Re:  Catherine Fetherstone's interesting post relating to sub-clinical
mastitis and elevated risk for acquiring HIV.  The phrase "sub-clinical
mastitis" jumped out at me. I would like to propose a discussion about this
issue.

 I see women all the time who have inexplicable breast and nipple pain, who
have treated for weeks for  suspected candidal infection with minimal
response.  I suspect in many of these cases that a sub-clinical infection of
the breast is occuring, and it is very difficult to get anyone to take this
seriously or to treat it.

Typically, these women have had cracked nipples, some early (usually short
exposure) to antibiotic tx for something, and they complain of irritated
nipples, breast pain that stabs and burns, is worsened by hot water, hot
weather, and touch point pressure.  A few times milk cultures have revealed
what seem to be sort of "background" levels of staph, but nothing the
doctors are ever very excited about.  The chronic pain is dismissed.  The
women are made to feel as if they are complainers and weaning (not diagnosis
of the problem) is seen as a solution.  I recently worked with one afebrile
mother with chronic breast pain (2-3 weeks duration) whose (female) OB asked
her to come in for an evaluation of post-partum depression and who advised
her to wean because she was complaining too much about pain.  My response
was:  You aren't crazy.  You're sick.   A second opinion from a diff. OB
stated that altho the first OB had tx for mastitis, the mother had been
given the wrong antibiotic, for the wrong lenght of time, in a too-weak
dosage strength.  Mother cleared up fine with better drug tx.  Her sx were
chronic pain, reddness on the breast, no fever.

Pain in the breast that is coincident with breastfeeding is trivialized by
the medical profession, and mastitis is poorly understood.  Most of the
texts describe febrile sx as the marker for mastitis, and it seems to be
required to receive treatment.  Yet few of the women I see are febrile.
Perhaps they mask sx by taking anti-pyretics, or perhaps they don't
typically spike fevers until terribly ill.  If cytokines are markers for
mastitis, is there research to give base-line numbers on levels that might
be used diagnostically in detecting and treating these cases that are called
"sub-clinical" but which frequently cause women sufficient pain to cause
weaning?

This is an area of study that has implications both within the AIDS epidemic
and beyond.  What we don't know about mastitis in humans would fill a
textbook.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html