HELP! Mastitis/Abscess/Blockages

[herethereandeverywhere]

I was wondering if someone on here could help (as so far the two doctors I've seen haven't).

I have mastitis and feel grim. Was prescribed antibiotics last night.

This has been coming on for weeks since I foolishly skipped one feed without my pump with me. I've been battling blocked ducts and following all advice from NCT counsellor and from Kellymom. Had the suspicion that my breast wasn't fully draining (about 1/6 of it stayed hard and heavy and sore directly beneath areola) but I couldn't feel any peppercorn lumps. Anyway mastitis finlly got me yesterday and I felt so ill I paid a doctor to come out of hours to start the ABs .

Anyway, my question is, if this is all caused by a blockage I just can't shift, will it just come back once the AB course is finished and wears off?

Am I doomed to automatically getting an abcess? How do I know when mastitis becomes an abcess?

How do I get rid of this thing if no amount of massage/compresses/changing of feeding positions/pumping seems to work?

And also, how the hell will I EVER wean if skipping ONE feed causes this?!! Can you buy the milk drying up pills on private prescription?

Thanks

[NotQuiteCockney]

Ok, let's just check through some stuff to see if you've covered all the bases.

First of all, how old is your baby? I assume her weight gain is good - it sounds like your supply is (ahem) sufficient!

Second of all, I bet this is all stuff you already know, but just to be sure:

1. if you think you're getting a lump, try to feed with the baby's chin pointing at the lump.

1. combing, hot compresses - but it sounds like you've got that already.

1. It doesn't sound like this is the problem ... but is there any way anything was pushing into your breast while you were feeding, or not? Do you ever just unhook your bra, or just hoist it up? Are you sure your bras fit properly? Are you holding onto your breast while feeding? I think a lump coming on for weeks seems unusual - I would wonder if there's a positioning/something else going on here. But I'm guessing you've fed in front of the NCT counsellor?

1. I would consider block feeding, if your baby's weight gain is good. This would reduce your supply a bit and put you less at risk for mastitis and lumps. Kellymom has lots on oversupply.

Third, an abcess, from what I know, is when the infection gets 'walled off' in the brest. It stops hurting. It seems fine. But it keeps growing, and is of course a big problem, that keeps getting bigger. But it doesn't sound like you have this.

Fourth, well, I'm hoping your baby is young. I think oversupply issues tend to reduce as babies get older - certainly engorgement just seems to stop happening around 4 months, for many mothers, to the extent that they think their milk has dried up. Ok, you might not be quite that lucky, but hopefully you will still see a reduction. (I'm desperately hoping your baby isn't 8 months or something!)

Fifth, yes, you can get the milk drying up pills. They have risks, but if you continue to be this strongly susceptable to blocked ducts etc, then they may be worth the risks. You would need to find a sympathetic GP, and you would probably want to look into the risk factors for side effects. (There has been at least one maternal death associated with these pills!)

This sounds so frustrating and difficult for you, I hope things get better soon. The ABs normally do help quite a bit.

[teaandcakeplease]

I had recurring mastitis with my second baby and as you've said I had to keep massaging downwards every feed when baby latched, to try and help. I also expressed after the feed if the breast still felt hard and sore, just to clear it out to be honest. Of course that may increase your milk supply but I didn't do it all the time, only when the breast still felt hard and sore. For comfort really but it definitely helped me.

I did have periods without mastitis, and periods where it flared up again but never in the same area and it always flared up when, like you, I didn't express off if skipping a feed and left my breast engorged too long. It could just be an idiosyncrasy with me though, so don't take it as gospel.

I don't have a tip for you but I can say that your milk supply will adjust to however many feeds you do, so by the time you start weaning, your milk supply will adjust nicely to that stage.

Hopefully some other MN will have some other advice and answers to your questions that I don't.

Goodluck x

[teaandcakeplease]

Notquitecockney replied at the same time as me

So you have had another MN help you Much better than me.

Hope it all gets better soon x

[PacificDogwood]

Hi there, I am posting mainly to send my sympathies and support as Cockney and, by the sounds of it, your own homework seems to have covered all the basis.

I am sorry you are having a rubbish time, I know it can be crap .
The only thing that helped me at all was pointing the baby's chin at the lumpy area. Baby was clearly far far better lump/blocked duct remover than pump. I used to either have hot shower with massaging/combing before a feed or at least have a moist hot pack on the affected area before a feed with cold packs afterwards.

I also found this site really helpful, but it does cover some of the same ground as kellymom.

Here is something about lactation suppression. There was a thread on here recently, I cannot find it, but am also trying to make dinner.

I'll be back later.

[PacificDogwood]

Here is the thread about it.

The drug is called Cabergoline and not without risks (usually only used for mothers who have lost babies ).

Anyway, hope you find a solution. I, too, hope your baby is young and that things will improve with time and perseverence. I know they did for me . Hoping to do it all again come March....

[nigglewiggle]

I had similar problems and I sympathise.

