Hi Camilla,

Wow. Talk about everything but the kitchen sink. This is one dedicated mom.
But maybe this plethora of treatments has become part of the problem.

I would agree with Laurie Wheeler about stopping all the topicals - if this
didn't heal up when she didn't nurse for a month, then something besides
just a latch problem is going on. It is possible that all of these topicals
has led to a really bad dermatitis - was she still using the topicals when
she was not nursing?  Has she been on antibiotics at all?

It used to be that we did not pay much attention to staph epi - it was
classified as mostly a contaminant or normal flora, depending on where the
culture came from (I am also a medical technologist - hospital lab person).
However, these organisms are capable of causing problems in folks with
compromised immune systems and in particular they like to grow on things we
put inside of people, like catheters and heart valves. It is possible that
this woman's nipples have been colonized with staph epi (it is a common
cause of hospital-acquired infections). One of the things that bacteria can
do is form a type of film over whatever is has infected which makes it
difficult for antibiotics or even the patient's own while blood cells to
attack the bacteria. It is also possible that the finding of staph epi on
the nipples represents normal flora and has nothing to do with the nipple
damage. Unfortunately, many staph epi strains have become very resistant to
the common antibiotics and docs often end up having to use things like
vancomycin to treat.

This baby has had multiple incisions for the possible frenulum problems.
Although a surgically resolved tongue tie can lead to wonderful results, it
can also take a long time for the baby to alter established sucking
patterns. I would continue to concentrate on latch and using gravity, such
as laid-back positioning, may help a baby that is having problems
maintaining an open-jaw attitude while nursing. It will also help with the
oversupply effects as the milk can just leak out if baby opens a little
wider rather than using a clamping motion. However, considering the baby's
age, again, ingrained habits have been established. It may take time.

One other thing is that I would make sure that this mom is taking care of
herself and her immune system. Is she getting enough Vit. D?  Several
thousand units a day wouldn't hurt. Astragalus is probably one of the best
herbs for boosting the immune system. She should be eating plenty of
colorful fruits and vegetables for antioxidants and vitamin C. And B
vitamins are good for stress, which she obviously is under.

The dermatology consult will be interesting. Perhaps it will shed needed
light on the situation. Let us know how it goes.

Sharon Knorr, IBCLC, NY

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