i am very impressed at the careful attempt to get really specific ducts
cultured by melanie at stanford (does she know about the hand expression
funnel medela sells, and can it be autoclaved? wouldn't be much good if it
couldn't but it sure looks like it makes it a LOT easier to catch hand
expressed milk).

after livingstone's article came out and we had a long discussion of it at
journal club last year, i had two moms that had been treating for thrush
unsuccessfully for quite a while. i ended up recommending that both go on abx
and voila! they saw a rapid resolution of the same sx as barbara describes.

 one mother had been self-medicating for the thrush and using extremely
aggressive measures (not including GV) that caused what looked like
dermatitis to me. her condition began when her toddler bit her during nursing
(she sneezed) and obviously caused a wound, as the mother found a scab a few
days later (she didn't realize the bite had broken the skin as it was under
the breast). when that breast began to hurt she believed it was thrush (she
is training to be a volunteer bf counselor) and treated the skin of both
nipples (to be on the safe side) with various things, including undiluted tea
tree oil.

so she used APNO substitute (best i can do here) and ABX and got quick
relief. second mom had a longer history, vague nipple pain/skin distress that
never resolved, and resolved only a bit with GV. it did not resolve with
diflucan either (appropriate dosages for mom and baby, wow, it was pretty
amazing to have a doctor prescribe without complaint). she then had a course
of ABX and her sx went away.

and thanks so much to cathy f. for posting the procedure for the culture
sample.

carol brussel IBCLC

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