Here is a puzzling situation, a client/friend is breastfeeding her second
child, he is almost 6 months old. 6 weeks ago she had symptoms of what we
thought was a plugged duct and possibly yeast.
After treating it like a plugged duct for a few weeks, symptoms not
resolving, increased symptoms of yeast occurred and so her physician put her
on Diflucan. It was a struggle to get him to order it to begin with but
after I sent him the info from Hale's 11th Edition, and Dr. Newmans
handouts, he ordered the med. After she had been on diflucan for one week,
he rewrote the order for 2 more weeks. She came to me again for help,
symptoms not resolving. That is when I found out what her doctor had
ordered her, he ordered 400 mg a day for the first week. The second order
was for 800 mg a day for 2 weeks. I was floored, I suggested that she call
him and discuss the dosage because it seems too high. He told her not to
worry about the dosage and to continue taking it because it is not going to
be harmful to her or the baby. He is aware that both the pharmacist and
myself strongly questioned the dosage. Anyway her symptoms are not resolved
completely. I truly feel that she has had a few things going on, possibly
starting with a plugged duct, and then adding to that a yeast infection. Her
nipples had gotten very tender and that part is resolved. Now she still
has very strong deep ductal pain intermittently, mostly at night on one
breast, especially after a feeding but not always after. It is excruciating
pain and she can barely tolerate it any longer. We did try doing a series
of ultrasound treatments as recommended and that did not work either.
My recommendation to the doctor was that they do a diagnostic ultrasound. I
recommended this a few weeks ago saying that if there was no relief with the
therapeutic ultrasound I feel that a diagnostic ultrasound would be
appropriate.
Any suggestions?
Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager
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