Annie
This sounds like an unusual presentation. It does not seem to be mastitis,
to me. Remember, though, that mastitis can be present without a fever. It is
*usually* unilateral but can be bilateral esp. with strep.
The phrases I've noted below make me think it could be a fluid/electrolyte
situation or lymphatic drainage situation. Make sure the baby is indeed
transferring milk (it seems you've done this with the diaper counts) well
and gaining wt. The mom may have an oversupply problem going on along with
an edema situation. Some ideas: remove the bra, if she wears one. Lie on her
back when she can to facilitate drainage of lymph fluid/edema, consider
lymphatic drainage (there are skilled practitiioners), sometimes taking a
diuretic under dr. supervision is helpful. Natural diuretics are watermelon
and cucumber and lots of water. Watch out for too much salt. Manage the
oversupply if that is present with the usual measures. Just a thought, some
people with low protein/low albumin have edema problems. How is her general
nutrition/health? Hope some of this is helpful.

<<all the IVs made her whole body swell to the point of pain to the touch.>>

<<After the initial edema subsided, she started getting engorgement at the
wierdest times, like an hour after a good feed or pump. >>

<<  The pain and swelling is all the way to both armpits.   this can happen
so quickly to her, not when I
would expect it>>   <<When it happens, she can barely get out any milk with
the pump and the baby struggles.   Then it will resolve in about 12
hours.... The baby does very well at the breast with the shield. >>

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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