Understanding Mammary Constriction and Vasospasm

It's now recording. Yeah. Yes. So everybody, you are now recorded. We are now recording the session. I'm very sorry for those who, it's never like this. I don't know what's going on tonight. I'm quite embarrassed. Okay. Cool. Can you see it now? Yes. Okay. So you can carry on. All right. Cool. Well, welcome, everyone, and thank you for joining us tonight. Oh, wait. I want to say something. Sorry, Sam. I just want to tell the people that we are incredibly lucky because we've got people of such high standard. I said it last week, and I'm going to say it again. I went quickly through. Sam's CV before we started and I'm astonished yet again because she won a Jock Gare Memorial Award for achieving a high level of clinical competence in professional practice in caring for clients and patients in both community and hospital settings. She also won a Tara Morris Psychiatric Nursing Award for excellence in psychiatry and nursing theory and practice and Samantha also had a distinction with SSLC and she started a private practice in 2009. And she's going to tell you the rest. And I know she loves sport very much. So now you can carry on, Sam. Cool. Do we have lots of students tonight? Who's on the audience? It's a mixed girl. Mixed girl. Okay, cool. Well then, some of you know me, some of you don't. Please ignore the date of my presentation. I changed it about five times today and then I remembered I didn't change the date until tonight. So just ignore it. Cool. So before we start, we're going to do, it's more vasoconstriction than just mammary constriction syndrome. Can people see me? Do you want to see me? Is there anybody who can hear us and see us? Just you and I talking to each other, Hetty. Oh, wait, I'm hearing you too. And I don't mind if you want to keep your screen closed or show your face. I think the others would like to see your face. Mine says my camera's on, but I don't know what's going on. It's blank. I don't know. I don't know. Is there anybody else? There are glitches tonight. I don't know. Anyway, doesn't matter. Cool. All right, cool. Before we go to that slide, what I want everyone to do, and this is what I wanted my camera on, but I don't know why my camera's not playing the game tonight. I checked everything this afternoon and then it was working, but clearly now it's being a drama. So what I'd like everyone to do is take your finger and I want you to pinch it really, really hard and just keep pinching it as hard as you can. Is everyone doing that? Please write in the chat because I know your mic's on. Or put your cameras on and let us see you doing it. Are you pinching your finger really, really hard? No, I want you to hold, pinch the one finger with the other finger as hard as you can and make it go really, really white. Okay, keep pinching it. Don't let go yet. Yeah, excellent. Excellent. Cool. So now I want you to let it go and I want you to feel the capillary refill. Can you feel that? Cool. Is everyone feeling it? Awesome. So the reason I wanted you to do that is because that's basically what is happening when we have a vasoconstriction or a vasospasm or something. But I want you to think about that feeling on your nipple. All right, and I want you to think about that as we go through the presentation, and I want you to keep thinking about that as we go along. So I want you guys to put the answers in the chat if you can, but I want you to think about your mom with a painful breast, and we're going to do a little bit of a differential diagnosis here. So the mom's describing that her breasts and her nipples are burning. She got a deep stabbing pain. she gets pins and needles, it's worse when it's cold, sometimes it's during breastfeeding, sometimes it's in between. I know you know what the answer is, but I want you just to write down for, especially for the students, what are all the differential diagnoses when your mom comes to you and she tells you this is the feeling that she's having. Quickly pop them in the chat for me. Lightning round. Can you see the chat? I could see it when it said the last thing is Zandri said can't see the presentation. Okay I've got a vasospasm, got a Raynaud's. Those are the answers because you know the name of the presentation. I want different things. Because Raynaud's isn't going to be the first thing you're going to go to when your mom says she's got nipple pain and breast pain. Thrush, candida, ductal thrush, that's what we like to hear. Incorrect latch, blocked duct, poor latch, nipple tissue damage. Keep going, one or two more. Mastitis. Cool. Nice. All right, cool. Thanks for that. So can you see when a mom comes up to you, well, not comes up to you, when she's in the consult with you, she just doesn't come to you on the street, although some of them do. But when a parent comes to you and they say to you, they've got breast pain. Okay, generally, so generally the first thing that we think about is, well I know I think about is that usually it's a baby issue in terms of there's a poor latch, okay, and poor latch is a big, big one that we want to look at, but tonight we're not going to look at latching issues, although it is something you always first have to fix, okay, is that incorrect latch, because no matter what you're doing, that incorrect latch is going to be the problem. But tonight we're going to look at a few different things that are causing that. And the first thing I want to chat about is, in the chat, if you can write down, what do you think the difference is between a thrush and a vasoconstrictive disorder? What would be the differences? You know me, I never let you guys just sit there. This is why I like live presentations, I always hit here, make everyone stand up all the time. Okay, thrush isn't affected by cold. Cool. I'm just keeping refreshing my chat. What do you mean by severe? Okay, someone's saying in the nipple pain there's only vaso... Sorry, only nipple pain invades the spasm and candida shoots through into the breast. Keep that in mind when we're chatting later on, that answer. Trix, what did you mean by severe? Okay, vasoconstriction is a deep nerve pain, okay? Triphasic color change. Awesome. Awesome. Okay. So, Hiti, if you don't mind going to the next slide. Okay. Oh, so you will tell me when I'm asked. Okay. Cool. Yeah. Okay, so once you've got all this information and you're looking at the differences, okay, thrush, we're not talking about thrush today, but I want you to always think about, especially if there's nipple damage, things like that, I want you to think about thrush as well, and you actually have to rule thrush out, okay? But sometimes, as you all know, we treat a lot for thrush, okay, and the treatment just isn't actually working, and we know thrush is difficult to treat at times, but... What I want you to think about as well is maybe it's not thrush. Maybe it's something actually mimicking thrush. And I actually see this quite a lot where you're looking at this nipple and you're thinking this isn't thrush, but all the symptoms are shouting thrush to you. So someone wrote in there that thrush is like a deep shooting pain into the breast. Okay. So now, who has ever seen or managed any mammary constriction syndrome? Does anyone even know about it? I don't think it. I think it might only be the qualified. Okay. I've got one or two putting their hands up. If you want to put your cameras on, you can. And just shout at me and just go like, cool, I'm here. Thumbs up. So one or two of you have seen it. Okay. Perfect, perfect. All right, cool. I'm glad you see it and I'm glad you treated it. Because it is something we sometimes forget to think about. for these moms, and sometimes a few simple little things can actually save them a lot of money, a lot of time at doctors, and a lot of stress in their lives by just doing a few deep things, okay, so what mammary constriction syndrome is, is exactly what the name says it is, okay, but what it actually presents as is deep breast pain during breastfeeding, okay, I really wish my camera was working, it's driving me mad, but When you actually press your breast just sort of just on the, you know, where it sticks out your bra. Okay, I'm not very good at anatomy. Where it sticks out your bra, I want you to press there. S-A-C-L-C-Q-L-C, Heather Jepsen 2. What's up, audio? Thanks. That wasn't me. All right, cool. When you press on that area there, that is where your clients often complain of the pain. And they tell you that it's going straight from their breast deep into their back. Okay, so someone said that vasospasm doesn't cause deep pain and thrush does. Okay, so I want you to think about sometimes vasoconstriction does actually cause this pain. Alright, so it can cause a deep breast pain during breastfeeding. Alright, so I want you to think about this as well. Alright, this deep, deep breast pain that these poor moms are actually having. Sorry, I just lost my screen again. So what's actually happening is that the pectoral muscle beneath the glandular tissue presses on the blood vessel supply on the breast and the nipple. So think back to midwifery, think back to everything you're doing. When there is lack of blood flow and lack of oxygen, it creates pain. So think of a contraction. Why do we have contraction pains during pregnancy? Because we have lack of blood flow, lack of oxygen. Similarly, when the pectoral muscle is pressing on those blood vessels, the breast has lack of oxygen and lack of blood flow. So the way the moms describe this pain is it's a throbbing constant. It can be deep. It can be superficial. It can be itchy. It can be tingling, aching. Some tell you it feels like someone stabbed them in the breast. Okay. I'm shooting sharp, dull, burning, freezing. So can you hear all these words? And generally when you hear those words, your first thought is thrush, thrush, thrush, thrush, thrush. That's all we think about. And that's all we're treating for often. And I want you just to think for a second or two beyond that, that it could actually be this mammary constriction syndrome that's happening. Okay. Bernardine, you said you're seeing a mom that fits the profile. Do you want to pop your mic on quickly and just give us a quick, what is your experience with that? I think I'm on mute now. Yes. So I'm not 100% sure. I think she might be fitting the profile, but definitely had a lot of vasospasms and a lot of these symptoms she is complaining about. So we've really been focusing on heat, but then exactly where you say that spot, you'll always say it's very tight or hard. But if I feel that there's nothing that I can say, let's say it's blood ducts and so on. So I'm really... excited to learn a bit more about this condition. Yeah, yeah, absolutely. Thanks for that. And did you treat her for thrush? No. So I was very conscious because of the house temperature being very cold. We were very mindful that it might be vasospasms instead of thrush. Okay. All right. Perfect. Is everyone understanding that a mammary constriction syndrome is a type of vasospasm or a type of constriction? Is everyone feeling that? Is that coming through nice and clearly? Cool. All right, perfect. I love these thumbs up. They make me so happy. All right, cool. So I've just given you a little bit on mammary constriction syndrome. And then if you go to the next slide, okay, just a little bit on vasospasm. Hetty, can you go to the next slide? Oh, sorry. No worries. I'm sitting sleeping. So I don't know what can you see and what can't you see. I don't know if you see me or not. I can see you, yes, perfectly. I just can't see anybody. Perfect. All right, cool. So a little bit on what the mammary constriction is like, and now a little bit on vasospasm. Okay, so vasospasm is more around the nipple area, actually. So mammary constriction syndrome is more the breast tissue. Vasospasm is a little bit more around the nipple. Okay, so what we see is that we see a definite blanching. Okay, and what we mean by blanching is that the nipple actually turns white. And the reason for that white is because the blood flow is limited or it's cut off. So remember at the beginning, I asked you to pinch your finger. Okay, I want you all to do it again. Pinch your finger and I want you to look at it and see how there's no blood flow and it goes white. Okay, and then when you have the capillary refill, that's when it actually starts to hurt. Okay, so that's what we're talking about by a vasospasm. And what that can be caused by is usually more a latching issue when the baby's on nipple feeding as opposed to breastfeeding. It happens very, very often. Just in the chat quickly, do you guys know what I mean when I say nipple feeding and not breastfeeding? Because my moms never understand the