Fellow Lactnetters,

I'm presently no-mail due to heavy work load and the need to work on the
yearly nightmare of income taxes.  But, I'm in need of your experience and
wisdom with a mom I'm presently working with.

Mom started with what she felt was a breast infection, 102 fever, sore spot on
breast.  She called me over a weekend and I suggested keeping breast empty by
nursing more often on that side, heat, rest and call your OB.  I also ask
questions about yeast and cautioned her that if OB prescribed an antibiotic
she will want to watch baby's mouth for yeast and her nipples for soreness.
She told me she has a history of repeat vaginal infections especially after
antibiotics.  She did call OB, the OB precribed Augmentin.  Mom ask for
Diflucan to take with the Augmentin, but OB refused.  The following week the
mom came to my pedriatic office and saw the nurse practitioner as the baby had
thrush and mom's nipples were inflamed and even had a white coating on them.
The mother explained that the OB did not want to prescribe Diflucan as it
should not be used with nursing mothers (might hurt the baby--HELLO, we use it
with babies who have thrush).  I was not in at the time so the nurse
practitioner wrote the script for the baby and the mom treating mom with 200mg
STAT and five days 100mg.  Four days later the mom comes into see me with
extreme pain in left breast (from 12 o'clock to 4 o'clock area).  Extremely
painful even to the lightest touch, but no lumps or hard, thick spots.  Some
light pink spots.  Nipples have improved slightly, still inflammed and skin is
peeling.  I think ductal yeast, needs more Diflucan.  Mom has 101 fever and
chills and is also seeing her OB that afternoon.  I give mom info to share
with OB on yeast and also give mom info as well as sending her home with a
Classic to pump left side as it is too painful to put baby to. (She had been
pumping with an Even......, which I am sure has added to the damage.  I also
suggest using cabbage leaves to help reduce inflammation and take ibuprofen
for inflammation and fever. The OB puts mom on Keflex and says its a breast
infection, but does prescribe an additional week of Diflucan.  The following
day, mom's fever is up to 103, breast is swollen twice as big as other breast
and bright red.  Mom calls the OB, OB tells mom to call the LC at the
hospital.  Hospital LC tells the mom not to use cabbage leaves as they may dry
up her milk.  This breast is swollen so badly, mom can only pump 1/2 to 1
ounce.

I feel we need to work on getting the swelling down and this breast healthy
before worrying about supply (other breast is giving great supply).  Could
ductal yeast cause the fever and could the antibiotics is adding to the
problem instead of helping?  I strongly feel the yeast is the main cause to
the problem. I should also say that this poor mom is in a OB practice with
nine docs and has talked to three different ones with different opinions and
now two LCs that have different opinions which has added to her confusion and
frustration.  Any suggestions????  Please e-mail me privately
<[log in to unmask]>, thanks all.

Warmly,
Pat Lindsey, IBCLC near Orlando