I've just seen the worst mastitis of *my* career; I have no idea how common a sight it is for others.  Very inflamed and red, peau d'orange skin, shiny and taut.  She's been on dicloxacillin for about 4 days and both she and her partner say it's considerably improved, but wow!  She's a mother of 7 month twins, but has been getting only a half ounce or so when she pumps.  One of the babies nurses reasonably gently on that side, but pumping is more comfortable right now than nursing.  She pumped while I was there, longer than she's been pumping, and got just over 2 oz.  The milk looks fine - no pus or blobs.

She usually pumps with a 36 mm flange.  Right now, with all the swelling, it rubs more than usual.  She's been coating the flange with olive oil, which helps, but after the longer pumping this time there was a ring around her areola where breast enters neck.

I've suggested maximum dose ibuprofen for starters, and continuing the soaks in the tub that have brought her the most relief, but I have a thought I want to check with you all.  It's based on the James Herriott books about an English country vet in the 1930s:  Give her the super-large glass flange to see which is more comfortable for her, and perhaps suggest that she alternate if they feel the same, just to shift where the stress is on her skin.  Have her pump considerably longer than usual, at the lowest setting, with maybe a half hour break between sessions (during which she lies down!  They have extra help with the babies and she nurses fine on the healthy side).  Just keep milk flowing, flowing, flowing, flowing, using the baby when she feels like it but using the pump mostly, to keep that milk trickling out.  And to cradle her breast tenderly in both hands fairly often and just gently wiggle her fingers, by way of *very* gentle massage.  (She's not good at hand expression, and I can't see using hand expression on a breast that fragile looking.)  And, of course, move to another plan if she senses that her skin may be starting to object.

She sees her doctor again tomorrow.

Is there a down-side to having someone pump a mastitic breast for long stretches?  If it were *my* breast, I wouldn't be letting a 7 month old near it more than a few times a day, if that.  I just was so pleased to see those 2 oz finally come out, and would love to see that pattern continue.

The James Herriott story?  It was a cow with a seriously mastitic quarter.  James told the owner, who had only a few cows and who really couldn't afford to lose a whole quarter on a cow, that his best hope was lots of massage and lots of milking.  When he returned the next day, the cow was fine.  "What did you do?" he asked the farmer.  "I'll tell you what he did," said the wife.  "He spent the whole night right there on that milking stool, massaging through a whole bowl of lard and milking milking milking."  It made an impression on me even before I had children...

(When I saw the peau d'orange skin I immediately thought of all the warnings about inflammatory breast cancer, but the onset was so swift and the improvement apparently so clear that while I'll tell the doc I saw it, I do think I'm seeing just plain old nasty mastitis.)

Diane Wiessinger, MS, IBCLC  Ithaca, NY  USA
www.wiessinger.baka.com




             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome