Dear Jane: Thank you for the encouragement in the ultrasound arena. I was able to speak with the nursing director of the physical therapy facility associated with the client's medical home (I also spoke with Imaging, but they informed me that their machine could not be set for therapeutic use) and he was eager to try this, with a doctor's order, of course. The doctor did not answer my letter asking if he would consider this. Then the abscess developed, and I was wondering about the fibrous tissue of the encapsulating abscess wall. Do you feel it is still effective after the plugged duct has transitioned to an abscess? What have your experiences been?
Arly Helm, MS, IBCLC
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Friday, May 09, 2014 7:38 AM
To: [log in to unmask]
Subject: Re: mid-abscess ponderings: how to improve the situation
Do you have access to ultrasound therapy? I've seen this work AMAZING! And when they did the culture, was the staph responsive to clindamycin?
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Arly Helm
Sent: Thursday, May 08, 2014 6:02 PM
Subject: mid-abscess ponderings: how to improve the situation
An abscess has been drained twice by needle aspiration (four days apart; most recent was four days ago), and she is on her third antibiotic (amoxicllin -> Keflex -> clindamycin). The milk was cultured and was positive for Staph (specific species not mentioned). If there are any signs of the abscess in four days from today, it will be surgically drained. What can be done now to improve her chances of successfully avoiding the scalpel? She had relief from each of the two previous needle aspirations; is there a clear indication to move forward into surgical drainage, or would a third needle aspiration be preferable?
Still wondering about the fibrous tissue of the encapsulating abscess wall. Will engorgement treatment be helpful--frozen peas, cold cabbage, etc.?
So far, the dr has told her "most women want to stop breastfeeding" after surgical drainage, "because it leaks." Also, that the milk should be pumped out of the affected side and given by bottle for two days following needle aspiration (not dumped) because he doesn't want the baby's mouth "to introduce new bacteria." In response, I gave her printouts of the ABM protocol ("After surgical drainage, breastfeeding on the affected breast should continue..."), Breastfeeding for the Medical Profession, and Riordan/Auerbach (did not find instructions on bf after drainage in Riordan/Wambach). She may share these with her dr or just read and recycle.
Arly Helm, MS, IBCLC
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