In the Orlando area I have finally gotten some physicans to treat
mother and baby simultaneously for yeast but I still get many missed cases
that end up in my office after the OB or ped has basically told the mother
you just have to live with it. Last week was a really trying one and when I
saw two patients in the OB office. He agreed to prescribe diflucan for the
less involved case but refused for the woman who had been suffering for three
months (seen by their office staff and mds at least 3 times during this
period). His reason was basically that they had pegged this woman as a "pain"
starting with her refusal to wean her toddler during pregnancy. I proceded to
put my jock itch curse on him behind his back. I am not on their staff I just
use a room in their bldg.
      I have given out Kay Hoovers sheet, copied  articles, pulled them into
my office to see obvious cases but I am still the only person that knows (or
cares?) what yeast on the areola looks like. Is there any test that can
quickly and acurately DX yeast? My assistant said she heard of a litmas test
from K Hoover but didn't have details and I'm sure there must be a way to
accurately confirm this. And after seeing Diflucan work so well in some
clients- what criteria do other LC's use to decide what treatment to
recommend- topical or systemic? Also if using diflucan what would be side
effects to watch out for? I also am at a loss when a mother who has been
suffering asks me why I am the only one who picked up on this, especially
when her OB refered her to me-I don't want to make enemies but isn't this
documented enough?
       I think with everyone in my house sick and changes in my practice -I'm
losing my usual good humor!
       I also wanted to ad that in my practice I have had one mother and one
infant that were hospitalized with an abcess following mastitis as a baby in
the early weeks of life. The mother still has a scar but it did not seem to
affect lactation, the baby was an adoptive baby in foster care and was so
sick she was in the hospital 2+ weeks.
       TIA for any info on the above- Debby Kearney IBCLC in sunny but cold
Disneyworld