permission to post

What kind of physical therapy (US? cold lazer?) is beneficial in 
releaving severe induration of subacute mastitis?

Mother 7 weeks postpartum seen on request of her OBGYN for a case of 
significant "engorgement" in her L breast of at least a couple weeks 
duration.Patient was seen by an outpatient LC who did recommend 
agressive pumping, cabbage leaves and hot soaks and by her OBGYN who 
started her on antibiotics and did at least 3 sessions of manual 
expression with patial success.

First baby was breastfed without major problems, but mother was using a 
nipple shield all the time (no comment)

Second baby (the one who is 7 weeks old) is breastfed on R breast only, 
with the nipple shild that is too big (will address this issue on the 
follow-up appointments). Baby was diagnosed with failure to thrive and 
on recommendation of his pediatrician breastfeeding was stopped for 3 
days completely (?!) and then artificial milk supplementation was 
started. Baby is now receiving not more then 50% of his nutrition as the 
breast milk.

On exam L breast was severely indurated with a warm to touch mass size 
of a good fist just under the areola, not movable, painful on palpation. 
nipple was retracted, overlying skin erythematose with bluish 
discoloration, some peeling noted. Emergency US in the local breast 
center consultation revealed severe mastitis and 3.5 cm abscess. Breast 
surgeon did not see any indication for surgical intervention and 
recommended to continue with present care.

I definitely will show mom how to use the electric toothbrush (did not 
want to touch her without ruling out other, more nastier causes of 
induration...), but would like to be a little bit more aggressive in 
this case.

TIA,

Alla

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