Hi all,

I had an interesting case recently that I wanted to share so as to find out
how common it was and if there was some more light to shed on this.

Mom called and came in because she needed a more effective pump for a few
days.  She stated her nipples were "ripped and infected and starting to
peel."  Her family doctor had just started her on oral Keflex and topical
Bactroban.

We discussed her hx a bit, and it revealed:  Baby 7wks.  No problem until 2
weeks prior when baby began to be very gassy and started pulling on the
nipple at feedings.  This caused initial damage that continued without
healing until tx was received. Breastfeeding was painful, but tolerable until
the day prior to seeing me, when the pain had become unbearable.  Baby was
diagnosed with thrush and given treatment at the same prior 2 wk point that
he started fussy nursings.  The thrush was still unresolved when seen at the
same time mom was seen.  Mother stated baby has also had a diaper rash on and
off.  She was told by the family physician that there was no such thing as
nipple yeast infections. (I don't know the details as to who brought this up,
etc.)

Hmmm.  I have promised myself as a matter of policy to give all doctors as
much respect and benefit of the doubt as I want them to give me.......How to
handle it....

I told mother that there was such a thing as nipple thrush and that bacterial
infections were also possible.  I gave her K. Hoover's handout on thrush and
told her to give me a call if she wasn't feeling any better in 24-48 hours of
starting her medication.  [I had to nearly bite my tongue to keep from
telling her the antibiotic might make things a lot worse]  I promised her I
would fax the physician the same information with a note about seeing her and
what instructions I had given.

Surprise, Surprise!  Mother was nursing again, painfree, in 3 days.  It seems
the physician recognized a bacterial infection (or made a good guess???) and
mom has quickly recovered.

Questions for you all,
Does Keflex or Bactroban have any anti-fungal effect?
Are there any pictures or slides or medical textbooks that are available for
purchase to      people like me that clearly depict the difference between
yeast and bacterial      infections?  Is observation a reliable indicator?(I
know this is the physician's      responsibility, but I also have an
insatiable curiousity.)
Is nipple bacterial infection common in the presence of on-going oral thrush
in baby and      possibly nipple thrush in mom?  Is this a missing piece in
some of our unresolving      nipple/breast yeast cases?

Natalie Shenk, BS IBCLC
Private Practice in Ohio
Who now is very glad of her policy to show clients a respect for their other
health care provider's opinions as she adds her own information.