Hi Diane,

About the culture while taking Keflex.  An organism can be sensitive, partially sensitive or resistant to an antibiotic.  If it is sensitive, then a proper course of antibiotics should kill off  the organism and the infection should not recur unless the patient experiences another exposure to that organism.   If it is partially sensitive (the official designation is "intermediate"), then a course of antibiotics may kill off some, but not all of the organisms or may simply inhibit their growth.  Once the antibiotic is stopped, the organism will often begin to regrow and symptoms will recur, even without an additional exposure because the organism was never completely killed off to begin with. (This is also what happens when a patient stops therapy too soon - even if the organism is sensitive to the antibiotic, if there hasn't been enough time to kill off all of the bacteria, there will eventually be regrowth).   If the organism is completely resistant, then the antibiotic therapy will show little or no effect on the infection.  In the case of your mom, it is possible that the bacteria may be slightly sensitive to Keflex and if the milk were cultured, there might  be just enough of an effect so that the organism (difficult often to recover from milk in the first place) will not grow out in the lab and the culture will be deemed negative.  It would be better to wait until all antibiotics are stopped to attempt a culture in order to get the best chance of organism recovery and growth.  Of course, the doctor could simply switch her to another type of antibiotic and see what happens.

Is there any possibility that some kind of contact dermatitis is involved here?  Or a sensitivity to topicals?  Here's an idea:  5 days pumping only;  discontinue all topicals and just squirt the nipple with sterile saline/water if any cleaning is needed; then use a wide-bottomed shell to keep all material away from the nipples.  In other words, just leave the nipples alone completely except for milk removal.  See if this allows complete healing and then bring baby back to breast over the next couple of days.  Of course, there is always the chance that baby may wean totally at some point.  Or maybe continue with some nursing, but do all the other stuff.

The other thing that comes to mind is that this mom needs to have some general bloodwork done to check for anemia or thyroid problems which may be hindering the healing process (check on her diet as well.)  One extreme case that comes to mind is a child who presented to her doctor with a small wound which would never quite heal - a blood sample sent to our lab revealed that she had acute leukemia.

The problem we get into with these long-term cases is that we keep adding layers of therapy (whether it  be latch, positioning,gadgets, topical ointments, systemic drugs/herbs) and then it becomes difficult to backtrack to see how each of these interventions, separately or together, have affected the final outcome.  Then we start the second-guessing and the "what have I missed?" syndrome (sometimes justified, sometimes not.)  Good luck with this and let us know what happens.

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