Jack's quick post on lack of evidence based practice on the use of
fever-control meds was certainly provoking.  Sometimes it seems that the
information glut is just so over-whelming that one has to be ceaselessly
vigilent in order not to be negatively impacted by someone else's lack of
diligence.  So what to do with making sure that our little (but vital)
information base is adequately promulgated?

Yesterday, I saw a woman with purulant discharge and bloody milk.  Baby has
tongue tie, and positioning must have been bad, too, from the looks of the
wounds.  She was 9 days pp with deep, scabbed over positional stipes, and
what looked like impetigo on her left nipple.  Way too painful to even try
to latch the baby.  The little bit of milk we could pump from that breast
was clumpy with bloody, pus-y debris.  She had spoken with the OB office
earlier in the day to describe the red breast.  Since the mother had no
fever, the RN offered advice about yeast, certainly another illustration of
the inherent difficulty in managing lactation by phone.  My practice is
usually to fax info following a visit, but I call if I feel a crisis is
iminent.  I was grateful to reach a nurse whom I knew from conf.  She was
therefore willing to trust my observation and to immed. call in a
prescription for an oral antibiotic and a prescription strength
anti-fungal/cortisone ointment.  She wasn't willing to call in the final
ingredient to make a triple action cream (the topical antibiotic).  Her fear
was the Bactroban (mupirocin) would be dangerous to the baby.  My report
will be sure to include a ref. or two about triple action nipple creams
(from Hale) and the abstract page of Verity Livingston's JHL article about
mastitis and ascending impetigo.

Full refs:  Hale,T:  Clinical Therapy in Breastfeeding Patients, Pharmasoft
Med Publishing, Amarillo, 1999.

                 Livingston,V:  The Treatment of Staphyloccocus Aureus
Infected Sore Nipples:  A Randomized     Comparative Study, JHL 1999;
15(3):241.

What we do for a living is teach.  We teach moms, and we teach the medical
communities in our own home towns.  We do this with repitition, sharing
materials, reports, networking on boards and committies, and by bringing up
breastfeeding in off-topic situations.  When I took Lydia to see the
rheumatologist, one piece of info I made sure to provide was the length of
time she breastfed.  When I have my mammograms, I mention the total duration
of my lactation history.  The importance of including this info whenever
health hx material is gathered is partly our resonsibility to emphasize.

Kathy Dettwyler is right:  We serve as active catalysts for change.


Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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