I rang an NCT counsellor who was fab. She recommended cold compresses before feeding/expressing to reduce inflammation. She also recommended ibuprofen for the same anti-inflammatory effects - not usually recommended for BF, so perhaps check with GP. It eventually cleared, thankfully.

If you are taking antibiotics it is worth taking steps to ensure that you don't become susceptible to thrush. I found Acidophilous (sp?) tablets from a health food shop really helped.

[herethereandeverywhere]

Wow! Thank you so much to all who've responded.

DD is 3 months old. I haven't had a feeding session observed for this problem, the NCT advice was over the phone.

She's gaining weight really well, thriving, loads of wet nappies etc.

I wear different shaped clothes every day always a proper unhook maternity bra (one that is fully open, not just a hole) but sometimes I wear a dress and hoik my boob out of the neckline, it's quite tight, but under my boob (not on the breast tissue). One thing I've thought of is I love to sleep on my tummy and I have woken up a few times with my boobs feeling sore as a result. Do you think this could be a factor?

I express after each feed on the affected side but very little comes out and the lump stays (this was the case even before the mastitis took hold). The chin-to-blockage method worked at first but no longer. I'd have to hold her in a sort of rugby hold but dangle her down (the block is at 2-4 0'clock if looking down at my breast the floor is 12 o'clock). To add to the issues dd is wearing a pavlik harness to correct hip dysplasia so she's not quite as easy to position as most!

The lump/hard bit is about the size of a lime now, is that just swelling or milk that got stuck?

Hadn't thought of looking for info. on oversupply, I had a really hard time getting going breast feeding (I posted another thread recently about how DD was readmitted and tube fed formula but that's a whole other story!) Will check out kellymom ( I don't know what block feeding is yet

Will try to get the stuff to ward off thrush too. That's that last thing I want!

Sorry - another long post, it's good to talk

[NotQuiteCockney]

Yes, sleeping on your stomach could well be a source of problems! I would stop that asap, I'm afraid.

I would be worried about that lump, tbh. How long have you had it? Is it still hurting? That's inflammation, the lump. (iboprofen might help some) I'm afraid at that size, if it is an absess, you couldn't have it needle aspirated, and would have to have it cut open and packed, not a nice prospect. How long has it been that big? If it isn't shrinking with the antibiotics, I would be thinking of going to the GP this week.

Block feeding is about reducing your supply. I wouldn't start it until this lump is sorted. It is likely to cause engorgement, as your supply reduces.

I would also ensure you get a feed observed, just in case positioning, attachment and latch need to be fiddled with. If you can say what town you're in, I can have a dig to find baby cafes etc. (Also, do this before block feeding.)

[herethereandeverywhere]

Yikes! Will definitely keep an eye on the lump. I'm so cross about this, I went to my (rubbish) GP Wed this week saying something wasn't right but there was no redness so she prescribed nothing. Neither her or the private one that came last night actually EXAMINED my breast, perhaps I should have asked them to although I thought that was their job

I'm in sw London (Balham) there's a drop in centre but I don't think it's every week (tried to go last time but couldn't because of the snow!)

Will stop the tummy sleeping now!

The problem started on new years day and I think the lump has been building from then. It's felt really troublesome for about a week but only got redness/flu mastitis symptoms yesterday.

[NotQuiteCockney]

The redness mastitis symptoms are a good thing - that means the lump has not been walled off from your immune system. So with the help of ABs, it should be fixable. Smaller lumps can be needle-aspirated, which yeah, is gross, but not as gross as what happens if they're bigger.

Here is a list of Wandsworth breastfeeding cafes - there's one on Tuesday from 2 to 3:30. Others on that list might be good, too. It doesn't sound like a latch problem (blocked ducts etc can be - but normally with poor weight gain in the baby), but it's worth checking.

Oh, here is another list of BF support options in your area.

[PacificDogwood]

Yes, stop sleeping on your front - was a problem for me too!

I also found helpful on one very sore occasion to feed with me on all 4s and DS3 lying underneath me in just the right position to get his chin to where the lump was as otherwise I would have had to feed him upsidedown IYKWIM - I'll send you a drawing if you do not get the picture from this.

Also forgot to mention, do go on an antiinflammatory ie Ibuprofen or get Diclofenac prescribed.

I am at nobody examining you boobs - that is very poor practice (and I am saying this as a GP).

Get an experienced BFing counsellor to observe a feed - or 5 ! There might be little things they can tweak...

Re the lump, it is likely to be blocked gland filled with milk. An abscess would be exquisitely tender and you would get iller inspite of antibiotics, not better. The easiest way to diagnose the difference is via ultrasound scan - get yourself referred as an emergency to the on-call surgeons, they can sort that. Most abscesses (if you do have one) can be treated by aspiration, only a few need to be laid open.

Throughout it all, you are far better off continuing to BF, at least in the short term just to avoid further engorgment/blocking.

Good luck. Hope you have a good night. Keep us posted.

