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Update:March 6
My previous note is not an issue in that the babe in question has gained 5
oz.per my scale since 2 days ago.
The round fissures/wounds are still present.The babe's first or anterior
1/4 of tongue is normal pink now,but the thin coating of thrush is
present in 3/4 of the rest of tongue.None noted on inner cheeks.
I called Md's office to once again explain how this is a severe case,and
would they please see or and/or order something more
strong.......mentioning another Md who had used Diflucan with rapid results
and improvements in both mom and baby locally.

(This is a family Md and he was good to order both mom and baby meds on
Mon.pm when we called---but mom is so dreadfully in pain and in danger of
quitting that I was compelled to use stronger descriptives today after the
wt.check. I again spoke with the same assistant
(non-nurse,non-physician,and not very empathetic so possibly a non-parent)
and mentioned that maybe the woman would need to see her OB or
dermatologist.

The assistant's reply was: "Well,I'll tell dr. so and so,but he''ll
probably want her to wait until Friday."
My mild reply to this:"I don't think anyone would want someone to wait til
Friday if this were a male's private parts,do you?"
She,the assistant readily and heartily agreed so I hope that the message is
relayed as to the significance of the situation



Baby's tongue is now starting to cup up,it is long enought but had more of
a flat movement on Mon.
Also,it bunches up in back...I can't rely decipher it as well as many,and
may recommend she visit the D.O who sees literally 3 babies on several days
per week for suck problems.Hopefully some stronger meds. I would think at
least something P.O for mom will help.
the left nipple is healing,but the right is not,from what I saw Wed.covered
in cream.

Her Md. has BID so I told her to put it on before bedtime and midday.
By the time she came to me she had all sorts of advice and as much as I
repeated to her both Mon
and Wed. that baby could be fed more often so she's not as vigorous,mom
insists how good baby is--and the wets and poops are great
as is the little wt.gain I saw yesterday noon. The breasts are soft after
feeds.Baby spits up after most feeds.She kind of chewed her
way onto the nipple at first latch on--and I showed mom how to wait for the
wide open,but mom insisted on doing her way.Babe also
pursed upper lip under until let down occurred,which I showed mom and how
to do suck training before feeds.Mom said she really
did very little suck training past 2 days,so there is not much compliance
from the breastfeeding information I shared,just compliance with the meds
and of course I  had to instruct her on the how to's because the bottle
said 1 dropperful,the cream said twice a
day liberally.
One week ago they blew off or didn't recognize that the baby's tongue was
thinly coated white,(they said it was related to just having fed the
baby--but mom was in intense pain at that time as well.)

Somewhere I read that BF babies with thrush have milder cases which go
unrecognized and I can see why from this baby's mouth.But I know that this
is not univerally true as have assisted with one whose mouth and throat
looked like white mold/cheesy.

Update #2: March 8   I called mom to see what Md's office had decided to do
about persistent severe s/s. They had told her to call them today with
update.Mom asked me if she should go to another MD if her FP wouldn't see
her.I  highly encouraged her to be insistent to be seen and if need be,to
insist on speaking with MD.I also asked her to talk about more frequent
applications of cream and hydrocortisone as well,which I have been told is
helpful.I also mentioned that her Md might want to do a culture and that
possibly there could be a bacterial infection,but it really sounds and
looks like thrush and NOW baby has a red diaper rash.

March 8, 5pm   Mom called to say that she was seen and given RX for Difl
ucan X 2 days and refill X2 days prn.Mom states the nipples look a lot
better but she just couldn't stand the deep breast pain in all quadrants
(not so much radiating pain as described in many cases,just burning,on fire
and stinging.)

Denise Ferrell,RN,IBCLC