Anne - what an incredibly useful post.  Thank you so much!

Pamela Morrison IBCLC
Rustington, England
--------------------------------------------
Date:    Fri, 25 Sep 2009 21:27:09 -0500
From:    Anne Eglash <[log in to unmask]>
Subject: persistent breast pain

I find that women who have prolonged deep burning breast pain esp after
nursing or pumping  have a bacterial lactiferous duct infection. These
women tend to improve by 0-40%  with fluconazole for whatever reason,
perhaps because yeast joins in to create a coinfection when there is a
dysbiosis in the breast.
I normally confirm my suspicions by doing a breast exam. Usually these
women are tender on manual expression, and the breasts are tender on
breast palpation (a general breast exam). They describe having more
plugged ducts than usual, and their let-down feels painful, more than usual.
They oftentimes will report intermittent mastitis, but not always, and
about 75% will have a history at some point of nipple cracks and scabs,
and/or bleeding. Their breastmilk cultures usually reveal coag negative
staph, but at least 25% grow out coag + staph. Occasionally in my
geographic area the staph is MRSA, but in those instances, the women
tend to have purulent nipple lesions or an abscess.
I normally treat these women with antibiotics for at least 4-6 weeks
(often longer), until the pain is fully gone. There will be little
change the first 2 weeks of antibiotics, it takes at least 3-4 weeks to
see the pain markedly improve (75-80%).
Treating this infection is like treating prostatitis in men. It is hard
to prove other than finding a tender prostate on exam. The dx is mainly
in the history-taking.
I would love to find something other than antibiotics to treat this
infection, such as proper probiotics, but so far I have not found
anything else as effective in the 19 years that I've been treating this
syndrome. I've tried GSE, lactobacillus and other probiotics, fish oil,
antiinflammatories, and nothing has helped like antibiotics.
BTW, this bacterial lactiferous duct infection has been very well
described in the bovine literature. Farmers and dairy science folks have
been working on this problem for years.
Anne Eglash MD
Clinical Associate 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)

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