Hi Laurie and others who replied in private,
 
This mom has been on fenugreek for a couple of weeks now.  She does have the
wide spread breasts (and slilght cylindrical in shape) and with 8 pumpings a
day, was still only making 30-50mls each pumping.  She can't tolerate having
baby at the breast, even with a nipple shield.
 
The silvadene cream is working in that her nipples are finally no longer
worsening.
She is pumping about 5x a day, and redefining her goals.
I cultured her nipples and dripped milk yesterday.  I also did her nose and
babies nose, but they have no insurance, so we decided to only send off the
the nipple swab.
 
She used APNO for 3 weeks before getting to the States, which has
ketoconazole in it, an antifungal, which should have responded had it been
yeast.
 
Right now we are leaving it at Silvadene cream 2xday, soft shells, lanolin
prior to pumping, pumping when her body tells her to which is 5x a day.
This whole process has been incredibly stressful on them.  Add to the drama
of these nipple wounds:  moving from Japan to US, no insurance, no car, no
house (living with parents), no job for hubby yet, a death in the family.
All in 6 weeks!  Redefining goals is helping to keep them sane!  ;-) 
 
Thank you again to all you who responded.  Please continue to suggest ideas
as they come to you.  I will let you know if anything grows from the swabs.
 
Linda Hill RN,IBCLC
Austin TX
Capital Pediatric Group

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