The thing that interested me about Martha's complicated case was the
combination of breast pain that didn't respond well to anti-fungal therapies
of all sorts (just eventually went away) and low milk supply.  I suspect
that the woman had a low-grade breast infection of bacterial origen.
Reduced milk supply is a symptom of infectious mastitis, as is chronic pain.
I have recently seen a mother whose baby has a medically dx case of oral
thrush.  She'd had very mascerated nipples.  I weaned her to a pump because
she couldn't tolerate nursing, used topical antibiotics, rest etc. and got
nipples healed, re-taught positioning etc.  But when her breast pain
wouldn't go away, my first thought was fungal infection.  I initiated
measures for that, urged the MD to consider diflucan, etc. but also obtained
a milk sample.  Results were bacterial infection.  She never ran a fever, so
that stumped me and would have distracted me from concluding she had
mastitis had the culture not given that info.  In these long-running pain
cases -- esp. with reduced milk supply, I submit that maybe we ought to be
doing more cultures and sensitivities.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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