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Saturday, December 26, 2009

Mastitis Consult-- finding solutions

I have hesitated posting this case of chronic breast pain (mastitis) because it might scare you off from seeking help or continuing breastfeeding. But I tend to admire the mom's who make breastfeeding a priority under all circumstances and go to unusual lengths to preserve their breastfeeding. It is important for you to know how strongly I support breastfeeding through just about any circumstance. You can imagine how many times this mother has been told to stop breastfeeding.

If you read and are familiar with my last post, this mom was referred to me after her OB did an excellent evaluation and had done several cultures on her milk and offered her several rounds of commonly prescribed antibiotics and she still had pain. Her cultures showed that she should have responded to some of the meds she tried (Augmentin, Bactrim DS, Dicloxicillin). She also had an ultrasound prior to seeing me to rule out abscess. Seeing that she did not improve with those antibiotics, I suggested a Quinolone antibiotic with continued breastfeeding. Most physicians don't prescribe Quinolone type antibiotics to breastfeeding mothers. Having tried everything else, her OB's recommendation was IV antibiotics per PICC line (a short term needle providing access to bigger veins that you can receive daily IV medication and go home).

Mom chose to accept both courses of treatment. My Quinolone and her OB's antibiotics (Or she could have chosen one option and if no result the other option.). She got the PICC line inserted and than she had a complication (clots in her arm) as a result of having the procedure and then needed anti coagulation (blood thinners).

At one time she was on Fragmin, Coumadin, Diflucan, Vancomycin, and Levaquin Domperidone and Motherlove herbals.
Putting her case aside for a minute, some moms stop feeding because they take just ONE medication. It drives me crazy to hear a mother tell me she stopped feeding for Tylenol, Amoxil, Zithromax. Keep breastfeeding while you are checking your facts!

The Fragmin and Coumadin were the blood thinners. The Fragmin particles are too big to pass into the breastmilk. The Coumadin binds strongly in the mother's circulation and is approved by the AAP for breastfeeding mothers. The Diflucan use is to prevent a fungal infection. Vanc is given IV. If it gets into the breastmilk it won't get absorbed by the babies stomach because if it could it would just be given to the mother by mouth and not IV (Fragmin also gets destroyed in the stomach.). The Levaquin my idea is not my first line of antibiotic, but I consider it case-by-case. The Domperidone and herbs to protect her milk supply during the breast pain, procedures, hospitalization.

The current medications are Coumadin, Domperidone, and More Milk Plus. The pain was better while finishing the course of medication. The clot resolved and the PICC line removed. In one update mom told me some pain came back. But she is still breastfeeding and working with me, and her local IBCLC and oral motor therapist.

Both moms with breast pain/mastitis are reading along and I/we welcome any feedback.


Angela White said...

I too admire the determination of women who battle recurrent and persistent cases of mastitis.

If the mastitis is not responding to antiobiotics one thing that needs to be ruled out is breast cancer. I have had one or two commenters on my blog share their experiences with mastitis-like symptoms turning out to be cancer. This journal article discusses the possibility further:

I am sorry to raise that additional concern possibly for nothing, but I would want to rule it out. Best wishes to these ladies!

Angela White said...

Here is a link to the Mayo Clinic article on inflammatory breast cancer:

Sorry I couldn't include it in my comment above as I am posting on my Blackberry.

Please do let us know how these cases turn out -- I will be thinking of them and hoping for good news.

Permission to Mother said...

Thank you Angela for the links keeping this post accountable for a much more serious condition. Inflammatory breast cancer is certainly one that shouldn't be missed and one that I am thinking of as I am doing an exam looking for dimpling and signs of "orange peel," and ordering some imaging studies and cultures (to see if anything does grow out of the milk).

In general, I tend to want to look for common things first especially in the abscense of skin changes and positive cultures. But you have got me wondering if woman without skin changes and positive cultures wound up having cancer diagnosed.


Kelly said...

I'm the mother that this post was written about, and I find Angela's comments interesting. Both my OB/GYN, IBCLC, and Dr. Punger questioned inflammatory breast cancer, especially since I have had a few episodes of bleeding from inside the breasts (pumping large amounts of blood with clots in it). I don't have dimpling, or the orange peel look, and I had a mammogram and ultrasound that were both unremarkable. But, isn't it hard to diagnose inflammatory breast cancer? Are there any tests can that provide a definitive answer? I have no skin changes, lumps, swelling, etc.

Permission to Mother said...

I'll reply to this privately tomorrow. I have the resources for evaluation.

Tammie said...

I have had Mastitis a few times and my sister seems to be prone to it. We have found that it can be gotten rid of in 24 hours or less with some few simple rememdies. I like Dr. Christophers herbal Lymphatic Formula they are just in capsules and I take it for a few days just to be sure to clear it up. A warm shower while expressing some milk helps lots! And then I have found rubbing Dr. Christopher's Gladular ointment followed by his deep heating balm on the infected breast seems to work wonders! It seems to work EVERY time!

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