Hi Judi,
The burning, shooting breast pain after feeding certainly sounds like
thrush. It would help if she took oral antifungals as well as topical. In
Aust, we can prescibe fluconazole 150mg caps (which cost about A$35 each!),
so I will usually space them out - take one and then another 3 days later
and until pain gone. Or nystatin caps are cheaper (use 2 caps 3 x per day)
but may take longer to work. Is she also cutting out sugar and alcohol? And
treating the baby?
For more ideas see the Archives and LLLI LC Series Unit 18 on Candidiasis
and Breastfeeding - and the Dec 97 JHL which arrived in the mail has a case
study of a very persistent breast thrush.
Yes, I think thrush can infect the breast in pregnancy too. Usually I have
seen this in women who have had thrush in a previous lactation and the
sypmtoms flare up during another pregnancy. They can take oral nystatin
safely (one dose of fluconazole is safe in pregnancy, but it would be
prudent not to take long courses during pregnancy). If your pregnant
patient is a primip, maybe wait a bit and see if it settles. Sometimes very
fast breast growth will cause pain.
BTW, perhaps I should mention that the authors of the LC Series do not
benefit from sales of this publication. (Actually it is a labour of love
-like so many things related to breastfeeding. The authors spend a lot of
their own time and money on long-distance phone calls, faxes and postage.
It is touching when people show their appreciation of the work. I do wonder
though if we could have at least received a decent number of copies and
perhaps a thank you note from LLLI? I am very grateful for Bev Rae bringing
copies from NY to Melbourne on one of her trips, because the publishers
never acknowledged my orders).
Lisa Amir
GP / IBCLC in Melbourne, Australia - feeling hot and irritable today!