Back here after several days

Back here after several days of hibernation. Just finished in the office.  Wednesdays are my "long" days …  it gets exhausting after 12 hours in the office …  

Trying to get caught up with things.  Today I'm looking for information on mastitis.  Big problem for cows.   Hmm … AAFP has a very good article on common breast problems. .. Along with a patient handout on breast pain. But not much here on mastitis.   A mention in the Diary from a week in Family Practice from 1997 (scroll down to Tuesday) .. an interesting discussion of the "cabbage trick." (mentioned again in 1998 .. I wonder if it was the same patient!)

A key question for today is whether needle aspiration is effective in treating breast abcess.  The traditional teaching is that incision and drainage is necessary .. but a recent study suggests that over 80% of patients can be safely treated with aspiration + antibiotics.  But mastitis is usually treated rather easily with either dicloxacillin or cephalexin.  Resistant cases should be treated with Clav-Amox.

In researching this today, I've learned that there is rather little research on mastitis.  Indeed, there are very few studies that have looked at different diagnostic and/or treatment methodologies.  ? is it always infection?  Some authors suggest that it may not be, but there are few alternatives provided .. and there are no studies that suggest how we might differentiate simple obstruction from infection. 

The midwifery circles .. and drsears .. blame mastitis on stress.  Babyzone: says: "Stress and Fatigue Can Lead to Plugged Ducts and Breast Infection"  huh?  This is an interesting statment .. and it is certainly possible .. but I've been able to find NO research to support this statement.