Thank you for your suggestions.  I receive Lactnet in digest form, so I may
be leaving some questions unanswered.

1.  The mother has been on Augmentin (oral for the 1st diagnosis of
mastitis), IV Cefzil when 1st drained abscess resulted in secondary mastitis
in other part of breast, then (per what I understood the mother to say) IV
Omnicef before and during the 2nd abscess incised and drained, then oral
Augmentin.  She does not know what IV form she will be given beginning
tonight.

2.  She did try to keep the affected breast "going" via expressing since it
was too painful to have the baby at the breast.  Through all of the trauma
and infection, the supply dropped dramatically and she is only able to
visualize the leaking milk at the incision site and a few drops at the
nipple.  She is unable to express anything.  This is a mother who has nursed
or expressed every 2-3 hours around the clock for weeks to turn things
around and her stress level is, let's just say nicely, a bit high.  For me
to suggest that she start pumping the affected side every 2 hours right now
just may send her over the edge, especially now that someone has raised the
question about weaning completely.  Both the family doc and myself
encouraged her to keep the affected side flowing and she did so heroically
until she was unable to express anything during the last few days.

3.  Trust me, trust me, trust me on this...this client had and has yeast.
When I first saw her, both breasts were the classic shiny-pink and she was
crying through every "feeding"...she couldn't even call it "nursing".  Her
baby had a lovely white mouth and a yeasty diaper rash.  The mother also had
a horrific yeast infection vaginally *and* rectally.  She was finally able
to *nurse* without crying after a week on Diflucan w/ no other changes made
to latch, etc.  With all of the antibx she has been on and continues to be
on, I think the yeast battle will be ongoing.

4.  Biopsy done--I believe it was an incisional (not fine needle or tru-cut)
biopsy while draining the 2nd abscess.  The abscess was so deep (identified
by sono) that it required general anesthesia, at least per her family doc
and the general surgeon.

5.  This mother also has a cyst located underneath and bit offset to the
right of her areola.  By sono, all docs involved do not believe that the
cyst is affecting milk flow.

6.  OK, here's another thought that a friend of mine who had a grad degree
in pathology suggested...mycoplasmas.  My limited understanding is that they
are very hard to culture and often go undetected.  She had very clumpy,
stringy milk initially and some of you suggested that it was either yeast
and/or the infection.  Now I wonder if mycoplasmas could have been/are the
culprit?  I think they're sometimes called "stealth bacteria".  I'm not a
drug expert, so I wonder if the antibx above would be essentially useless in
this case.  Perhaps she had/has some "normal" mastitis that these usual
antibx kick down initially, but the real bug is simply continuing to do its
nasty work.

7.  Oh, yes, the incision for this 2nd abscess (the 1st was more toward the
surface and a wick was used)...a deep horizontal incision was made and I
believe that more ducts have been affected than had a vertical incision been
made???  Am I way off base on this?  It also makes me wonder if *that's* why
production has dropped since this 2nd abscess was drained...enough milk
ducts were severed???  Shannon???

I'll await more help and questions.  This has been such a challenging
situation that I desperately want this mother to feel supported in her
desire to keep nursing on the left side.  Short of a mastectomy, all ideas
are welcome.  If you respond to the list, would you also copy me at
[log in to unmask] and either give or revoke permission to forward to
the family doc and mother, please.

Thankfully in KS,
Rebecca DeYoung Daniels, MBA, RD, LD, IBCLC, RLC & MOM to 5

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