But thankfully within our medical system, I can be persistent (annoying) and see ten doctors and get ten opinions without shelling out a nickel – except in medication and remedies for ailments I don't actually have – until I get what I want. An answer that I agree with. A correct one...
My point? While it wasn't quite ten doctors or nurses or lactation consultants that I saw, it only took one who actually asked different questions to get it right. After a few days (and lots of internet reading), I realized that the medication I got from the ER doctor wasn't quite right, mostly dosage-wise.
First of all, Finn immediately got really dry skin and my pain wasn't subsiding. It just didn't seem right to me. So, back to the breastfeeding support centre. Again, they backed up every doctor's "theory" that I had developed a ductal yeast infection because of the way I'd described the deep, throbbing, burning, stabbing pain. The nurses there recommended a yeast/sugar-free diet which left vegetables, meat and nuts. No dairy, no sweeteners, no bread, no fun. But whatever, I was willing to try anything because I was so exhausted and short-tempered from being in pain all the time. I also asked them if they would try getting me an appointment with another doctor, who just so happened to also be a lactation consultant.
That was on Friday the 16th and they amazingly got me in to see her on the following Monday afternoon. First of all, she wanted to take care of the "milk blister" I'd had for seven weeks. She was the only one in town I'd heard of who would unplug them, even though I brought it up to every doctor I'd seen. (Everyone else just threw anti-fungal cream at it.) All she needed to do was take a nice, sharp needle to clear the bleb. And yes, it hurt. Kinda the same way it hurt to get stitches in my crotch without adequate freezing. Yeeeouch. After that, she asked me to nurse Finn on that side to clear out the trapped milk, to check his latch and examine me afterwards. And that's when she noticed that my nipple was kinda white. Aka, blanching.
Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings.
Vasospasm can also be caused by Raynaud's Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud's Phenomenon (Raynaud's of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change - from white to blue to red - as blood flow returns. The color change may also be biphasic - from white to blue.
Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse.
Per Anderson et al, "Because the breast pain associated with Raynaud’s phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud’s phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents."
That was interesting. So, I started taking the vitamin B6 and extra calcium she recommended and aside from a couple painful periods in the last five days, I've felt a whole lot better. The key seems to be to keep warm. Really warm. So I haven't been turning on the air conditioner much, at least until supper time or the early evening. I put blankets on when I feed Finn. And we nap up in our sunny bedroom – for five hours yesterday, three of which I shared.
How funny that when you know the problem, the solutions to manage and control it are so much easier.