t know how many episodes ago, I was like, Heather, I have a bird living in my bathroom and she’s raising babies while I poop.
Yeah, so if you haven’t heard that one, I was like silently blinking at her from across our recording space just like, of course you have a fricking bird in your bathroom. Yeah, so anyway, somewhere I left the window open, a bird made a nest and laid eggs in my bathroom and they’re federally protected species, so we just left her there.
They hatched, they grew up, and then one day I came into the bathroom, and like the day before, I was like, they’re gonna fledge so soon. They look like adult birds, basically. And I came in, and you know how when you open a double hung window, there’s like the gap between them? Oh boy. So I came in and one bird was stuck in the tub, one, thank god, was not in the toilet, it was just near it, and then the other was stuck between the windows.
Why are babies always trying to unalive themselves? No, they’re really They were just like toddlers, I swear. So I scooped up the two that were easy to access and threw them out the window and they flew. You just throw them? Yes, you just throw them. Well, I mean, I like gently, like, pfft. You know, like, just Oh my god.
I didn’t, like, throw them like a ball. I just kind of, like, underhanded, like, like She just overhand I just kind of, like, boosted them. Shucked this house wren out the window. And I could hear the parents out, like, the parents in Are part of the fledging process, so they were out in the poplar tree by the window, like, yelling for them.
So I just kind of, like, boosted them out, but then that one between the windows, there, it was so stuck, and when I pushed the windows, like, open to try and grab it, it got, like, wedged, and then it was, like, it was a process, but I do, I did put a video on my personal TikTok account, because Griffin was there, so he was videoing.
But I got it out safely, which is hard to do because they’re so delicate, they’re like, their bones are like toothpicks, so I was like, I don’t want to break you. And I got it out, and I just like, gently extended my hand out the window, and that one flew away because I wanted to be a little more gentle with that one.
And it successfully flew out into the yard, and their parents fed them all, and it was fine. Why does that give me so much anxiety? It was a hectic moment to walk into my bathroom and have birds flying around. I just, that’s one of those things I just don’t need to deal with in my life. You know what I mean?
You know, it was exciting though. Oh God, so much pressure. If I had killed a baby bird by accident, broke its little wing, and then softball pitched it out the window, I would have been so sad. Well there were only three birds in my bathroom and I know four had hatched, but I, it was really hard to tell if four Reached fledging because the nest like was so small.
I could never tell if all four were in there after a certain point, you know, because they’re just like in a little bundle of snuggle birds. So I don’t know if they all made it, but I know three did and 75 percent is pretty good. Yeah, you know that I feel success. I’m going for a hundred percent with my kids.
Yeah speaking of Leaving the nest. I think like, you know fledgling mortality rates are generally higher. I would hope so Yeah speaking of leaving the nest Heidi started pre pre k because she’s three and a half and She’s going to the big girl school and she keeps talking about how she I I growed up And I’m like, Oh, Heidi, she told me she’s going to start driving soon.
I was like, you’re, you’re not going to start driving soon. And she’s like, I’m going to drive myself. And she goes, but I don’t know how to turn around. And I was like, well, turning around is a really big part of driving. So maybe we’ll just wait. And she’s like, yeah, maybe we’ll wait. And so I said, Are you nervous about your first day?
And she was like, no. And I said, are you going to make friends? And she goes, yeah. And so when I picked her up, of course, she’s covered in dirt, head to toe. And I love the school that she goes to. Their playground is twice as big as the building, which shows where their priorities are. And she literally was filthy and I, and she was exhausted.
And I said, hi, did you have a good day? She goes, yeah. Yes, I made 50 friends. So I’m really proud of her. She has fledged all the way to the early learning facility called ELF. That’s so sweet. Yes. And she’s having a great time. She’s there right now. Oh yeah. Yeah. Oh, they’re so sweet. It’s really hard to believe.
Do you know, I. Just yesterday witnessed, like, possibly the first instance of actual, like, cooperative play between my children. Oh. You know, like, they’ve done some parallel play, which is like, you know, like, occasional things you see, and like, You know, year and a half, two year old range. But this one, Griffin, he was doing something really annoying.
He was pretending to be a cat, so he was like crawling around on all fours, going like, MEOW! You know, it’s like the most annoying thing, but Lyra looked at him and got on all fours, And started crawling around going, ROW! ROW! And like, interacting with him though, not just like, paralleling. You know, she’d like, crawl over to him and like, touch him and meow at him.
And I was like, oh my god, this is the most annoying, adorable thing I’ve ever seen! Amazing! Just wait, they’ll start fighting soon. It’s really funny to watch my nine year old fight with my three and a half year old. I’m like, buddy You’re nine, and you are full on arguing with a little terror. You should check yourself.
