The following tests need to be run:
An Ultrasound of the breast to rule out a mass which can create flow problems
that result in infection.
A CBC to rule out anemia
Nasal and oral cultures of the infant--if positive bactorban can be
prescribed to treat/lover the bacterial load  (sometimes they treat the whole family)

A milk culture to evaluate for fungus, yeast and bacteria--again treating
according to results.  Yeast is hard to culture but can be a cause of reoccurant
mastitis and can be treated emperically.

Also ask:
Could she be reinfecting herself with usage of contaminated creams applied to
the nipples.  What about contaminated pumping supplies?
Consider mechanical issues: Is she taking particular care to keep the breast
well drained, no underwires or other clothing that creates pressure, sleeping
on her stomach?  Does she massage that breast really well with feedings?

Nutritional status may be a factor--Is she eating well?
Fatigue/stress may be a factor--Can she get more sleep and do less around the
house?

It is acceptable to treat the mother with low dose antibiotics over several
months (like we do for UTI's).  Lawrence recommends  Erthromycin.  I have used
septra.  But her culture results may indicate a better choice.

The lecithin is a good idea and may solve the problem.  I hope it does.
Chris

> om:   Jackie Sinicrope <[log in to unmask]>
> Subject: Recurring Mastitis
>
> Hi,
> I have been working with this mom (mostly by email) for about a week (other
> issues - when to start solids, sleeping through, etc). History: baby boy is
> 6 months old, 21 lbs, exclusively breastfed; baby has dairy allergies, and
> she has eliminated all dairy from her diet; Father of baby had dairy
> allergies as well as wheat allergies. Her doctor has suggested taking
> lecithin daily, which she is doing. I spoke with her this morning, and she
> is feeling better now, and seems less inclined toward weaning early, but is
> concerned for her health, and getting pressure from family. I told her she
> definitely has options other than weaning and gave her several from the
> Breastfeeding Answer Book. The mastitis and plugged ducts have occured in
> the same breast each time, and she said with the last occurence, it was too
> painful to wear a shirt. Is this within the normal range for recurring
> mastitis, or is there something else to look for? I would welcome any
> thoughts, suggestions, questions, etc.
>
> Thank you,
> Jackie Sinicrope
> LLLL, Cary NC
>
> I have permission from the mom to post the following email she sent me:
>
> Thanks so much for the reply.  I had planned on coming to the meeting
> today, but woke up at 4 a.m. with a terribly painful round of Mastitis.
> I had Mastitis just 4.5 weeks ago so this makes 3 times for Mastitis and
> at least 5 blocked ducts.  My Mom is a BIG LLL person, but she told me
> today she is worried about my health and thinks it might be better for
> me to stop nursing.  Of course I don't want to do that, but with a
> temperature of 102 and my body fighting so hard it is pretty miserable.
> The doctor has told me today that there is no way to avoid the Mastitis,
> but I keep getting it in the same side.  He said that you get Mastitis
> from bacteria in the baby's nose.  So, I hate to imagine it, but perhaps
> what I need to do is pump and then give him the breatmilk in a bottle to
> avoid the infections.  I'd hoped to make it to 12 months or at least 9
> months and he was eating well on solids.  Plus I have been doing a
> slower pace on his vaccinations and believe it is important that he get
> breastmilk during those.  What are your thoughts?  Have you read up on
> anything to prevent Mastitis or plugged ducts?  Is there a danger
> physically to getting Mastitis over and over again?  Each time I get it
> the infection seems more severe and bigger spread and MORE painful.  Now
> it is painful when I breathe as it hurts all the way into the under arm
> and is incredibly flaming red.   Any advice would be great.
>
>        ***********************************************
>


Christine Betzold NP IBCLC MSN
www.starfireinternational.net/breastfed

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

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

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