difference. I want to make sure you're all in there. Okay, good. All right. So remember, we want moms to breastfeed and not nipple feed. Alia, you've got a question. Oh, sorry. I was trying to react with a thumbs up. Okay. Just checking. Just checking. And Tarin, Tarion, Thompson, question. You've got your hand up. Not. Okay. All right, cool. So what can cause the baby to nipple feed is obviously a very poor latch. Okay. One I actually saw this morning and it was causing this terrible vasospasm as well is that the mom had a very fast letdown. Okay. That baby was being overwhelmed with the milk flow because it was super fast and the baby was actually using its mouth to clamp down to control the flow. So when your moms have got a very, very fast letdown and they are complaining of pain, like a nipple pain, think about is that baby cutting off that blood flow to that nipple? And let's look when the baby comes off, what does that nipple look like? And what we need to do is we actually need to look at ways to control the fast letdown so that we can actually control the vasospasm. Okay. I'm not going to get into tongue ties at all today, but tongue ties definitely can cause a vasospasm because our babies definitely have a very poor latch. And one way to differentiate between what's happening with the vasospasm is that the pain is usually when the blood returns. So you see these moms, what they say to you is that... On the latch, it's a little bit sore, and then it calms down through the feed. And then when the baby delatches, what those moms do is they naturally, they take their hand, flat hand, and they press it on their nipple, and they hold their nipple tight, tight, tight like that. Okay, so they actually push into their nipple with their hand, and you see them do it naturally because that's what actually controls the pain. And then you can start thinking this is a type of vasospasm because what the mom's trying to do is she's actually trying to get that capillary refill to come in a little bit quicker. Okay, because she's, because of that, she wants that blood flow there because the capillary refill is what causes the pain. That's why I wanted you to press your finger so you can feel it. Okay, and then if it's a true vasospasm, okay, that usually happens in between nursing. Okay, and that is usually caused by the cold. So when you were talking earlier saying one of your moms, the room was extremely cold and that she was feeling, that is a true vasospasm. All right. So that's usually by the cold. And what also happens is we find moms get very, very sensitive. So when they've had previous nipple damage. So in the first few weeks, they had cracked or bleeding nipples. because of a poor latch or a tongue tie or anything along those lines, we find sometimes they do get a type of vasospasm later down the line. And that's purely because they've had previous damage and they get extreme sensitivity. Actually, on one of the groups today, someone was, or yesterday, I can't remember, someone was talking about sensitivity. And what it can be is it can be a type of vasospasm from a previous nipple damage. And that's where we've got to look at. at these different diagnoses as well, because it can just be one of these things. All right. Now we're going to look at Raynaud's and then we're going to look at all of them together. And we're going to look at how can we actually manage these clients? Because I'm not going to get into anatomy and physiology. It's more about how do we get these clients to be happy and actually resolve this problem. So, if you can go on to the next slide. Okay. So, Raynaud's phenomenon of the nipple. Okay. is where there is the white blanching, but then it often goes blue and then it often goes red. So we call it a triphasic color change. Sometimes it can just go white to red. Okay, so they call it a biphasic color change. But sometimes you can actually see that definite white, blue, red as it changes. But the difference here is it's usually bilateral. So it's usually both nipples that it happens to. It usually lasts a little bit longer than a normal vasospasm, okay? And it can happen at any time. So the mom is, you know, happily going about her day, baby sleeping, and suddenly she feels this extreme pain. And this is where we're often confused a little bit with thrush because we think maybe it's the thrush that's causing the pain. All right. But the nice thing with Raynaud is it's sometimes a little bit simpler to diagnose because it's bilateral, so it's usually both nipples that it happens. And it potentially has happened before or on other parts of her body. So the mom, especially during pregnancy, she may have felt it happening. And she might be the mom who's got, you know, in winter, the tips of their fingers go blue. The tips of their toes go blue. I'm sure I find everyone's got one or two friends that have got blue fingers constantly. Okay, I know I've got one. She goes actually like purple around it. So, that's a slight difference between the two, is that there's actually an underlying reason and it's not caused by breastfeeding. What's happening is that the breastfeeding is exacerbating your underlying Raynaud's syndrome that the moms are experiencing. And some of the reasons a mom can have a Raynaud's, there's an underlying reason for it, or it can be things like medications, such as your oral contraceptives. Why I've highlighted fluconazole in green, I don't know why green, it was just when I was studying I always used anything to do with thrush I had green for some bizarre reason. But we sometimes think that the mom has got thrush and then she's treated with the fluconazole and then it actually makes her symptoms worse and that could potentially be because she's actually, it's not a thrush, it's a Raynaud's syndrome of the nipple. and the fluconazole is actually making it worse. Okay? Then your mom with endocrine issues, so your hypothyroidism moms, which we know there's lots of, moms with lupus, rheumatoid arthritis, and then your moms with previous breast surgery can really see some nipple Raynaud's. That's happening. So this is why I'm such a stickler for the history. Okay. I see lots of people who, when they walk into a consult, they go straight to looking at the baby, looking at the mom. And I have to control my moms as well, because I'm sure you all feel it when you go into the consult. As you sit down, the mom hasn't even said hello to you. What she's doing is she's already telling you. about the pain and the feeding and everything. And you actually have to sit down and you have to calm her down slightly. Okay. That's why I always start with basic questions. What's your name? What's baby's name? Who's your doctor? Who's your midwife? Who's your ped? Let's go through a little bit of what meds you on. All of these things. And we start beginning a real good history so that you can take her step by step. So we don't miss any of these little things. Because it is so important on a differential diagnosis. Because if you just go straight into the... watching the baby breastfeed, we're going to miss a lot of these little things. And then we start treating for thrush. We start treating for tongue ties. We start treating for all of these things. And it's actually something a little more, not that it's simple, but a little bit different or outside of what we normally treat. So it's very important that our history is important here. And I want you to do a differential diagnosis. Even if you sit down with a piece of paper with the mom, And you actually go through the different things that it could be. So the mom describes her symptoms. And make a little spray diagram on your consult sheet. My consult sheets look terrible because they've got writing all over them. Luckily, I'm not in a team with anyone else because no one would ever be able to see my consult sheet. I'm so scared of getting sued because if a lawyer had to read that, they would think I'm all over the place. I write lots of things down on there and you just do a little differential diagnosis. Does she have oversupply? When is the pain happening? What type of pain is it? Can you visually see anything? What is the nipple doing on latch? What is it doing on D latch? What color is it? What shape is it? Okay. Is there cracks? Is there bleeding? And we go through all of these things. And even if you sit and highlight things and you work out what is actually going on with this mom, it's very, very important. before we jump into any form of treatment or diagnosis or anything. And we always fix the latch first, no matter what symptoms these are, we always fix the latch first. That's probably the most important message we're looking at all of these, is fixing the latch. Okay, before I go on to some of the ways to manage this, all of these symptoms, what are your questions up front about this? I don't like a quiet audience. You can put your, you can put your... you can do in the chat or you can put your um unmute yourselves let's chat what are your questions on this any questions nothing yeah what would you say is the most like prominent sign that it's not thrush but Raynaud's experience. So seeing it more practically. What I find is that color change. It really is. I want to play this video for you, but we're having so much technical drama. I don't even know if it'll play because my hyperlink's not working. But what you can do is you actually go, there's so many videos on it. On Dr. Newman's page, if you go look up Raynaud's and Dr. Newman's page, he's got tons of videos. Of the actual color changes that you see. And that's a very important thing to look. I don't know how many of you are actually looking when the baby delatches. How many of you are actually looking at that nipple? Because I want you to go through the things. Are you looking at what the shape is? Is it round and pink? Is it white? Is it lipstick shaped? What's happening? So you need to be looking at that nipple straight after that baby comes off. Okay, thanks, Sam. Cool. Anyone else? I want a question. Sam, you can. Sorry, you can send me the link afterwards, then I can post it on the group. Okay, cool. I'll do that. Please. Yeah, I'll definitely send it afterwards because it's such a nice video. You can actually see it. And the poor mom's in pain because she can't hold her nipple to get rid of the pain. But it's a very nice video. You can actually see the color change. Cool. Anyone else? Any questions you're having on this before we treat it? the pain description um so the pain on season news hand is raised Use hand? Yeah. Did you want to ask something? No, she asked earlier. Okay. Someone asked, does the nipple change color when you press on it? It's actually not. It's actually when there is that nipple feeding or that constriction. That's when we see the color change. But you can just see it if the moms get really cold. You can actually see it go white. And then you can see it warm up again and you can see the color change with the Ray nods. And you can actually almost see it in their fingers and their toes as well. They go white and then they eventually go blue and then eventually go red. So that triphasic color change is what you're seeing, but you have to have had the constriction or you have to have something that's triggering to see the nipple change. If you just press it, you're not going to see it. And then Khada says, Is the pain description the same with vasovasovasomy constriction syndrome? It's actually not. So I find mammary constriction is much closer to thrush complaints. So when a mom says thrush, I'm always thinking, is it mammary constriction syndrome or is it thrush? And if you're seeing the flaking skin and all of that, then we go more thrush. If you're seeing no external signs or anything like that, then we're thinking it's probably more. mammary constriction syndrome. But to be honest with you, I always treat for mammary constriction syndrome because it's such simple treatment as we're going to see now. It's so easy. There's no harm in doing it because it's non-invasive, very easy. So I think all the moms should do it anyway. All right. So Hetty, if you want to go to the next slide, we can start looking at plans. Okay. So as I said up front, the first thing is we always check and improve the latch. Because no matter what happens, if we're having a poor latch, we can do all of these fancy things. We're not going to solve any problems. Okay. So we always have to correct the latch. Okay. Do your differential diagnosis exercise. Okay. Then we're going to show you now on the next slide, pectoral massage and pectoral stretches. Okay. So you can go to the next one. Okay. And now if any of you can stand up. All right. And walk around. I want you to actually do these exercises. All