Ok, I have been a RN 20 yrs + and an IBCLC for 6 + years.  I feel stupid or
uninformed at the least, but after reading experienced Diane's question and
her thoughts about yeast I am going to respond.   This is purely anectdoctal,
but obviously a lesson I needed to learn to better help my patients in the
future.  Last year while nursing my 3 1/2 year old I developed some form of
yeast. I 'lived' with it. After several months the breast pain was
unbearable, the classic knife cutting right through the center...I wanted to
literally rip my breast off.  This happened before the great, latest JHL
article, so I went to the HMO clinic 'armed' with printed copies of Dr. Jack
Newman's article on yeast and Diflucan treatment only to have a new 'green'
MD female grad insistently say,"Who diagnosed yeast, I cannot order this
medicine for you! It is too expensive, my director would never approve this!"
 She was so unsure of herself, it was pitiful.  I immediately walked around
the corner to the patient representative and while waiting to talk to the
rep., asked to speak to the Pharmaceutical Director.  He was older and wiser
and into customer service...he quietly read the literature and acknowledged
my personal expertise.  He walked out and handed me the Diflucan needed to
supposedly erradicate the problem. Within two days, the discomfort was
tolerable.  I completed 21 days of therapy and I thought the problem was
behind me.  I was driven to end the breastfeeding relationship sadly, when my
son was 4 1/2.  I did not want to repeat this scenario.  The yeast did
return, remember the Diflucan does not kill the yeast.  I e-mailed Dr. Newman
and he concurred to try gentian violet and repeat the Diflucan if the gentian
violet did not help.  The gentian violet had to be special ordered from a
local pharmacy, but arrived in a day and only cost $1.67 for a fluid ounce.
The first time I applied it to my breast, the stabbing pain immediately
started.  It was as though the gentian violet attacked the yeast and a
horrific battle was going on.  I was amazed!  I have been even more impressed
at how quickly the gentian violet improved my problem.  Within 24 hours no
itching, burning or discomfort for the first time in about a year.  I can
handle the purple breast, although I feel like I belong at Mardis Gras with a
tassle too!  So, for those of you out there who knew this, please disregard,
but for those of you who are not familiar with gentian violet, I strongly
reccomend this be the first choice.  Most of the literature states this and
most of the experienced LCs, I believe suggest this, but again we get caught
up in the latest.  I certainly wish I had tried it before all that expensive
Diflucan that did not seem to work as well.  So, yes Diane I would give a
purple toe a try too!
Sincerely,
Anne Williams RN BSN IBCLC
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