Mira,

Have you watched this mother feed her baby in her own home?  If not, this
might be an idea, I would like to see how she handles this baby, her own
breasts and the whole breastfeed.  Ask about when she feeds throughout 24
hours - may be some clues there.  Ask if mother can see any triggering factors
that line up with each episode.

I would guess that a contents of a galactocele would  not be full of nasties,
whereas abscess would be - have lab check this out.

Repeated bouts of mastitis - take swab of baby's nose and throat and see what
is cultured.

How often does she change her bathroom towels/flannels, does she put them onto
a *really* hot wash?

Take swab of pump parts.  Boil them for no less than 20 minutes

Is she sneaking in use of breastshields still?  Are they contaminated?

Is mum careful with washing her hands and keeping fingernails clean? I'm sorry
everyone, I mention this a lot in posts, but . . . . .   :-D

Does her partner handle her breasts?  Help,now I'm sounding a little more than
fussy here!

Somebody mentioned on lactnet the other day that one is more predisposed to
mastitis if  anaemic.

The good breast should carry on working, absolutely no reason to stop, they
are not plumbed into each other!  With care, it would be a great pity to stop
on other side either.

Now, everyone, I have the J M Dixon paper on Repeated aspiration of breast
abscesses in lactating women, BMJ volume 297, 10 December 1988;

and the 'ABC of breast diseases' made up of the following:

Dixon, JM and Mansel, RE 1994: Congenital problems and aberrations of normal
breast development and involution. BMJ vol 309, pp797-800.  Mansel, RE 1994:
Breast pain. BMJ, vol 309, pp866-868.  Dixon, JM. 1994: Breast infection.
BMJ, vol 309, 8 October, pp946-9.

Are there other more up-to-date papers on breast abscesses (surgery or fine
needle aspiration under guidance of ultrasound)?  Looking at lactnet postings
the docs are doing all sorts of treatment, there seems no general consensus of
opinion on what to do when faced with an abscess.  Has someone done research
on this and set down guidelines?

I have been on the receiving end of many telephone conversations with a mum
with an abscess who lives a goodly way from me so I was unable to meet up with
her, who stood her ground with getting docs to use FNA.  The first doc who saw
her wanted her to stay and have operation, another doc listening in, who was
kindly, listened to her saying "no, I've  left baby at home with my mother"
and asked them to do aspiration first of all.  She had five aspiration
sessions over 2 and a bit weeks.  They only used ultrasound once and that was
after aspiration, she could not persuade them to use it to guide the needle
and to be able to see the size of it.  She had three docs do this over the
period, two of them were not personable and also thought nothing of
waggling/sweeping the needle around once in, these sessions always drew the
most blood . . . .  She had her last session a week ago now as the last doc
who was kindly felt there was a great improvement, she finished the course of
antibiotics a week and a half, just keeping fingers and toes crossed for her.

kind regards, and Mira, I do hope your mum gets over this and can become well
again.  Comments please from those abscess experts out there!

and now I hope that it is not my aol that is giving red digests - hope my men
have not been fiddling!

helen woodman, NCT Breastfeeding Counsellor, UK