Hi Rita,
I have several thoughts. My first thought is that due to the infection,
which is not yet resolved, her skin is friable and prone to injury. My
first priority for her would be to get a surface (skin - especially where
it is oozing) and a clean-catch milk culture and sensitivity. She may have
to be on antibiotics for a longer period of time and needs to know the
right one to be on. She should also explore whether her breast pump could
be a source of re-infection, as sometimes this can be the case. Not just
the obvious parts and tubing but the bag and/or motor. This can be
especially true if the pump is used or has been around a while. I will try
to find the info at work about this and email you.

Re infections and antibiotics, I suggest improving her nutrition as much as
possible, and taking probiotics.

Does she lubricate the flanges with oil or lanolin? That could help
minimize the trauma. Could she pump the unaffected side and simultaneously
hand express the affected side when she experiences letdown? I recently
worked with a mom who had many bf challenges, including recurrent mastitis.
Cultures revealed a germ I had never heard of but is not really rare, and
ultimately (after months and months and seeing bf specialty doctor) decided
to wean the affected side. I hope your client does not have to do this.

Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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