Happy New Year!  I have been contacted by another IBCLC who is asking for
help for a mom with a history of chronic mastitis.  The mom has given
permission to post.  Baby is 3 1/2 months old. Mom works outside the home
full time. She has had 6 bouts of mastitis.  First was 2 weeks postpartum.
Mom also has a health concern - common variable immune deficiency.  Her
body no longer makes the necessary immunoglobulins needed to fight off
common viruses and colds and bacteria.  She has low levels of IgG and IgA
and gets Gamma globulin (IgG) infusions (Gammagard) once/month.  Her doctor
told her that she is likely to continue getting mastitis as long as she
continues to breastfeed.
Mastitis typically with 102-103 deg fever with redness and warmth over
affected area with tender hard lumps. Antibiotic treatments included 4
rounds of Keflex, 1 round of IV vancomycin.  Doctor tried 250 mg of
azithromycin on Monday, Wednesday, and Friday as a preventive effort .  A
week or two later another round of mastitis (her most recent)  Mom put on
Clindamycin 3x day for 2 weeks.
Baby has been sleeping through the night since 6 weeks, but mom has
continued to wake up around 2- 3am to pump until just recently.  She states
she wakes up in pain every morning around 5:00 am and "breasts feel like
they are about to burst." Her typical schedule is 6:00 wake up and pump (13
oz).  8:00 pump prior to starting work (3 oz)  11:30-12:30 pump (7 oz)
4:30 pump (6-7 oz).  7:30 Direct breastfeed at home.  10:00 Pump to empty
breasts before bed (4-5 oz).
Two side notes:  Mom has been checked for inflammatory breast cancer.  Baby
has been checked for tongue tie.
After receiving this request for help, I suggested that information be
shared with this mom about reducing supply and also suggested trying
cloxacillin/dicloxacillin for next round of mastitis.
Any suggestions would be greatly appreciated by this mother!
Cher Sealy, RN, BSN, IBCLC
Private Practice Lactation Consultant
Montgomery, AL

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