>I am seeking a variety of therapies/suggestions for management offered to
>mothers who have symptoms of thrush.
Well, Kathy, here it is, quite a formidable piece--the Pat Gima Yeast
Treatment Plan. I'll send you the LC version and at the end is the the
recommendations that I give to the mother.
If the mother calls me early on and the main problem is sore nipples and
some breast pain, I recommend Gentian Violet for 3 days, repeating for a
second 3 days if necessary. If there isn't noticable improvement, then we
go to the Diflucan. I always recommend the complementary treatments,
whether with GV or a prescription antifungal.
Pat Gima
Milwaukee WI
________________________
I had a lot of requests for my yeast treatment plan. I'll admit that it can
be overwhelming. I have developed it over about 5 years while I became the
"yeast queen" of Wisconsin, but I don't know what I would have thought if
someone had handed it to me all at once. So don't go screaming and throw
it in the fire yet. A lot of this post is for explanation and the "simple"
part at the bottom usually seems managable to the moms, especially with
their very sore nipples and especially if they are committed to continuing
to breastfeed.
We always have yeast in our bodies. It lives in harmony with the bacteria
throughout our system. When our immune systems are compromised or when we
take an antibiotic, the bacteria is killed off and the yeast grows
excessively. This is a "yeast infection" or yeast overgrowth. The goal is
not to get rid of the yeast permanently but to restore the healthy balance.
Any yeast infection--nipples, feet, mouth, vagina--is always systemic, as
the yeast/bacteria ratio is out of balance in our GI track, so topical
treatments must be accompanied by oral treatments. This explanation makes
it easier to follow
all of these instructions.
One of the hardest parts for moms to follow (until she has had a
recurrence) is that the accomapnying treatments MUST BE CONTINUED FOR AT
LEAST 2
WEEKS AFTER ALL SYMPTOMS ARE GONE. The balance is tenuous until the
bacteria colonization is secure. In advanced cases I recommend one month of
the complementary treatments.
>From our MDs on Lactnet and from my personal experience, I have adopted the
following treatment:
Diflucan--200mg loading dose on day 1
100mg-150mg following for the next 13 days
Baby can be treated with Nystatin. It's not too good, but it is what peds
usually use. The prescription usually says every 6 hours, but yeast grows
back in 1 1/2 -2 hours. I recommend treating every feeding with half the
amount recommended. Just squirting it in the cheeks doesn't do much, so I
recommend rubbing it around with a finger. This should be continued for 2
weeks after all symptoms are gone. Often baby needs two bottles before it
is resolved. Swallowing it will help control the yeast in the GI track
while the helpful bacteria is restored.
If baby has yeasty diaper area (red around anus) then a Nystatin cream is
good, as is Desitin, which has zinc, an antifungal. Mom should not use
"wipes" as they have substances that are favorable to yeast growth. She
should have a bowl of 1 C of water with 1 T WHITE vinegar added. She rinses
baby's diaper area with this solution after every diaper change, blots it
dry and applies antifungal.
Mother can use a topical antifungal for her nipples. It is thought that a
cream made for skin is preferred over one for mucous membrane (the vaginal
ones). The OTC Lotrimin AF is a topical treatment that is recommended for
nipples by MDs. Some moms are bothered that it says for athlete's foot, but
assure her that it is the same as what a pharmacist would prepare for her,
and that it has never been on an athlete's foot. :) Also, by prescription
is Lotrizole, with antifungal, cortozone, and antibacterial for seriously
damaged nipples. She should rinse her nipples after each feeding with the
vinegar/water solution, blot dry and add her antifungal cream. Vinegar
doesn't kill yeast but it creates an environment that is in-hospitable to
yeast growth. Before the next feeding she can rinse her nipples with clear
water.
Now, Mom can take all of the antifungals that she wants and the yeast will
be killed off, but it will return in a few days unless she recolonizes her
intestinal tract with proper bacteria. When there is ductal or nipple
yeast there is always systemic yeast overgrowth also.
I recommend:
Acidophilus capsules--It must be the refrigerated kind found in a health
food store and kept in the refrigerator at home. I like Natures Way
company's Primadophilus or their Primadopilus and Bifidus combination or
DDS Acidophilus, but there are other good ones. She takes 5 a day,
continuing for at least 2 weeks after all symptoms are gone.
Baby needs to recolonize his intestines too. Mom can open one capsule of
acidophilus and sprinkle about 1/4 of the contents onto a wet finger and
spread in baby's mouth. Or she can buy a separate bifidus for him. The
combination is good
for this use. (Bifidus is the "good" bacteria that is in a breastfeeding
infant's gut.)