[nigglewiggle]

PD it's really interesting that you say that it is bad practice for GP's not to examine your breast in these circumstances. I had similar recurring problems and saw MW's HV's and GP's and I was amazed that no-one would ever examine me. I felt like asking, but I thought they would think I was some kind of exhibitionist!

I really struggled to speak to anyone who I thought knew what I was even talking about until I rang the NCT.

[PacificDogwood]

nigglewiggle, I have said this on MN before and I suspect I might again: nothing in my training/10+ years experience before I had children prepared me or taught me anything about BFing - except for the annoyingly trite "breast is best" slogan.
It's been a very steep learning curve.... (that's how I found MN - desperately looking for advice)

[herethereandeverywhere]

The GP I saw me last night told me NOT to take ibuprofen (he also told me not to continue to feed from that side but I ignored that as had read so much on here/kellymom)

I have got some diclofenac left over from my episiotomy recovery. Can I take paracetamol, ibuprofen and diclofenac all at once?! I need to keep the fever/sweats/shivers away and paracetamol has been quite good at that.

How do I get an emergency appointment for a scan? Should I try to see my GP tomorrow and get a referral from her? [not very hopeful as she's cr*p emoticon]

Thanks so much NQC and Pacific and all the others for your advice. Pacific I do get the picture re: the all fours dangle feed, will try but not sure DD will play ball (She's likely to think I've lost the plot

[Cadelaide]

Don't know if anyone has mentioned this but the slightest bump or seam in a bra can cause problems (I had recurring mastitis with all 3 DCs). In the end I got some seamless bras and it helped a lot, Emma Jane or something.
Sorry if this is unhelpful/irrelevant, have to confess to not having thoroughly read the thread!

[NotQuiteCockney]

Paracetamol is fine with ibo or diclo, but you can't take diclofenac and iboprofen at the same time. Diclofenac is stronger, but harder on the gut. If you don't have gut issues, you can maxdose diclofenac and iboprofen and hope you get some sleep.

[Cadelaide]

this bra

[PacificDogwood]

You can safely take Paracetamokl + Brufen or Diclofenac (they are both antiinflammatories, so do not take both of them; increased sideeffect potential and no additional benefit).

Yep, dangle feed, that's about it , but it worked. DS did not seem to mind at the time, but you need strong arms...

Re referral: here (Scotland) I'd pick up the phone and ask on-call surgeon to see a lactating mother re ?breast abscess, give patient a letter/note and off they go. They usually get scanned the same day, are not kept in overnight, and like I said laying open of abscess is very much a last ditch treatment when all else has failed, but is then usually necessary and will settle the problem.

To end on a positive note: after rubbish BFing experiences with DS1 and 2 (for different reasons) and a rocky start with DS3, I BF him to 13 months and stopped because I wanted to, not because I had to/needed to for health reasons. So I take that as a success . It took me to 4-5 months before it was quite obviously easier than the faff with FF/bottles.

[fairylights]

just wanted to say i got awful mastitis when my dd was 3 months and had constant hassles with oversupply and cracked nipples, but it was definitely sleeping in a really uncomfortable position on my side (we were away for the weekend and my older ds wouldn't settle in his bed so i got into it with him ) and having baby in a sling for ages a party that evening too.
My GP was also totally useless but by a fluke i got an appointment with the nurse practitioner and she took it all a lot more seriously and examined me (which the GP never did) and diagnosed mastitis even though there were no red patches at that point (although they came later). Much much sympathy anyway, i have never felt so awful . But 2 months on and feeding has totally settled down and i am enjoying it at last! all the best

[fairylights]

ps - nigglewiggle i did ask the GP (a man) to examine me and he just looked embarrassed and said that not many women said that to him and refused to do it! What the hell do they teach them at medical school?!

[fairylights]

pps sorry i am just waffling on now, but i definitely found that expressing just did not get all the milk out in the same way as feeding dd did. sure someone else has said that but too tired to read all posts properly sorry!

[herethereandeverywhere]

Yes - expressing isn't very efficient for me either. That's why I ignored the advice not to feed dd on that side.

Lovely bra Cad (my maternity ones are awful)but I'm a weird size (32g) so makes finding any mat. bra a bit of a nightmare.

Will have to tread carefully with GP tomorrow as she shouted at me the last time I pointed out her advice was unclear (it had resulted in my abnormal smear going untreated )

I'll keep you posted.

[herethereandeverywhere]

Update: slept well (thank God for my angel baby dd who sleeps through!)woke with awful pain going into armpit and redness has got bigger. Have taken paracetamol, diclofenac and antibiotic currently sweating profusely.

Have managed to get a GP appt for 5pm today, fingers crossed she'll do something.

[mariasmummy]

hello,

pleas request a hospital visit for ultrasound incase you have an abscess. GPs will presciribe ab and sometimse they work but its worth it to ease your mind. the pain you sound in sounds awful and i can relate.

all the best,
mariasmummy

[herethereandeverywhere]

Update 2: Doc has referred me to A&E(?) it was that or an 8 day wait for the breast clinic. So I'm off to sit in a very long queue. Just want someone to tell me it's not an abcess!!!