Monday, October 29, 2012

Womanly Art Of Breastfeeding*

Y'all, I like nursing my kiddos.  For some value of 'like.'  But I will harm to the next person who claims it is easier, cheaper, and/or more convenient than formula.  I have been in pain since May.  (MAY!!)  After five months of four different antibiotics, four trips to the local breastfeeding specialist-doctor, and a lot of fluconazole (with bonus periodic liver tests to make sure it's still working!) I've now been prescribed Nasty Drugs Until You Wean, and asked, um, how much longer did I want to nurse?  And this by someone whose specialty is, quite precisely, my exact problem.  Maybe this antibiotic won't give me migraines.**  I hope.

Also, the same thing happened with my first child. Except not quite as bad. 

Anyhow, if you are some other poor soul on the Internet wondering why the blocked duct keeps coming back and it hurts to nurse and yet there's nothing overtly wrong, well, I'm not sure this will make you feel any better.

* Last time I dropped by my LLL meeting someone suggested herbal tinctures.  HA HA HA no.
**I don't mean 'a bad headache'.  I mean 'standing outside the library deciding if I must throw up on a decorative tree or not', with a bonus of that postdrome WTF feeling the next day.  On good days, it's just a bad headache.

(Below: What Is This?  Also: How to create a multi-drug-resistant chronic mastitis infection in several dozen miserable steps.)

1) Persistent plugged ducts are frequently a symptom of underlying infection.
2) You can have chronic mastitis without having a fever.
3) If you have chronic mastitis, you should be treated for at least two weeks and probably four with high-dose antibiotics. 
3a) You should seriously think about asking for fluconazole too.  The usual dose is 200 mg/day for at least two weeks and probably four or more.
3b) Get some nystatin for the baby too, who almost certainly has no clinical signs of infection.  Smile sweetly, then threaten to cry.  
4) But first someone should do a breast milk culture for bacteria.
5) Here is a quite useful presentation from Kaiser on the subject.
6) Take lots of probiotics, or regret it.  (Intestinally, not otherwise.)

My Tale Of Woe

May: Get blocked duct.  Heat and massage and heat and massage and nursing and heat and massage.  Goes away after 3 days.
Next week in May: Same blocked duct.  Call midwives.  They are completely useless and prescribe me nothing and say "Hmm... perhaps you should see this other person."  Twats.
Next week in May: Same thing.  Call breastfeeding-specialist.  She has an appointment next week.
Last week in May:  Same thing again while waiting for appointment.
June: See breastfeeding specialist.  1 month of Sulfameth/Trimeth.
Start vitamin D and lecithin supplements.
July: Plugged duct again.  Now I have thrush too.  Switch to 2 weeks of  Augmentin, plus 2 weeks of fluconazole.
Mid-July:  Still in pain.  Switch to azithromycin, four-week course.
August: Okay for two weeks.  Then in pain again.  Azithromycin again.  It gives me migraines every day. 
September: One month of azithromycin, every other day, and fluconazole, every day.  Finally insist the baby gets some nystatin. Thrush finally goes away.
October: Stop taking azithromycin.  Still giving the baby nystatin.
Next week in October: Plugged duct returns.
Last week in October: Erythromycin, 300 mg 3x/day, until I wean the baby.  If I cannot tolerate it, it's back to the migraine-inducing azithromycin, or I can wean.


  1. Anonymous10:40 AM

    Wow. Just out of curiosity, do you have a point of diminishing returns where you would decide the benefits of breastfeeding do not outweigh the costs? Or is this just something you re-evaluate every day?

    1. It's more like, I am too stubborn and lazy to wean a baby who still really wants to nurse. I'm not sure it has a ton of benefits (scientifically proven ones, that is) but it's sure a great tool for sleep cues. (BTW the baby is one already, so...)

      Also as long as I don't have migraines, just a bad headache all the time... I can probably make it until spring, which may keep the baby from getting sick and dehydrated (he won't take a bottle, but he will always nurse).

      On the other hand, if even the antibiotics can't keep the this-is-a-symptom blocked duct at bay, I'm totally throwing in the towel.

      If you're thinking, wtf is wrong with this woman, well, I'm thinking it too.

