Hello everyone, I am back from a nice vacation in the Tenessee mountains.  I
have a mom that I have been working with for about 3 weeks that is having
many problems that I need help with.  This mom came to me initially at 3 days
postpartum with severe engorgement and a baby that would not latch on.  She
started using an electric pump and feeding the baby the expressed milk with a
bottle.  The baby is now able to latch-on without difficulty but the mom has
had reocurring mastitis since day 6.  The first bout of mastitis was in the
left breast, she had 103 temp. and the entire breast was red and hot.  Her
doctor prescribed 150 mg of Dicloxacillin 4x a day for 10 days.  After one
week of this drug, there was no noticeable improvement.  The doctor then
prescribed 500 mg of Cephradine (Velosef).  The mom has been on this for 1
week today, and still there is no improvement.  She is not running a fever
now, but the breast is still red and hot to the touch.  The really strange
thing about all of this is the consistency of the moms milk.  When she pumps,
big clumps of milk will plop into the bottle.  These clumps are about the
size of a golf ball and look like clabbered milk.  The baby refuses to nurse
on the left breast, which until recently was the only breast affected.  Now
she tells me that her right breast has started producing the clumps of milk,
too.  Her breasts are very lumpy and the lumps do not go away after nursing
or pumping.  Sometimes when she pumps or nurses the left breast is still very
firm to the touch, even though she may have expressed 5 or 6 ounces of milk
from it.  The pain that she is having is deep within the center of the breast
and she states that it feels like her breast tissue is being stripped away
from the chest cavity.  She also has complained about feeling alot of
pressure in the breast like it was ready to explode.  Upon examination of the
clumps of milk, they are sometimes the color of the breastmilk and sometimes
more yellow.  There is a thin clear layer of membrane that holds the clump
together, but if shaken in a bottle they will mix with the other milk.
 Sometimes there are many smaller clumps instead of one big one.  The baby is
3 and a half weeks old now and gaining well.  This mom is determined to
breastfeed but is of course growing tired with all of the pain.  She eats a
very healthy diet, no saturated fats and is already taking lecithin daily.
 She is on a pumping or feeding schedule of every 2 hours at this time.  She
called me today and said that the milk from her right breast tasted sweet and
the milk from her left breast tasted salty and sour.  I have never seen
anything like this before and would appreciate any advice that I could pass
onto this mom.
                                                      TIA,
                                             Pam Holland, IBCLC