Hello,

I am a LLL Leader in the Boston, MA area.  I'm trying to help a mom who is 
having very intense pain at letdown.  I have her permission to post.

Mother's symptoms started when baby was 4 weeks old (he is now 10 weeks 
old) - no nursing problems or pain until that point.  Since baby was 4 
weeks old, mother has experienced intense, all-encompassing, searing pain 
in both breasts (not nipple pain, full breast pain) for 45 to 60 seconds at 
letdown only.  Pain occurs in both breasts at the same time.  She says pain 
is 8 or 9 on a scale of 10.  She has occasional shooting pains in breasts 
at other times of day but these seem to occur randomly.  She has no other 
symptoms and says her nipples appear normal after feeding.  Baby has no 
symptoms.

This is her second child.  She had similar symptoms at about 8 weeks with 
her first child.  At that time, both mom and baby were treated with 
Diflucan and symptoms resolved immediately and did not return.  That's what 
made her assume thrush this time around.

This time around, she was originally treated with Nystatin cream and 
Diflucan for baby - no improvement.  Then they switched her to 100 mg/day 
of oral Diflucan for her and nothing for baby - no improvement.  Then they 
switched her to 200 mg/day of oral Diflucan and nothing for baby - no 
improvement after 12 days, at which time she gave up and stopped taking the 
Diflucan.

Should she try a higher dose of Diflucan?  Is it likely to make a big 
difference if baby is treated at the same time?  Has anyone seen success 
with an alternative antifungal?  Is it possible it's not thrush?

Any help or suggestions would be greatly appreciated!

Sally Martin
LLL of Belmont, MA

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