>She is now to the end of treatment of diflucan(has 2-3 days left)and she
feels the same burning coming back.  I have searched the archives but could
not find anything about diflucan NOT working.  She did feel that it worked
for a short time(about a week).<

I'll just jump in while everyone in N America is still asleep....

You don't mention what dose or length of course of diflucan was given.  Here
in the UK I have heard of all sorts of combinations and lengths of courses
(including a one-off dose).   The fact that it worked at all is an
indication that you are on the right track.  (We get a lot of complete
misdiagnosis of 'thrush' here in the UK which does not respond -- becasue it
isn't thrush, or is only partially thrush.  It is a difficulty with
positioning and attachment -- this needs to be considered and reconsidered
in every case of thrush, imo.  If there is some improvement with drugs, then
sometimes the rest of the discomfort is due to poor attachment.  If there is
some improvement with attachment changes, on the first intervention, then
sometimes the woman can more clearly feel types of pain/discomfort which are
diagnosable as thrush.)

Was baby treated concurrently?  Has she used all the self help measures
(boiling nappies bras and towels, scrupulous hand washing, acidophilus,
sterilisation of any teats, dummies cups etc [and tossing after a week],
avoiding use of milk expressed during period of thrush overgrowth, etc etc
etc.).  Chris Hafner Eaton's article at www.mothering.com goes through all
these self help measures plus lots of herbal approaches.

Bodley, V. Powers, D.  Long term treatment of a breastfeeding mother with
Fluconazole – resolved nipple pain caused by yeast: a case study.  Journal
of Human Lactation 13(4), 1997, p 307-311.  This case study is one where
repeated courses of diflucan were used.

I have just supported someone through a really nasty thrush episode.  She
had had a c section and felt very well -- was out at the shopping centre
about three weeks after the birth....  we talked about the traditions of
giving yourself a rest for 40 days.  The drugs won't work on their own, they
need to be part of a way of addressing the causes and the wider picture of
why thrush has taken hold.  Perhaps you can go back to the wider picture you
have built up in working with this mother and look at some of the things
which need to be thought through again.

All the best

Magda Sachs
Breastfeeding Supporter, BfN, UK

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