Pat - your post about mastitis and risk really got to me!  The multiple
dilemmas of risk of abscess vs risk of yeast, risk of use of antibiotic vs
risk of non-use.  I have to tell you personally that I LOATHE every case of
mastitis I'm asked to help with - truly nail-biting stuff!  I've worked with
about six cases of mastitis that eventually progressed to abscess when the
mum came to me late (l- 3 weeks after the first symptoms, and when she'd
ALREADY been treated by a doctor - invariably with an antibiotic).  The
history nearly always reveals that she delayed seeking treatment for several
days (3 - 4), and/or that she was prescribed an antibiotic, but given little
or no information to keep the breast well drained.  I've also worked with
one case (NEVER again!!!) where I was involved from the beginning, but
relied - after the first two days - on TELEPHONE follow-ups, and believed
the mum when she told me she was draining, and one more, where there was a
history of abscess in a previous lactation and mother elected to wean in the
middle of mastitis against my advice.

Each case is individual, isn't it?  So it's not really possible to
generalize.  But my personal opinion is that a case of Thrush is something
of a minor irritation (sorry!) compared to surgery and all the accompanying
nause of extended pain, worry, decisions as to whether it IS an abscess,
what to do about it, hospitalization, more pain, separation from the baby,
milk leaking from the incision for WEEKS and so on .. and on.

So, if I see mastitis very early (within 24 hours, hopefully earlier) and
it's mild (mild to moderate inflammation, smallish area, no fever) I make
sure the breast can be drained every 2 hours (baby, manual expression, pump)
and arrange to follow up the next day  - if it hasn't hasn't improved A LOT
I send her off to get an antibiotic, get very insistent about CONTINUED
FREQUENT drainage and keep following up daily (usually next 48 hours) until
it's on the wane.  If it HAS improved I do the same but without the
antibiotic.  If she's come to me late (symptoms have existed 3 - 4 days) or
if the mastitis is severe (large area, dark inflammation, fever) I send her
off for an antibiotic immediately, stress drainage etc, follow up and just
HOPE.  If the doctor wants to hold off on an antibiotic that's fine, I would
have no hesitation in sending her back if it looked as if it wasn't
resolving within a day or so.  If she's casual about the drainage part of it
I warn that I'm going to "nag" and get a bit graphic about the possibility
of abscess.  If there's Thrush after all this, then it's regrettable, and
inconvenient, but treatable.

Feel for you Pat, you gave your client the advice you thought was best for
her in her circumstances at that time, and you can only offer the
information and hope that she acts on it.  More than one doctor has told me
that SOME of them progress to abscess in spite of everything you can do.
Don't open that Bookstore yet!

Pamela, Zim