right. Because they're super easy and you know what, they actually make you feel amazing as well. We all could do with a little bit of pectoral stretching. Okay, so very simply, what you want to do is you get the mom to stand in the doorway. Okay, and you can see the first guy on the left. And he puts his arm up at, if you want to call it a 90 degree angle. And you actually walk through the door. Okay, so you're actually doing a nice stretch like that and you walk through the door. That's one way to do it. Or you can see the guy in the third picture. He actually holds, you hold on to the frame of the door and you get the mom to walk through the door like that. Okay. So she holds on and she walks through the door. Can you see what a simple stretch that is? Is anyone standing up doing it? I want to see people standing up doing this. This is power. I promise you, you're going to feel so amazing. And it feels so amazing. Okay. So just do a nice little stretch like that. The other area you can do it, you can see the guy in the middle picture. He's actually in the corner of his room. And he's actually doing both arms at the same time. Okay. He's actually doing a nice big stretch like that. So the reason I wanted that picture in is because I want to remind you to do both sides. Okay. So if the mom is doing walking through the door. She's got to come back into the door as well. So she does both sides. Or we're going to do it in the corner of the room. So she's actually stretching both sides. Because it's usually both sides that cause the problem. Okay. Another simple one she can do is you see the lady at the bottom. She's just doing a stretch. Which I think all of us have done at some point in our lives. If you do an exercise class. If you do anything. We always stretch that muscle. And for some reason, moms don't stretch. I don't know why. But we actually really need to start getting these moms up and stretching, okay? Because they are very cramped forward, they're very cramped over. It really causes problems. So I want nice, deep stretching movements like that, okay? And then this is somewhere you can get the partners quite involved as well, okay? Is the partners can do a very nice pectoral massage, okay? So it doesn't have to be anything hard. We're not going anywhere near the nipple. We're not necessarily massaging the breasts, okay? We are actually massaging the pectoral muscles. So can you see in my little anatomy picture there, okay? We need to be massaging those pectoral muscles, okay? So right at the top, okay, big nice massage. This is something that dads can definitely do. Get a bit of oil, get a bit of something, and do a little bit of massage. You don't have to be a physio. You don't have to be a massage therapist, anything like that. You just do a nice pectoral massage for the mom, and she'll guide you as to where you need to do the massage. If the partner is not keen on doing it, you can actually show the mom. She can do it herself, and you can actually do a nice pectoral massage. Okay, so nice deep stroking movements. nice warm use an oil use a cream use something so that we're not hurting that skin then you can see in the in the last picture there what some moms do is they actually use a tennis ball okay against the wall and they roll the tennis ball on that area or even if you don't want to do it against the wall the wall just creates a nice pressure but just take a tennis ball and just roll it on that area it actually works so nicely from a little bit of for a little bit of massage on that area. Okay. All of you stretching. Okay. And then these exercises, I want the mom to do it before or after every feed. Okay. It's nothing invasive. It's not hard. It's nothing she can. So if she can't do it before the feed because baby is screaming and crying, I want her to do it after the feed. Okay. And don't make it prescriptive. Don't like you have to do your exercises eight times a day after the feed. What you want her to do is when she's finished the feed, you say to her, okay, let's stand up. Okay. And let's just walk through the door. She can have the baby in her wrap so she can do it with baby. That's not a problem at all. If she can put baby down, she can do that. But you can actually do the little exercises when she's walking to the toilet. Okay. They are really not. hard exercises to do you don't need any equipment whatsoever so when she gets up to go to the toilet she stands up and she walks through the door and she just does her stretching and she does the other one on the way out of the toilet so it doesn't have to be prescriptive it's nothing hectic to add to a day because you you know being a new parent i mean if you think about all the things you're told to do from each different profession there's just not enough hours in the day to do all of these things and baby's got to get in different sleep times and everything. So don't be prescriptive on how many times a day they need to do it. Just give them practical tips. So say to them, every time you go to the toilet, walk in the door and stretch, walk out the door and stretch. Okay. If your mom's nice and tall, she can even stretch both arms on the top of the doorframe as well. It doesn't really matter. So nice, nice, deep stretching exercises. And then when her partner gets home, he can do a massage for her. which is really nice. And it's a nice way for the parents to actually reconnect as well. You know, so chat to the dads, chat to the partners and say, come, let's help a little bit here as well. Okay. Before I answer these other questions on there, any questions on the exercises or any physios who want to jump in and say something? Because this is your area of expertise. And they are quite a few physios. Yeah. And then I'll just, while we are waiting for them, Eva, can you put in the attendance form in the chat, please? No, for this. Okay. All right. So I'm going to go through a couple of these questions. So someone asked, are the results instant, or do you see they're fixed after a week or so? I can tell you that. Most of the moms actually feel almost immediate relief. I had one mom who the only way she could have pain-free was when we pressed a certain area on her breast. So what she would actually happen is she would be in extreme pain all the time. We pressed down on that pectoral muscle. She would do a beautiful feed with no pain whatsoever. And the minute we released it, she was in pain again. Obviously, I referred her then to physio because she needed some deep... some deeper massage than what we were offering at the time but it's almost instantaneous relief for them um if it is mammary constriction syndrome because that blood starts to flow that oxygen starts to flow it is actually it's almost immediate it's not something that takes weeks and weeks to effect that's what's so nice about it it's so simple it's so easy that's why even if you think it's thrush do the exercises anyway what difference does it make okay there's no harm no foul i would definitely do it you Lauren, you wanted to say something? Hi everyone, I'm a physio. Yay! And what I find, even though I'm a student now, I've been working alongside some amazing lactation consultants here in Cape Town. And what I find is those women that are really struggling, is if you get them to use a happy hugger, and they get that seated down and let that run along the back of their spine as they're feeding, so they can almost relax into that position. And then you almost release, almost along the posterior part where their bra... um clip goes that automatically gets them to relax and releases the anterior part as well but they're obviously always in that forward round position so that's also always a stretch so if you just get them to try and relax at the back the front automatically relaxes as well so these stretches are absolutely great you can just add them inside lying as well so before they get out of bed in the morning feel like they're reaching over to grab something from the side of the bed And then you get them to twist all the way over. So you're getting a nice rotation in the top part as well. And then obviously try and do the other side. And make sure they're picking up the baby's alternative side as well. So they don't get in that completely staggered same position thing all the time. Perfect. And Lauren, do you see that immediate relief as well? Instant. Absolutely instant. Yeah. Yeah. Good. All right. Cool. Thank you very much. I love physios because they always answer this question so much better because this is your field of expertise here. Definitely. But everyone can do it. And that's what's so nice about this. And that's why I'm saying it's such a simple treatment for the mammary reconstruction syndrome is get those moms stretching. Get them up. Get them stretching. Get them in a good feeding position as well. And especially when you start looking at a little bit of the oversupply. If they're sitting back, we like laid-back nursing, that's exactly how they need to feed to prevent that. Okay, I'm just going to go through one or two of these other questions. Have you noticed a difference with moms with augmentation? To be honest with you, I've never really looked at it specifically, so I definitely can't answer that, but I will have a look. But I don't know how much research has been done on mammary constriction syndrome and augmentation, because there's been very little done on the field as it is. So I don't think they've ever specifically looked at augmentation. So if you don't mind me asking, what was the reason for that question? Oh, it's you, Lauren. Sorry, it's you. Yes, so my question for that is, depending, are they having it beneath the pectoral muscle or above the pectoral muscle? And do you know, or if you have seen a difference in moms that have had implants? Yeah. in my little world um those that have had above the pectoral muscles seem to have a lot more pain due to the way they've cut through to place the implants in versus cutting through the pectoral muscles and placing underneath and have less of pain and have minimal struggles with breastfeeding that's where i'm sort of coming from okay anything like that um i can't say i have so um it'll actually be a little star i've written it down on my piece of paper here I'm actually going to, in the moments with augmentation, I'll actually just, in my own brain, make a little note. And maybe if everyone does it, it's just something we can have a look at and see if maybe there is something to that. Or if you're seeing it quite a lot from a physio perspective as well, then it's something to maybe look at. Hetty's always looking for case studies and clinical things. And that's something you can maybe have a look at if the augmentation actually makes a big difference. But from my side, I can't say I've seen a massive, I haven't looked for it. So it's not something that popped into my brain, but definitely will be looking at it now. And then in terms of the medications, it's just, so the oral contraceptives, all of that, it can cause, someone asked why would oral contraceptives cause it? Because oral contraceptives can cause vasoconstriction. And a lot of these... medications can cause that. So that's just sometimes why it worsens the Raynaud's. But it's definitely not a reason to stop taking your oral contraceptive because a big side effect of not taking oral contraceptive is more babies. So definitely wouldn't advise stopping the oral contraceptive, but it is something just to notice that it can actually cause that. All right, I'm going to the next slide. Oh, yeah. I think Heather has posted the link in. That's for those people who need CPDs. If you can please fill it in for us because I don't have everybody's HPCSA number yet. So I made it very easy so that you can put in your HPCSA number first and then your name because I only need the HPCSA number and saying can I HPCSA. a HBCSA number for the journal club. I'm going on. Cool. Thanks. So that's more the mammary constriction syndrome, and now we're going to look more at the actual vasospasms. Okay. So my first thing, I haven't put it on my list, but my first thing is always treat the latching problem because if that baby is nipple feeding, we're never going to solve this problem. Okay. So number one is always fix the latch. Okay. But I'm assuming now that that is done. So then we look at things. And I know we're all a little bit ice mad at the moment because everything is ice it, ice it, ice it, ice it. So when it comes to vasospasm, we're a little bit on the opposite end here because we're going to avoid cold. So also a good reason why we're doing this now is because it's very cold. Well, especially in Joburg. I don't know about the rest of the country. But we're very, very