Dear friends,  This is an update on the mother with bilateral mastitis.
First of all, to those who asked why I suggested baby not nurse, the one
case report in the lit. describes a situation of bilateral mastitis caused
by strep during with a young infant acquired the infection and died.  The
few additional refs I consulted all suggested extreme caution be used and
that baby be observed for signs of illness.  I referred baby to pedi. She
was seen next day and cultured. Pedi wants baby off breast until culture
says its safe for her to be on these open-lesion nipples.  Mother saw OB/GYN
in person.  Meds not changed nor topicals provided for nipples.  I saw
mother later in day.  After 4 days on antibiotics both breasts are still
scalded.  Rt. breast so impacted yest. would not pump or nurse a drop.  OB
did prescribe syntocinon.  I had mom pump with Classic pump while I rubbed
her back and we finally got 1 oz milk out of that breast.  I phoned the
breast surgeon I admire so much, and managed to get her an appt. within 24
hrs.  She will go there this morning and I feel certain he will be able to
dx the situation, rule out all the worst reasons for this non-resolving
situation (like inflammatory breast cancer -- although I think that would be
very rare to see bilaterally.  But what if the breast which has been this
inflammed twice has inflammatory cancer and the other is a fooler with just
'regular' mastitis?  What if this is a strep infection inadequately treated
with current meds?  What if there is a yeast infectiion too? ) Mom's nipples
are already better after 24 hrs on polysporin.  I'd like to see a stronger
topical in use.

Lets keep one thing in mind.  I am not a doctor and it is not my job to
diagnose.  My job is to know trouble when I see it and utilize the
appropriate referrals.  It is very inappropriate for an LC to draw too many
conclusions.  We manage, we mop up, hopefully we prevent.  We support, we
research, we advocate. We know how to be part of a health care team which
insures that mother and baby are best protected and breastfeeding is
preserved.   We do not practice medicine.

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html