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Subject:
From:
"Shaver, Sonya (VDH)" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 10 Aug 2010 09:59:41 -0400
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Hello all,
I am new to the list and would like to ask for help on an issue.  I am
working with a mom who has given me permission to ask for help here.
She has been having persistent, severe nipple pain since birth (started
on the very first day of life), and I don't know what to do next to help
her.  This is a mom who is very committed to breastfeeding, yet the pain
is so severe that she has contemplated weaning because of it.  The baby
is almost 3 months old now.  The mom had antibiotics one week before the
birth. I did not see the mom until the baby was almost 2 months old, but
at that point I helped her with latch and positioning, but it did not
help that much.

She has symptoms that would point to thrush, however, none of the
treatments she has tried has had any effect.  The other complicating
factor is that it seemed to me that the baby had a high palate, and I
wondered if she might have a possible tongue tie that was not easily
seen.  The baby made a clicking noise while nursing that the mom could
sometimes stop by adjusting the positioning and latch some, but it would
always start again.

Her symptoms are:

--nipples are very red, but not cracked or bleeding
--pain is worse at the beginning of a feed, often lets up as the feed
goes on, but sometimes persists throughout the entire feed; pain feels
like ground glass, pins and needles
--nipples are very sensitive, brushing up against something for example,
is incredibly painful
--pain is now described as deep breast pain also

This is how she described her symptoms to me just before the baby was
two months and she reports they have not changed.

Early on, the mother took two oral doses of Diflucan, one week apart,
for the nipple pain, but there was no change as a result of this.  She
then started doing the Jack Newman candida protocol, following it in the
stepwise fashion of starting with the topical treatments first.  She
used:

--oral GSE (125 mg bid; brand: Nutribiotic) and topical GSE 
--oral probiotics for mom and swapping probiotics inside baby's mouth
(Klaire labs brand)
--All Purpose Nipple Ointment, compounded according to the protocol


There was no change after two weeks.  She was not taking the oral GSE at
the full dose suggested in the protocol.   She then increased the GSE,
and tried the Diflucan again, this time doing a 400 mg loading dose and
100 mg bid for two weeks.  Around Day 10, her nipples became slightly
less sensitive, and she was able to wear a shirt for short periods
without a bra and not having the intense pain when her nipples brushed
up against the shirt.  This only lasted for a couple of days.  On Day
12, the baby was evaluated for tongue tie by an ENT and had a frenotomy
for a Type 3 or 4 tongue tie.  On the same day, mom's nipples became
even more sore again, and this has persisted.  She stopped the Diflucan
on Day 14 because there had been no change at all in the pain.

The baby still often makes the clicking noise while nursing.  On
Thursday, July 29, the baby started drooling a lot (this was five days
before the frenotomy).  She has also been sucking her fists a lot more.
In the past week, she had also started sucking her tongue on the roof of
her mouth even when she is not nursing, the mom reports.

The baby has never been treated for thrush (except for getting
probiotics swabbed inside the mouth, and getting some of the Diflucan
through breastmilk when she took it for two weeks) and has never had any
symptoms of thrush.  The mom is doing some tongue exercises with the
baby since the frenotomy (which has been one week now).

I would be very grateful for any advice you have.  I know that some say
that there might be a bacterial infection involved and not yeast, but
how would that be determined, and where can I get information to take to
her health care provider about what to do to address that?  Is this
something they would culture?  Does she need to see a dermatologist?
Many thanks in advance for any suggestions, and thanks for reading.

Sonya Shaver, BS, CHES
WIC Breastfeeding Peer Counselor

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