I'm behind on my L'net but I wanted to throw in my $.02.  I get calls
similar to this quite frequently -- unresolving or recurrent yeast -- and
they turn out NOT to be thrush in about 99% of the cases.  Unless mom has
ITCHING burning nipples, it's not thrush.  The itching should be the first
thing mom gripes about, so bad that she can't leave the house because the
itching is unbearable (anyone who has ever had a raging vaginal yeast
infection knows "the itch").

I'm willing to bet dollars to donuts that baby's causing the pain and damage
to the nipples, maybe because TT isn't completely resolved, bad positioning,
or baby needs a little encouragement to relax the pressure coming from the
back of the tongue.  Ask mom what her nipple looks like immediately after
baby lets go; if it's the classic new-tube-of-lipstick flat, then baby could
be pistoning the back of her tongue to slam mom's nipple to the roof of her
mouth.  You can tell what baby's tongue is doing by having her suck on your
finger (I wear a glove), pad side up, and envision what the tongue is doing
to create that pressure.  I'm guessing you'll feel the back of the baby's
tongue slamming your fingertip against her palate with every suck, which is
what she's probably doing to mom's tender nipple tips.

Cathy Genna's wonderful book, *Supporting Sucking Skills in Breastfeeding
Infants, *will help both in diagnosis and suggested finger exercises to
retrain the tongue to reduce the amount of posterior pressure.  Meanwhile,
salt water soaks and lots of air-time for the fissured nipple will help her
cope.  If she does show signs of vasospasm from the immense pressure and
temp changes after baby releases, warm DRY compresses immediately following
release of nipple (I like socks filled with rice, like you mentioned)
and rolling the blood back into the tip of the nipple with thumb and index
finger should give her relief.  The vasospasm may take a while to subside
even after the cause has been remedied because the nerves are probably
pretty upset at the abuse they've endured.

HTH,

Debbie Gillespie, IBCLC, LLLL
Tempe, AZ

On Wed, Feb 9, 2011 at 10:57 AM, Jessica Sattler
<[log in to unmask]>wrote:

> I would love to hear any thoughts on this for a friend of mine.  I have her
> permission to post:
> Second time mom, vaginal birth to term, healthy baby girl with tongue tie
> seven weeks ago.  Diagnosed by midwife with thrush, and have been treating
> both mom, then baby for ~4 weeks.  Here are the high points from an email:
> +++++
> Baby:
> -tried Nystation for a short time, then went on Diflucan for about 2.5
> weeks (1 mg/day).  Medicine is about gone now.
>
> Mom:
> -on Diflucan for about four weeks now (initially 100 mg day, then 200/day).
> -taking Natren Healthy Trinity 3 times a day (two pills each time)
> -taking 250g grapefruit seed extract three times a day
> -applying liquid grapefruit seed extract to nipples
> -wearing bras and shirts and using towels only once.
> -rinsing clothing in vinegar during wash
> -applying Dr. Jack Newman’s all purpose nipple ointment after each
> feeding. This contains Mupirocin 2% ointment (15 grams), Betamethasone
> 0.1% ointment (15 grams) and miconazole powder so that the final
> concentration is 2% miconazole
> -taking one capsule of coconut oil per day and using coconut oil for
> any cooking (which isn’t much)
> -each yogurt and grapefruit daily
> -just recently, started avoiding white carbs and sweets.
> -have been attending a weekly breastfeeding support group to get
> assistance. Many of the things I’m doing already were recommended
> there.
>
> Some additional factors are:
> -Breastfeeding started out very rough and we had to cut Linden’s
> frenulum.  I had cracks and bleeding.  The largest crack is still not
> healed.
> -my diet is pretty high in sugar. I was hoping to be able to get rid
> of it without restricting my diet, but it seems that may not be
> possible.
> -as was the case with Soren, the symptoms are clear in me (red and
> sore nipples, shooting pain through breast) but not very visible in
> the baby.+++++
> In a later email she let me know she also has symptoms of Raynaud's, and
> had it also in concert with thrush with her last baby.
> Things I've suggested:-trip to derm to rule out other skin conditions-white
> vinegar/water rinse-warm air dry nipples (hairdryer on warm
> setting?)-coconut oil topically to nipples-warm packs after nursing (rice
> sock?)-B6/ calcium/ magnesium-nifedipine
> My thinking is that since the standard thrush treatments don't seem to be
> working, that the Raynaud's would be the first priority to manage, the
> rationale being that with good bloodflow, healing will happen.
> What am I missing? Other thoughts?  Thank you for reading this long!
> Many thanks!Jessica Sattler, mother/baby RN IBCLC hopeful in 2011!
>
>
>
>
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