This woman has an ongoing infection in the ducts of her breasts. She was 
probably given dicloxacillin, not doxycycline.
She really ought to have a breastmilk culture done, and treatment based 
on culture and sensitivities. I realize that most doctors don't know how 
to do this, and don't know how to interpret breastmilk culture results, 
so I guess I am describing the ideal world, not the real world.
Anyway, if the dicloxacillin is helping, she should stay on this until 
all pain is gone deep in the breast, which may be 4-6 weeks of 
treatment. If the dicloxacillin stops working, then she should be 
switched to a different antibiotic. Sulfa tends to work the best for 
these intraductal infections.
Good luck,
Anne

Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)

On 5/30/2012 8:12 AM, LACTNET automatic digest system wrote:
> Wed, 30 May 2012 09:12:33 -0400
> From:[log in to unmask]
> Subject: unresolved nipple pain
>
>        PTP. First time mom, 5 1/2 mo, breastfeeding. Came to me on 5/16 with c/o pain in right breast, nipple only. She noted baby had blood in his spit up after feeds. Saw once in expressed milk. Described the pain as burning, sharp, intermittent, that came from top of the breast down to the nipple with the onset of the feed. Baby is a one sided feeder. She has noted that when she pumps the right side has only 2 streams and the left has multiple streams. She noted the soreness has been present from the begiining of her breastfeeding history.
>
>        In observing the feed, baby did occasionally pull off to look at me. Otherwise, the right nipple was shaped normally but there was a small almost blister like lesion on that side. We discussed positioning, though nothing looked amiss with latch itself. Mom denied any pain with that feed. I thougth the pain in her breast was related to her MER and milk coming through fewer duscts than on left and the blood may have been related to small vessel breakage with same. She did note blood was seen more often in the earlier parts of the day. I recommended an appointment with OB and possible use of an antibiotic ointment for the sore. I suggested warm to the breast to see if it decreased the pain. On 5/22 she called with c/o contniued pain and blood and feeling like his tongue was sandpaper on her nipple. She had an appointment in 2 days.with a NP in OB's office. LC asked her to call me with that follow up.
>
>       Today she called. She saw NP who said the sore spot was from using the same position to breastfeed and recommneded that she pump that side until the sore was healed and then when she returned baby to breast, she should use a different position. She pumped for a few days, sore got better. She returned baby to breast and by Saturday am, she started with a fever. By the end of the day, she had progressed to redness in the breast and chills. MD prescribed doxycycline and she does feel better today. Nipple is again very sore.
>
>      She is returning today for me to assess baby's palate, work on latch again. I suggested CST or chiropracter for both of them. I have the info on maamary constriction syndrome just to see if any of the breast massge techniques might be helpful. Any other suggestions?
>
>
> TIA,
>
> Allyson Michaels, RN, IBCLC
> Charlottesville, VA

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