Inflammatory Breast Cancer or Mastitis?

If you're not nursing, but you have mastitis-like symptoms, have you considered getting checked out for Inflammatory Breast Cancer? It's different to the mainstream breast cancer we've been trained to inspect for because there is no lump, but it's just as lethal. Here's a 6 minute video clip from ABC News with some good info.

Inflammatory Breast Cancer

WhyMommy at Toddler Planet, who is currently fighting IBC, is doing a world of good by helping get the word out.

If something doesn't feel right, get it checked out. Something to keep in mind as we go through our daily struggles to avoid falling behind on work and family affairs.

Mastitis

I wish I knew all of the "what ifs" about nursing because it wasn't an easy start, let me tell you. Let's get in the "way, way back machine" and start at the very beginning. When I started nursing, I just went with the flow (tee hee...flow) and let MetaBaby nurse away. He latched on well and was doing a great job. I had a lot of milk -- possibly too much milk. At some point, just after I was recovering from my C-Section, I got a lump on my breast. After doing a lot of research online, I discovered it was probably a plugged duct, which Dr. Sears describes as follows:

Sometimes a milk duct leading from the milk-making cells to the nipple gets plugged, resulting in a tender lump beneath the areola. There may also be a wedge-shaped area of redness extending from the lump back towards the wall of the chest. Unlike mastitis, the pain comes and goes with a plugged duct, and unless the duct is infected, you will not feel generally ill. If left untreated, however, a plugged duct may become infected, resulting in mastitis, infection, or a breast abscess.

I tried the following methods to clear the duct, which were a combination of tips I read online, as well as suggestions from my lactation consultant.

• Nursed from the affected side first at every nursing session.
  
• Pressure massage the lump in the direction of the nipple.
  
• Apply moist heat compresses or take a shower before nursing.
  
• Wear a non-restrictive nursing bra.
  
• Treat self like you have a cold: get a lot of rest (nurse baby in bed), drink fluids, take echinacea, lecithin, and extra vitamin C & E.
  
• Position nursing baby's chin towards plugged duct.

Despite my best efforts, the lump only got worse. I didn't have a fever, so my lactation consultant and I were consoled in knowing that I didn't have mastitis. She really helped me exhaust the natural methods to clear the duct. While I really didn't want antibiotics, in the end I had no choice. I started on them on a Friday, and the next day, I noticed there was an abscess in the affected area. It turns out that I not only had mastitis, it had developed into an abscess, which in case it's not obvious, hurts like you would not believe. A portion of it drained that weekend, and I went to see my ob/gyn on Monday.

She was pretty nonchalant about it until she saw it. She gasped in what I can only assume was horror, and sent me straight to the surgeon two floors down. He took a look and sent me to get an ultrasound to see how much fluid was left and if it was worth draining. It turns out there wasn't much left, but he was pretty concerned, so he drained it to allow the area to heal properly. Out-patient surgery...eek! The sound of that scared me, but it turns out it wasn't too bad. It was quick, and MetaBaby was cooing in his stroller a few feet away. I won't say it was painless, but it didn't hurt as much as the abscess, so I just coped. I went back for a few follow ups and it seemed to have cleared up pretty well. Once I stop nursing, I need to go back and get a mammogram to evaluate the health of the breast when it's off duty and milk free.

The moral of the story?

• You can have mastitis even if you don't have a fever or flu-like symptoms.
  
• When you start nursing, avoid engorgement as much as possible. Allow you're baby to drain each side well, but don't use a pump to finish the job as this will impact your milk supply.
  
• Cabbage leaves on your breasts serve to reduce your milk supply. They're great to relieve engorgement, but do so sparingly so you don't overdo it.
  
• Wear a bra that doesn't dig into any sensitive areas, and avoid underwires entirely, or at least until after your milk supply settles.

Dr Sears' list of mastitis symptoms:

• Part or all of the breast is intensely painful, hot, tender, red, and swollen. Some mothers can pinpoint a definite area of inflammation, while at other times the entire breast is tender.
  
• You feel tired, run down, achy, have chills or think you have the flu. A breastfeeding mother who thinks she has the flu probably has mastitis. Mothers with mastitis will sometimes experience these flu-like symptoms, even before they get a fever or notice breast tenderness.
  
• You have chills or feel feverish, or your temperature is 101F or higher. These symptoms suggest that you have an infection.
  
• You are feeling progressively worse, your breasts are growing more tender, and your fever is becoming more pronounced.
• With simple engorgement, a plugged duct, or mastitis without infection, you gradually feel better instead of worse.
  
• Recent events have set you up for mastitis: cracked or bleeding nipples, stress or getting run down, missed feedings or longer intervals between feedings.

Potential causes, per KellyMom:

• Engorgement or inadequate milk removal (due to latching problems, ineffective suck, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby's time at the breast, nipple shield use, twins or higher order multiples, blocked nipple pore, etc.).
  
• Infrequent/skipped feedings (due to nipple pain, teething, pacifier overuse, busy mom, return to work, baby suddenly sleeping longer, scheduling, supplementing, abrupt weaning, etc.).
  
• Pressure on the duct (from fingers, tight bra or clothing, prone sleeping, diaper bag, etc.).
  
• Inflammation (from injury, bacterial/yeast infection, or allergy).
  
• Stress, fatigue, anemia, weakened immunity

The Pump Station's list of possible causes:

• Missed or irregular feedings and/or an unusually long interval between feedings.
  
• Pressing the breast to provide nostril space for the baby.
  
• Wearing a tight or poorly fitting bra that impedes milk flow.
  
• Having an overabundant milk supply and insufficient breast drainage.
  
• Practicing vigorous upper arm exercise.
  
• Extreme exhaustion.
  
