July 15, 2012

Udder Complications...

Just when I thought Iza and I were getting the hang of breastfeeding along comes a set back.  And, in my typical fashion, it couldn’t just be a small bump in the road!  No, we are talking about a massive sinkhole we’re still trying to climb our way out of!

After Iza had her two month vaccines she became incredibly sleepy, so she wasn’t eating very well.  Each time she would wake up she was cranky, so I would try to feed her only to have her fall in to a deep sleep on the breast within the first minutes.  I continued trying to get her to eat each time she would wake, but wasn’t having much luck and as a result I realized later that evening I was developing a clogged milk duct.  I began pumping as soon as I realized the problem and was working to prevent it from moving forward to mastitis as best as I could, but the clog became worse with in the next 12 hours.  

My right breast slowly turned hard as a rock in one large area and became red.  The telltale signs of the beast called mastitis.  But I didn’t have a fever and still felt fairly well considering the pain in my breast that felt like it weighed 20 pounds.  After a couple of days trying to work the clog out with warm compresses, massaging, acupuncture, pumping and frequent feedings (as in every 2 hours whenever possible) it still hadn’t bugged, so I went to see my OB.  She took one look at it, felt the warmth radiating out from the lump and told me that it was bound to turn in to mastitis soon and once I got a fever I would feel like I had been run over by a truck, so she prescribed me a round of strong antibiotics to go ahead and start now so I could avoid that awful feeling and to continue all the things I had been doing to work the dried milk clog out. 

Well the idea of taking antibiotics proactively before a fever set in just didn’t seem jive with me.  Especially when I considered how poorly my body reacts to them and the concerns I had over possibly developing yeast and giving Iza thrush and how her little belly would fair with the drugs.  So we filled the script to have them on hand, but still felt that with persistence I might be able to work the clog out before my breast became infected.  WRONG!!  After a week and a half since all the trouble began I spiked a fever of 100.4*, suffered cold chills, my head began feeling cloudy and I couldn’t think straight, so I began taking the pills as quickly as I could fill my glass of water. 

Unfortunately over the course of the following week on antibiotics, along with all the other measures I was taking to move the milk out of my system, nothing improved.  In fact at times my breast seemed harder, tenderer and I could see visible bruising.    My breast had gotten so firm that the shape became distorted and nearly two weeks in to the ordeal Iza decided the breast wasn’t fit to nurse off of any more.  I just wanted to cry!  Scratch that, I *DID* cry!!  I desperately reached out to the Lactation Consultants for help.  We did a feeding and weight to see how much milk Iza was able to consume from each breast during a typical feeding.  It turned out there was so much internal swelling the milk wasn’t able to escape and poor little Iza wasn’t able to get the food she needed.  Our baby girl had lost almost a pound in the two weeks I was battling against this massive clog!  We had to begin supplementing each feeding with an additional 2 oz of previously pumped breast milk.  They assured me I was doing all the right things to resolve the clog and mastitis, but also encouraged me to contact my OB for a follow up since after nearly a week of antibiotics I hadn’t improved and I might have an abscess.  I quickly became depressed feeling like I had once again failed my daughters and my body was failing me when all I wanted to do was provide Iza with the proper nutrition she needed.   A feeling all too familiar as a Baby Loss Momma and one I hoped to never experience again once my Rainbow was born safely.

A couple of days later I spoke with my OB’s nurse and explained all of my concerns and that I felt like after nearly three weeks of treatment the lump should have resolved. She called back after she spoke with my OB and had scheduled me for an ultrasound the following morning.  Low and behold I had an abscess the size of a large grapefruit!  After having the ultrasound I had to wait for the Dr. to review the images before I could leave.  She came in after the procedure and asked me a couple of questions while having the tech check a couple of additional things to get a better idea of the size and then went to call my OB while I waited.  The Dr. came back with instructions from my OB to come to her office immediately for us to discuss a plan. Since we had Iza with us we needed to change and feed her before heading to the office, but as we were unloading my OB's nurse met us out at the car and told us we were to go to the surgical center down the street. She didn't know what the plan was, but knew they were waiting for me.

I arrived (while Trey stayed outside trying to soothe a restless Iza) only to discover I'm in the wrong place and should be at the other surgical center next door (!!??). I filled out tons of paperwork and was then told that the Dr. I was going to see is finishing up for the day, so I would now be seeing a different Dr., but she was still tied up in surgery at the hospital and wasn't expected back until 1:45 - did I want to wait, leave and come back or reschedule? I asked the receptionist if she knew what was going to happen today and I was assured it was most likely going to be a consult only and if any procedure was to be done it would be scheduled for a later date. We went to lunch and called Trey's parents to see if they were back home and available to watch Iza while we went back to my appointment. Thank God they were able to take care of her for a few hours and thankfully I had been prepared with bottles of pumped breast milk to leave with them! Once we got back we had to wait an hour to see the Dr.   The nurse took us to an exam room and had me change in to one of those glamorous paper shirts while we waited for the Dr. to come in, but the nurse quickly reappeared and moved us to the procedure room.  At this point panic and anxiety began to set in my bones! 

