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Thread: "Milk Stones"?

  1. #11

    Default Re: "Milk Stones"?

    Hi ladies! Thank you both so much for your super, super helpful contributions. I truly appreciate you both!

    maddieb: thank you so much for your valuable input. Yes, this has been an incredibly frustrating journey, especially because it started off so well - I just wish I could figure out where everything went wrong. To clarify, in a 24-hour period, I take milk out of my breasts 5 times total (4 times pumping alone, 1 time nursing/pumping combo). As of now, this means "emptying" each time (since after my baby nurses, which is my 5th "session" and last of the day, I pump to fully empty). I get what you're saying about overproduction and I agree. So, just to make sure I understand, you're suggesting I perhaps pump more frequently (maybe go to 6 times/24 hours as opposed to 5 times/24 hours) but pump less each time - maybe just to comfort and somewhat soft breasts. Honestly, it wouldn't be the easiest thing to add another pump session at work, which is what I would have to do if I increase frequency, but I could try. I used to pump 3x/day at work (which made for 6 sessions of taking milk out of my breasts/24 hours), but I was away from my desk so much that I cut it out - and honestly didn't notice any increased issues because of it. Could I perhaps keep it at 5x and just pump less anyway? If I understand your thinking, not emptying will help my production slow down, and might in fact help with the stones, as well, as it appears the "emptying" part isn't necessarily keeping them away. Is that right? Any other personal overproduction tips you have from your research would be appreciated. I feel so ignorant about all of this sometimes! I am about to read the articles you linked about about block feeding. Thank you again.

    mommal: thank you so much for your help! I did some googling using your suggestions and found a lot of great info from the veterinary world. And that article is awesome, I had actually seen it before, it just didn't seem to say what can be done to prevent them (unless I missed it). What do you think? It seems the veterinary sites made mention of too much calcium in the diet, which you'd suggested before, but one of the contributors on there said the same was not necessarily true for humans (but didn't elaborate). But at any rate, it does seem many of these are pointing to calcium/diet as a factor - I have half a mind to eliminate dairy and stop taking my vitamins/supplements for a (reasonable) period of time just to see what happens. What would you do if this were you? Do you have any research/anecdotal experience regarding the birth control question I posed in my last post?

    Honestly, I can't thank you both enough for continuing to think through this with me. There is something so reassuring about fellow moms offering support and encouragement, and actually spending their OWN TIME trying to help you - it's a blessing to remember how many good, helpful people there still are in the world THANK YOU! It helps me feel not alone! This whole experience has been very alienating - I hear a lot of "I've never heard of that" or "you're the first I've seen with this" - makes me feel isolated, even though I know that's not the case. Hopefully sometime in the future, another woman with this unique problem will come across this post and not feel the way I have!

  2. #12
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    Default Re: "Milk Stones"?

    maddieb: thank you so much for your valuable input. Yes, this has been an incredibly frustrating journey, especially because it started off so well - I just wish I could figure out where everything went wrong. To clarify, in a 24-hour period, I take milk out of my breasts 5 times total (4 times pumping alone, 1 time nursing/pumping combo). As of now, this means "emptying" each time (since after my baby nurses, which is my 5th "session" and last of the day, I pump to fully empty). I get what you're saying about overproduction and I agree. So, just to make sure I understand, you're suggesting I perhaps pump more frequently (maybe go to 6 times/24 hours as opposed to 5 times/24 hours) but pump less each time - maybe just to comfort and somewhat soft breasts. Honestly, it wouldn't be the easiest thing to add another pump session at work, which is what I would have to do if I increase frequency, but I could try.
    Actually I do not think you would need to increase pump frequency, necessarily. And certainly not at work. I think 3-4 pump sessions over a typical 8-10 hour(?) work day is probably plenty, maybe even more than enough. But you may find that once you stop pumping "to empty" you will need to temporarily add another pump session in there because you start to feel full- you might also do a quick hand express to relieve pressure when at work rather than adding another pump session if over-fullness happens.

