Dear Lactnetters;

I wanted to update you on a mother I wrote about recently.  She originally
came to me with painful breasts, sore nipples, a baby who (4.5 months) was
tugging and pulling at the breast despite an adequate milk supply.

She had a red, tender area on the right breast and reported feeling generally
unwell.  I suspected two things, mastitits and a yeast infection.  A
colleague felt she had nerve damage from the baby's tugging and pulling but
did not feel there was either infection or yeast.

Mother was treated for a breast infection with 10 day of dyclox.  Mastitits
symptoms were resolved but mother continued with breast pain and sore
nipples.  One breast became puffy with no lumpiness or redness or warmth.
 Someone on Lactnet reported that this could be the yeast.

I suggested she begin treatment for yeast at the end of her antibiotic
treatment.  She spoke to the doctor who perscribed mycelex trouches.  After 5
days she called me back, no improvement.  When I realized what she was taking
I suggested she call the doctor and ask about changing to diflucan.  Which
she did, 200 mg, day 1, 100 mg day 2-10.

Mother got immediate relief on day one and we thought we were on the right
tract.  Baby then presented with a flaming yeast diaper rash.  Mother
continued at 100 mg per day for 4 days at which time the swelling was reduced
but the pain returned and she presented with a major vaginal yeast infection.

At this point I called a doctor who is knowledgeable about this after a
 discussion with a fellow LC.  He suggested that the dosage may need to be
increased to 400 mg the first day and 200 mg each addl day and that it may
take two rounds.

This mother is going wild!  I sent her out to get "The Yeast Connection" by
William Crook and have tried to be reassuring.  Any insights?  Comments?

Second case - a mother with flat nipples, baby nipple confused and very
opinionated.   Baby went to breast briefly then refused the breast and
screamed, arched, turned red, etc with every attempt to put her to breast.
 In despiration I tried a nipple shield with limited success.  Mother was
extremely engorged when I saw her initially on day 4.  Sent her home with a
pump and the nipple shields and suggested, ice, warmth before pumping every
2-3 hours and try to woo the baby back to breast using the nipple shields if
necessary.  Come back and see me on Monday (this was a Friday).

Monday mother comes back with scabby, mascerated, bleeding nipples.  Baby has
never been to breast, mother is pumping with a lightweight, rental pump, one
side at a time.  I have seen this one other time and suggested she begin
treating for thrush as that is what was responsible the last time.  We went
over pumping proceedures and all sounds appropriate.  Any other ideas?

Denise Parker, BA, IBCLC