I sometimes recommend Echinacea as an immune system booster unless mom's
eyes are glazed over with all of this strange stuff. I use the tincture,
which is more concentrated and recommend 3 droppers full a day. But if
acidophilus is new to her I usually leave off the Echinacea and just rely
on garlic and sunlight.
Whole grains are better than processed when working with yeast overgrowth,
but again, I evaluate the mom's capacity to adapt. Sometimes I add a B
complex (yeast free) to the plan.
Some people feel that city water that has chlorine in it kills off some of
the good bacteria that we are trying to colonize. Mom can either drink
bottled water or she can let a pitcher of water sit out overnight and the
chlorine disapates.
Garlic, which is antifungal and an immune system booster. Most Americans
don't eat much garlic, so I recommend a good odorless capsule. Either Kwai
or Kiolic brands, that can be found in any pharmacy. She will take 6 tabs
of Kwai or 4 capsules of Kiolic a day. And this is also continued for 2
weeks after all symptoms are gone.
Moms often tell me that they can't remember how many they have taken, so I
suggest that they put the desired number of acidophilus and garlic tabs in
a bowl in the fridge (acidoph. must be kept refrigerated) and then they can
be sure that they take enough. They should be spaced throughout the day.
If mom uses breast pads she should use disposable ones and change at each
feeding.
A new product that I am finding good for sore nipples is hydrogel dressing.
It is located in the pharmacy in the firstaid section near bandaids. One
common brand is Second Skin. It is a thin plastic rectangle that has a
genatinous watery substance on one side. Mom cuts it to fit just a bit
beyond her nipples, places it on with the watery side toward the nipple.
Then she holds it in place with a breast pad.
It is very soothing and keeps any anti-fungal cream from being rubbed off
on a breast pad or bra. She can use it for several feedings before
changing it. The Second Skin comes with 4 packs and the mothers I have
used it with cut them in half. So your client would want to buy several
packs.
If the doctor refuses to treat with Diflucan I have had women recover with
the other treatments in cases where the yeast overgrowth isn't too advanced.
Mom will need to take this yeast problem seriously and, if you explain that
it is
systemic, she will be motivated to treat her whole body. Here is the plan
laid out more simply and what I give to my clients:
Treatment for yeast overgrowth in the breastfeeding mother and baby.
Mother:
Nipple or intraductal yeast:
Diflucan: 200mg loading dose day 1
100 mg-150mg a day for 13 days
or
oral Nystatin taken at equal intervals throughout the
day
After feeding:
Rinse nipples with solution of 1 T. white vinegar in 1 C. water
Pat dry and apply antifungal cream
Apply hydrogel dressing, changing morning and night
Take 5 capsules of acidophilus evenly spaced throughout the day. I
prefer either Nature's Way Primidophilus or DDS Acidophilus.
Eat a lot of garlic or take odorless garlic capsules. 6
tabs of Kwai or 4capsules of Kyolic spaced throughout the
day. These garlic procucts can be found in most drug stores.
If you have trouble with remembering whether you have taken enough of these
products you can count them out in a cup in the morning and it is
easier to space them out. Remember to keep the acidophilus in the fridge.
Diet:
Reduce sugar to a minimum and use NO artificial sweeteners.
Eliminate dairy products until two weeks after all symptoms are gone.
(Dairy products do not include eggs, but products that come from cows milk.)
Infant:
Oral:
After each feeding (or every 3 hours) apply antifungal solution to
mouth, gently rubbing it around to cheeks and gums. I suggest
squeezing the solution into a small cup then dipping your
finger into it.
3 times a day, open a capsule of acidophilus/bifidus, sprinkle 1/4 of
contents on wet finger and let baby suck finger.
Diaper area:
Rinse with each diaper change with white vinegar/water solution
Apply antifungal cream.
Do not use baby wipes. Use clear water for clean-up of bm, then
rinse with the white vinegar solution.
The following should be continued for at least 2 weeks after all symptoms
are gone:
White vinegar rinse for nipples
Antifungal cream
Acidophilus for mom and baby
Garlic
White vinegar rinse for diaper area
Nystatin cream for diaper area, or if you run out, Desitin will do.
The routine does get easier as you grow used to it.
And Sunlight is a good treatment for yeast overgrowth. Sunlight on nipples
and baby's diaper area is helpful, but even a walk in the sun or sitting in
an sunny window helps also.
Also Fun. Try to remember what brings you joy, and do it. Laughter or
relaxation or things that make you smile will boost your immune system and
help your body to return to a state of health.
_____________________________
To LC:
This is a lot to digest, and some things are more essential than others and
each mother is diffferent in the health of her immune system and her
emotional health. But, the "simple" treatment plan is what I consider as
minimal for resolution. I'm sure that some mothers recovered without doing
all that I recommended but this is what I give them.
Patricia Gima, IBCLC
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