<...I examined her breasts and nipples--no "obvious" signs of yeast, no
cracking, blisters, scabs, redness or blanching. The baby latched on
beautifully and got 2 ounces in a sort of "snack" nursing. The mom did not
express feeling any pain. He was smiling and content and gaining weight. I
did not see any more evidence of thrush in his mouth, and he had only the
barest "suggestion" of a diaper rash...>
Kirsten,
I agree this is a confusing story.
Is she still experiencing pain? You said she "did not express feeling any
pain"; she says <We treated it with Diflucan for 2 weeks and nothing
happen.> What does she mean? We need to know more about the pain: in the
nipples (one or both?)?, when?, how long?, in the breasts? how does she
describe it? how severe (I use a scale where 0 = no pain and 10 is the worst
pain you've ever experienced), what makes it better? worse?, do the nipples
go white?
And has the baby got thrush? She mentions a fungicide cream for his "rash".
I would expect some improvement with 14 days of fluconazole (Diflucan). Does
she really mean there was no improvement? I wouldn't expect a difference in
using 150mg or 200mg daily.
I would be thinking:
- maybe she has had some improvement with the fluconazole, but it isn't
completely better (and this is causing her anxiety)
- maybe it is candida - but not C. albicans; if it is C. glabrata it is
resistant to fluconazole and she might want to try ketoconazole (Has she had
cultures taken from the vagina during the pregnancy?)
- maybe it isn't candida, but something else - ?vasospasm, (I guess you've
ruled infant problems like tongue tie or attachment difficulties).
When women say they get vaginal thrush ever time they have intercourse, it
does not necessarily mean they are getting infected each time. Sometimes the
candida is always present and just flares up with the act of intercourse
(think how the nipple pain flares up after feeding - thrush is there all the
time but pain is worse after the baby sucks). Sometimes it is not candida at
all. It may be vestibulitis or another vulval problem mislabelled as
"yeast".
<...What also concerns me is that she reports that she is losing weight and
frequently expressed concerns and worries about her son's health both to me
and to my colleague..>
I would agree with others that this may indicate anxiety / depression. I
find that when women can't be reassured about their baby's health / their
milk supply/ etc that there are often underlying issues. She may welcome the
opportunity to talk to a psychologist or some one similar about the
situation.
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia
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