Thanks to all for the wonderful suggestions for the resident with the
difficult case of mastitis.  The mastitis improved promptly after she was
switched to cephalexin and diflucan was added.  She had also
postponed her return to a full residency schedule, gotten some
homeopathic remedies and reflexology.  Within a few days, though
her breasts were soft and comfortable, she had worsening of the nipple
pain, which got even worse when I recommended that she add lotrisone
(combination anti-fungal and steroid) and bactroban (they caused stinging
on application and she d/c'd them).  I had her restart the gentian violet,
and she is now much improved.  She is now off the cephalexin and I have
recommended that she continue the gv for a total of 7 days, and the
diflucan for another 2 weeks.  Hopefully, she is now on her way to a happy
outcome, with continued nursing even after her return to the residency.
I'll keep you all posted.  Thanks again, Alicia Dermer, MD, IBCLC

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