  2. Anonymous2:35 PM

    Sounds terrible. I feel your pain. I nursed my son for one year (he self-weaned after that). During that year, I had mastitis 4 times, and have taken four courses of antibiotics, and had numerous blocked ducts as well. Applying white cabbage leaves to the boobs between nursing sessions and then this exact procedure which consisted of: taking Ibuprofen (to reduce inflammation) about one hour before nursing and then massaging the blocked duct with a warm water bottle (i.e., rolling it down to blocked duct) for a minute or so right before (or during, if your kiddo lets you) nursing worked like a charm. Once I got this method down, this is the *ONLY* thing that worked for me, so I just thought that I'd pass it along. Occasional Ibuprofen obviously is not ideal for the kiddo, but I believe the benefits outweigh the risks...

    1. Unfortunately for me the blocked duct is a symptom of an underlying problem- it hurts like hell even when the duct isn't blocked. (I already take NSAIDs.) Thanks though!

  3. Do Not Get Me Started on the Womanly Art BS. Bit of a hobby-horse of mine, as you might have noticed. I am lucky in that my particular Womanly Pharmaceutical reduces the severity of my migraines. (See: we are having a major hurricane and I have only had to take codeine once and have yet to vomit.) I will miss that part.

    I am sorry you are having all this awful trouble. The Bean is 20 months old, and I intend to be done weaning before cold season is over -- We're basically down to the morning session at this point.

    1. I prefer Womanly Pharmacopœia, though I had to look up how to spell it. :) I still have a few leftover narcotics from two-summers-ago's migraines. I'm thinking of asking for more. Did I ever tell you my favorite conversation with a pregnant woman? Me: "You know what's both safe AND effective for blindingly painful headaches while pregnant?" Her: "Um... tylenol?" Me: "No. Vicodin."

      I'm glad you were able to successfully cut Bean down to once a day. At that stage there was a lot of "Ma muk?" "No, all gone. Cheerios."

    2. They also have a lovely version thats something like the Womanly Art of Having Twins (I think its called Mothering Mulitples).

      The whole thing basically goes - it sure is challenging to comfort two newborns at once...but if you don't you are a horrible mother and your kids will end up with two heads...but I can't actually articulate how you will accomplish this. So, good luck. But remember the two heads.

  4. My computer keeps eating my comments :p Painful breast feeding = craptastic. You = awesome mom, no matter how long you keep up the breast feeding. With any luck, the babe will be so distracted by the learning to run he will lose interest in milk. Or, the erythromycin will be the long-lost wonder drug to get you through the winter! Whatever makes the migraines go away, because I can only imagine how horrible it would be to parent with a splitting headache, nausea, etc.

    1. I think the painful headache makes me a very crabby short-tempered parent, mainly! Here's to running away from the boobs. Run, baby, run!

  5. Anonymous3:11 PM

    Potentially bizarre suggestion. Can you wean on only that side?

    Could you just stop nursing on the side with the mastitis? That side would then produce less milk and potentially the problem would go away? It could be the best of all worlds- no more migraines, no more abx, don't have to wean, still have sleep cues?

    1. Ah. Perhaps I could... but it's on both sides. Yep, I'm just that lucky!

  6. I know this is an old post, but I was wondering if you had success (avoided mastitis) with the erythromycin 3 times a day until weaning regimen. My daughter is 15 months, and I've had mastitis 8 times now. I'm not ready to wean, but I'm losing hope at this point.

  7. I think I ended up taking something else - I've mercifully forgotten what, but it turns out all macrolide antibiotics give me migraines. I avoided acute mastitis, but it still hurt all the fucking time. I weaned the baby that March - he was... maybe 18 months old. I actually would have weaned him in October, but winter in Wisconsin = tons of illnesses, plus the other one had gotten pneumonia as a daycare baby, so I was a little paranoid about it. (The baby didn't get anything more serious than the sniffles; I have no idea if nursing/sucking hard on boobs had anything to do with it but whatever).

    I also ended up with some seriously bad side effects from that many antibiotics (an exacerbation of an already-existing Oral Allergy Syndrome condition) but that's pretty rare/unlikely. Email me (jf dot scientist AT gmail dot com) if you want the name of the breastfeeding/mastitis specialist; she's great.

    I really do also recommend thinking about some fluconazole- there's frequently an underlying fungal infection going on at the same time, chronic not acute- same deal with a lot of pain and recurring infections but not the ground-glass-in-my-nipples feeling you get with acute thrush.

    Good luck, and I totally understand the not ready to wean thing, and YET sometimes it's for the best to not be in misery/pain all the time and really truly your kid will be completely fine. (The baby is now a healthy, hearty 2.5 year old who was way less upset about weaning than I was.)


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