cold at the moment. So we're going to start seeing these popping up a little bit more as well. Okay, so we want to avoid cold. So try and ask the moms to make sure that they are feeding where it is nice and warm. And it's also good to keep the extremities warm. It sounds silly, but if their feet are warm, if their hands are warm, if they've got a blanket on, it actually helps to prevent the vasospasm. And they've seen that in quite a lot. Dr. Newman goes into that in quite some detail. as well. I'll send you all the links of the pages, but he goes into quite a lot of detail as well, where he's found if the moms are warm, the vasospasm is actually improved quite a bit. And I see this quite a lot. The room is often warm, which is perfect, but the moms sit there without a top on breastfeeding, which is exactly what we want them to do. And they're doing the skin to skin. If they really are having problems, they need to actually make sure that they do have a blanket around them. They have got socks on. If they do get in their fingers, they need to put gloves on or something along those lines just to keep themselves warm. Okay. And then what we're looking for to warm it is a dry heat. Okay. So if you've got those bean bag things that they put in the microwave, you know, those rice bags or something along those lines, please make sure they don't get burnt. Because moms are very forgetful at this time of their lives. So they mustn't get burnt. But, um... Just put the bean bag in the microwave and then after the feed they can actually put that dry heat onto their breasts. There's some people who actually use the cloth nappies because apparently those work really nice from a warmth point of view. They've got a clean cloth nappy there and they actually just put it on just to keep it warm but we're looking for a dry heat because a cold wet actually gets cold after a while so we try avoid things like a wet face cloth. and things like that. So we want a nice dry heat. Okay. And then after the feed, if there's no damage to the nipples, you can actually massage the nipples as well, get that blood flowing. So we want that capillary refill to be there a lot quicker. Okay. And some resources recommend oils. So like an olive oil or a bio oil or something like that. Just make sure that no one's allergic to it or baby's not allergic to it or anything like that, or it has to be constantly wiped off. So don't use anything. random but um just a little bit of massage as well okay and then from a food point of view we want to try and avoid caffeine okay so i'm not saying the moms can't have their cup of coffee but if they are suffering from this maybe they should skip the two or three espressos that they were having because caffeine does cause it and there's a lot of hidden caffeines as well so i'm trying to avoid some of the hidden caffeines and you got to check if your moms are smoking Okay, obviously we don't have research or anything on vaping, but I always come smoking and vaping together. I think it's going to cause all the same problems. So I don't care if they're smoking or vaping. If they are having this, they actually need to start cutting down or start avoiding it, especially if they're suffering quite badly from a vape, a constriction. Smoking, I find, is one of the biggest ones because, first of all, it actually lowers the supply. So the baby is often clamping down as well. sucking really hard trying to get that milk out and the smoking actually just it just worsens any form of constriction, so Definitely try and do what you do to encourage the moms just to decrease the the smoking or the vaping Okay, and then a lot of moms take cold meds that have got pseudoephedrine in it pseudoephedrine causes a vasoconstriction and can actually worsen any type of vasospasm and often we don't connect those two things at all. So just be wary this time of year it's cold and the moms may be taking some form of Pseudoephedrine. So just be aware of that as well. And then If the moms are on beta blockers as well, it can sometimes just worsen the vasospasm. Okay. So some things the moms can take to actually help it. We always like a little bit of ibuprofen every now and again if the moms are really suffering. Okay. But obviously that's not a long-term solution. We try and solve what is causing the problem rather than just treating pain. But if the mom is really in severe pain, a little bit of ibuprofen won't harm. Then what you can also take is calcium and magnesium. Very, very nice for a vasospasm. And then Dr. Newman describes quite nicely about taking vitamin B complex and making sure within the vitamin B complex that there is B6 in it and niacin. And he actually goes to say that we want 100 milligrams of vitamin B6, which I found quite a high dosage, but that's what he's recommending from a dosage point of view, but a vitamin B complex. actually can help the vasospasms quite successfully. To be honest with you, I don't really give vitamin B6 to my moms in general, but I have never treated it like that, but it is in his literature that the vitamin B6, I stick to my calcium and magnesium, to be honest with you. I find those work actually very effectively. And then if the moms want to take a fish oil, I haven't used fish oil personally. But there is a lot of literature saying that the fish oil actually works really nicely from that point of view. Who posted that picture? Yes, that is Raynaud's syndrome of extremities. If your moms have got that, their nipples are probably hurting as well. Definitely hurting as well. And then for my Raynaud's syndrome, remember Raynaud's syndrome is a type of vasospasm. If none of these things are working. Okay, then the mom will have to go to your doctor for this. So her GP, her gynae, whoever is treating her. And you can use low-dose nifedipine. Okay, so that's one 13-milligram tablet. And if they can get the slow-release formulation, it works a lot better. And then what you do is you take it once a day. And usually within two weeks, it actually takes the pain away. and then you stop taking it and if it recurs you can take it again but it generally shouldn't and then if it is getting more severe then you can start taking it again but this is under the treatment of a doctor okay so you do need to that's not something that's within well definitely not within my scope and I don't know how many doctors on the call but if there are you can actually give your opinion on this but Usually when it is this severe and we're needing nifedipine, then we do start referring to a doctor and we have a chat about it as well. Because obviously it is a medication, but it is very effective treatment. But it has to be a Raynaud's syndrome diagnosed by the doctor of the nipples. So do we have any doctors on the call? I think so, yes. Would any of them like to comment on the nifedipine? Can't see them, so I don't know if there is. So I'm just taking a wild guess. But can I chip in? Yes, please. I've had a very, very interesting case of vasospasm the other day. Now, in our area, most of the women, when they have a stalk tea, they get a set of silver mama's. whatever you want to call it, because Christine has one now, and then there's the lady that spoke to us once. So they get it as a present, a very expensive present, on their baby shower for sore nipples. So this one mom had real vasospasm. She had Raynaud's, also from the extremities and everything. And before she went to the doctor, And without me knowing it, she only phoned me afterwards because I've actually referred her to the doctor for the low dose of nifedipine. And then what she did is she took the silver nipples and she heated it in hot water and quickly dried it and then put it onto her breast. And that is what worked for her. And she didn't need to go under nifedipine. Now, I don't want us all now to go and say to everybody, get that, because I'm not sure if it really helped. In my mind, I can't see how could it help because by the time when you put it onto your breast, when you take it out of the hot water and you dry it, I don't know how hot it is or how warm it is when you put it on your nipple and you can also have burns. But I just found it very interesting that she swear by it and she used that. After about two weeks, it went away. So I don't know if it was real Raynaud's or if it was by fluke or what, but it did help her. But please, I don't say you need to go and advise the mothers about that. I'm just saying, I'm just telling you that this is what happened to me and I found it quite interesting. Yeah, awesome. Zanya, you got a question? Sorry, I'm sorry. I don't know if I'm not onto the latest research, but on... We're not afraid of vitamin B6 for the supply, taking the supply. I am a little bit. That's why I've never actually given it, to be honest. It is in Dr. Newman's literature, but that's why I stick to calcium, magnesium. I haven't used fish oils either, but I'm very wary of that high dose of vitamin B6 because I have seen moms supply plummet. when they're taking vitamin B6. So I stay away from it, but it is there for complete sake. And I'm assuming he knows better than me. Oh, me too, definitely. So it is in his literature, but that's why I said to you, I don't do the vitamin B6 because I'm nervous to bomb that supply. But that's how I stick to the calcium and magnesium. Someone's asking, is the pregnancy supplements adequate? I actually find I give a little bit extra. So if they take in their pregnancy supplements, I give a little bit more calcium and magnesium, especially the magnesium I find actually works very, very well for this. So I wouldn't just stick to the pregnancy supplements. I would do a specific magnesium on its own and maybe a little bit of calcium as well, but definitely a magnesium on its own over and above the pregnancy supplements. Yeah. And then, yeah, amphetamine is used to lower blood pressure. So that's why it has to be treated under the care of a doctor. And you've got to look at what all other meds the mom's on. So it's not something we can just hand out to any patient because it is a blood pressure treatment. So it does need to be monitored by the doctor. But it does actually work quite well and it's a very low dose. So it generally doesn't cause blood pressure problems for the moms. That was the question. So just in conclusion with this, you can see all of these treatments are very, very simple. Okay. So there's nothing fancy that you can do, but I find we forget about these. We forget about mammary constriction syndrome. We forget about the vasospasms. We forget about the Raynaud's because we're so focused on tongue ties and latching and thrush and all of these other things and all these treatments and sometimes just simple little things like. Like dry heat, some exercises, and a little bit of magnesium can actually go a long way into helping this mom. And it is something definitely within our scope, something definitely we can treat. And it's simple little things that we can do. So my whole goal today is to say to you just take that history, take it very, very seriously, your history, and don't let the moms rush you through it. Okay? I find it... It is definitely a skill in history taking. And I find the moms really try to rush you through it because they want to get to the problem. And they always think it's milk supply. But they want to get to the treatment straight away. And this is where we miss all of these little things. And instead of her having expensive treatments and seeing doctors and seeing all different specialists, let's just do these simple little things first. supplements do cost a bit but the exercises don't cost much to don't cost anything to do um and most of the stuff doesn't cost anything to do so do them anyway and let's see if maybe that solves the problem before we we carry on um so i'm done from my side a very simple little thing and you know me i don't like doing anatomy and physiology and all the drama i'm like you can look that up in the textbook um so this is just to make you think and make you want a different diagnosis rather than the normal. So I'm just going to open it up now to questions or if there are other specialties here who have a specialty in this, then please let's chat rather than just... um do lectures i don't like slideshows anyway cool any questions in the chats you can put your mic on whatever makes you happy any questions come on come on um is there specific magnesium you use um i generally use magfos i know it's probably old and um but And the Natura tissue salts, the magnesium also actually works quite well. The MagFos, but to be honest with you, I'm not brand specific. Maybe if there's someone who does a lot of supplement stuff that he knows their brands a lot better, but I don't know.