He’s like, I know, but God, I’ll hear, Heidi! Griffin already is just like, Lyra, ugh! Yeah. She, so she understands potty humor now. Oh, yes, that’s the first kind of humor. It is. So now when she farts, she waves her hand in front of her nose and wrinkles it, you know, and laughs. And then she farts on purpose.
You’ll see her go like, and like squeeze another out and then do it. Yes, and she’ll go over to Griffin and stick her butt on him and squeeze out a fart and then laugh about it. She’s like one year old. I I’m shocked at her, like, literally pushing farts out because everybody laughs. Like, I, I, I know they get that humor at that age, but like, she’ll look at you and her whole face will turn red, you know, and she’ll like, squeeze one out and then laugh about it.
Oh my gosh, that’s hilarious. Yeah, we, Heidi just, she slips she calls penises, peanuts, and vaginas, poo poo ginas, and she sneaks those two words into every one of her jokes, and, you know, and if she really gets you laughing with, you know, something separate, then she’ll just start randomly saying, yeah, and peanuts and poo poo ginas, peanuts and poo poo ginas, just to like keep you laughing because she’s enjoyed it so much.
Oh, yeah. Oh, that girl. I know. It’s wonderful. They’re growing up so fast. They are. All right. Well, much like our children, the mastitis protocol has grown up and we’re releasing it. We’re fledging it out into the world. Please spread the word. This would be very helpful if you shared it with all of your people.
As you can tell, it’s very, very important that we get this new information out there for everybody so we can prevent. Antibiotic resistance, and chronic mastitis, and breast surgery, basically, is what we’re preventing here, and early weaning, because nobody likes any of that.
I tell all my patients who are brand new parents to put a list of soothing techniques on their refrigerator so they can both remember what they’ve already tried for soothing baby. I like to put a happy tummy on that list. It’s a natural herbal wrap that soothes and relieves pain instantly, and it’s so fuzzy.
It’s so great. It helps babies sleep at night, resolves colic, gas, or constipation, and it’s great because it has a little cute animal on the front for when they’re doing tummy time, which provides gentle pressure to help them get their tooths out. And you know what? They’re not just for babies. They have them for teens and adults, too.
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All right, well, before we get out of here, we’re going to give an award in the alcove. And can I give this one? Because she’s my buddy. So this award goes to Jamie from West Virginia. Well, she said I could use her full name. This goes to Jamie Williams from West Virginia. Everybody knows her and loves her because she’s on our local radio station.
Jamie says, I’m still on my breastfeeding journey with my four and a half month old son. Since I work full time, I’m mostly pumping. Over a weekend, there was a fundraiser that involved me camping in a tent in a business parking lot until I could raise 10, 000 for the local no kill animal shelter. My biggest concern was where can I pump?
The business was generous in offering me their only bathroom. They don’t have a private office or break room. I found an alternative, the giant mobile boom box for our radio station. It is often used in parades or for sporting events, and it’s basically the size of a parade float and plays music. So every four hours there I was on a camping chair inside a giant boom box so I could feed my kid.
What an experience. You think that vibration of the boom box was helping? I hope so. Jamie, we’re going to give you the. Boom and boobs award love that because obviously pumping in a boom box is incredible and you deserve all of that. And also congrats on raising 10, 000 for a local no kill animal shelter.
It’s really great. I mean, there’s just so much good happening in that one award. I mean, this is part of why I love the awards because I feel like we get to see these. Like, little personal moments from such amazing, dynamic people that listen to this podcast. Yeah, there’s good people out there, guys.
Really good people. Like this one, who wrote us an Apple review, Libby Love 1269. Binge watching. I found y’all on TikTok and started listening to a recent episode while I was cleaning the house. I loved it so much I started from episode one and I listen all day long. My baby is so used to it now that he sleeps through the podcast playing.
Thank you both so much for all the answered questions. Aw, thank you so much, Libby. We’re so happy to help. Thank you, Jamie, and thank you to everybody else listening out there. Yes that’s been another episode of the Milk Minute Podcast, y’all. Yeah, and thank you for helping us change the way we do things here with this new mastitis protocol because we need to change this big system that’s just not really helping us.
If you found value in what we produced for you today, you can become one of our VIP patrons. So head on over to Patreon. com slash Milk Minute Podcast and you can get Early and ad free episodes, merch, you can message us, you can do live video with us, you can see all of our personal behind the scenes stories, and you get to support a really cool project and help more people just like you access this information for free.
Sounds good to me. It does. Okay guys, we’ll see you next week with another amazing episode. Alright, buh bye. Bye.