• Rapid weaning.

I hope none of you ever have to deal with any of these issues, but you're better off if you know what you're dealing with. That said, this post is only a reflection of my experiences. Be sure to contact your doctor if you have any serious symptoms because time is of the essence. The sooner you resolve the problem, the less drastic your course of action.

Note: October is Breast Cancer Awareness month. Go check out Mom's post at What Works For Us on breast cancer facts and statistics. The numbers are staggering.

Breastfeeding on Codeine

Are you nursing? Are you taking codeine? NPR reported on a recent FDA advisory to doctors and nursing mothers cautioning on the mother's use of codeine for the sake of nursing babies. If a mother is a "supermetabolizer," her body will break the drug down into its active form, morphine, too quickly. The morphine then floods the bloodstream, which "can cause drowsiness and interfere with breathing," potentially resulting in an overdose in the baby. It's rare though (1 reported death), and no other medications that include codeine (e.g., cold medication) have reportedly EVER caused any problems.

"If you're a nursing mother taking codeine, call your doctor if you're having difficulty taking care of your baby," Kweder says. "It could be a sign that you're metabolizing the drug more rapidly than most people."

It's the most widely prescribed postpartum medication, and the agency is NOT trying to eliminate its use. However, since 1-10% of people metabolize codeine rapidly, the article says there's reason to be cautious and watch for baby's reactions. There are genetic tests, but they're very expensive and not widely available. Mom's are better off getting the lowest dose of codeine for the shortest amount of time.

Overall, it sounds scary, but it's not a life-altering concern. Be cautious and observant with your baby. The article's suggestion to "call your doctor if you're having difficulty taking care of your baby" is a bit generic. What new parents get home and say "wow, this is much easier than I thought." Babies are difficult to take care of, full stop. But as with anything, if something doesn't seem right, call your doctor; that's what s/he's there for. And as your baby gets older, it becomes easier to see when behavior is out of character.

Generally, I try to take the least amount of medication needed (dose and duration) for my sake, and moreso now that I'm nursing. I take a daily vitamin. After a terrible bout of mastitis, I was taking lecithin for a while in hopes of keeping the ducts clear and flowing, though I stopped after a while with no ill effects. I've taken a bit of cold medicine during the worst part of my cold (twice since MetaBaby was born), though I try to keep that to a minimum because my doctor said antihistamines reduce a nursing woman's milk supply (true or not, why tempt fate?). The only other thing I take is Tylenol for my occassional migraine, which just barely lets me get by.

Inflammatory Breast Cancer

There are so many unknowns in our lives. We do what we can to stay informed and be cautious with those things we care about. Health is one. For years, for example, it was assumed that women's health issues were to be equally compared to men's, which is why women's strokes often went misdiagnosed. It turns out that women experience different symptoms to men during a stroke, leading doctors and nurses to miss the window of opportinuty for effective treatments.

But then there are other diseases that we might feel we understand. If you have a lump in your breast, get it checked out. But what if you don't have a lump? Below, Why Mommy's post at Toddler Planet on her experience. That rash...that inflammation...that nuisance...it was cancer.

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Inflammatory breast cancer

We hear a lot about breast cancer these days. One in eight women will be diagnosed with breast cancer in their lifetimes, and there are millions living with it in the U.S. today alone. But did you know that there is more than one type of breast cancer?

I didn’t. I thought that breast cancer was all the same. I figured that if I did my monthly breast self-exams, and found no lump, I’d be fine.

Oops. It turns out that you don’t have to have a lump to have breast cancer. Six weeks ago, I went to my OB/GYN because my breast felt funny. It was red, hot, inflamed, and the skin looked…funny. But there was no lump, so I wasn’t worried. I should have been. After a round of antibiotics didn’t clear up the inflammation, my doctor sent me to a breast specialist and did a skin punch biopsy. That test showed that I have inflammatory breast cancer, a very aggressive cancer that can be deadly.

Inflammatory breast cancer is often misdiagnosed as mastitis because many doctors have never seen it before and consider it rare. “Rare” or not, there are over 100,000 women in the U.S. with this cancer right now; only half will survive five years. Please call your OB/GYN if you experience several of the following symptoms in your breast, or any unusual changes: redness, rapid increase in size of one breast, persistent itching of breast or nipple, thickening of breast tissue, stabbing pain, soreness, swelling under the arm, dimpling or ridging (for example, when you take your bra off, the bra marks stay – for a while), flattening or retracting of the nipple, or a texture that looks or feels like an orange (called peau d’orange). Ask if your GYN is familiar with inflammatory breast cancer, and tell her that you’re concerned and want to come in to rule it out.

There is more than one kind of breast cancer. Inflammatory breast cancer is the most aggressive form of breast cancer out there, and early detection is critical. It’s not usually detected by mammogram. It does not usually present with a lump. It may be overlooked with all of the changes that our breasts undergo during the years when we’re pregnant and/or nursing our little ones. It’s important not to miss this one.

Inflammatory breast cancer is detected by women and their doctors who notice a change in one of their breasts. If you notice a change, call your doctor today. Tell her about it. Tell her that you have a friend with this disease, and it’s trying to kill her. Now you know what I wish I had known before six weeks ago.

You don’t have to have a lump to have breast cancer.


P.S. Feel free to steal this post too. I’d be happy for anyone in the blogosphere to take it and put it on their site, no questions asked. Dress it up, dress it down, let it run around the place barefoot. I don’t care. But I want the word to get out. I don’t want another young mom — or old man — or anyone in between — to have to stare at this thing on their chest and wonder, is it mastitis? Is it a rash? Am I overreacting? This cancer moves FAST, and early detection and treatment is critical for survival.

Thank you.