It's now recording. Yeah. Yes.

So everybody, you are now recorded. We are now recording the session. I'm very sorry for those who, it's never like this. I don't know what's going on tonight. I'm quite embarrassed.

Okay. Cool. Can you see it now?

Yes. Okay. So you can carry on.

All right. Cool. Well, welcome, everyone, and thank you for joining us tonight.

Oh, wait. I want to say something. Sorry, Sam. I just want to tell the people that we are incredibly lucky because we've got people of such high standard.

I said it last week, and I'm going to say it again. I went quickly through. Sam's CV before we started and I'm astonished yet again because she won a Jock Gare Memorial Award for achieving a high level of clinical competence in professional practice in caring for clients and patients in both community and hospital settings.

She also won a Tara Morris Psychiatric Nursing Award for excellence in psychiatry and nursing theory and practice and Samantha also had a distinction with SSLC and she started a private practice in 2009. And she's going to tell you the rest. And I know she loves sport very much. So now you can carry on, Sam.

Cool. Do we have lots of students tonight? Who's on the audience?

It's a mixed girl. Mixed girl. Okay, cool.

Well then, some of you know me, some of you don't. Please ignore the date of my presentation. I changed it about five times today and then I remembered I didn't change the date until tonight.

So just ignore it. Cool. So before we start, we're going to do, it's more vasoconstriction than just mammary constriction syndrome.

Can people see me? Do you want to see me? Is there anybody who can hear us and see us? Just you and I talking to each other, Hetty.

Oh, wait, I'm hearing you too. And I don't mind if you want to keep your screen closed or show your face. I think the others would like to see your face. Mine says my camera's on, but I don't know what's going on.

It's blank. I don't know. I don't know.

Is there anybody else? There are glitches tonight. I don't know.

Anyway, doesn't matter. Cool. All right, cool.

Before we go to that slide, what I want everyone to do, and this is what I wanted my camera on, but I don't know why my camera's not playing the game tonight. I checked everything this afternoon and then it was working, but clearly now it's being a drama. So what I'd like everyone to do is take your finger and I want you to pinch it really, really hard and just keep pinching it as hard as you can.

Is everyone doing that? Please write in the chat because I know your mic's on. Or put your cameras on and let us see you doing it. Are you pinching your finger really, really hard?

No, I want you to hold, pinch the one finger with the other finger as hard as you can and make it go really, really white. Okay, keep pinching it. Don't let go yet. Yeah, excellent. Excellent.

Cool. So now I want you to let it go and I want you to feel the capillary refill. Can you feel that? Cool. Is everyone feeling it?

Awesome. So the reason I wanted you to do that is because that's basically what is happening when we have a vasoconstriction or a vasospasm or something. But I want you to think about that feeling on your nipple. All right, and I want you to think about that as we go through the presentation, and I want you to keep thinking about that as we go along. So I want you guys to put the answers in the chat if you can, but I want you to think about your mom with a painful breast, and we're going to do a little bit of a differential diagnosis here.

So the mom's describing that her breasts and her nipples are burning. She got a deep stabbing pain. she gets pins and needles, it's worse when it's cold, sometimes it's during breastfeeding, sometimes it's in between. I know you know what the answer is, but I want you just to write down for, especially for the students, what are all the differential diagnoses when your mom comes to you and she tells you this is the feeling that she's having.

Quickly pop them in the chat for me. Lightning round. Can you see the chat?

I could see it when it said the last thing is Zandri said can't see the presentation. Okay I've got a vasospasm, got a Raynaud's. Those are the answers because you know the name of the presentation. I want different things.

Because Raynaud's isn't going to be the first thing you're going to go to when your mom says she's got nipple pain and breast pain. Thrush, candida, ductal thrush, that's what we like to hear. Incorrect latch, blocked duct, poor latch, nipple tissue damage.

Keep going, one or two more. Mastitis. Cool. Nice. All right, cool.

Thanks for that. So can you see when a mom comes up to you, well, not comes up to you, when she's in the consult with you, she just doesn't come to you on the street, although some of them do. But when a parent comes to you and they say to you, they've got breast pain.

Okay, generally, so generally the first thing that we think about is, well I know I think about is that usually it's a baby issue in terms of there's a poor latch, okay, and poor latch is a big, big one that we want to look at, but tonight we're not going to look at latching issues, although it is something you always first have to fix, okay, is that incorrect latch, because no matter what you're doing, that incorrect latch is going to be the problem. But tonight we're going to look at a few different things that are causing that. And the first thing I want to chat about is, in the chat, if you can write down, what do you think the difference is between a thrush and a vasoconstrictive disorder?

What would be the differences? You know me, I never let you guys just sit there. This is why I like live presentations, I always hit here, make everyone stand up all the time.

Okay, thrush isn't affected by cold. Cool. I'm just keeping refreshing my chat. What do you mean by severe? Okay, someone's saying in the nipple pain there's only vaso...

Sorry, only nipple pain invades the spasm and candida shoots through into the breast. Keep that in mind when we're chatting later on, that answer. Trix, what did you mean by severe?

Okay, vasoconstriction is a deep nerve pain, okay? Triphasic color change. Awesome. Awesome.

Okay. So, Hiti, if you don't mind going to the next slide. Okay. Oh, so you will tell me when I'm asked.

Okay. Cool. Yeah. Okay, so once you've got all this information and you're looking at the differences, okay, thrush, we're not talking about thrush today, but I want you to always think about, especially if there's nipple damage, things like that, I want you to think about thrush as well, and you actually have to rule thrush out, okay? But sometimes, as you all know, we treat a lot for thrush, okay, and the treatment just isn't actually working, and we know thrush is difficult to treat at times, but...

What I want you to think about as well is maybe it's not thrush. Maybe it's something actually mimicking thrush. And I actually see this quite a lot where you're looking at this nipple and you're thinking this isn't thrush, but all the symptoms are shouting thrush to you.

So someone wrote in there that thrush is like a deep shooting pain into the breast. Okay. So now, who has ever seen or managed any mammary constriction syndrome?

Does anyone even know about it? I don't think it. I think it might only be the qualified.

Okay. I've got one or two putting their hands up. If you want to put your cameras on, you can.

And just shout at me and just go like, cool, I'm here. Thumbs up. So one or two of you have seen it. Okay. Perfect, perfect.

All right, cool. I'm glad you see it and I'm glad you treated it. Because it is something we sometimes forget to think about. for these moms, and sometimes a few simple little things can actually save them a lot of money, a lot of time at doctors, and a lot of stress in their lives by just doing a few deep things, okay, so what mammary constriction syndrome is, is exactly what the name says it is, okay, but what it actually presents as is deep breast pain during breastfeeding, okay, I really wish my camera was working, it's driving me mad, but When you actually press your breast just sort of just on the, you know, where it sticks out your bra. Okay, I'm not very good at anatomy.

Where it sticks out your bra, I want you to press there. S-A-C-L-C-Q-L-C, Heather Jepsen 2. What's up, audio? Thanks.

That wasn't me. All right, cool. When you press on that area there, that is where your clients often complain of the pain. And they tell you that it's going straight from their breast deep into their back. Okay, so someone said that vasospasm doesn't cause deep pain and thrush does.

Okay, so I want you to think about sometimes vasoconstriction does actually cause this pain. Alright, so it can cause a deep breast pain during breastfeeding. Alright, so I want you to think about this as well. Alright, this deep, deep breast pain that these poor moms are actually having.

Sorry, I just lost my screen again. So what's actually happening is that the pectoral muscle beneath the glandular tissue presses on the blood vessel supply on the breast and the nipple. So think back to midwifery, think back to everything you're doing. When there is lack of blood flow and lack of oxygen, it creates pain. So think of a contraction.

Why do we have contraction pains during pregnancy? Because we have lack of blood flow, lack of oxygen. Similarly, when the pectoral muscle is pressing on those blood vessels, the breast has lack of oxygen and lack of blood flow.

So the way the moms describe this pain is it's a throbbing constant. It can be deep. It can be superficial. It can be itchy.

It can be tingling, aching. Some tell you it feels like someone stabbed them in the breast. Okay.

I'm shooting sharp, dull, burning, freezing. So can you hear all these words? And generally when you hear those words, your first thought is thrush, thrush, thrush, thrush, thrush.

That's all we think about. And that's all we're treating for often. And I want you just to think for a second or two beyond that, that it could actually be this mammary constriction syndrome that's happening.

Okay. Bernardine, you said you're seeing a mom that fits the profile. Do you want to pop your mic on quickly and just give us a quick, what is your experience with that? I think I'm on mute now. Yes.

So I'm not 100% sure. I think she might be fitting the profile, but definitely had a lot of vasospasms and a lot of these symptoms she is complaining about. So we've really been focusing on heat, but then exactly where you say that spot, you'll always say it's very tight or hard. But if I feel that there's nothing that I can say, let's say it's blood ducts and so on. So I'm really...

excited to learn a bit more about this condition. Yeah, yeah, absolutely. Thanks for that.

And did you treat her for thrush? No. So I was very conscious because of the house temperature being very cold.

We were very mindful that it might be vasospasms instead of thrush. Okay. All right.

Perfect. Is everyone understanding that a mammary constriction syndrome is a type of vasospasm or a type of constriction? Is everyone feeling that? Is that coming through nice and clearly?

Cool. All right, perfect. I love these thumbs up. They make me so happy.

All right, cool. So I've just given you a little bit on mammary constriction syndrome. And then if you go to the next slide, okay, just a little bit on vasospasm. Hetty, can you go to the next slide?

Oh, sorry. No worries. I'm sitting sleeping.

So I don't know what can you see and what can't you see. I don't know if you see me or not. I can see you, yes, perfectly.

I just can't see anybody. Perfect. All right, cool. So a little bit on what the mammary constriction is like, and now a little bit on vasospasm. Okay, so vasospasm is more around the nipple area, actually.

So mammary constriction syndrome is more the breast tissue. Vasospasm is a little bit more around the nipple. Okay, so what we see is that we see a definite blanching.

Okay, and what we mean by blanching is that the nipple actually turns white. And the reason for that white is because the blood flow is limited or it's cut off. So remember at the beginning, I asked you to pinch your finger. Okay, I want you all to do it again. Pinch your finger and I want you to look at it and see how there's no blood flow and it goes white.

Okay, and then when you have the capillary refill, that's when it actually starts to hurt. Okay, so that's what we're talking about by a vasospasm. And what that can be caused by is usually more a latching issue when the baby's on nipple feeding as opposed to breastfeeding.

