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Date: | Sat, 26 Nov 2005 17:07:28 +1100 |
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Chris said:
"Here are a few ideas:
raynauds
eczema
bacterial infection
resistant thrush."
While I would agree - can I add some comments?
Raynaud's - I prefer to call this vasospasm unless mother actually
expreiences Raynaud's of the fingers. Yes, I would ask about blanching and
if the pain is worse in the cold.
Eczema - a definite rash can be seen if the diagnosis is dermatitis or
eczema. This is one reason I like to see the woman, rather than diagnose
over the phone or internet (but digital photos can get around this!)
Bacterial infection - is there evidence of discharge or inflammation?
Otherwise doubtful - in my opinion. (Staph is easy to grow - this doesn't
mean it is the cause of the pain).
Resistant thrush - I would say the problem is probably thrush - just not
treated enough. If she has internal breast pain, she needs oral antifungal
treatment (eg fluconazole). Think of other fungal infections (eg tinea on
the feet) - if they don't better, we don't say "resistant tinea", just that
fungal infections are stubborn and need persistent treatment (and often a
change in the environment - ie. less time in sweaty shoes, or less refined
sugar in the diet).
Lisa Amir
MBBS, MMed, PhD, IBCLC in Melbourne, Australia
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