The Dr. didn't even look at the files the imaging place sent with us, but had me hop on the table and she began slicing, dicing and draining me! It honestly felt like she was working on me for at least an hour.  She said she was cutting close to the areola and was trying to minimize scarring, so I told her I wasn’t as concerned about scarring as I was about my ability to continue breastfeeding, or at least pumping.  The pocket of infection was so large she had to expand the cut, widen the incision and go deeper to allow it all to drain out. By the time she was finished cutting my wound ended up being about two inches long and nearly three inches deep!  The gunk coming out of me was so nasty Trey started to get sick to his stomach and weak in the knees!  The incision is left open to drain and heal from the inside out, which will take about 2 - 3 weeks.  He's been cleaning and packing my wound with gauze several times a day and should taper down as the infection shrinks and it begins to heal. She changed my antibiotic to augmentin, put me on oxycodone and told me there is the chance it might reoccur.  If that happens I'm to call her immediately and she'll admit me to the hospital for IV antibiotics and take me to the operating room for a more extensive draining.

The abscess was very large, deep and very nasty pocket of infection!!   We've changed the wound dressing several times now and have spend last weekend desperately trying to figure out how to pump the breast, so I can keep my milk supply and empty the breast so the mastitis doesn't spread and cause more problems and pain.  The wound is so close to the areola that I can't get a tight seal with the breast pump and if I try to hand express it feels like I'm pushing stuff out of the wound.  Not pleasant!  This has caused me a TON of anxiety, stress, depression and many, many tears of worry and failure.  Luckily Trey has been great about pressing the Lactation Consultants to help come up with a solution and they were able to find a smaller sized pump flange that seems to be helping.  The only problem now is that each time I pump the wound is also being compressed causing it to open and close and all the fluid is leaking out of the wound and all over me.  Gross!  Trust me, I know!  The wound continues to fill up with milk and make an awful mess as I soak through one bandage after another, but hopefully we've been able to catch it in time so my breast won't dry up!  It’s been a horrible freakin' ordeal!!! 

We’ve since gone to one of my follow ups with the surgeon to check on my healing and learned that while the wound looked good there was an additional complication and appeared to be another lump down low.  I had thought it was in a place she had previously checked with a needle aspiration and decided it was a small abscess that would dry up with the antibiotic, so I hadn’t been overly worried.  However once she began looking at it she said the area she had been inspecting previously was more to the side of my breast and this was something different, so she wanted to take three biopsy samples to be safe.  I couldn’t help but feel like life was kicking me in the face!  Or, in this case, kicking me in the breast!  Even though she numbed the area it hurt like a bitch all the way across the back of my breast and to the wound on the other side.  I even experienced nerve tingling in my nipple an hour later and that really had me freaked out!   

So in the time we’ve waited for the biopsy results to come back we’ve continued to care for the wound and sought more help from the Lactation Consultants (we’ve become regulars at the WNC Breastfeeding Center).  For now they have me working on building up my milk supply in the left breast by feeding and pumping as much as possible during the day and maintaining a supply on the right by pumping a few times daily.  We can’t do much else at this point because it would be disastrous to increase the supply to both breasts since my right one will continue to be very limited in its use until it’s healed completely.  Once it’s healed and Iza is able to return to the breast I’ll go back to have them help me build up my supply on the right as much as possible.  Unfortunately, as much as it pains me, I now realize this may never have the flow it had before and after all this pain and anguish I may still be limited to feeding solely off the left.  At the rate we are supplementing each feeding we are quickly running out of our stock piled milk supply and it’s breaking my heart!

Yesterday I finally received the biopsy results and learned the smaller lump is a benign Lactating Adenoma (http://www.breast-cancer.ca/type/lactating-adenoma.htm).  Over time it should shrink up or at the very least not increase in size and I was told that it doesn’t increase my chances of developing breast cancer.  That is a huge relief!  I guess you could say it’s the silver lining in an otherwise cloudy situation.  I’ll continue my weekly check ups with the surgeon until the abscess wound is healed completely and I will continue doing everything with in my power to continue breastfeeding my sweet little Rainbow for as long as humanly possible.

Thankfully my husband has been a wonderful supporter during this entire fiasco!  With out his help, both with keeping my wound properly dressed and figuring out how to adapt the breast pump to work around my wound, I would have never lasted this long and still be stuck at the bottom of the sinkhole.  Trey also lent his artistic abilities and sketched my boobie, so I could share the extent of the damage and how traumatic this ordeal has been.  

Abscess incision and small biopsy entry point

Please send us tons of milky wishes for the coming week!  And if you’ve happened to suffer a breast abscess in the past I would be very interested in hearing how you were able to manage breast feeding and finally resolving the abscess, so please feel free to speak up.

1 comment:

  1. Tons of just the right amount of milky wishes for an awesome mama, and support wishes for the awesome daddy. Iza will thrive with your sustenance and loving care.