It happens very, very often. Just in the chat quickly, do you guys know what I mean when I say nipple feeding and not breastfeeding? Because my moms never understand the difference. I want to make sure you're all in there.

Okay, good. All right. So remember, we want moms to breastfeed and not nipple feed. Alia, you've got a question. Oh, sorry.

I was trying to react with a thumbs up. Okay. Just checking. Just checking. And Tarin, Tarion, Thompson, question.

You've got your hand up. Not. Okay. All right, cool.

So what can cause the baby to nipple feed is obviously a very poor latch. Okay. One I actually saw this morning and it was causing this terrible vasospasm as well is that the mom had a very fast letdown. Okay. That baby was being overwhelmed with the milk flow because it was super fast and the baby was actually using its mouth to clamp down to control the flow.

So when your moms have got a very, very fast letdown and they are complaining of pain, like a nipple pain, think about is that baby cutting off that blood flow to that nipple? And let's look when the baby comes off, what does that nipple look like? And what we need to do is we actually need to look at ways to control the fast letdown so that we can actually control the vasospasm.

Okay. I'm not going to get into tongue ties at all today, but tongue ties definitely can cause a vasospasm because our babies definitely have a very poor latch. And one way to differentiate between what's happening with the vasospasm is that the pain is usually when the blood returns.

So you see these moms, what they say to you is that... On the latch, it's a little bit sore, and then it calms down through the feed. And then when the baby delatches, what those moms do is they naturally, they take their hand, flat hand, and they press it on their nipple, and they hold their nipple tight, tight, tight like that.

Okay, so they actually push into their nipple with their hand, and you see them do it naturally because that's what actually controls the pain. And then you can start thinking this is a type of vasospasm because what the mom's trying to do is she's actually trying to get that capillary refill to come in a little bit quicker. Okay, because she's, because of that, she wants that blood flow there because the capillary refill is what causes the pain.

That's why I wanted you to press your finger so you can feel it. Okay, and then if it's a true vasospasm, okay, that usually happens in between nursing. Okay, and that is usually caused by the cold.

So when you were talking earlier saying one of your moms, the room was extremely cold and that she was feeling, that is a true vasospasm. All right. So that's usually by the cold. And what also happens is we find moms get very, very sensitive.

So when they've had previous nipple damage. So in the first few weeks, they had cracked or bleeding nipples. because of a poor latch or a tongue tie or anything along those lines, we find sometimes they do get a type of vasospasm later down the line.

And that's purely because they've had previous damage and they get extreme sensitivity. Actually, on one of the groups today, someone was, or yesterday, I can't remember, someone was talking about sensitivity. And what it can be is it can be a type of vasospasm from a previous nipple damage. And that's where we've got to look at.

at these different diagnoses as well, because it can just be one of these things. All right. Now we're going to look at Raynaud's and then we're going to look at all of them together. And we're going to look at how can we actually manage these clients?

Because I'm not going to get into anatomy and physiology. It's more about how do we get these clients to be happy and actually resolve this problem. So, if you can go on to the next slide. Okay.

So, Raynaud's phenomenon of the nipple. Okay. is where there is the white blanching, but then it often goes blue and then it often goes red. So we call it a triphasic color change.

Sometimes it can just go white to red. Okay, so they call it a biphasic color change. But sometimes you can actually see that definite white, blue, red as it changes.

But the difference here is it's usually bilateral. So it's usually both nipples that it happens to. It usually lasts a little bit longer than a normal vasospasm, okay?

And it can happen at any time. So the mom is, you know, happily going about her day, baby sleeping, and suddenly she feels this extreme pain. And this is where we're often confused a little bit with thrush because we think maybe it's the thrush that's causing the pain. All right. But the nice thing with Raynaud is it's sometimes a little bit simpler to diagnose because it's bilateral, so it's usually both nipples that it happens.

And it potentially has happened before or on other parts of her body. So the mom, especially during pregnancy, she may have felt it happening. And she might be the mom who's got, you know, in winter, the tips of their fingers go blue.

The tips of their toes go blue. I'm sure I find everyone's got one or two friends that have got blue fingers constantly. Okay, I know I've got one. She goes actually like purple around it. So, that's a slight difference between the two, is that there's actually an underlying reason and it's not caused by breastfeeding.

What's happening is that the breastfeeding is exacerbating your underlying Raynaud's syndrome that the moms are experiencing. And some of the reasons a mom can have a Raynaud's, there's an underlying reason for it, or it can be things like medications, such as your oral contraceptives. Why I've highlighted fluconazole in green, I don't know why green, it was just when I was studying I always used anything to do with thrush I had green for some bizarre reason.

But we sometimes think that the mom has got thrush and then she's treated with the fluconazole and then it actually makes her symptoms worse and that could potentially be because she's actually, it's not a thrush, it's a Raynaud's syndrome of the nipple. and the fluconazole is actually making it worse. Okay?

Then your mom with endocrine issues, so your hypothyroidism moms, which we know there's lots of, moms with lupus, rheumatoid arthritis, and then your moms with previous breast surgery can really see some nipple Raynaud's. That's happening. So this is why I'm such a stickler for the history. Okay. I see lots of people who, when they walk into a consult, they go straight to looking at the baby, looking at the mom.

And I have to control my moms as well, because I'm sure you all feel it when you go into the consult. As you sit down, the mom hasn't even said hello to you. What she's doing is she's already telling you.

about the pain and the feeding and everything. And you actually have to sit down and you have to calm her down slightly. Okay.

That's why I always start with basic questions. What's your name? What's baby's name?

Who's your doctor? Who's your midwife? Who's your ped? Let's go through a little bit of what meds you on. All of these things.

And we start beginning a real good history so that you can take her step by step. So we don't miss any of these little things. Because it is so important on a differential diagnosis. Because if you just go straight into the...

watching the baby breastfeed, we're going to miss a lot of these little things. And then we start treating for thrush. We start treating for tongue ties.

We start treating for all of these things. And it's actually something a little more, not that it's simple, but a little bit different or outside of what we normally treat. So it's very important that our history is important here.

And I want you to do a differential diagnosis. Even if you sit down with a piece of paper with the mom, And you actually go through the different things that it could be. So the mom describes her symptoms.

And make a little spray diagram on your consult sheet. My consult sheets look terrible because they've got writing all over them. Luckily, I'm not in a team with anyone else because no one would ever be able to see my consult sheet. I'm so scared of getting sued because if a lawyer had to read that, they would think I'm all over the place.

I write lots of things down on there and you just do a little differential diagnosis. Does she have oversupply? When is the pain happening?

What type of pain is it? Can you visually see anything? What is the nipple doing on latch? What is it doing on D latch? What color is it?

What shape is it? Okay. Is there cracks?

Is there bleeding? And we go through all of these things. And even if you sit and highlight things and you work out what is actually going on with this mom, it's very, very important.

before we jump into any form of treatment or diagnosis or anything. And we always fix the latch first, no matter what symptoms these are, we always fix the latch first. That's probably the most important message we're looking at all of these, is fixing the latch. Okay, before I go on to some of the ways to manage this, all of these symptoms, what are your questions up front about this? I don't like a quiet audience.

You can put your, you can put your... you can do in the chat or you can put your um unmute yourselves let's chat what are your questions on this any questions nothing yeah what would you say is the most like prominent sign that it's not thrush but Raynaud's experience. So seeing it more practically. What I find is that color change. It really is.

I want to play this video for you, but we're having so much technical drama. I don't even know if it'll play because my hyperlink's not working. But what you can do is you actually go, there's so many videos on it.

On Dr. Newman's page, if you go look up Raynaud's and Dr. Newman's page, he's got tons of videos. Of the actual color changes that you see. And that's a very important thing to look. I don't know how many of you are actually looking when the baby delatches. How many of you are actually looking at that nipple?

Because I want you to go through the things. Are you looking at what the shape is? Is it round and pink? Is it white? Is it lipstick shaped?

What's happening? So you need to be looking at that nipple straight after that baby comes off. Okay, thanks, Sam.

Cool. Anyone else? I want a question.

Sam, you can. Sorry, you can send me the link afterwards, then I can post it on the group. Okay, cool. I'll do that.

Please. Yeah, I'll definitely send it afterwards because it's such a nice video. You can actually see it.

And the poor mom's in pain because she can't hold her nipple to get rid of the pain. But it's a very nice video. You can actually see the color change. Cool.

Anyone else? Any questions you're having on this before we treat it? the pain description um so the pain on season news hand is raised Use hand? Yeah. Did you want to ask something?

No, she asked earlier. Okay. Someone asked, does the nipple change color when you press on it? It's actually not. It's actually when there is that nipple feeding or that constriction.

That's when we see the color change. But you can just see it if the moms get really cold. You can actually see it go white. And then you can see it warm up again and you can see the color change with the Ray nods.

And you can actually almost see it in their fingers and their toes as well. They go white and then they eventually go blue and then eventually go red. So that triphasic color change is what you're seeing, but you have to have had the constriction or you have to have something that's triggering to see the nipple change.

If you just press it, you're not going to see it. And then Khada says, Is the pain description the same with vasovasovasomy constriction syndrome? It's actually not. So I find mammary constriction is much closer to thrush complaints.

So when a mom says thrush, I'm always thinking, is it mammary constriction syndrome or is it thrush? And if you're seeing the flaking skin and all of that, then we go more thrush. If you're seeing no external signs or anything like that, then we're thinking it's probably more. mammary constriction syndrome. But to be honest with you, I always treat for mammary constriction syndrome because it's such simple treatment as we're going to see now.

It's so easy. There's no harm in doing it because it's non-invasive, very easy. So I think all the moms should do it anyway.

All right. So Hetty, if you want to go to the next slide, we can start looking at plans. Okay. So as I said up front, the first thing is we always check and improve the latch. Because no matter what happens, if we're having a poor latch, we can do all of these fancy things.

We're not going to solve any problems. Okay. So we always have to correct the latch.

Okay. Do your differential diagnosis exercise. Okay. Then we're going to show you now on the next slide, pectoral massage and pectoral stretches. Okay.

