Breast Abscess

As you can tell from the title, this blog involves the boob. Please stop reading now if that makes you uncomfortable!

Before getting pregnant, I had heard terrible stories about breastfeeding moms who developed mastitis and how extremely painful it is. Naturally, I ended up being one of those "lucky" moms...

When Hudson was just a couple of weeks old, I noticed a pretty good size knot on one side. The knot was painful and the skin was red and warm to the touch. My temperature was 100.3 degrees. I figured it was mastitis so I called my OB that Thursday who prescribed an antibiotic to take care of the problem. I was given strict instructions that if it wasn't improving in 48 hours, then I needed to be seen. So I waited 48 hours till Saturday rolled around, and the knot seemed to have gotten larger. I felt fine (no fever), but it was clear that the antibiotic wasn't doing the job. I got ahold of the on-call OB at the hospital, and he immediately advised me to go to the ER to get checked out because it sounded like it might have turned into an abscess. So Thomas took over baby-duty while I headed to the hospital.

First I saw the triage nurse. She took one look and said I would have to see the nurse practitioner and possibly the doctor. The nurse practitioner immediately had me placed in a room to be seen by the doctor. The ER was pretty busy, so it took a while for the doctor to see me. So I just sat back and relaxed in the bed and watched a little TV. I sure did enjoy not having to worry about Hudson for once!

Eventually the doctor came in. As soon as he felt the knot, he said it was an abscess. :( Not what I wanted to hear! He went on to explain what he had learned about abscesses in med school: "First make an incision and drain. If that doesn't work, make an incision and drain again. If that still doesn't work, make another incision and drain. The last step was to treat with antibiotics." Ugh! Are you kidding me?!?!? You want to cut my boob open???

The doctor brought in an ultrasound machine to take a closer look at the abscess. From the outside, the knot measured 10cm wide. From the ultrasound, he measured the fluid pocket to be 4cm wide and 3cm deep. He said he was going to call the on-call OB to see what he recommended or if he wanted to come in and see me. I got the feeling the ER doctor wasn't too comfortable treating me... He knew he needed to drain it, but he was a little hesitant to actually do it. That made me a little uneasy.

The on-call OB was the same doctor I had spoken with on the phone earlier who instructed me to go to the ER. He told the ER doctor that he would come in and drain it for me, but he wanted to do a needle aspiration instead of an incision. Apparently it is successful about 60-70% of the time, but it is much less invasive than making an incision and draining it that way. This sounded much better to me (although it still sounded AWFUL). So I called Thomas and we quickly arranged for a babysitter. I needed someone there for support if they were going to stick a giant needle in me! The OB was there within minutes. Of course Thomas was going to be another 20 minutes before he could be at the hospital, and I knew the OB didn't want to wait for him since he came in just for this procedure. I had to buck up and do this on my own!

The nurse didn't take my advice about which vein to use to draw blood. He attempted a spot on my forearm first, and then he proceeded to tell me that my skin is REALLY thick while he was digging... Then he went straight through the vein. Of course next he used the vein I had suggested. No problem getting that one! #MenNeverListen :)

The OB first numbed the skin with some lidocaine injections. I felt a pinch for a couple of seconds and that was all. Then came the ginormous needle. I told him not to show me the needle or I would probably pass out. He thought I was joking but I was dead serious. He told me he was inserting the big needle and I braced myself for the worst pain in my life. He had explained that I would feel pressure at most, but I just didn't see how that was possible! Turns out, I didn't feel a thing! About 10 seconds after starting the procedure, I heard him say "jackpot!" He had reached the fluid pocket and was now drawing up as much of the fluid as he could get. He inserted the needle into my skin about an inch before he got inside of the abscess. Wow! The abscess was deep under the skin, that's for sure!

When he was done, he showed me the syringe filled with nasty brownish liquid tinged with blood. He removed 30mL (1 oz) of fluid. I wish I would have taken a picture of it because it was sooo gross! They sent it off to the lab to run cultures and see what we were dealing with. The nurse later informed me that she had totally grossed out the lab tech when she dropped it off at the lab. The tech saw it and said, "Oh my gosh. What is that???" Ha! I can't imagine what that stuff smelled like... Yuck.

They gave me a booster antibiotic through my IV and then some IV pain medicine as well before they sent me on my way. They switched me to a different oral antibiotic and gave me a script for hydrocodone for pain. He said I would be in a lot of pain the next day and that ibuprofen (which is what I wanted to use) would not cut it. I got my scripts filled late that night and drove back home with instructions to follow-up with my OB on Monday.

I saw my OB on Monday. I was anxiously awaiting the lab results, so the nurse immediately started looking to see if they were in my chart yet. Cultures came back positive for MRSA. Well that wasn't fun to hear! The good thing was that the antibiotic that the ER had me start was effective in killing this bacteria. So I should be on the road to recovery! She wanted me to be seen again one week later. So the following week, I arrived for my second follow-up appointment. This time I was seeing the nurse practitioner. She took a look and went to find the doctor on duty (which was the other doctor in the practice who was not aware of my situation). This doctor said there was still some fluid inside the abscess but not much. She offered to do another needle aspiration, but she wasn't sure if she would be able to get much fluid out. She then asked me about the culture results... I told her it was MRSA. Her eyes widened and she said, "oooohhhh!" Apparently the nurse practitioner was not aware of this tiny detail either. She said this was her first breast abscess patient where it was MRSA. Because the antibiotic that I had just finished should have killed the infection, the doctor was a little concerned. She stepped out to take a look at the culture report which shows which antibiotics are effective against my particular infection. She then called the infectious disease team at the hospital to discuss my situation - she really wanted to use another drug that would still allow for me to breastfeed. They talked about oral vancomycin but thought maybe daily IV vancomycin would work better... That meant I would have to come in everyday for IV antibiotics! How the heck do I accomplish that with a newborn??? And the other bad thing about vancomycin is it's not compatible with breastfeeding.

They eventually decided on another oral antibiotic - Bactrim. Of course, this drug gave me a terrible, TERRIBLE rash on my hands the last time I took it. I had to stop the medication it was so bad! However, in this situation, I would rather deal with a terribly painful rash on my hands rather than a daily trip to the hospital with an infant for an IV! I bought some benadryl to take before I started the Bactrim in hopes to prevent or lessen the extent of the rash. Surprisingly, it worked and I never developed a rash!! It's now been a week since I finished this antibiotic. The knot is still there, but it is smaller. There are no signs of infection, and it's not painful anymore. I think the knot that is still there is just all of the inflamed and involved tissue that was encompassing the abscess. It should slowly keep shrinking and eventually go away. If not, they will likely have to make an incision and surgically remove that tissue.

So it has been a long process that I wish no one ever has to experience! Somehow, I've been able to continue breastfeeding through all of this. Shocking, I know! I'm not sure how many times my mom said to me, "So since it's MRSA, you can't breastfeed anymore, right?" Or "Are you sure they said it's ok to keep breastfeeding?" Ha! Actually continuing to breastfeed was part of the treatment as it keeps the milk flowing so nothing gets stopped up again. The only time I couldn't follow the doctor's orders was right after the needle aspiration when that side was producing what I called "strawberry milk!" They said it was totally fine for him to get blood-tinged milk, but I couldn't give it to him. I told Thomas I didn't want a vampire baby!

One of my many talents... homemade strawberry milk!