Hi all -- have a really difficult case and am looking for ideas. Have permission to post.

Mom has ongoing symptoms of yeast as well as non-healing nipple wounds on the side of both nipples.  Case has been reviewed by 2 LC's and ob-gyn.  

Mom has used:
5 weeks of APNO (took 10 day hiatus to see if it impacted wound healing and will start APNO again tomorrow)
topical gentian violet  (took a 10 day hiatus and will start again tomorrow)
topical grapefruit seed extract
topical coconut oil
oral probiotics
oral Diflucan (400mg loading dose, 200 mg for 14 days -- now on 2nd 14 day course)
Following hygeine instructions (laundry, cleaning, boiling bottle nipples / pump parts, etc.)

babies tx'd with oral nystatin (no overt symptoms)
no other family members with any known fungal infection

during initial tx with diflucan mother's rash mostly resolved but she continued to have breast pain.  Now, while on 2nd course of Diflucan, rash has started to appear again and pain is increasing.

Pump flanges fit well (no evidence of pump injury) and mother is currently taking a complete break from feeding at the breast (babies just dx'd w/ PTT and referred for release)

Nipple wounds are supspected to be infected with staphylococcus aureus (non-healing, tiny amt of yellow crusting).  Mom is currently being treated with oral dicloxicillin concurrently with the diflucan.  Nipples and wounds have been cultured and sent to lab for further investigation.  Results are not back yet.

What else can we do?

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