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Thread: "Milk Stones"?

  1. #1

    Default "Milk Stones" causing plugged ducts?

    Hi all,

    I really need some help!

    My daughter will be 9 months next week. I work full time, so I pump for 4 of her 5 feedings every day (she nurses before bed). Our breastfeeding journey started off without a hitch, nursing on demand with no issues. But when she was around 9-10 weeks, I started getting frequent clogged ducts. Sometimes they would last days at a time and none of the usual measures would relieve them. I eventually figured out what was causing the blockages - hard, tiny white "stones". Sometimes the "stone" is visible at the surface of the nipple and easy to remove (I simply open the nipple skin a little with a sterile needle and express, and it shoots out), but much more often, the stone is deep down in the nipple and will not budge without me going in there after it. This involves the needle and me carefully working at it for 1-2 hours until I finally see it. I will then either express it out using manual pressure (it will fly across the room when it comes out) or I use the needle to just kind of knock it out.

    Pain: there is no pain at the nipple whatsoever EXCEPT the pain I cause with the needle, obviously, but even then it's minimal. The only pain I experience is 1) if the clog isn't relieved quickly and milk starts to back up in my breast or 2) there is very often a dull ache and sometimes a sharp pain that accompanies the blockages - it will start days before the actual blockage occurs. It's almost like a kidney stone, in theory.

    What I've done to try to fix it: I feel like everything. I've talked to more lactation consultants than I can count, my OB's office has no idea (they try, but are at a loss), my family doctor, and a breast specialist/surgeon (at OB's recommendation). I have done 2 rounds of Bactrim (antibiotic) which, I should note SEEMED to keep the stones at bay for a period of time. I would still get blockages, but they seemed more like normal blebs where something tiny was blocking the duct, or maybe skin had grown over it - whatever it was, I got it clear in a few minutes with no big drama and no obvious stone.

    I empty my breasts completely with each pumping using a rented hospital-grade pump.

    Currently, my family doctor has me starting a round of Kelfex and possibly diflucan in case it's related to candida (as some LCs have suggested to me). I feel like everyone says something different! All I know is I can't keep breastfeeding/pumping with these issues, they are driving me nuts after 7 months. I also feel like I will never be able to wean! I have an ample supply (I make twice what she eats and have tried Sudafed, sage, and more to reduce with no luck). It won't slow down, but it's hard to get it to do that when I'm constantly having to express to clear these stones/blockages. I am at my wit's end.

    Has anyone heard of this? An internet search yields a few anecdotes about women experiencing this but none say if they ever got them to stop, or how they weaned with this going on. I will take any/all advice to heart - while I have a great team of professionals trying to help me, it's clear they don't know the why/solution, either.

    Thank you so much for your time! I've attached a picture of one of the stones for reference - hard to see, but hopefully this helps.
    IMG_0978.jpg
    Last edited by @llli*mollyp; May 12th, 2016 at 10:45 AM.

  2. #2
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    Default Re: "Milk Stones"?

    Welcome to the forum!

    I had not heard of this particular problem, and like you I was unable to find much of anything about this issue in the human lactation literature. I have discovered that when information on humans lets you down, you proceed to the literature about animal lactation. Because dairy is an industry, there is a lot more research on animal lactation than there is on human lactation, and it's often applicable to humans! Anyway, what you describe sounds like something called a lactolith or milk calculus, which is a known problem for dairy animals.

    The only information I could find about treating a lactolith suggested three options: first, the "stone" could either be milked out (I.e. flushed out as the milk is expressed); second, it could be cut out (in the case of a lactolith that was too large to be flushed out); and third, it could be crushed using a small forceps. Obviously you're trying option one and it's incredibly time-consuming and a huge bummer. Option two is no good, for obvious reasons. Option three- crushing the thing with the forceps, or maybe just trying to break it up by massaging/crushing it with your fingers- might be something to try. It sounds pretty awful but is probably not worse than picking these things out with a needle!