    I am more concerned with what is happening the rest of the day- the other 14-16 hours when you are not at work. And what about weekends? "Taking milk out of the breasts" means baby nursing as well-Are you saying your baby only nurses once per 24 hour day and then you pump after that one nursing session? Or is baby nursing with no pumping added with more frequency than that? That is what I would suggest increasing- how often baby nurses. If baby is already nursing frequently- several times a day- then yes my suggestion would be to gradually and carefully decrease how much you pump out each time. If no, baby is NOT nursing frequently for that half a day or more you are with your baby, then I suggest that is the time to increase frequency of milk removal- by nursing, ideally, and by pumping, if needed. And at the same time, decreasing how much milk you extract when you PUMP. Again, I am not suggesting limit time at the breast for baby.

    A nursing baby takes what baby needs/wants at the moment, so baby nursing even with high frequency as long as baby wishes will NOT act to unnaturally boost milk production but will act to keep milk flowing regularly from the breasts, preventing milk stasis (milk sitting long periods in the breast.) It is the pumping to the point no more milk is coming out that is causing your milk production to be so overwhelming many months past the point it would have typically calmed down.

    If you do increase how often baby nurses, or baby is already nursing frequently, one thing you can try is that if baby is typically taking both sides at once, you might gently encourage baby to nurse one side at a time. Assuming baby is ok with that.

    More frequent milk removal over the 24 hour day, and stopping the pumping "to empty" practice, should help to calm the OP a little, but probably not very dramatically. Assuming that part goes well, then the next step would be to start carefully block nursing/pumping as described in the articles I linked in pp.

    I do suggest you discuss these ideas with your IBCLC before attempting.

  3. #13
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    Default Re: "Milk Stones"?

    What I find interesting about the articles I found is that none of them seem to agree on why these calculi occur. More than one mentioned infectious agents as a possibility, but dairy science articles take contamination very seriously, which makes sense when you consider that barns are pretty non-sterile places. Another mentioned high-calcium fodder as being a potential source. Another mentioned that the calculi tend to occur when the udder is being dried off- that is, when lactation is ending and the mammary gland is drying up. A lot of the articles were quite old- I found one going back to 1913!

    My point is, I don't think any of those articles give you any real guidance on how to prevent the stones. They are more like suggestion of avenues to explore... I think that the fact that you didn't get any calculi for a couple months after taking Bactrim suggests that some sort of low-level infection may be to blame, and in your shoes I would want to try another round of antibiotics. I think it would be particularly wise to have them on hand as you follow MaddieB's excellent suggestions about reducing supply and nursing more often.

    Since a dairy elimination can't hurt and might help, I would try that, too. While a temporary avoidance of vitamins and supplements will not hurt you or your baby, Ihate to suggest that a nursing mom stop taking her vitamins. Maybe you could keep on taking some of them, while skipping the calcium part of the supplement?

    Regarding your birth control question, I am on the fence. On the one hand, I think there is every reason to expect that your supply would be decreased by taking a combination estrogen-progestin pill. On the other hand, the effects are unpredictable- you don't know how far your supply would be reduced by the pill. If you do decide to take this option, I would be prepared to reverse course immediately and stop taking the BCP if you felt like your supply had dropped too far.

  4. #14

    Default Re: "Milk Stones"?

    Hi ladies!

    I am so sorry I went MIA. I was home with a sick baby and didn't get on the computer much the past couple of days. Thank you, again for your suggestions. I am taking them all to heart!

    MaddieB, here is my current 24-hour schedule, give or take 30 minutes (and I currently keep this even on the weekends):

    6:30a: pump at home
    10:30a: pump at work
    2:30a: pump at work
    7p: nurse baby (and pump the remaining couple of ounces out when she is done)
    1a: pump (obviously at home)

