> This is her 3rd baby who is now 5 mos. old. Baby is fine, no diaper =
> rash, growing well, latches great (has a cold right now).  Mom has no =
> visible problems with her nipples.  She states after 5-10 min. after BF, =
> her nipples burn and sting (no blanching) sometimes and her breasts feel =
> sharp stabbing pain which is making it hard for her to function in the =
> family.  She has had 3 cases of mastitis with this baby.  Dr. thought it =
> was thrush so she was on 200mg. of Diflucan for 5 days. (not enough, =
> right?)  She also used gentian violet.  >

 This sounds like breast thrush to me - radiating breast pain after feeds, 
probably following antibiotics for mastitis. I wouldn't  expect 
costochondritis to cause pain so closely related to feeds. It is worth 
considering vasospasm - but by definition, there must be colour changes of 
the nipple. She may need to check her nipples for colour changes. Is it 
worse if she is cold? Does she tend to have cold hands/feet?
Did she get any improvement with the fluconazole? Was the baby treated as 
well? Does she have a past history of thrush (yeast)?
If she noticed some improvement with fluconazole, she may need more. If no 
change with fluconazole, she could consider ketoconazole instead (in case it 
is non-albicans Candida).
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia 

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