    As to why you keep getting these things... Well, I didn't come up with anything in the peer reviewed literature, but I have some ideas. First, I think that some sort of inflammation or infection could be the root cause. If that is so, the sugges ted course of action- antibiotics and antifungals- should help. Second, it's possible that some sort of physical trauma is to blame- rough nursing, poorly fitting pump shields? If that's the case, getting the baby checked for lip or tongue ties, and making sure that your pump shields fit absolutely perfectly, would be good things to try. Third- and this hypothesis is definitely a stretch!- maybe there is something that you are imbibing that is causing you to have elevated levels of... Maybe minerals or salts? And finally- and this is a total stretch- maybe cut down on your consumption of leafy greens like spinach and kale, if you eat a lot of them. They contain a checmical called oxalic acid which is thought to contribute to the formation of kidney stones. Perhaps it could cause these lactoliths as well? As I said, that hypothesis is really stretching things!

    You will be able to wean, I promise! It just might take longer and be more complicated than you would like.

    How often do you get one of these stones? And what exactly have you tried, in terms of pumping, when it comes to reducing supply?

  3. #3
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    Default Re: "Milk Stones"?

    Wow interesting info mommal. I really do not have any ideas to add about this particular issue of stones, (has anyone offered to check these out for you under a microscope? I would be really interested to know what exactly is the makeup and how it differs in structure/makeup from a 'regular" milk plug.)

    But I do have some ideas about reoccurring plugged ducts and over production and reducing OP. To me it is unlikely that it is simply coincidence that you have this issue of milk stones and extreme OP many months past the point OP has commonly reduced. But even if they are unrelated, I think it makes sense to start solving the issue of the OP.

    First let me make sure I am understanding some parts of your situation-
    You have OP, making twice what baby needs. Can you tell us how much milk you pump each pump session/day? (about)
    Your baby nurses once a day, and you pump 4 times over your work day, so, milk is removed from the breasts only 5 times total in 24 hours? And also, most of that happens during the day- over about 12 hours say? (If this is correct, what happens the other 12 hours- any milk removal?)
    When you pump, you pump to "empty" your breasts-meaning you pump to the point no more milk is coming out, or nearly to that point?
    Do I have all that correct? If so, I just have a couple more questions-
    What happens on weekends/non work days as far as nursing/milk removal frequency?
    Do your breasts leak?
    If there is no milk removal overnight or for any stretch of many hours at a time, do you ever feel fuller during that time?

    Here is what I am thinking.
    First, Pumping to "empty" the breasts is actually a milk production increasing technique. I know that moms with reoccurring plug type issues are told to empty the breasts, but I am not at all sure there is proof this is needed or more helpful than frequent milk removal but NOT actually to empty the breasts. After all, in the biologically normal scenario of lactation, a mother would not be pumping, a baby would be nursing. And a baby is unlikely to "empty" both or even one breast every time, especially if mom is making twice as much milk as baby needs. But a baby might well nurse far more often than mom actually needs to pump in order to provide enough milk for her baby- especially if mom overproduces. So I wonder if you have tried more frequent but less "aggressive" milk removal?

    OP is usually very responsive to block feeding, (or block pumping) but for best results overall milk removal is frequent, and even on the "blocked" breast, some milk removal can/should occur during the block to prevent mom getting too full or getting plugs. So the idea is not to never let a drop of milk out of the breast during the block, it is to overall give the body the message that less milk is needed. The body will get that message if the breasts are NOT emptied, but stay a bit fuller, while frequent milk removal would act to reduce milk stasis and the issues that occur due to that.

    Basically what I am thinking is that since you report very little pain even though there is clearly lots of milk in your breasts, and you continue to overproduce despite very infrequent milk removal, I wonder if you have fairly great milk storage capacity, and that is possibly what is contributing to the stones- milk sitting in the breasts a long time?

    If you have very large milk storage capacity and are trying block nursing/pumping to reduce milk production, you might have to block each breast a much longer time than the average mom with OP. But again, while also removing a little milk as frequently as needed to hopefully avoid plugs.

    You might want to read about or ask your LC about the Full Drainage and Block Feeding method for reducing milk production. In your post you say you have talked to many LCs. Have you ever been seen by an IBCLC in person for a complete consult?
    Last edited by @llli*maddieb; May 12th, 2016 at 08:55 PM.

  4. #4
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    Default Re: "Milk Stones"?

