Ami asks? about a mom with persistent mastitis:


"I had a breast reduction in 2001 -- my nipple remained attached throughout,
but I don't know much more about the surgery technique"

I would be thoughtful about the surgery, however not assume that every problem here is related to the surgery.

"baby in March and have been nursing her for 9 weeks. I have not been able to
breastfeed exclusively, but we breastfeed first and then give her a bottle
of formula and let her eat to satisfaction. I am taking domperidone (90
mg/day), fenugreek and goat's rue to boost my milk supply and build mammary
tissue."

I do not like giving the breast and then the bottle b/c the baby will often learn to wait for the bottle, be overfed,
and associate satiety with the bottle. Mom would be far better off feeding at breast with a supplementer--baby 
will not be overfed, her suckle may well improve (esp with the Lact-aid) and she will optimize her potential to 
make milk.  I also wonder at such a low dosage of domperidone and the use of only fenugreek and goat's rue--
I prefer a blend of herbs that includes many others. 

In my third week postpartum I developed a fever and then swelling/pain in
both breasts. I was diagnosed with mastitis and given a 14-day course of
keflex. (I am told that bilateral mastitis is rare, but I was using nipple
shields at the time to help my daughter latch on to my flat nipples -- we
are no longer using them -- and I suspect they caused the infection to
spread to both sides). I felt better within a few days and happily finished
my course of antibiotics. However, I had lingering sharp pains in my breast,
particularly around the 7 o'clock area."

I am sure this infection would have nothing to do with the nipple shields. More likely it has to do with insufficient 
emptying of the breasts. So, has baby's latch been evaluated? Has anyone done a pre and post feeds weight? 
Has he been evaluated for posterior tongue-tie?Is mom pumping at all? If she is not supplementing at breast 
and not pumping, how does she hope to build supply? More importantly, though, I think moms who have inefficient
emptying by baby must pump thoroughly at least once per day. Has mom tried nursing on the left side why 
laying on the right side and vice-versa? 

"We stopped using the nipple shields sometime during this infection. Her
latch has since improved and is really good at this point, not causing me
any pain/injury."

Again, a pain-free latch does not mean a good latch. Lots of babies who just hang out at breast cause no pain at all.
Especially if she is just waiting for the bottle? Is the bottle being fed correctly? Has mom been shown to feed with
the baby upright and the bottle held horizontally? 

"Three days after I finished the keflex, I had severe nipple and breast pain
in my right breast. It was so bad it radiated into my back. I thought it was
my Reynauds -- I have vasospasms after nursing that I try to control by
keeping warm. But when I looked at the breast I saw that there was a huge
red area near the pain, and within a few minutes I developed chills and
dizziness. I was diagnosed with mastitis yet again and given a 10-day course
of dicloxacillin. Again, I felt better within a few days and finished the
course of antibiotics. This time, I developed some skin irritation on the
nipple including a blister (not a milk blister) that took time to heal, and
the outer later of skin on my nipple and breast peeled off a bit like a
sunburn. Also, the pain in my breast/nipple continued."

"I also had an ultrasound of my breast at this time and no abscesses were
found. During the first round of mastitis, a culture of the milk in my right
breast showed GBS, but during the third round, the culture only grew skin
flora."

Five days after I finished the diclox, same routine -- exceedingly bad
nipple and breast pain followed by a wedge of redness and heat in the breast
that spread. This time I took 60mg ibuprofen immediately and did not develop
a fever. I was diagnosed with mastitis and put on 7 days of clindamycin. I
finished that round this morning and am worried the infection will just come
back."

I have such concern about all the drugs this mom and baby have been exposed to and the condition of
both of their guts. Are they taking probiotics?

"In terms of care, during the first few days of each infection, I soaked my
breast(s) in warm salinated water before feeds, massaged my breasts before
and during feeds, and took on a number of other self-care approaches,
including drinking a lot of fluids, trying to rest as much as possible,
taking echnicacea/Vitamin C/garlic for my immune system, and lecithin to
think milk clots (3,600mg per day to start - now trying double that). I have
also tried boosting my iron supplementation, taking homeopathic levels of
phytolacca, and pumping. I seem to be able to drain my breasts well most of
the time -- there is one spot that does not resolve, but it isn't where the
"wedge" starts and it hasn't changed size or shape in weeks. (Again, I have
shown no signs of abscess)."

Castor oil compresses are the most essential tool I use in treating plugs and mastitis. Women can massage 
their own breasts into a greater state of inflammation. Most people also take so little echinacea that it is pointless. 
I prefer elderberry and zinc for immune support and given the difficulty in healing, zinc is essential anyway. 
I don't understand the comment "homeopathic levels of phytolacca". If you are using a remedy, then it is 
inherently a "homeopathic level". I hope she is not using the herb instead of the remedy. But, I only use phytolacca
for plugged ducts--once there is infection, I use belladonna or for recurrent mastitis, I use hepar sulph.

"For the breast pain, I took a two-week course of dicflucan and supplemented
with grapefruit seed extract, thinking maybe it was yeast, but nothing has
changed. If anything the pain has gotten worse."

I hate seing women ever use diflucan. It's like giving stadol in labor--it never helps but it keeps being done. 
And, IMO, women who use it should use milk thistle to clear their livers. Have the mom take 16mg of bioton 
per day instead.

"So here's my dilemma:

1) I don't know how to get rid of the mastitis and keep it gone
2) I don't know what is causing the breast and nipple pain
3) I don't know if the mastitis and pain are related or separate"

Go back to the baby and the birth. Are we ignoring something b/c it is all being tied into the surgery? Like a TT or
birth trauma or overuse of bottles (what about pacifiers) or lack of MER (I had a mom who had an increase in milk
w/ every new galactogogue, but needed syntocinon to finally get the milk to the baby. Granted--it may be the reality of 
the surgery, but nothing should be ruled out w/o consideration. 

"I saw a UCSF midwife -- who is their leader on mastitis issues in postpartum
care -- yesterday and she's stumped. She wants me to see a breast
specialist, which might help academically. I have some theories about what's
going on but want to keep them to myself for the time being because I want
to see what the LCs here have experienced that might be relevant to my case."

"I am likely to start a course of B6 for the vasospasm to see if it helps."

I think vit D is essential in resolving vasospasms. Her levels should be tested. I would also suggest she take 
NaturalCalm. I would also want to se an iodine test.


"i have recommended culturing the baby's mouth, and trying ultrasound
treatments.  any other thoughts?"

Culturing the baby for what? I am not a fan of u/s.

Now--as to the "reality" of the surgery. Form always follows thought. That is the basic law of all matter. So, 
mom can use EFT (emofree.com) to help her body overcome the limitations that the surgery has created. 
When moms are willing to use EFT, they can have amazing results. Personally, I would rather a mom was 
willing to optimize the mind-body connection than use more gadgets and take more stuff. So, if she wants 
to do it all, do it all--but as with most things in life--the game is won in the head.


Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network, LLC


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