In response to Marie's query about thrush and persistant sore nipples.

Had a mom who came to my drop-in with sore nipples. NICU nurse.  Babe 6wks.


Thrush diagnosed 1 week previously.  Was treated with Nystatin (soln/babe)
and Nystatin (cream/mom) with no relief.

One week into tx, nipples still sore.  She saw another pedi who told her to
use the nystatin soln on her nipples. So she did and they got a little
better.  But not completely and that's when she came to see me. She thought
I should check the latch.

She c/o shooting pains up into her breasts and vasospasms in her nipples
few minutes into nursing which lasted 15-45 minutes.  I didn't see the
vasospasms altho she nursed both brsts x 15+ min.  Baby nursed great, latch
great and baby's mouth was clear, wt. gain good.  Nipples looked OK (mom
said they had been BRIGHT red but were normal/pink now) and she had gotten
some relief from the Nystatin soln since she began using it.

Told her to continue with the Nystatin tx since there had been some
resolution.   If no further relief by the next clinic day (3 days hence) to
go back to her Ob/Gyn NP who might give her Diflucon for ductal yeast. ( I
had sent lots of materieal to this NP-sorta setting her up).

Two weeks later, she is on 3rd bottle of Nystatin.  2 weeks of Diflucon
cleared up the shooting pains but then her nipples became inflammed and
painful again. Thrush in the baby's mouth again. Vaso spasms decreasing
slightly.

She went to see another Pedi who said, "Oh, you are looking for the magic
pill!"  Gave her Rx for Clotrimazole.  Mom crushes the pills and disolves
in water and swabs baby's mouth and her nipples after each feed.

After 2 applications, a marked difference in her nipples!  Baby's mouth
seeminly beginning to clear.  But vasospasms still occurring, mainly in the
evening.  Tried to reach her today after a full day's+ tx but she wasn't
home.  Will let you know.

Also, a friend gave her a bottle of Phellostatin - 3 tabs daily. ( "an
antifungal, tonic for spleen and stomach")  An herbal/homeopathic Tx for
thrush.  It contains phellodendron, codonopsis, attactylode, anemarrhena,
plantago, pulsatilla, capilaris, cnidium fruit, houttuynia, dioscorea,
licorice, cardamon.   PHEW!!!  I suggested she not take that yet, to give
the clortrimazole a chance first before putting unknowns into her system.

Has anyone used clortrimazole in this way for resistant yeast??  Anyone
heard of Phellostatin???  Also, as we (4 nurses - me, the mom, the mom's
friend, Maggie Lang my back-up LC) were talking, we identified about 5
nursery/peds nurses who had had resistant thrush infections.  A connection
between hospital work and the more resistant yeast strains????

Christine Palmer,  Mill Valley CA