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Amy Hastanan

on 26 February 2014

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Transcript of Mastitis


breast tenderness (98 percent)
fever (82 percent), chills (78 percent)
malaise (87 percent)
redness (78 percent), and a hot spot (a localized area of warmth and tenderness on right breast)

3rd week POST PARTUM
2nd Child
Patient is in 3rd week postpartum and has had these s+s before; during her 1st pregnancy.
She feels guilt and embarasment that this is happening again, even though she is an "experienced" mother and could not avoid an infection due to "improper breast feeding.:
breast feeding 10x's a day
wears a tight nursing bra
reports cracks and soreness of Left breast
high stress job
lack of sleep
uses her arms a lot; heavy lifting of pans, chopping, etc.
thermometer reads ; low grade fever: 101
visually observed redness, edema, and sensation of heat coming off the clients body
Diagnoses of mastitis is based on a physical exam, taking into account signs and symptoms of fever, chills and a painful area in the breast. Another clear sign is a wedge-shaped area on the breast that points toward the nipple and is tender to the touch. As part of the exam, your doctor will make sure you don't have a breast abscess.
L.Ac should refer out and treat once the patients Primary Care Physician has seen them.
A rare form of breast cancer — inflammatory breast cancer — also can cause redness and swelling that could initially be confused with mastitis. The doctor may recommend a diagnostic mammogram, and/or biopsy to make sure there is no risk for breast cancer.
An M.D. can rule out:

Mastitis results from
stagnation of milk within the breast
removal of milk as it is formed could largely prevent the condition.

Stagnant milk provides a medium for bacterial growth.
Factors that increase risk:
Breast feeding up to 10x's a day (recommended to feed 6x's a day or less)
Previous breastfeeders—are at greater risk
Each additional 10 minutes per feeding increased risk of developing nipple fissures, cracks, or sores. Trauma enhances the entry of bacteria into breast tissue. Nipple trauma is common in the first week postpartum.
other factors...
Many women have the experience that if they miss a breastfeed, or if their infant suddenly starts to sleep through the night and the time between feeds increases, mastitis may follow
LATCHING! Poor attachment as a cause of inefficient milk removal is now seen as a major predisposing factor for mastitis
Pacifier use may also be associated with poor attachment at the breast
Tight clothing
Prone sleeping position
facilitating breastfeeding and bonding, early skin-to-skin contact of a mother/infant
If a mother is in close contact with her infant immediately after delivery, she transfers to the infant her own strain of respiratory and skin organisms. These organisms grow and populate her infant’s gut, skin and respiratory tract. Once a flora of commensal organisms is established, the growth of pathogenic bacteria is inhibited. This process, known as bacterial interference, has been used deliberately in clinical settings to prevent and control outbreaks of infection by the more virulent forms of Staph.
Chief Complaint: DEEP BURNING Breast pain
When your baby is done breast-feeding, you can break the latch by using your pinky finger. Place one finger into the corner of his or her mouth. This will gently break the seal.
Blocked Duct:

Symptoms are rapidly relieved when the hard particulate material is expressed, and milk is released from the affected part of the breast.

White granules which may be found in accumulated milk are thought to be formed from a mixture of casein and other materials hardened by salts containing calcium.

Fatty- or stringy-looking material, sometimes brown or greenish, is also sometimes extruded from apparently blocked ducts, followed by relief of symptoms
Acupuncture Points:
Ren 17
ST 39
SI 11
SI 1 ***
Wu Wei Xiao Du Yin
Five Ingredient Decoction to Eliminate Toxin
Tx: Toxic Heat causing abscesses or boils that penetrate into Blood
Jin Yin Hua
Zi Hua Di Ding
Pu Gong Ying
Ye Ju Hua
Zi Bei Tian Kui
another formulas...
Xiao Chai Hu Tang
Minor Bupleurum Combination
Tx: Harmonizes the Shao Yang
Chai Hu
Huang Qin
Ban Xia
Sheng Jiang
Ren Shen
Zhi Gan Cao
Da Zao
LI 11
Du 14
Shi Xuan
UB 40
GB 34
Du 26

rest, in bed if possible

breastfeed very often from the affected breast

put a warm compress on the affected breast, bathe it in warm water, or have a warm

gently massage any lumpy areas while the infant is feeding to help the milk to flow from

seek help from a health worker if she is not better next day.
Early stage
Thorough and frequent hand washing by both health workers and mothers is necessary
breastfeed as often and as long as her infant is willing, with no restrictions.

- **Supportive counselling**:
Lactation counselor, doulas, midwives
A woman needs emotional support. She may have been given conflicting advice from health professionals, she may have been advised to stop breastfeeding, or given no guidance either way. She may be confused and anxious, and unwilling to continue breastfeeding.

- Effective milk removal

- Antibiotic therapy:
Amoxacillin, Erythromycin, etc

- Symptomatic treatment
Ibuprofen, Paracetomol
The main principles of treatment of mastitis are:
Is it LEGAL to breast feed in public?
Not only is it legal to breastfeed in the United States,

but many states have enacted laws

to protect a woman's right to breastfeed

in any place, public or private, as long as she's authorized to be there.

Some states have laws so strict that asking a nursing mother to stop, cover up, or move elsewhere is a violation of her civil rights and gives her grounds to sue for damages in a court of law.
Full transcript