    We used to nurse exclusively, but as I mentioned before, once I returned to work and the stones started, and I was under the impression they were forming partially because my breast wasn't being emptied by the baby, we switched to the current schedule of almost-all bottles/pumps. Baby eats 5x/day, about every 3-4 hours, and does NOT eat between 7p nursing session and 6:30a bottle (sleeps all night). She eats solids before her 2nd & 4th meals and seems quite content with her current schedule. So, aside from nursing her in the morning before work instead of pumping/giving a bottle, I am not sure how I would add more nursing sessions in during the time I am home. Of course, on the weekends, I could certainly go back and substitute a nursing session for a pump - but that's only 2 days/week, so I don't know how great of an impact it will have. I know I need to focus on just not emptying the breast when I am pumping during the week. Thank you for your suggestions, I really do appreciate them. I know at least one of the IBCLCs I spoke to suggested oversupply might be the root cause of this also, so I think you are certainly on the right track. I mostly got confused about that when the stones mostly stopped (temporarily) after my first round of antibiotics - I thought well then it certainly must be an infection causing it. So who knows. Either way, I need to get production down, and if it happens to cure the issue, then ALL the better!!!

    MommaL, thank you thank you. I have started to really limit my calcium and I am currently still on the Keflex (antibiotic) and fluconazole (antifungal). I'm not yet a week in to either, so I am holding out hope that this will make a difference. I haven't had a stone in a few days so we will see how this goes. Thank you also for the advice about the birth control pill. I am thinking I will start it after I finish the other medications and see how it goes.

    I appreciate you both very much. If you have any further ideas, or run across anything new on this, please please don't hesitate to send it my way. I will certainly be monitoring the board. You have both been great blessings to me!

  5. #15
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    Default Re: "Milk Stones"?

    ok, So my original surmise was correct- milk is being removed from the breasts only 5 times in 24 hours. This is very infrequent and can cause a few issues.

    This would simply not be often enough for normal lactation outcomes in many cases- in other words, it would lead to low milk production and other issues like plugs caused by milk being left in the breasts so long. But, because you are pumping to empty each time, and because you have extreme over production and, I suspect, a very large milk storage capacity within you breasts (this is different than breast size by the way) in your case, infrequent milk removal it is not leading to poor milk production. If you continue to have such infrequent milk removal, then it may be that pumping "too empty" is needed to prevent plugs. It is hard to say.

    But the other issue with such infrequent milk removal is milk stasis- milk sitting in the breasts a long time. This is caused by long periods of time between milk removal. This leads to plugs and mastitis.

    If milk is removed frequently and with normal efficiency, then whatever is "left" in the breasts is reabsorbed by the body. It does not just sit there forever. But if there is a tremendous amount of milk in the breasts left for long periods, that cannot be all reabsorbed. This leads to issues like plugs etc.

    Because infrequent milk removal to the point of being literally empty is NOT the norm for breastfeeding. What is the norm is frequent milk removal but not to the point of being "empty." And the vast majority of the time, the best way to solve/prevent breastfeeding issues is to keep things as close to the norm a possible. That means that even when a mom must pump, pump sessions are not to the point of emptying and are frequent. It also means that when a baby is fed with bottles or even solids, it is frequently but with small, biologically normal amounts. If your baby is eating milk 5 times a day he is probably getting more milk each time than would be the biological norm. This is a common issue when bottle feeding.

    Your baby is nursing/milk is being removed form the breasts an unusually infrequent amount of times per 24 hours. Removing milk so infrequently means that milk sits in the breasts for an unusually long amount if time. My best guess is that the infrequency of milk removal is contributing to the issue. That is my entire point.

    So if your think you are overproducing and that is part of the issue, to reduce op, you can either change the feeding/nursing/pumping patterns you and your baby are in to more reflect the biological norm, meaning, more frequent milk removal but not so much taken out when you pump- which I think will help immediately in reducing the issues caused by milk stasis - and then also try block feeding/pumping at some point in order to reduce milk production , or you will need to find some other way to safely block feed or reduce the total taken from the breasts each time without increasing the frequency of milk removal.

    I personally think the latter is more likely to cause issues than the former. This is why I have suggested increasing the frequency of milk removal by encouraging you baby to nurse more often, day and night. You might start that process by encouraging baby to nurse more a variety of ways I am happy to elaborate on if you are interested. This would also probably mean bottle amounts could be decreased. Yes, doing that is going to change your current feeding patterns, but is otherwise an entirely benign intervention. It cannot possibly hurt your baby to nurse more often.
    Last edited by @llli*maddieb; May 17th, 2016 at 12:17 PM.