So you can go to the next one. Okay. And now if any of you can stand up. All right.

And walk around. I want you to actually do these exercises. All right.

Because they're super easy and you know what, they actually make you feel amazing as well. We all could do with a little bit of pectoral stretching. Okay, so very simply, what you want to do is you get the mom to stand in the doorway.

Okay, and you can see the first guy on the left. And he puts his arm up at, if you want to call it a 90 degree angle. And you actually walk through the door.

Okay, so you're actually doing a nice stretch like that and you walk through the door. That's one way to do it. Or you can see the guy in the third picture. He actually holds, you hold on to the frame of the door and you get the mom to walk through the door like that. Okay.

So she holds on and she walks through the door. Can you see what a simple stretch that is? Is anyone standing up doing it?

I want to see people standing up doing this. This is power. I promise you, you're going to feel so amazing.

And it feels so amazing. Okay. So just do a nice little stretch like that.

The other area you can do it, you can see the guy in the middle picture. He's actually in the corner of his room. And he's actually doing both arms at the same time.

Okay. He's actually doing a nice big stretch like that. So the reason I wanted that picture in is because I want to remind you to do both sides.

Okay. So if the mom is doing walking through the door. She's got to come back into the door as well. So she does both sides.

Or we're going to do it in the corner of the room. So she's actually stretching both sides. Because it's usually both sides that cause the problem. Okay.

Another simple one she can do is you see the lady at the bottom. She's just doing a stretch. Which I think all of us have done at some point in our lives.

If you do an exercise class. If you do anything. We always stretch that muscle.

And for some reason, moms don't stretch. I don't know why. But we actually really need to start getting these moms up and stretching, okay?

Because they are very cramped forward, they're very cramped over. It really causes problems. So I want nice, deep stretching movements like that, okay? And then this is somewhere you can get the partners quite involved as well, okay?

Is the partners can do a very nice pectoral massage, okay? So it doesn't have to be anything hard. We're not going anywhere near the nipple.

We're not necessarily massaging the breasts, okay? We are actually massaging the pectoral muscles. So can you see in my little anatomy picture there, okay? We need to be massaging those pectoral muscles, okay? So right at the top, okay, big nice massage.

This is something that dads can definitely do. Get a bit of oil, get a bit of something, and do a little bit of massage. You don't have to be a physio. You don't have to be a massage therapist, anything like that. You just do a nice pectoral massage for the mom, and she'll guide you as to where you need to do the massage.

If the partner is not keen on doing it, you can actually show the mom. She can do it herself, and you can actually do a nice pectoral massage. Okay, so nice deep stroking movements.

nice warm use an oil use a cream use something so that we're not hurting that skin then you can see in the in the last picture there what some moms do is they actually use a tennis ball okay against the wall and they roll the tennis ball on that area or even if you don't want to do it against the wall the wall just creates a nice pressure but just take a tennis ball and just roll it on that area it actually works so nicely from a little bit of for a little bit of massage on that area. Okay. All of you stretching. Okay.

And then these exercises, I want the mom to do it before or after every feed. Okay. It's nothing invasive.

It's not hard. It's nothing she can. So if she can't do it before the feed because baby is screaming and crying, I want her to do it after the feed.

Okay. And don't make it prescriptive. Don't like you have to do your exercises eight times a day after the feed. What you want her to do is when she's finished the feed, you say to her, okay, let's stand up. Okay.

And let's just walk through the door. She can have the baby in her wrap so she can do it with baby. That's not a problem at all. If she can put baby down, she can do that. But you can actually do the little exercises when she's walking to the toilet.

Okay. They are really not. hard exercises to do you don't need any equipment whatsoever so when she gets up to go to the toilet she stands up and she walks through the door and she just does her stretching and she does the other one on the way out of the toilet so it doesn't have to be prescriptive it's nothing hectic to add to a day because you you know being a new parent i mean if you think about all the things you're told to do from each different profession there's just not enough hours in the day to do all of these things and baby's got to get in different sleep times and everything. So don't be prescriptive on how many times a day they need to do it. Just give them practical tips.

So say to them, every time you go to the toilet, walk in the door and stretch, walk out the door and stretch. Okay. If your mom's nice and tall, she can even stretch both arms on the top of the doorframe as well. It doesn't really matter. So nice, nice, deep stretching exercises.

And then when her partner gets home, he can do a massage for her. which is really nice. And it's a nice way for the parents to actually reconnect as well.

You know, so chat to the dads, chat to the partners and say, come, let's help a little bit here as well. Okay. Before I answer these other questions on there, any questions on the exercises or any physios who want to jump in and say something? Because this is your area of expertise.

And they are quite a few physios. Yeah. And then I'll just, while we are waiting for them, Eva, can you put in the attendance form in the chat, please? No, for this. Okay.

All right. So I'm going to go through a couple of these questions. So someone asked, are the results instant, or do you see they're fixed after a week or so?

I can tell you that. Most of the moms actually feel almost immediate relief. I had one mom who the only way she could have pain-free was when we pressed a certain area on her breast.

So what she would actually happen is she would be in extreme pain all the time. We pressed down on that pectoral muscle. She would do a beautiful feed with no pain whatsoever.

And the minute we released it, she was in pain again. Obviously, I referred her then to physio because she needed some deep... some deeper massage than what we were offering at the time but it's almost instantaneous relief for them um if it is mammary constriction syndrome because that blood starts to flow that oxygen starts to flow it is actually it's almost immediate it's not something that takes weeks and weeks to effect that's what's so nice about it it's so simple it's so easy that's why even if you think it's thrush do the exercises anyway what difference does it make okay there's no harm no foul i would definitely do it you Lauren, you wanted to say something? Hi everyone, I'm a physio.

Yay! And what I find, even though I'm a student now, I've been working alongside some amazing lactation consultants here in Cape Town. And what I find is those women that are really struggling, is if you get them to use a happy hugger, and they get that seated down and let that run along the back of their spine as they're feeding, so they can almost relax into that position. And then you almost release, almost along the posterior part where their bra...

um clip goes that automatically gets them to relax and releases the anterior part as well but they're obviously always in that forward round position so that's also always a stretch so if you just get them to try and relax at the back the front automatically relaxes as well so these stretches are absolutely great you can just add them inside lying as well so before they get out of bed in the morning feel like they're reaching over to grab something from the side of the bed And then you get them to twist all the way over. So you're getting a nice rotation in the top part as well. And then obviously try and do the other side. And make sure they're picking up the baby's alternative side as well. So they don't get in that completely staggered same position thing all the time.

Perfect. And Lauren, do you see that immediate relief as well? Instant.

Absolutely instant. Yeah. Yeah. Good.

All right. Cool. Thank you very much.

I love physios because they always answer this question so much better because this is your field of expertise here. Definitely. But everyone can do it. And that's what's so nice about this.

And that's why I'm saying it's such a simple treatment for the mammary reconstruction syndrome is get those moms stretching. Get them up. Get them stretching. Get them in a good feeding position as well.

And especially when you start looking at a little bit of the oversupply. If they're sitting back, we like laid-back nursing, that's exactly how they need to feed to prevent that. Okay, I'm just going to go through one or two of these other questions.

Have you noticed a difference with moms with augmentation? To be honest with you, I've never really looked at it specifically, so I definitely can't answer that, but I will have a look. But I don't know how much research has been done on mammary constriction syndrome and augmentation, because there's been very little done on the field as it is.

So I don't think they've ever specifically looked at augmentation. So if you don't mind me asking, what was the reason for that question? Oh, it's you, Lauren.

Sorry, it's you. Yes, so my question for that is, depending, are they having it beneath the pectoral muscle or above the pectoral muscle? And do you know, or if you have seen a difference in moms that have had implants? Yeah. in my little world um those that have had above the pectoral muscles seem to have a lot more pain due to the way they've cut through to place the implants in versus cutting through the pectoral muscles and placing underneath and have less of pain and have minimal struggles with breastfeeding that's where i'm sort of coming from okay anything like that um i can't say i have so um it'll actually be a little star i've written it down on my piece of paper here I'm actually going to, in the moments with augmentation, I'll actually just, in my own brain, make a little note.

And maybe if everyone does it, it's just something we can have a look at and see if maybe there is something to that. Or if you're seeing it quite a lot from a physio perspective as well, then it's something to maybe look at. Hetty's always looking for case studies and clinical things. And that's something you can maybe have a look at if the augmentation actually makes a big difference. But from my side, I can't say I've seen a massive, I haven't looked for it.

So it's not something that popped into my brain, but definitely will be looking at it now. And then in terms of the medications, it's just, so the oral contraceptives, all of that, it can cause, someone asked why would oral contraceptives cause it? Because oral contraceptives can cause vasoconstriction. And a lot of these...

medications can cause that. So that's just sometimes why it worsens the Raynaud's. But it's definitely not a reason to stop taking your oral contraceptive because a big side effect of not taking oral contraceptive is more babies.

So definitely wouldn't advise stopping the oral contraceptive, but it is something just to notice that it can actually cause that. All right, I'm going to the next slide. Oh, yeah.

I think Heather has posted the link in. That's for those people who need CPDs. If you can please fill it in for us because I don't have everybody's HPCSA number yet. So I made it very easy so that you can put in your HPCSA number first and then your name because I only need the HPCSA number and saying can I HPCSA. a HBCSA number for the journal club.

I'm going on. Cool. Thanks. So that's more the mammary constriction syndrome, and now we're going to look more at the actual vasospasms. Okay.

So my first thing, I haven't put it on my list, but my first thing is always treat the latching problem because if that baby is nipple feeding, we're never going to solve this problem. Okay. So number one is always fix the latch. Okay.

But I'm assuming now that that is done. So then we look at things. And I know we're all a little bit ice mad at the moment because everything is ice it, ice it, ice it, ice it. So when it comes to vasospasm, we're a little bit on the opposite end here because we're going to avoid cold. So also a good reason why we're doing this now is because it's very cold.

Well, especially in Joburg. I don't know about the rest of the country. But we're very, very cold at the moment.