    This was so interesting to me that I kept on googling last night. From what I am seeing, it looks like the general consensus is that milk stones are combinations of calcium and casein (milk protein). I found another interesting suggestion for treating this, which was to reduce dietary calcium. It's supposed to help, at least if you're a goat! (Sorry to keep referencing dairy animals- like I said, there's a lot more research on animal lactation than on human lactation.)

  5. #5
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    Default Re: "Milk Stones"?

    It's like tonsil stones in your boobs? OMG. You guys are SOOO lucky I didn't find about this until right now. And didn't have them. I would go CRAZY trying to mine them allllllll.

    Way too lazy for formula

  6. #6

    Default Re: "Milk Stones"?

    Hi ladies!

    First of all, I cannot thank you enough for your time and efforts to help me. I can't tell you how much I appreciate it! I am taking every little thought and suggestion to heart. I'll provide a bit more information below and perhaps this will help give a better picture:

    - I was, in fact, dairy-free for the majority of my baby's first weeks until about 8-9 weeks (not long before the stones started)- she had reflux so I cut dairy to try and help. I had wondered previously if adding dairy back in was the cause of this, so I spent a period of time reducing my dairy, but I wasn't super-vigilant about it and the stones kept happening, so I got discouraged. I wonder if a really intentional reduction/elimination for a period of time (as an experiment - it can't hurt right?) would be a good idea! I think I will try this next.
    - I pump about 7-10oz at each session, sometimes up to 13-14oz but that's usually only overnight or first thing in the morning, not throughout the day. I estimate my daily output as 45-50oz.
    - I pump first thing in the morning, then twice at work, nurse my baby at night (and I pump the remainder of the milk out after, it's only a couple of ounces but I did it under the impression that leaving milk in my breasts is contributing to this issue), then I get up once overnight and pump (which is pretty depressing to me).
    - I pump to the point that no more milk is coming out of my breasts (and I will massage a bit to make sure)
    - On the weekends, I keep basically the same schedule - I still do not nurse her even though I am home because she rarely empties my breasts at feedings and again, I was thinking this contributes to the stones so instead of enjoying it, it was stressing me out
    - my breasts rarely leak - sometimes just a bit in the morning if she cries, etc. before I have pumped. But not during the day and I would said I DON'T leak more mornings than I do.
    - I am pretty full when I wake up to pump in the middle of the night and in the morning. I am not in pain, but my breasts are full and larger. Not like "cannonballs" as they were when my milk first came in, ha! and I can usually wait 20-30 mins after being up in the morning to pump and be ok.
    - I used to get the stones every few days or so, but after the first round of antibiotics (Bactrim), I didn't get one for about 2 months (or at least, if I did, they were small enough that I was able to remove them without even seeing them as I noted above - more like normal "blebs"). Then I got an actual stone 2 weeks ago and another yesterday morning.
    - In terms of trying to reduce my oversupply via pumping, I would try to shave time off my pumps but I would get discouraged when a) I didn't notice my supply decreasing (I perhaps didn't give it enough time) and b) when I would get a stone and have to clear it (lots of manual expressing or pumping) I felt like it was counter to what I was trying to achieve and would often just kind of give up on trying to pump less time - it all seemed so useless when I was clearing the stones so often.
    - I agree that oversupply could certainly be part, if not a huge contributor, to this issue! Though the stones occur in both breasts, they mostly occur in the same breast (the left) which, ironically, is my somewhat "normal" producer (will produce 3-4oz per pump compared to the 5-8oz the right one produces). And, oddly enough, in the same 3 ducts primarily (2 on the left and 1 on the right). Also, when my baby was very young and before any of this started, I was never concerned with emptying my breasts after her feedings. I would just feed her, and start on the same breast I ended on at the next feeding. Since all was going fine, if I was still super-full, I just went about my business, even overnight (she slept 5 or 6-hour stretches starting early on, so I was often extremely full in those early days) but the stones still didn't happen then...so, it's like something was a catalyst. The dairy? An infection?
    - I alternate between using Jack Newman's APNO and a mix of polysporin and Motherlove thrush/diaper cream (can be used on nipples) after pumping or feeding. This is mostly because there is usually some level of nipple trauma going on if I've had to dig, unblock a pore, etc. I am not sure why I use both. Habit I guess. I started this around the time I did the first round of antibiotics and things started to improve, so I'm not sure if this actually helps or is just a coincidence.