  6. #16

    Default Re: "Milk Stones"?

    Hi MaddieB, thanks again for your help!! I really appreciate it. What you are saying makes a lot of sense. I will say, when these problems started when she was 10 weeks old, she was still nursing every 2-3 hours and I only pumped once/day (after her morning feeding), so I was removing milk very frequently (even overnight) yet the problems persisted (as they did when I pumped every 3 hours when I first came back to work). I have worked over time to get down to less pumps/day and the problems have not gotten worse, though they are certainly persisting, if that makes sense. But I agree that it could perhaps certainly be a contributing factor in which case, it does not hurt to try, and I will work on some ways that I can increase frequency of removal while not increasing volume of removal. Thank you again for your time in helping me, I know you don't have to and it means a lot you took the time to do so!

  7. #17
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    Default Re: "Milk Stones"?

    One reason increasing frequency of milk removal might help is that it seems to me that it must take some time for these "stones" to form. Taking a little milk out more frequently could either prevent the stones from forming in the first place, or at least flush them out before they grow so big that they become problematic.

    I have to wonder if one reason why these things seem fairly well-recognized in dairy animals and barely heard of in humans is that most dairy animals are milked just twice a day...? That would give the milk a nice long time to sit and form little clumps of minerals and casein.

  8. #18
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    Default Re: "Milk Stones"?

    I understand that your experience so far does not point obviously to less frequent milk removal as a cause of or contributor to the issue. And again, I do not know what the cause of the 'stones' is. I am just looking at the OP and how long it has lasted. OP past 3-4 months is really unusual and tends to happen due to "over" pumping. In your case the "over" is not the frequency but perhaps the extent to which milk is removed. At this point it is interesting to go over the history- for example, I am curious if the stones only appeared after pumping began, and also I am curious if you had any other issues from the OP prior to the stones. But, I am not at all sure that what was happening several months ago has any bearing on what is going on now. I am basically taking the view that right now, at 9 months, you have OP and, related or not, are having these stones happening, and since they are causing you problems, it makes sense to try to solve that problem. (If there was no problem there would be no need to do anything- some moms have OP, can pump or nurse with low frequency, and it works fine for them- in other words neither OP nor low frequency milk removal after the first couple months is always a problem -they are problems when they cause problems.) If you try the ideas I am suggesting and they do not help or worsen the situation, you can return to what you are doing now at any point.

    I wondered that too about dairy animals. I was just reading a book to my son tonight and the story takes place on a farm and the cows were "bellowing" at milking time. I thought, ouch.
    Last edited by @llli*maddieb; May 18th, 2016 at 01:10 AM.

  9. #19

    Default Re: "Milk Stones" causing plugged ducts?

    i have this same problem!!
    stones.jpg
    i went for a breast ultrasound, and they could see A LOT of little stones all in my ducts! i go to penn medicine, which is one of the top health systems in the US, and even they haven't heard of this. the breast surgeon said it is rare, but may be crystallized milk fat.
    doing my own research, i started taking sunflower lecithin, vitamin D, vitamin C, and drinking a tablespoon of apple cider vinegar mixed in water, and also increased my water intake, and i haven't had any stones stuck for months! the radiologist said there was a lot in my ducts, but after taking all those supplements, i've only had to remove maybe 2-3 small shards out of my nipples since the ultrasound. i think they shrank and passed through! i'm also seeing milk come through nipple pores, that never had milk come through before.
    i started wondering if thrush could have caused the stones? they always say that thrush pain feels like shards of glass coming down the ducts and in the nipple, and that's exactly how mine felt. for me, now i know why, because there was LITERALLY shards of whatever that is, coming through the ducts!

  10. #20
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    May 2006
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    Default Re: "Milk Stones"?

    Welcome to the forum! So interesting to hear that you have had the same issue with the "stones"- it makes me wonder if they are more common than we think? Anyway, thrush as a root cause for the stones makes perfect hypothetical sense. Yeast would cause inflammation and might even provide some sort of physical structure which would then calcify...

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