Friday, September 05, 2008

Sore about it

When it comes to health problems (for me at least), it seems to never rain but always pour!

First it was the high BP (which by the way does not seem well controlled even with the additional diuretic - last night I recorded a BP of 134/105. Could be because I was in discomfort/pain, but generally over the past nights when I checked, the diastolic still hovered around 95 to 98.), then it was the dang prolapse, and now, its the right breast.

The right breast has always been 'Owain's breast'. Ever since Trin was born and I tandem-nursed them both, one kept to the right, the other to the left. This has stayed until the day Owain stopped nursing. Even now, Trin keeps to the left. So the right breast has been unused for almost a year already.

The last time I tried hand expressing to see what came out of the right breast, all I got was oil seeping out of the pores and some thickened milk solids.

My breasts have always been lumpy. And since I am turning 40 soon, it was always at the back of my mind that I should be going for the usual exams - a pap smear, a mammogram. But thanks to the cost, I keep putting this off.

Knowing that my breasts are always lumpy, I never saw cause for concern. But two nights ago, while lying down, I was idly doing a breast exam, just feeling around the rim of the right breast when I noticed a mass near the wall of the breast. This has always been there but I could not be sure if this was just ligament or muscle connective tissue or was it a real mass. The same area on the left breast did not seem so enlarged or prominent. It didn't hurt as I palpated it. So I just sort of filed it away mentally as a note to "remember to book a slot for a full exam soon".

But something must have niggled at me. The next day I tried hand expressing again and this time, not only the usual oil oozed out, but also a stream of pus. Eeks! I hope no one is reading this while eating!

I could not be sure at first and thought it was milk changes again. But the breast did feel lumpy and was starting to be a bit sore and tender. The more I expressed, the more pus oozed out.

So I think I must have some sort of breast abscess. I have not nursed for so many months on that breast, so I cannot understand why or how I could get any form of breast infection. But as the afternoon wore on, it began to feel more and more like a plugged duct, bordering on mastitis. I know I have been feeling a bit fluey and under the weather generally, and the trip to Malaysia over the weekend also left me pooped. My sleep at night has been interrupted by bouts of anxiety that wake me and leave me feeling restless and worried (Don't ask me what I am worried about! I just get a sense that something is UP.)

So maybe all this could have triggered some form of breast infection??

Right now the right side is definitely tender when probed. It does not hurt otherwise. It also feels warmer to the touch than the left. So it does feel like plugged ducts. But as the how and why, since I am no longer lactating on that side, I am absolutely clueless.

I have made an appointment at the KK Breast Centre and the earliest appointment is for Tuesday. But since I am already in some form of discomfort, I think I'd just go queue at the polyclinic later today and get some pain-killers or something. I would like to avoid the antibiotics, but I don't see how that would be possible. I'll just have to dose myself concurrently with probiotics then. Maybe the polyclinic would give me a referral to the Breast Centre - so any investigations done would be a lot less expensive! I would imagine that any preliminary exam would also include an ultrasound of the breast and possibly mammography as well. All that would certainly cost an arm and a leg if done as a private patient!


Cory said...

psle perhaps? lemme me know how it goes ok? you've been v quiet :)

Anonymous said...

nursing from the other breast does stimulate the lactogenice hormones prolactin and oxytocin and those do affect both breasts.

So it is quite possible that either breast develops mastitis. Btw mastitis is not always and infection - in fact it is only rarely caused by infection. Nonpuerperal mastitis and granulomatous mastitis are mostly caused simply by elevataed prolactin levels.

So your case of asymetric nursing seems like a very atypical mix of puerperal and nonpuerperal mastitis.

Antibiotics will be of little help, your problem is residual milk in the breast. Normally you would get rid of it by nursing - but I do not know how you could do that when there is pus. Regularly pumping might help, but beware that some pumps actually make things worse. Another possibility is completely stoping nursing from both breasts and possibly take either vitex agnus castus extract or lisuride for some weeks.

Momto5 said...

Interesting. Anonymous, whoever you are, you seem to know a lot about lactation issues. Thanks for the insight. Are you Singaporean?

Stopping nursing altogether is not possible because Trin still depends a great deal on nursing to sleep/comfort etc.

I ended up seeing a doctor on Friday who gave me antibiotics. I have not taken the abx and now, after reading this, I am glad I didn't. It just didn't feel right to me to take the abx.

Its been two days but the pain the breast seems to have subsided and all the symptoms of a plugged duct have gone. There is still some residual soreness at the rim, but nothing like what it was on Thurs.

So looks like I won't have to take the abx anyway! I will, however, still go for mammography but not because of this situation, more so because I think its time.

Anonymous said...

hi, i read your post on lumiere montessori (your blog came up on google) and would like to ask if your son did go and if so, how you're liking it so far. we just moved to singapore 3 months ago, and recently to a condo close to lumiere. we're also considering shaws (on lynwood grove) which is approximately equidistant. any thoughts? thanks so much!

Anonymous said...

Glad to read it looks better.

Not anonymous by purpose, rather not experienced enough with this coment posting stuff. I thought you would see my AOL/AIM which btw does not work for me atm and I prefer email wherever possible. That is if you want to keep in touch you can create an email account at one of the throwaway email account providers and post it here.. or maybe there is a way to email but I don't see it?

Did not mean to say antibiotics were evil. But they are way overused in mastitis and not needed in most cases, see eg here:

Otoh abx can be useful to prevent further complications in some circumstances. I am glad your your case improved without any intervention because none of the normal treatments would fit this case particularly well.

You do not empty the affected breast so it is more like nonpuerperal mastitis.. which is the reason why it caught my attention.

It is not unusual that there is residual milk production, even in women who are not nursing at all. Often it is caused by elevated prolactin or TSH, something that is expected when you are nursing.. the hormones do affect both breast though and not just the nursing one. In a few cases the produced milk causes trouble. It can he mechanical damage when the ducts stretch too much, there can be autoimmune reaction or the fluid can get infected.

The most effective treatment for nonpuerperal mastitis (bromocriptin, lisurid or cabergolin) obviously is not applicable as long as you are nursing so lets hope conservative treatment does it.

The most effective treatment for puerperal mastitis - emptying the breast would stimulate milk production in it even more which seems problematic unless you want to use both breasts for nursing.. and I do not think that would be good at this stage.

So be cautious, avoid soy products as well as other xenoestrogens, allergenic stuff and such.

I do not expect any complications once you stop nursing, in fact it seems like your lactation inhibition works pretty well but just in case you would want to use the vitex agnus castus prophylactically.. you would start some 3-4 months after weaning and use it for 3-6 months.

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