PTP

First time Mom presented with inverted nipples, no medical hx, no allergies.  Baby was able to latch well on one side, poorly on the other causing significant amount of trauma to the nipple.  Latch issues resolved, nipple healed relatively well with use of lanolin and APNO, but Mom was just dx with thrush on rt nipple only.  This is the more inverted of the two and is not dimpled as her other inverted nipple (and other inverted nipples I've seen), but the face of the nipple has a deeper red circle between the external shank of the nipple and the central portion where the ducts terminate.

For thrush, Doctor prescribed diflucan, continued use of APNO on the nipple, and monistat on the areola with instructions to wipe monistat off before feedings.  3 days later, the areaola is looking and feeling better (white patches on areaola are gone), but the nipple is still burning and sore with no difference between pumping or nursing on that side (Doc suggested pumping may relieve some of the pain).  APNO applied to the nipple is increasing the burning sensation.  Mom is continuing the diflucan (2 more doses and a recheck at doc's on Monday) but this rt side nipple pain has been going on for a total of 6 weeks between the initial latch problems and then the thrush and it is clearly wearing on Mom.

We've discussed Newman protocols, but Mom wants to follow doc orders and not do the gentian violet or GSE.  She has made up some garlic infused olive oil to use directly on the nipple in lieu of the APNO to see if that helps with the burning.

I'm wondering if there's something else both the doc and I are missing here.  Maybe something specific to they type of inversion she has and the red ring around the termination of the milk ducts?

Thanks!
Jillian Malan, LLLL, IBCLC
 Michigan

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