    I'll attach two more pictures below. The first is a recent stone and the second is what it looks like when I "smash" it between my fingers. So weird, right? It really does look like milk but I'm wondering if it's cells, etc? My OB as well as my family doctor have wanted to culture one of them, but it's never worked out - either because I didn't do a sterile catch, it broke apart before I could get it in, etc. I have seen 2 IBCLCs in person, and talked to others via email and phone. One of them is also very interested in culturing one of the stones (she's also an APRN and knows some physicians, etc. who might be able to help), but hasn't found anyone yet.

    Anyway - I hope this new information sheds more light on all of this. Again, I can't tell you how much I appreciate your help. Just reading your thought processes is so helpful to me - new ideas and new logic to try and solve this. So great! Thank you!

    IMG_0816.jpgIMG_0817.jpg
    Last edited by @llli*mollyp; May 13th, 2016 at 10:42 AM.

  7. #7
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    Default Re: "Milk Stones"?

    I am not sure why there is the need for a sterile catch- I think that first you want to know what the heck these things are made out of? I think all that would be needed is a microscope and maybe a comparison to slide of a drop of your expressed milk at least as a first step.

    When you say:
    and I pump the remainder of the milk out after, it's only a couple of ounces but I did it under the impression that leaving milk in my breasts is contributing to this issue
    do you mean that you have observed that not pumping to empty every time you or baby takes milk from the breasts exacerbates the stone issue, or someone told you it would exacerbate the issue? Again, "emptying" the breasts as you are doing is not physiologically the norm, babies do not as a rule empty the breasts. Regular "emptying" of the breasts is typically only suggested when a mother is under producing. Sometimes it may help to "empty" the affected breast temporarily in order to extract a plug, but not to prevent them. Some theorize that pumping to empty one time, or maybe once a day, along with block nursing, can be helpful in cases of extreme hyperlactation, see article below about full drainage and block nursing.

    Anyway, based on what you are saying, you have extreme overproduction/hyperlactation. Hyperlactation is a leading cause of plugs and blebs. Whatever else is going on, I really have to wonder if the underlying issue or at least an exacerbating factor to the stones is the OP.

    Pumping to empty the breasts each time a mom nurses AND pumps is going to act to increase production. So this will work counter to any other measures mom might be taking to reduce production. I get it you do not want to increase the formation of these things by not pumping to empty- but obviously pumping to empty is not solving the issue either. I wonder if a few more stones is the temporary trade off that might be needed in order to ultimately solve the issue?

    I am not suggesting pump/nurse less often- I am saying maybe do not pump so much milk out each time, and maybe pump or nurse MORE often, overall, or maybe spread milk removal out a little more- do you really need to pump 4 times over your workday, for example. (I am still unclear how often baby is actually nursing, sorry.) Also I am suggesting trying block feeding - not pumping or nursing from one side at a time for a period of time- while still letting out a little milk on the blocked side - with hand expression or a small amount of pumping- as often as needed. It might be very often at least at first. Have you tried those things alone or together? You may have to reduce how much you pump out each time very gradually. You will probably have to increase block time also gradually. And yes, of course it will take some time to reduce such extreme OP.

    I think it is important to take any changes in pumping/nursing routine slowly and carefully and listen to your body, obviously. You do not want the cure to be worse than the problem. But since you are not in extreme pain or getting ill from these stones, I again wonder if the risk of a few more temporarily in order to permanently reduce your production to something your body and your baby can handle might make sense. Sorry to keep harping on this, but I really think that even if you figure out how to no longer have stones with diet or whatever, you would still be at a high risk of plugs due to the hyperlactation.

    Here are a few articles about block feeding that might be helpful:

    Do's and don'ts of block feeding: http://www.nancymohrbacher.com/blog/...dos-donts.html
    Dark side of block feeding: http://www.cwgenna.com/blockfeeding.html
    FDBF method for lowering milk production: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075483/

  8. #8

    Default Re: "Milk Stones"?

    Hi, maddieb! Thank you so much for your advice and those articles. I can't wait to take a look at them this weekend.

