Michelle,
It does sound like yeast to me (because mom gets better when using
diflucan).  I find that it is harder and harder to get rid of yeast
symptoms these days, especially when not treated thoroughly the first
time.  While diflucan works for many mothers, I have found that some
women respond better to alternative forms of yeast treatment.  In order
to get complete relief, mothers need to incorporate dietary changes into
their daily routine which balances the candida with good bacteria that
keeps their intestines healthy.

Many of the mothers I have worked with get much better when they
completely eliminate all forms of sugar from their diet.  I usually
suggest that a mother start with a complete sugar elimination diet for 2
weeks.  Almost immediately mothers will say to me that they "crave"
sugar and eat it all the time!  That's a big clue.  A yeast overgrowth
will cause you to crave sugar because yeast thrives in a warm, "sweet"
environment.  I include fruit juice as part of the elimination diet as
that is also a concentrated form of sugar.  After 2 weeks without sugar,
mothers usually feel much better and I encourage her to continue without
sugar for an additional 2 weeks.  It takes lots of support to help them
stick to this diet, but it works!  I also encourage mom to eat a lot
more green vegetables and salads during this time.

In addition, I recommend that mom gets on a good probiotic---one that is
purchased from the refrigerated section of the health food store.  Mom
should take the probiotic (which contains both acidophilus and bifidum)
for at least 6 weeks, following the directions on the bottle.

I also suggest that the mother pick up some Candida Cleanse while she is
at the health food store.  Candida Cleanse is made by Rainbow Light and
is found in the "yeast fighting" section of the health food store.  I
believe it can also be ordered online.  Mom takes the Candida Cleanse
(one tablet per day) for 30 days.  In very persistent cases, I suggest
that her partner also take one tablet per day for 30 days.  Most
partners are willing to do anything for 30 days in order to eliminate
all the complaints from a nursing mother with painful breasts!  If you
think about it, sharing bed space with another individual involves being
physically very close and breathing in each other's faces etc.  Pillows
and linens can also be a hiding place for yeast.  I try to treat as many
obvious sources as possible.

Mom is treated topically with APNO for 2-4 weeks and baby gets either
oral nystatin or gentian violet.  (I only suggest gentian violet for the
baby for 4 days.)

Family hygiene and the proper cleaning of pumping kits and bottles are
also addressed during this time.

If all of the above suggestions do not bring about a remarkable
reduction in pain within 1 week, then I recommend that the mother
eliminate all grains (especially wheat) from her diet.  This is much
harder to do than the sugar elimination.  Grains are quickly converted
to insulin by the body and yeast feeds on sugar.  That's why this
extreme step is necessary in some cases.

I know that all of these dietary changes sound overwhelming, but a happy
breastfeeding mother will gladly tell you how her life has changed as a
result of being able to nurse her baby pain-free!

Janet Talmadge, IBCLC
Naperville, IL

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