Currently treating a 39 yo mother of four children -fourth born 10 years
after the last. She came at 5 weeks with severe breast pain during and after
the nursing -burning and stabbing.  Going over the first 5 weeks she had
already had sore nipples from the beginning, at least one bout of mastitis
treated with inadequate antibiotics (amoxicillin) and then with cephalexin
that she was taking for an infected toe. On physical exam she had plugged
ducts at 3 and 6 oclock on both breasts. Baby latched on well and held with
good position. It sounded like a classical yeast infection so I gave
fluconazole as well as soaks and massage to the plugged areas. After two
days she felt much better. She then developed the beginning of mastitis in
one breast (local redness and pain over one of the areas that had been
plugged)- treated again with dicloxacillin. (she was still on the
fluconazole) By the next day she was back to pain in both breasts, burning
and getting worse. I have suggested a higher dose of the fluconazole boiling
all artificial nipples (I first suggested not using these but haven't
succeeded there). She is crying and about to give up on the nursing.  All
advice gratefully accepted. Could this be something other than yeast? If so
what and what can be done to help reduce the pain?
TIA

Deena