I first want to thank all of you who wrote to me with suggestions for my
client who had bilateral nipple abrasions and 10/10 pain with breastfeeding.
She was started on APNO - the first time that had ever been prescribed
locally! - and had immediate relief of her pain, and gradual elimination of
the wound on her left nipple and a decrease in size of the wound on her
right nipple. She reported her pain decreased to 3/10.
Today she reports a return to 10/10 pain, and the LC who is working with her
called me to consult by telephone.
My suggestions are to treat both mom and baby for persistent yeast by use of
diflucan and nystatin, perhaps gentian violet; to consider use of hydrogel
dressings, but first and foremost - work on the latch!  I have observed this
mom feeding: she puts baby up near her breast and he does some nibbling and
licking motions, then latches shallowly - more onto the nipple than deeply
taking in a good mouthful of breast.  When I made suggestions to mom, she
tended to resist them, despite her pain, by making comments about "oh but
his mouth is too small" or "he does not like that position."

Anyhow, if you have any ideas to add to her "treatment" or plan of care,
please email me.  Again, I thank you for your earlier advice!
Ann Marie

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