I've had two women with mastitis over the past few days.

One: plugged duct, white in nipple pore and very uncomfortable milk back up
to the lateral breast.  Infant had been stretching nipple and had bitten it.
 I recommended intermittent cold to the engorged area and heat applied to the
nipple and areola before massage and nursing.

Second: started to wean gradually in April.  Two episodes of fever and aches
of two days duration each time not identified by mother as mastitis; one in
April, one in May.  Now in June 1 week ago had red spot on L breast, started
nursing every two hours, went away.    Sunday morning she woke up with
shooting pain in her breast (not while feeding) had her 18 month old son
nurse, he bit off a tiny piece of nipple which hurt and continued to feel
painful when the toddler nursed to the point where it became unbearable.
 Monday morning the son had blood in his mouth atfer nursing.  She presented
Monday with rubor circumscribng the nipple, involving the areola and about
3/4 inch beyond, engorged, and the upper half of her nipple was white and
appeared to have clear exudate.  She used a pump and got 6 oz. from the
involved breast, 4 from the other of thin, whitish milk with no frank blood.
 the breast was then soft with no  lumps palpable.  The doc on call had given
her a script for dicloxacillin and told her to apply cold compresses.

I saw her after the pumping and the nurse at the Center said that the redness
was now extending further back on the breast than before pumping - another
inch.  We went down to see her physician in the clinic who said that she
needed to keep the breast empty and use heat only as the heat would increase
blood supply and allow more antibiotic to reach the breast and that the
emptying would decrease compression to the vessels and therefore do likewise.
 Her temp was 99.? F.  He increased the diclox. to 500 mg.  4 times a day.

My question:  would anyone recommend intermittent application of cold to the
breast as well?