Jay - have you tried taking a nipple swab or doing a culture of the
milk?  I have seen awful nipples which just don't seem to heal, and lab
work reveals S Pyogenes.  I have never seen this written up in any of the
journals, but now have about 14 documented cases in my own files, over
several years.  At first the lab used to send back a note to say that the
container must have been contaminated, but a repeat test showed the same
bacteria.  Now the lab will usually send back the results with a list of
Abx to which the organism is sensitive or resistant, the doctor prescribes,
and the nipples eventually start to heal, though with such severe damage,
it may take a while.  It usually needs the nipple resting, or intermittent
breastfeeding you have already tried as well (topical mupirocin too, maybe,
though just topical treatment doesn't seem to be enough to fix
it).  Eventually they do heal.  What alerts me to the possibility of a
bacterial infection is: very severe damage (pus, holes, awful pain) that
goes on and on in spite of good positioning, resting, and all the other
things which *should* work, but don't. There seems to be an increased risk
of mastitis too.

Would love to hear the outcome of this.  Yes, the mom deserves a medal ....
What grabs me is that often the moms I see seem to believe that this kind
of pain/damage is inevitable and don't seek help for weeks.

Pamela Morrison IBCLC, Zimbabwe

Jay wrote,
Peas In The Hole in the Nipple
A mother (wonderful mother!) of a one month old baby has damaged nipples to
the extent that she can place a pea (I don't believe she has ever tried) in
the fissure in the center of each nipple after her baby nurses.
We have tried nipple rest with pumping and finger/syringe feeds for some
weeks alternating actual baby to breast half days and on and on.
Her nipples seem to heal and then open when she nurses for a little while.
Jack's APNO has helped some but I have run out of ideas.
Again, she's rested and pumped and done many permutations of those ideas
without complete healing. Please, what am I missing?
Jay Gordon

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