----- Original Message -----
From: Chappel
To: [log in to unmask]
Sent: Sunday, July 02, 2000 4:31 PM
Subject: 2 puzzeling cases
Hello! I have been a lurker for months now and I love Lacnet! So here it is- a long weekend and I have 2 women with problems that are puzzling me. My first thought was, I need Lacnet now! Did anyone stay home this weekend that could send a few words of wisdom?
Client #1- Primip, 4 weeks postpartum with tender nipples, one more so than the other. Nipples are intact, very slightly reddened. Latch with baby looks great, quick let down with very nice flow. Baby's mouth looks normal, attachment looks great. No abnormal suck when given my finger. Mom's complaint is that since birth, when she nurses without a nipple shield- within 2 feedings the skin on the tip of her nipple breaks open and bleeds. She says first it looks like a blister (pin head size) appears, it breaks open and then erodes even further- to the point of bleeding. The baby goes to breast willingly- with shield or without and baby has had a good weight gain. She wants to stop using the shield. I questioned about yeast infections, antibiotic use etc and the answers were all no. I had her try the famous 4-part nipple cream and there has been no change over 5 days. The only thing a little different is that she is a blonde with fair skin and pale pink areola's. Could she just have very friable skin? When using the nipple shield, she nurses pain free and her skin holds up well. I know- if it works don't mess with it. But I don't understand what is different here.
Client #2 Experienced multip- at 3 weeks postpartum, she developed "burning pain" deep in one breast and a very sore nipple. Her OB treated her for mastitis with 7 days of antibiotic. During that time, her baby developed and was treated for thrush. She says the antibiotic took care of "90%" of the pain but not all of it. Some pain lingered on for 2 more weeks then I saw her. One nipple was cherry red, with a deep fissure filled with white cotton. She complained of burning pain in and behind the nipple that sometimes radiated deep in the breast. I thought "Classic" yeast- I wished I could take a picture. Her OB perscriped 4-part cream and Mom had enought Med for the baby to treat him for a week. Amazing recovery.. but in 7 days the pain was "90%" gone but not totally. The fissure healed, the pain was much improved and she started using the cream just 2 times a day. In a week, it was starting to all come back. We discussed gentian violet (thank you Dr Newman for the fact sheet!) and she treated herself and the baby for 5 days. The skin again healed, and she said again, the pain was 90% gone- just an occasional burning pain with latch. And here we are. The whole thing is starting over again, skin reddened, nipple breaking down; burning,itching pain that sometimes radiates deep in the breast. I gave her OB information on oral diflucan (Thank you, Dr Hale) and she chose to perscribe an oral antibiotic. The OB is anxious about using the heavy duty dose for such a long time.
I want to believe we are just partially treating her for yeast. Only one nipple/breast is involved. She has never had eczema but she believes the 4-part cream is all that keeps the problem somewhat controlled. So I wonder. Her OB is concerned and very willing to help. Could this be part yeast- part something else. It is a puzzle.
Thank you for just reading this long post. But I am open to any suggestions.
Anita Chappel, RN (in sunny southern Oregon)
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