I have permission to post...Hx is long but I'll try to be concise.

Mom of 4 week old infant breastfeeding and gaining well.

May 13: S&S of clinical mastitis. Swollen breast. Red streaking. elevate temp. Mom to ER and prescribed 14 days of dicloxacillin. Continued breastfeeding plus some pumping in addition. Heat rest etc.

May 17-18: blood noticed in pumped milk.  Still symptomatic. 

May 20: Ultrasound and culture of milk. No signs of abbess and nothing grew out in culture. 2 days later streaking disappeared and mom reports feeling better.

May 23: Sever burning in breast.  Mom prescribed Diflucan by physician. 200mg loading dose and 100 mg for 2 weeks.

May 26: Symptoms getting  much better per mom.

June 6: Breast pain. Temp of 103. Breast red and swollen. Dr. prescribed Rocephin by injection 1 per day for 3 days. Darvecet and Ibuprofen for pain. Mom had reaction with severe vomiting and received 3 bags IV fluids. asked for antibiotics IV and was refused. Cont. Diflucan per physician. 2nd ultra sound shows no abbess. Referred to military "breast Dr." who instructs mom to quit nursing immediately per new "article" he had read about mastitis. Mom asked about pumping. He said no pumping but did state could resume breastfeeding after 10 days as milk supply should "come right back in"! Mom asked about nursing on unaffected breast and was told that than the other breast would "just continue to make milk. Mom went home and continued to breastfeed on both breasts.

June 9: Mom in to my office. Large severely swollen red breast. nipples pink, baby with white coating on tongue. Mom still on Diflucan. Wants to try a round of Gentian Violet for nipples and infant's mouth. 

This mom is military and we may have a hard time getting her referred out to a breast surgeon. (which I believe she needs). Her original physician may call me today to discuss.  Any suggestions?

I am concerned that her docs may be overlooking something serious or at least something really resistant to what they are treating her with. Would another culture be warranted?   

Holly McSpadden IBCLC
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