So we're going to start seeing these popping up a little bit more as well. Okay, so we want to avoid cold. So try and ask the moms to make sure that they are feeding where it is nice and warm.

And it's also good to keep the extremities warm. It sounds silly, but if their feet are warm, if their hands are warm, if they've got a blanket on, it actually helps to prevent the vasospasm. And they've seen that in quite a lot.

Dr. Newman goes into that in quite some detail. as well. I'll send you all the links of the pages, but he goes into quite a lot of detail as well, where he's found if the moms are warm, the vasospasm is actually improved quite a bit. And I see this quite a lot.

The room is often warm, which is perfect, but the moms sit there without a top on breastfeeding, which is exactly what we want them to do. And they're doing the skin to skin. If they really are having problems, they need to actually make sure that they do have a blanket around them. They have got socks on. If they do get in their fingers, they need to put gloves on or something along those lines just to keep themselves warm.

Okay. And then what we're looking for to warm it is a dry heat. Okay. So if you've got those bean bag things that they put in the microwave, you know, those rice bags or something along those lines, please make sure they don't get burnt.

Because moms are very forgetful at this time of their lives. So they mustn't get burnt. But, um...

Just put the bean bag in the microwave and then after the feed they can actually put that dry heat onto their breasts. There's some people who actually use the cloth nappies because apparently those work really nice from a warmth point of view. They've got a clean cloth nappy there and they actually just put it on just to keep it warm but we're looking for a dry heat because a cold wet actually gets cold after a while so we try avoid things like a wet face cloth.

and things like that. So we want a nice dry heat. Okay. And then after the feed, if there's no damage to the nipples, you can actually massage the nipples as well, get that blood flowing.

So we want that capillary refill to be there a lot quicker. Okay. And some resources recommend oils.

So like an olive oil or a bio oil or something like that. Just make sure that no one's allergic to it or baby's not allergic to it or anything like that, or it has to be constantly wiped off. So don't use anything.

random but um just a little bit of massage as well okay and then from a food point of view we want to try and avoid caffeine okay so i'm not saying the moms can't have their cup of coffee but if they are suffering from this maybe they should skip the two or three espressos that they were having because caffeine does cause it and there's a lot of hidden caffeines as well so i'm trying to avoid some of the hidden caffeines and you got to check if your moms are smoking Okay, obviously we don't have research or anything on vaping, but I always come smoking and vaping together. I think it's going to cause all the same problems. So I don't care if they're smoking or vaping.

If they are having this, they actually need to start cutting down or start avoiding it, especially if they're suffering quite badly from a vape, a constriction. Smoking, I find, is one of the biggest ones because, first of all, it actually lowers the supply. So the baby is often clamping down as well.

sucking really hard trying to get that milk out and the smoking actually just it just worsens any form of constriction, so Definitely try and do what you do to encourage the moms just to decrease the the smoking or the vaping Okay, and then a lot of moms take cold meds that have got pseudoephedrine in it pseudoephedrine causes a vasoconstriction and can actually worsen any type of vasospasm and often we don't connect those two things at all. So just be wary this time of year it's cold and the moms may be taking some form of Pseudoephedrine. So just be aware of that as well.

And then If the moms are on beta blockers as well, it can sometimes just worsen the vasospasm. Okay. So some things the moms can take to actually help it. We always like a little bit of ibuprofen every now and again if the moms are really suffering.

Okay. But obviously that's not a long-term solution. We try and solve what is causing the problem rather than just treating pain.

But if the mom is really in severe pain, a little bit of ibuprofen won't harm. Then what you can also take is calcium and magnesium. Very, very nice for a vasospasm. And then Dr. Newman describes quite nicely about taking vitamin B complex and making sure within the vitamin B complex that there is B6 in it and niacin. And he actually goes to say that we want 100 milligrams of vitamin B6, which I found quite a high dosage, but that's what he's recommending from a dosage point of view, but a vitamin B complex.

actually can help the vasospasms quite successfully. To be honest with you, I don't really give vitamin B6 to my moms in general, but I have never treated it like that, but it is in his literature that the vitamin B6, I stick to my calcium and magnesium, to be honest with you. I find those work actually very effectively.

And then if the moms want to take a fish oil, I haven't used fish oil personally. But there is a lot of literature saying that the fish oil actually works really nicely from that point of view. Who posted that picture?

Yes, that is Raynaud's syndrome of extremities. If your moms have got that, their nipples are probably hurting as well. Definitely hurting as well.

And then for my Raynaud's syndrome, remember Raynaud's syndrome is a type of vasospasm. If none of these things are working. Okay, then the mom will have to go to your doctor for this. So her GP, her gynae, whoever is treating her.

And you can use low-dose nifedipine. Okay, so that's one 13-milligram tablet. And if they can get the slow-release formulation, it works a lot better. And then what you do is you take it once a day.

And usually within two weeks, it actually takes the pain away. and then you stop taking it and if it recurs you can take it again but it generally shouldn't and then if it is getting more severe then you can start taking it again but this is under the treatment of a doctor okay so you do need to that's not something that's within well definitely not within my scope and I don't know how many doctors on the call but if there are you can actually give your opinion on this but Usually when it is this severe and we're needing nifedipine, then we do start referring to a doctor and we have a chat about it as well. Because obviously it is a medication, but it is very effective treatment.

But it has to be a Raynaud's syndrome diagnosed by the doctor of the nipples. So do we have any doctors on the call? I think so, yes.

Would any of them like to comment on the nifedipine? Can't see them, so I don't know if there is. So I'm just taking a wild guess. But can I chip in? Yes, please.

I've had a very, very interesting case of vasospasm the other day. Now, in our area, most of the women, when they have a stalk tea, they get a set of silver mama's. whatever you want to call it, because Christine has one now, and then there's the lady that spoke to us once. So they get it as a present, a very expensive present, on their baby shower for sore nipples. So this one mom had real vasospasm.

She had Raynaud's, also from the extremities and everything. And before she went to the doctor, And without me knowing it, she only phoned me afterwards because I've actually referred her to the doctor for the low dose of nifedipine. And then what she did is she took the silver nipples and she heated it in hot water and quickly dried it and then put it onto her breast.

And that is what worked for her. And she didn't need to go under nifedipine. Now, I don't want us all now to go and say to everybody, get that, because I'm not sure if it really helped. In my mind, I can't see how could it help because by the time when you put it onto your breast, when you take it out of the hot water and you dry it, I don't know how hot it is or how warm it is when you put it on your nipple and you can also have burns. But I just found it very interesting that she swear by it and she used that.

After about two weeks, it went away. So I don't know if it was real Raynaud's or if it was by fluke or what, but it did help her. But please, I don't say you need to go and advise the mothers about that. I'm just saying, I'm just telling you that this is what happened to me and I found it quite interesting.

Yeah, awesome. Zanya, you got a question? Sorry, I'm sorry. I don't know if I'm not onto the latest research, but on... We're not afraid of vitamin B6 for the supply, taking the supply.

I am a little bit. That's why I've never actually given it, to be honest. It is in Dr. Newman's literature, but that's why I stick to calcium, magnesium.

I haven't used fish oils either, but I'm very wary of that high dose of vitamin B6 because I have seen moms supply plummet. when they're taking vitamin B6. So I stay away from it, but it is there for complete sake.

And I'm assuming he knows better than me. Oh, me too, definitely. So it is in his literature, but that's why I said to you, I don't do the vitamin B6 because I'm nervous to bomb that supply.

But that's how I stick to the calcium and magnesium. Someone's asking, is the pregnancy supplements adequate? I actually find I give a little bit extra.

So if they take in their pregnancy supplements, I give a little bit more calcium and magnesium, especially the magnesium I find actually works very, very well for this. So I wouldn't just stick to the pregnancy supplements. I would do a specific magnesium on its own and maybe a little bit of calcium as well, but definitely a magnesium on its own over and above the pregnancy supplements. Yeah. And then, yeah, amphetamine is used to lower blood pressure.

So that's why it has to be treated under the care of a doctor. And you've got to look at what all other meds the mom's on. So it's not something we can just hand out to any patient because it is a blood pressure treatment.

So it does need to be monitored by the doctor. But it does actually work quite well and it's a very low dose. So it generally doesn't cause blood pressure problems for the moms. That was the question.

So just in conclusion with this, you can see all of these treatments are very, very simple. Okay. So there's nothing fancy that you can do, but I find we forget about these.

We forget about mammary constriction syndrome. We forget about the vasospasms. We forget about the Raynaud's because we're so focused on tongue ties and latching and thrush and all of these other things and all these treatments and sometimes just simple little things like.

Like dry heat, some exercises, and a little bit of magnesium can actually go a long way into helping this mom. And it is something definitely within our scope, something definitely we can treat. And it's simple little things that we can do.

So my whole goal today is to say to you just take that history, take it very, very seriously, your history, and don't let the moms rush you through it. Okay? I find it...

It is definitely a skill in history taking. And I find the moms really try to rush you through it because they want to get to the problem. And they always think it's milk supply. But they want to get to the treatment straight away. And this is where we miss all of these little things.

And instead of her having expensive treatments and seeing doctors and seeing all different specialists, let's just do these simple little things first. supplements do cost a bit but the exercises don't cost much to don't cost anything to do um and most of the stuff doesn't cost anything to do so do them anyway and let's see if maybe that solves the problem before we we carry on um so i'm done from my side a very simple little thing and you know me i don't like doing anatomy and physiology and all the drama i'm like you can look that up in the textbook um so this is just to make you think and make you want a different diagnosis rather than the normal. So I'm just going to open it up now to questions or if there are other specialties here who have a specialty in this, then please let's chat rather than just... um do lectures i don't like slideshows anyway cool any questions in the chats you can put your mic on whatever makes you happy any questions come on come on um is there specific magnesium you use um i generally use magfos i know it's probably old and um but And the Natura tissue salts, the magnesium also actually works quite well.

The MagFos, but to be honest with you, I'm not brand specific. Maybe if there's someone who does a lot of supplement stuff that he knows their brands a lot better, but I don't know.

Transcript for:Understanding Mammary Constriction and Vasospasm

Transcript for:
Understanding Mammary Constriction and Vasospasm