    I am not sure about the sterile catch, either - but that's what the doctor's office told me when I offered to bring it in. The IBCLC that I work with most often is working on how we might evaluate one of these things - your suggestion sounds simple enough, I will see what she says.

    Regarding "emptying" my breasts: I was told early on in this journey (by LCs) that "insufficient emptying" was most likely contributing to these issues, so around the time I started the antibiotic the first time (and tried to get really intentional about figuring this out), I started making sure I was reallllly emptying. Again, since this was about the time I start the medication, it's hard to know what helped, but I did experience a bit of reprieve after so I just kept emptying because I didn't know WHAT was helping - does that make sense? I will see the article you included about this - it makes sense that fully emptying the breasts is not necessarily the norm, and one of the LCs I've spoken to has suggested I stop doing it in order to reduce supply but at the same time says it could be contributing to the formation of the stones - a catch 22! But you raise an interesting point, regarding running the risk of a few more temporarily in order to permanently reduce production. I've wondered the very same thing and to be honest, the fear, anxiety, and exhaustion this has created in me over the past 7 months is mostly what's stopping me. I feel like I will do ANYTHING to try and avoid the stones, even if I know it's contributing to my oversupply - it's such a weird, strange cycle. I don't know where to start but again, I have to agree with you that the oversupply itself might just be a big contributor - in which case it's a bit of a chicken and the egg scenario.

    To clarify my "schedule", I empty my breasts a total of 5 times over the course of the day. This includes my nursing session (which I usually pump a bit after, as I mentioned). I also meant to add that I take lecithin granules every day and a host of vitamins - which makes me wonder about mommal's point about my body not processing something thoroughly.

    Last but not least, a few professionals have suggested I take a combination birth control pill to try and reduce my supply down to a more manageable level. I've read mixed reviews on this, and though I am assured it's safe by the doctors, I'm also told that with lactation being as established as it is at this point (baby is almost 9 months), it might make no difference at all. I don't want to take it just for kicks, so I would only want to do it if I felt the reward really outweighed the risks - I am not totally sure what to do.

    Again, thank you for the advice. I can't wait to read those articles. I hope this additional info I've provided brings a bit more clarity. Thank you!!!!

  9. #9
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    Default Re: "Milk Stones"?

    Yes I am sure this has been a very frustrating journey. And I do not pretend to have the answers. This milk stones thing is a new one on me. But for personal reasons, overproduction is something I have done a good bit of study on. And one thing I think is that the term "insufficient emptying" is often misused. In my research, It does not mean that the breasts require being literally emptied several times a day (or every time baby nurses, or every time mom pumps) It means that milk is removed from the breasts frequently and effectively overall Effectively means enough milk is taken out to feed the baby- with an older baby, about 3-6 ounces, total both breasts. Or, in a case of hyperlactation where mom is making enough milk for twins or triplets, it might mean removing more than that, enough milk to soften the breasts, make mom comfortable, etc. What "Frequently" means is going to vary mom to mom and obviously change with the age of baby and the current situation, but the general normal ballpark for milk removal frequency for a 9 month old is 6-12 times per 24 hours. I am still confused about how often - how many times each 24 hour day- you take milk out of the breasts whether with nursing or pumping or a combo, and whether or not you think this frequency could possibly be increased while possibly decreasing how much you take out each time you pump (I would not suggest limiting baby's time at the breast.)

    As far as BC, I am probably not the person to ask, I am suspicious of all hormone based BC. I will say I do not hold with the idea it would not do anything because your production is "established." I am pretty sure that the evidence shows that estrogen containing BC may act to reduce milk production at any point. However, I again would say that the frequent total emptying of the breasts is possibly going to work counter to any substance you take to reduce your milk production.
    Last edited by @llli*maddieb; May 13th, 2016 at 07:24 PM.

  10. #10
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    Default Re: "Milk Stones"?

    I have had a productive morning of googling! I found several mentions of this issue by looking up the words "under stone" and "lactiferous calculi". There were several veterinary articles which described these things as concretions of calcium and magnesium held together with casein. This was the article that seemed to best match your situation: http://www.breastfeedingclinic.com/c...20syndrome.pdf. And it's about humans, for a change!

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