Hi everyone,
        I need to do a reality check.  I am awake in the middle of the night reviewing cases in my mind, I've even been to the textbooks, now lactnet.
In the past week or so there has been a huge increase in the number of clients coming in with symptoms of nipple/breast yeast.  One day last week almost every patient I saw  had it (even the relactation case both mom and baby with terrible oral thrush!).  It makes some sense that this would increase seasonally  with the warm wet climate, but are others seeing this dramatic increase?   I have had 3 moms within the last few weeks who came in for mastitis then had yeast overgrowth then mastitis again.  To get well these women had to take simultaneous diflucan and antibiotics.
        The other part of this is the problem with diagnosis.  We have physicians in our area who call us and say "See this patient and tell us what to do for her" as well as some who are very upset if they think we are making the diagnosis.  Last week I saw a patient who had been in severe pain with every feeding for 20 days.  She had been given help with latch on and a variety of topical "comfort" type treatments.  On exam she had all the classic yeast symptoms, hot pink nipples and areola, itching burning pain of the skin which was excruciating when touched and "hot pokers" deep in the breast for up to an hour following each feed.  The baby had white patches in the mouth.  While the mom was in my office I called her doctor and described what  I saw.  I asked if they wanted to see her or if they could prescribe for her.  I recommended that she be treated with topical and oral meds and offered information by fax.  They were so nice on the phone "What else does she need, how about Tylenol 3 for pain."  They did not need to see her.   The next day I found out that another doctor in the same practice got quite upset about me "diagnosing yeast"  and for recommending oral medication which is unsafe according to his info.  They only prescribed topical.  This is like puting neosporin on strep throat in my opinion.  The patient was upset after feeling like she was going to get better and now there was a controversy.  I offered more data to the new doctor and was told that he wanted to talk to me, but he didn't call me back.  Before I left the office, I called his office and he had left for the day. 
        Today I will call the patient and see how she is doing.  She was really close to weaning when I saw her.  I will shore up my confidence and professionalism. I will probably see more yeast, but try hard not to diagnose it myself, rather say "Check in with your doctor, you have symptoms that may be consistent with a yeast infection".  Even though half the time they may hear from their doctor that nipple yeast does not exist. 
thanks for listening.
tracy throckmorton rn ibclc
portland oregon