Dear colleagues,

After a couple of weeks of ‘no mail’, I have turned to ‘mail’ again. A week in Basel for the VELB/ILCA-conference and a week in the US (thank you Cathy, Pat and Susan! :-)) seemed like a good reason to go ‘no mail’, to prevent the whole mail box system from breaking down... hahaha!
Now I hope to be able to keep up with the steady flow of mails again. I’ll add to it straight away.
I just read through a series of postings on the IBCLC-PP-list about recurrent mastitis.
My colleague and I have already sent a mail to Trevor Smith, considering his excellent lecture for GOLD10, but haven’t heard back from him yet.
Maybe some of you have suggestions as well, because we have run out of ideas.
A mom who’s baby is now about 17 or 18 weeks, has had some 14 or 15 bouts of mastitis. It is non-infectious, as far as we can see, but severly inflamed.
She doesn’t really feel it coming up, but in no time her breast is bright red and painful and she feels terrible herself.
They quickly follow eachother up, hardly leaving time for mom to recoup.
After the 12th time, I went to the hospital with her to the radiologist for an ultrasound, hoping we would be able to find something. Result: nothing found, not even a single cyst.
Ab doesn’t seem to do anything: healing shows no difference with or without ab.
Lecithine seemed to do the trick, but she has had two bouts after that (with some three weeks in between).
Probiotics seemed to do help a little bit in combination with the lecithine, but as I said... two bouts after that.
Drainage of the breast is okay, no lumps, baby drinking well, latch improved and no nipple cracks.
Constantly the same breast, other breast perfectly fine (so mother considers drying up the one breast and feeding with the other).
There is a tiny little white spot on the affected breast, that she has tried to peel the skin of, thinking it might be a bleb.
Hasn’t really worked so far, although piercing it with a needle is something she hasn’t done yet, as far as I know.
I spoke to her today: she has been out of symptoms for almost a week now, but is hesitant to trust she is through the trouble.
She has been disappointed before and although she feels better this week, she is still alert and not sure that it’s over now.

Does anyone have an idea as to what this could be?
I’m sure I may have forgotten details you might like to know about, but the most logical things have been tried and didn’t work (such a topical candida treatment; diflucan not done yet).
I was so curious with regard to the ultrasound, hoping it would show something, and was sort of disappointed that nothing special was found.
It left us in the dark, more or less, and mom is very brave: she still prefers to find the cause to drying up that breast and not having the riddle solved.
Therefore, your thoughts will be very much appreciated, by her and me and my two colleagues who have been busy helping her.

Warmly,

Marianne Vanderveen IBCLC, Netherlands


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