I'm working with a mother of a 6-week old infant.  Mom experienced mastitis
at 10 days, it cleared w/out antibx, but reappeared w/ a vengeance the
following week.  Mastitis progressed rapidly to abscess for which I & D was
done and wick placed.  Augmentin prescribed and I have not determined
whether milk was cultured since mom just contacted me and I'm piecing this
together.

Mom had strep B so had antibx during vaginal delivery.  Experienced thrust
w/in first week and was given Nystatin oral liquid for infant and herself
(yes, the goopy liquid, not the ointment).  Thrush has worsened as Mom has
been dealing with abscess.

Initially Baby's weight gain was good.  Mom reports that she was a pound
above birth weight at 2 weeks.  Following the abscess situation, baby
dropped 8 oz, so doc told Mom her supply was low and she needed to pump and
bottle to measure intake (aarrgghh!).  I think that Baby was just sleeping a
lot and Mom didn't awaken to nurse, so Mom paid for it with the abscess and
Baby got into that sleepy/low energy/doesn't effectively suckle/loses weight
cycle.

This past weekend (at 5 weeks), Baby was visiting grandmother out of town
and experienced a strange, almost anaphylactic episode for which she was
transported by ambulance 2 hours to larger metro children's hospital.  No
diagnosis...gave Baby several antibx and discharged after 2 days.  LC saw
Mom at hospital and said to use nipple shield on unaffected breast since
thrush pain was so horrific.

I'm leaving out some of this, but I get the phone call after discharge from
hospital with all the complaints you can read between the lines above.  Wick
was removed today, however, abscessed side is still producing very, very
stringy, goopy milk, so I wonder if the right antibx was prescribed.
Tuesday was my first encounter w/ dyad.  Mom was pumping and bottling, plus
using abm up to 16 oz q 24 h.  Baby would take 6 oz abm and/or ebm at times,
but Mom was concerned about projectile vomiting.  At that time, Baby was
minimally at breast.

Long story made as short as I can...I tackled the supply issue first and Mom
is now "ahead" with no abm required today (Thursday).  Baby is nursing on
unaffected side w/ shield in place, then Mom pumps and tops off with ebm.
The whole mental game with the amount is an issue now, of course.  Diaper
count is great and Baby weighs same as 1 week ago *before* hospital
admission, etc. and unknown illness (?), so I think that we can move forward
with supply.  Mom is willing to try no shield since it is still painful w/
or w/out shield, likely because thrush is pretty bad.  I've looked at all
the options...Mom did start probiotic for herself and Baby yesterday and is
willing to use gentian violet or "whatever will work".  I feel as if the
cart and the horse keep trading places, but I think I would like to tackle
the thrush and not panic if Baby likes the shield at this point.

I'm a bit worried about supply down the road because Mom just told me that
she's anemic.  Is it stupid to think about galactogogues (oops...is that the
preferred spelling or am I fixating on it and it's wrong?) with the abscess
that I'm still worried about given the strings we're seeing?  Right now I'm
having her focus on increased breast stimulation, but want to have some
reasonable options down the road if they become necessary.

It's been a long day, so I know there are gaps I can fill in, but I welcome
some help.  My immediate plan is to continue with her nursing, then pumping
with a weaning from the topping off as we watch diapers and check weights.
Mom is also willing and ready to nurse on affected breast, so she may try
that tomorrow.  Right now she is allowing one 4-5 hour stretch for sleep and
is feeding at least every 2 hours the rest of the day.  This is a dedicated
Mom who is also back to work (from home, thanks to a great employer).  She
is, however, asking for help w/ meals, is realizing she needs to rest, etc.,
so I'm encouraged to think we can turn it all around at the 6 week mark.

Thanks in advance,
Rebecca DeYoung Daniels, MBA, RD, LD, IBCLC & MOM to 5 in KS

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