I saw a patient today who , at 5 months of pregnancy, her left breast
got very hard, red and the pores became very large, including her
areola. She was sent to a breast surgeon who biopsied, mamagrammed and
ultrasounded the breast and couldn't find anything. She never had a
fever or flu like sx's, but they decided it was a type of mastitis and
treated her with 2 rounds of antibiotics. She has delivered at term,
the breast is no longer red and the upper part is softening, but it is
still significantly larger than the other one, and most of it is still
hard and the pores are still large. The baby doesn't (they say "can't")
latch on that side, but is doing fine on the other side. I told her to
start pumping the affected side. Has anybody heard of this or seen
anything like it? I am clueless.
I have another patient I have been working with since birth. Initially
it was a latching problem, and when he wouldn't latch on after a couple
tries she started asking me if I ever tell women they can't or shouldn't
breastfeed. I sid there may be cases where BF doesn't work out, but I
didn't think that was the case with her (I mention this because I feel
it may say something about her committment). Breastfeeding got going
before discharge. She then ended up coming back in at about 2-3 weeks
for sore, cracked nipples. I felt like it was a good consult (the crack
was pretty deep) and I helped her. I was concerned about the baby's
suck, it was very "jerky" Things improved briefly, then seemed to get
worse. She's at 6 weeks and the crack has just healed, but now she says
she has this internal shooting pain every time she feeds, and sometimes
it's nearly unbearable. It lasts sometimes for hours after a feed, now
even pumping hurts, and she can't bear for anything to even touch her
nipples. I thought it might be yeast, but when she saw her OB she told
her she didn't think it was yeast. She's considering weaning (it seems
like she's been asking me all along - does it ever not work out?). But
she keeps telling me she really wants to breastfeed and just isnt't
ready to wean, even though feeding always hurts.
I personally don't buy in to "giving permission" to wean. I asked her
today if she has a history of sexual abuse - she said no. I asked her
if she was asking for support to wean. And she wasn't really sure. I
did tell her I thought she had worked really hard to resolve this
problem and it is not normal. I feel really frustrated. Am I missing
something? Could it be the baby's suck? Help?
Andrea Tran
Boulder, Colorado
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