I don't know how I missed Jayne's initial email, but I've seen some of
the responses on this topic and wanted to throw in my two cents. I had
recurrent yeast and used nipple shields, too. APNO didn't help me
(although I probably used it a total of 6 weeks in two separate
courses.) Diflucan 100 mg qd for 2 weeks resolved it the first time.
Soon after it recurred. Then, I threw out all pacifiers, bottle
nipples, nipple shields and got new. Also, started changing hand towels
in the home daily. Sterilized pacifiers, bottle nipples, nipple shields
daily. Did Diflucan 100 mg qd for 3 weeks. Baby treated with small
amounts of nystatin in mouth with cotton swab, although he never had
symptoms (full doses made him spit up more, which worried me, so I
stopped). Helped, but not 100%. Instead of leaving milk/baby's saliva
on the nipple after nursing, I started rinsing it with the edge of a
clean washcloth and plain water (did not reuse same edge - washed
laundry on hot, including nursing bras). Let nipples airdry (or blow
dry). Allergic to lanolin, so tried aquaphor on nipples, which didn't
help. Tried pure zinc oxide ointment (after each feed/rinse cycle).
Helped a lot! After the three weeks of Diflucan, I continued taking
150mg Diflucan q week untill baby was about 8 months old! Then tapered
that off. Able to get rid of nipple shields for day nursing around 3.5
months, for night nursing by about 7 months. Nipples still get
increasingly sore about once a month (baby now 15 months old) and I take
150 mg Diflucan. I continue to have to rinse and use zinc oxide after
each feeding (if I miss for more than one or two feedings, nipples are
sore again). I wonder why the monthly diflucan helps. Here is my
theory: my nipples (now) don't acutally have a yeast infection
(although I believe that they did early on, which stabbing breast pain,
severe nipple pain, etc). I believe that my skin is super sensitive for
various reasons. The friction, moisture of nursing, coupled with
enzymes in baby's saliva (why the rinsing works and the barrier of the
zinc oxide?) is too irritating for my skin. Couple that with the fact
that people do get yeast colonization in the gut, which may kick up my
immune system a smidge. I wonder if killing the yeast in the gut allows
the immune system to calm such that the nipple irritation from nursing
isn't as provacative for my system.
Also, baby and I take daily probiotics, since the second round of diflucan.
I hope that some part of that rings true for your client and helps her.
Sincerely,
Rachel Bittker, MD
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