I'm back on lactnet after way too long off it, and of course I'm back with a
puzzle.

This mom had assorted difficulties establishing breastfeeding with her
first:  thrush, plugged ducts, mastitis, oversupply.  Once it was all
resolved she went on to breastfeed for at least a year.

That was three years ago.  Her second child is nearly a month old and she's
still battling... well, *something*.

She has overcome initial latch problems, and the baby now creases the far
edges of the nipple base *very, very* subtly, with no other deformation or
elongation of the nipple.

Both nipples are eroded at the tip - wounds about .3 cm across.  They're
clean-looking, but eroded and not healing.  Occasionally one bleeds when she
pumps.  Pumping hurts less than nursing, but isn't fully comfortable.
Taking three days off to pump exclusively brought some healing, but the
tissue broke down again with a return to nursing, even though her nipple
leaves the baby's mouth appearing virtually unstressed.  Some latches are
more comfortable than others, but she never sees compression or shaping,
beyond that very slight crease that wouldn't bother most mothers.  She hates
pumping, but pumps for some of his feeds and is considering another stint of
exclusive pumping.  As before, she has an oversupply.

She has occasional shooting pains or tingling in her breasts.

She had 2 weeks of Diflucan followed by almost a week so far of Keflex, with
no improvement.  The Keflex was begun about 2 days before the end of the
Diflucan, so there wasn't much overlap.  I'd have felt better if there had
been, just so she could have had a one-two punch.  She's taking acidophilus
and has been using APNO for about 3 weeks.  Nothing has made a difference.

Her doctor says they can't do a culture until she finishes the Keflex.  I
don't quite understand that; if it's an organism that isn't sensitive to
Keflex, does it matter?

I have a call in to the Cornell Dairy Mastitis Lab to see if they can do it
sooner, or if they have additional thoughts.

Is there anything we're missing?  Am I right in thinking that anything
mechanical would show up in some deformation of the nipple when it's
released, and that we're dealing with some sort of infection?  Does it make
sense to go back on Diflucan, whatever else is done?

--
Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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