Before it becomes to controversial let me clarify my statement about taking
care of mastitis over the phone. Generally, these cases start as plugged
ducts, so when moms call us with s/s - thickened area or lump, sore to touch,
with our without fever, with or without sore nipples, we give out the "empty
breast, massage, warmth before feeds, cold after feeds, ways to fix latch"
type information. Sure we would like to see all these moms for the most
effective and informative ways of figuring out what is wrong. However, only
a small percente of those that call are willing to come in to the office for
a visit, less are going to covered by insurance. I don't like it, but that
is reality. So should we say sorry you are having trouble and not offer
advise? I don't think so. May they have other problems ? Sure, but we also
tell them if the fever is not gone after 24 hrs of treatment by other
measures to call their Dr. Do you think they have them come in?, not
usually.
The pt that had mastits and made it to the hospital had been being tx
over phone by the OB. His advice was heat and antibiodics. Ignoring she'd
had a cracked nipple for the past 8 weeks since delivery of course. When we
saw her she'd had IV antibiodics for 16 hrs. Her L breast (the effected
side) was several times larger than the R, reddened up to her collar bones,
skin had "orange peel" texture. Crack was about an inch long, opened with
hand expression, not that we could do much due to the extreme edema of the
areola and whole breast. Ice and cabbage worked great. I'm sure she needed
the antibiodics at that point. I think if we had had phone contact we could
have prevented the hospitalization, and had her in the office to fix the
crack. No way could a 8 week old crack be fixed over the phone I am sure.
To make this shorter, she went home day after we saw her in hospital. Came
in next day for further latch assistance as not able to work on it much until
breast healed some. She is better.
I still want other thoughts on heat vs cold Tx. thanks,
Evonne
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