A fly on the wall, I observed a woman and her newborn come into the office, clearly already familiar with the lactation consultant. After exchanging pleasantries and the crux of her visit, mastitis, the woman launched into her recent experience at an urgent care. She went there two days ago for mastitis where she was a given a shot and some antibiotics and then told not to breastfeed for a few days, followed with, ‘if your baby drinks formula she won’t want breastmilk anymore because she’ll like the sweetness of formula better.’ Thankfully, this mom knew she had received some ‘bad information’- her words. The major symptoms of the mastitis had resolved, but she was still experiencing breast fullness and discomfort. Enter the main purpose of her visit, and the part of this lactation practice that I found wildly fascinating: therapeutic ultrasound.

Sarah Glenn, IBCLC offers this service at her private practice in South Carolina. I was fortunate enough to shadow her for a day and came away with a proverbial treasure chest full of techniques, practices and verbiage.

The treatment sessions are about 15 minutes and, depending on the situation, may involve therapeutic ultrasound, lymphatic massage, and/or kinesiology tape. As an observer, the process itself appeared pretty simple. With both breasts exposed, she maneuvered the ultrasound wand around one breast and then the other. Next, she performed lymphatic massage, one side at a time, using coconut oil, all while explaining to this mom how to perform lymphatic drainage at home. This particular patient did not need the kinesiotape, so the session ended with an agreement to update Sarah in 24 hours to share how she is feeling and to determine whether a second session will be recommended. Take comfort in the fact that Sarah did address the misinformation shared at the Urgent Care. I never thought, before this visit, that urgent care centers would need to know how to treat mastitis, but it makes sense that not all new parents would know to go to their lactation consultants or OBGYN for fever-like symptoms. This sounds like a good project for Breastfeeding Coalitions: share updated mastitis information with the urgent care centers in their state.

Now, back to therapeutic ultrasound. How does Sarah determine who is eligible for therapeutic ultrasound? She looks for the following criteria:

• Patients with breast firmness and discomfort who have been following the breast care basics for at least 24 hours (ice, ibuprofen, etc.) with no signs of improvement.
• No signs of systemic symptoms: fever, chills, etc. These patients get referred to their OBGYN for mastitis treatment.

Of the many, many different elements that Sarah Glenn offers her patients at Lactation Station and More, I zeroed in on therapeutic ultrasound because I wonder if it is an underutilized tool in our world of lactation professionals. The Academy of Breastfeeding Medicine Protocol #36 The Mastitis Spectrum, reports that therapeutic ultrasound uses thermal energy to reduce inflammation and ‘may be an effective treatment for conditions arising in the mastitis spectrum’ (1). In the past, when I worked in an outpatient clinic, we would occasionally refer to a physical therapist in town that offered this service for lactating parents. I would assume – tell me if I’m wrong – that there are not many LCs out there referring, or offering, therapeutic ultrasound. On that note, there probably are not many practitioners out there who offer therapeutic ultrasound for breast inflammation even if lactation professionals wanted to make referrals.

May this inspire lactation professionals to consider adding therapeutic ultrasound referrals to their toolbox of breast pain remedies.

References:

1. Academy of Breastfeeding Medicine Protocol #36 The Mastitis Spectrum