Dear Netters,

I have been a frequenter of Lactnet on and off for several years and
have posted now and then. Please offer any feedback or help in response
to the situation of a mother I met at our LLL meeting this week.  I
apologize for the length of my post.
This first time mom of a three month old boy has suffered terribly with
persistent yeast, fore and aft, since the birth of her baby.  She is
highly allergic, especially to milk, and has had recurrent vaginal yeast
infections throughout her life.  Fortunately, she herself was breastfed.

From birth, her baby, though gaining well, pooped very infrequently.
Mom says it took one month for the meconium to clear.  The pediatrician
was so concerned by this, and by the baby's colic, that he told the
parents he suspected Hirschprung's disease.  When he said he needed to
take a section of the baby's bowel in order to make a firm diagnosis,
the parents got a new pediatrician!  The new pediatrician felt that,
though baby was pooping infrequently, all other signs pointed to good
health.  Focus turned to yeast.
This recent vaginal yeast has been so severe that the mom can't even sit
or walk without terrible pain.  She also has pink, flaky, though not
particularly sensitive, nipples and shooting deep breast pain.  The baby
has a diaper rash.  Baby has nystatin oral suspension and cream, as well
as hydrocortisone cream.  Mom  has been taking diflucan, at first only
three doses (200 mg each).  Two weeks later, another three doses.  Two
weeks after that, her doctor put her on diflucan, 200 mg per day, for a
month.  On this longer course of diflucan, the mom feels that the yeast
has been brought under some control, but she and her baby suffer
occasional concurrent flare ups.  The doctor feels that since the yeast
has not resolved, it must not be yeast, and wants to stop the diflucan.
The breast milk has been cultured for both strep and yeast, and came out
negative for both.  I think I remember reading that cultures can be
falsely negative or positive.  Is this true?
To make matters even more weird, the mom went to a hand specialist for a
type of tendonitis called "cubital" and the specialist told her it
wouldn't get better until she stopped breastfeeding!  Can anyone
enlighten me on this, as well?
Back to yeast--Mom believes stopping diflucan would be taking away the
only thing that has ever even marginally helped.  She feels that she
will have to stop breastfeeding if the diflucan stops because she cannot
endure the severe yeast she believes will recur.  She is aware how
important it is for her baby to have breast milk in light of possible
severe allergies, and was near tears telling me this.
Mom wonders how long she can safely be on diflucan.  Her doctor believes
that this long term use of diflucan could cause liver damage.  I have
read on Lactnet that Tom Hale recommends up to 12 weeks on 200 mg/day if
yeast recurs after initial 400 mg loading dose and 28 days of 200
mg/day.  Mom went to Tom Hale's website and found information about
diflucan and it's safety, but this isn't enough for the doctor.  Now Mom
is wondering if she should change doctors!
The mother says she has had liver enzymes checked both before and after
being on the diflucan, (not sure why before--maybe as a baseline for
monitoring?) showing a better assessment after being on the diflucan.
Mom uses good handwashing and boils and throws away pacifiers.  I
suggested more preventive measures, vinegar rinses and bleach solution
for household surfaces.  I suggested dietary changes.  I suggested
treatment for the baby's father as well.  I told her that yeast may not
resolve completely for several weeks, and that treatment should not be
discontinued too early.  I have either talked with her about, sent her
or referred her to everything I have learned about yeast including
everything I've learned on Lactnet, and I believe she will be trying
these.  I hope to be getting copies of the information from Tom Hale's
book to send to her.  Unfortunately her diflucan is ending tomorrow and
she is truly fearful of the yeast that will come down on her and her
baby at that time.

Is there anything I am missing?  Or is this a case of stubborn doctor in
the face of tons of evidence?

I appreciate your help immensely,
Diane D, LLLL from VT

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html