Leslie
To recap your case presentation:
emergency c/s and abx therapy, then painful nipples x first 2wks - may have
been normal but maybe not? Then at 2 wks had mastitis treated w/ homeopathy;
possible thrush - patches in baby's mouth; topical treatments have not
worked totally; mastitis recurred at 6 wks and was self-treated; nipple tips
now pink, irritated, and possible fissure. Baby uses a soother (pacifier).
So my differential diagnosis (I'm not really supposed to diagnose becoz I'm
not a doctor, but you get the idea) would be
1) thrush which has not been adequately treated in both mother and baby and
for long enough time and with effective therapy; nystatin and gv may not
work, she has not tried the systemic route yet, may need the long term
course of it - refer to archives, Karen Zeretzke's Leaven article on thrush,
LC series on candidiasis - and go for the total picture to eliminate thrush
like boiling (or discarding) soothers, changing pads, washing bras etc.
2) subclinical mastitis or abscess which may be due to candida or bacterial
infection or both - maybe check on ultrasound, probably needs full treatment
3) nipple fissure is infected - candida or bacteria or both, may respond to
Dr Jacks all purpose nipple ointment
4) would not recommend weaning from affected side (of course mother can
choose to do so) but rather would encourage continued milk expression if too
painful to nurse so that lactation on that side can be preserved.
Good luck to her and hope this resolves soon.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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