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Subject:
From:
Barbara Latterner <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 22 Aug 2000 21:30:33 EDT
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Dear Fellow Lactnetters,

Having returned from a two week vacation, I wanted to share, before details
are too hazy, an interesting case I was involved with before my departure.
(I have permission to post from the mother.)

On a home visit, made to assess breastfeeding that according to mom was going
"pretty well," I note the following which causes me concern (in addition to
poor latch and flagging weight gain which may or not have been products of
what caused major concern):

1.  Mom's nipples, especially R, are damaged.  When I express alarm at
condition of R nipple which has approx. 1 1/2 cm by 1/2 cm deep healing
fissure, mom states" this wasn't caused from breastfeeding;  I had this
before he started nursing and I rubbed it to get the stuff (exudate) off and
it bled; but it's only a little sore.  Further questioning revealed she'd had
this "condition" since adolescence.  When asked if her HCP was aware of it,
she stated no but he examined my breasts at begining of pregnancy and didn't
say anything.
My initial thought, before she said she'd had since adolescence, was Paget's
and I admit I was stumped after that but recommended she be seen by her OB,
sooner than her six week check.

2.  Upon examining infant's mouth  noted a cluster of pin-head sized yellow,
intact lesions on inner aspect of lower R lip.  Informed mom they didn't look
like thrush, but could be and that she should have baby seen by ped for
assessment.  (I have seen cases of thrush before from tongue coating, whole
mouth involvement to one or two small dots on inner cheek, but I was in
error, thinking this could be thrush.)

I called ped after visit, unable to speak to dr, informed nurse of findings
and my concerns (mom had seen me for first baby, this was second, and she'd
had so many BF problems with first, she seemed to be in denial that anything
was wrong this time).  Spoke with mom later that evening and ped office
called her and she had appointment the next day.

To shorten this story a bit;  baby was seen by ped who suspected
herpes-hospitalization occurred at well-known pediatric facility (mucho
specialists available), treatment for baby begun before cultures came back
due to severity of herpes, of course.  Mom's breast nipple cultured, too.
Baby on ABM and mom pumped to maintain supply. (I was in contact with LC's on
staff, who were very helpful to mom).  Mom maintained all along that she just
felt it wasn't herpes but knew not treating was never an option.  Also, her
ped felt nipple discharge was due to crusting, a condition caused by ducts
never fully closing.

The final outcome was not herpes and mom said she realized her older son had
coxsackie virus a few days prior to her delivery!  She said HCP's were
baffled but didn't feel it could be cocksackie due to the location of the
lesions.

I was humbled, frightened and learned alot from this experience and thus my
reason for sharing.  I have never seen an actual case of herpes on the
nipple/areola, except in photos in texts and this did not resemble these.  I
am glad I at least knew something wasn't right and that further assessment
was made.  I will never, never forget this case and should I ever come across
suspicious looking nipples and infant lesions, the appropriate referrals will
be made asap!
I still wonder about mom's nipple- anyone know if this is an actual
diagnosis?  Why would it occur in adolescence without pregnancy/birth?

Have been unable to reach mom since my return, but just before I left
breastfeeding was going fairly well, some occasional supplementing with ABM
and mom satisfied with this.  I felt so sorry for both mom and baby boy for
having to go thru all this; mom was a real trooper throughout!

Barbara Latterner, BSN,RN,IBCLC
Brewster, NY

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