I would appreciate input on a mom who is having problems with one nipple.
She has a six month old baby who is nursing well and growing well. She
nurses both sides, and has extreme pain when nursing on the problem breast.
She has had a problem with this breast for about four months. She called me
Friday for the first time. She did not deliver in my hospital and has
recently moved to Rock Hill. Her OB's nurse referred her to me for help.
She had some redness and pain in the breast four months ago. Was treated
with Keflex and got somewhat better., but not totally. Nipple then began
crusting constantly and burning. Back to doctor, treated with cortisone
cream. No change, crustiness and burning continue. Back to doctor, treated
with Augmentin for mastitis, no change. Mom hanging in there, wants to
nurse a year.
When she called Friday I talked to her about yeast. She has not been treated
and was told it was not yeast because baby doesn't have it (which I know
doesn't mean anything) and because it was only on one side.
We discussed her talking to her MD and going back for another visit. After
I got off the phone, I keep thinking about the crusting of the nipple, which
she says she can flake off but it comes right back. I looked up some
information about Paget's disease of the nipple, a rare breast cancer which
has symptoms of crustiness, burning and being unilateral. It sounded like a
possibility to consider.
I called her physician and told him that I had talked to her about yeast and
that I had asked her to come in and see him on Monday. I asked him what he
thought about the possibility of Paget's disease and he was very
disrespectful, basically laughing in my face and said there was no way it
was Paget's disease. He said he had only once seen a case of that in all his
years of practice and it was in a much older woman. I would like to know
more about Paget's and to know if I was totally off base suggesting it as a
possibility. I would appreciate it if anyone who has more information could
let me know if this is not a disease that can affect young women, and that
it is so rare that he could say without seeing the mom that it was
definitely not it.
Also I would like suggestions as to what it might be. I have dealt with
lots of yeast, lots of mastitis, some eczema over the past 22 years, but
this just seems different to me. In the past year, I have also encouraged 3
women with "different" symptoms to continue to search for a cause with their
HCPs and all 3 have been diagnosed with breast cancer. So maybe I am just a
little overly cautious. Help?
Ann Calandro, RNC, IBCLC
Waxhaw, NC also under 15 inches of snow, after not seeing one flake of snow
in two years!
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