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Subject:
From:
Mari Douma <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 3 Jun 2002 23:17:26 -0400
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Hello all! I have avidly read the recent posts on sore nipples having just
received an email from a student of mine who has deep ulcers on both
nipples-- very painful. The ulcers are on the medial aspect of each nipple,
on the tip and shaft on the nipples. I have passed on the wonderful and very
fortuitous replies everyone had to Nikki's query.

Having read all of these replies, I'm still going to post her situation to
see if anyone has anything to add. So thanks in advance for bearing with me
on posting about sore nipples after everyone JUST wrote really great stuff
on this topic!

My description here is a bit sketchy since we just talked on the phone and I
haven't seen her yet (will do this tomorrow night). Her baby is now 5 weeks
old and this has been going on from the beginning. There was meconium during
the birth and so he was laryngoscoped (possibly momentarily intubated) and
went to the NICU for the first two hours, much to her dismay. She had
difficulties with engorgement and latch and had a pump during this time.
Then she developed a yeast infection (had antibiotics for a perineal tear
infection). This went undiagnosed for 4 weeks and she is now on diflucan.
She is also using APNO and the baby is being treated with nystatin. She saw
a LC who said the latch looked OK at one point. To make things even better,
her baby is tugging at the breast.

In her words: sometimes he will latch on and drink for 3-4 minutes then pull
off only to scream and immediately want back on. This sometimes continues
for 20 minutes or so. On and off. I have tried to force him too stay on by
holding his head, but that just makes it worse. He screams and cries. This
doesn't happen everytime though. But it seems to occur in clumps 3-4
sessions in a row. then fine. back and forth. I thought maybe the letdown
was too fast or too slow, but that shouldn't affect the whole feeding. Maybe
the yeast isn't clearing up? I don't know. All I know is it is 5 weeks now
and I still can't make it through a feeding dry eyed and without intense
pain. Any advice or suggestions would be greatly appreciated! Thanks so much.

The baby is growing fine although is often fussy (has been prescribed
Mylicon and Levsin-I know, I don't like having babies on these meds
either!). Yellow, not green stools.

So, many possible issues here. The only additional thoughts I had included
Lansinoh on top of the APNO and possibly hydrogel, although the yeast
concerns me with both of these options. Tonight, we talked about nipple
vacation and using a pump again. I think that this is probably going to be
helpful. And of course making sure latch is truly OK.

Well, if anyone has any additional ideas, we would truly appreciate hearing
them. Thanks for putting up with a post that has just recently been so
nicely discussed.

Mari Douma, DO
Michigan State University
East Lansing, Michigan

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