Hello everyone. Hope all is well. I have PTP. I have a mother who I have worked with on and off over the last several years, now has her 3rd child who is 9mo old. She called and spoke to a co-worker today who then called me. She called with complaints of the most painful bout of mastitis she has ever had. 


Hx: Mother's 3rd child. Last weekend had cold symptoms, caught from her oldest, with what she called a fever. (temp in low 100's) and was better on Monday. On Tuesday morning, she again had a low grade temperature, but now had a sore spot in her left breast. She took ibuprofen, pumped and nursed through it so was clear on Wednesday. At the lunch feeding, she saw bright red blood and a clot in the nipple shield. Infant continued to breastfeed without any problem and she saw no further blood. On Thursday evening, she noted pain with breastfeeding and woke up in the early hours on Friday with a "fever" and the worst pain she has ever had in her breast, but was now in the right breast. She took the ibuprofen again, the fever broke but the pain was still unbearable. She saw her OB that day who prescribed Clindamycin 300 mg 4 times a day for 10 days and vicodin for pain. She was unable to eat much, the vicodin made her nauseated. She had a headache as well. Her OB marked the breast as it was remarkable to him. She said her breast was red with red streaks and was hard and swollen. She had no one spot as she usually had in the past but if she had to pinpoint one area that was more painful, she would say the inner aspect was the worst. That evening, she noted bright red blood and clots in the shield. That night, the infant vomited up a large amount of blood and clots. Today she has noted some improvement in how she feels thought the pain and headache are still there, but slightly less painful. She pumped at the usual feeding time and was only able to express 1 oz of very bloody milk whereas in the am's she is able to get 5-6 oz.


Mother is feeding the child at breast 4 times a day, single sided: breakfast, lunch, dinner and bedtime and the child has solids at other times. Mother is home most days and only pumps if she has missed a dinner feeding; she pumps the left and breastfeeds on the right for the bedtime feeding, as the dinner feeding is the right breast. She has noted that the next day, the left breast is engorged. She has a history of difficulties with her other 2 children. She had to use a nipple shield with her 1st for flat nipples. She had cracked nipples, an oversupply  and several bouts of mastitis related to the timing of the cracked nipples. She eventually came to me, and we had the OB change the antibiotic and prescribe APNO. She healed, stopped using the shield, and breastfed from 6-13 months problem free. With her 2nd child, she did not have any mastitis but agin had some cracking around 6 months. She pumped to heal but then her son preferred the bottle and she pumped for 4.5 more months. 


With this child, she has had 3-4 bouts of mastitis she told me, over the summer, and had been prescribed Clindamycin and Cleocin at different times. Again, some cracking nipples may have been the causitive factor. She did not call me for any of those incidences. She has large nipples and had to again use a nipple shiled but we tried a large Mamsi. I had talked to her prenatally about nipple everters. She uses a Medela shield now, but not all the time and mostly on the left breast. 


She has a hx of asthma and takes several meds for those, her prenatal vits, and usually a dose of Airborne every evening. 


My recommendations: Follow up with MD on Monday and if no improvement, change antibiotics, discuss culture and ultrasound. I suggested cold to breast for 24 hours to reduce inflammation and then warm by castor oil compresses. We discussed using a rental pump as she has the same personal pump for all the kids. I read about how the inflammation may be causing the bleeding. She will use her stash of EBM for the feedings that would be from the affected right breast. We discussed homeopathy a la Jennifer Tow. 


Any thoughts/suggestions?




TIA:   Allyson Michaels, RN IBCLC
         Charlottesville, VA






             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome