Hi everyone, a friend of mine who is studying to become an IBCLC recommended
I ask you guys about my experience, as it's one that has stumped a couple of
LCs and a UCSF midwife so far. 

I had a breast reduction in 2001 -- my nipple remained attached throughout,
but I don't know much more about the surgery technique than that. I had a
baby in March and have been nursing her for 9 weeks. I have not been able to
breastfeed exclusively, but we breastfeed first and then give her a bottle
of formula and let her eat to satisfaction. I am taking domperidone (90
mg/day), fenugreek and goat's rue to boost my milk supply and build mammary
tissue. 

In my third week postpartum I developed a fever and then swelling/pain in
both breasts. I was diagnosed with mastitis and given a 14-day course of
keflex. (I am told that bilateral mastitis is rare, but I was using nipple
shields at the time to help my daughter latch on to my flat nipples -- we
are no longer using them -- and I suspect they caused the infection to
spread to both sides). I felt better within a few days and happily finished
my course of antibiotics. However, I had lingering sharp pains in my breast,
particularly around the 7 o'clock area. 

We stopped using the nipple shields sometime during this infection. Her
latch has since improved and is really good at this point, not causing me
any pain/injury. 

Three days after I finished the keflex, I had severe nipple and breast pain
in my right breast. It was so bad it radiated into my back. I thought it was
my Reynauds -- I have vasospasms after nursing that I try to control by
keeping warm. But when I looked at the breast I saw that there was a huge
red area near the pain, and within a few minutes I developed chills and
dizziness. I was diagnosed with mastitis yet again and given a 10-day course
of dicloxacillin. Again, I felt better within a few days and finished the
course of antibiotics. This time, I developed some skin irritation on the
nipple including a blister (not a milk blister) that took time to heal, and
the outer later of skin on my nipple and breast peeled off a bit like a
sunburn. Also, the pain in my breast/nipple continued. 

I also had an ultrasound of my breast at this time and no abscesses were
found. During the first round of mastitis, a culture of the milk in my right
breast showed GBS, but during the third round, the culture only grew skin
flora. 

Five days after I finished the diclox, same routine -- exceedingly bad
nipple and breast pain followed by a wedge of redness and heat in the breast
that spread. This time I took 60mg ibuprofen immediately and did not develop
a fever. I was diagnosed with mastitis and put on 7 days of clindamycin. I
finished that round this morning and am worried the infection will just come
back. 

In terms of care, during the first few days of each infection, I soaked my
breast(s) in warm salinated water before feeds, massaged my breasts before
and during feeds, and took on a number of other self-care approaches,
including drinking a lot of fluids, trying to rest as much as possible,
taking echnicacea/Vitamin C/garlic for my immune system, and lecithin to
think milk clots (3,600mg per day to start - now trying double that). I have
also tried boosting my iron supplementation, taking homeopathic levels of
phytolacca, and pumping. I seem to be able to drain my breasts well most of
the time -- there is one spot that does not resolve, but it isn't where the
"wedge" starts and it hasn't changed size or shape in weeks. (Again, I have
shown no signs of abscess).

For the breast pain, I took a two-week course of dicflucan and supplemented
with grapefruit seed extract, thinking maybe it was yeast, but nothing has
changed. If anything the pain has gotten worse. 

So here's my dilemma: 

1) I don't know how to get rid of the mastitis and keep it gone
2) I don't know what is causing the breast and nipple pain 
3) I don't know if the mastitis and pain are related or separate

I saw a UCSF midwife -- who is their leader on mastitis issues in postpartum
care -- yesterday and she's stumped. She wants me to see a breast
specialist, which might help academically. I have some theories about what's
going on but want to keep them to myself for the time being because I want
to see what the LCs here have experienced that might be relevant to my case. 

I am likely to start a course of B6 for the vasospasm to see if it helps. 

Any help/recommendations would be recommended. I am terrifically frustrated
and feeling quite powerless -- and don't want to give up breastfeeding. 

Thank you so much, 

Beth

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