Heather,
Your client's case makes me think of a few things. In my experience, pain
free bf followed by painful bf often means a case of thrush. I am definitely
of the mindset that thrush is greatly overdiagnosed and treated. I live in
hot, humid New Orleans and rarely see or get a case of thrush but it does
happen. Usually there is antibiotic use associated with this, and often
concomitant vaginal yeast, baby thrush, diaper thrush etc. Thrush does
usually seem to be bilateral in its presentation.
In the mother you present, there is a history of sore, cracked nipples in
the first days. This would be a red flag, to me, of possible anatomical
concerns like ankyloglossia, very poor latching (even though you say he is
thriving I would still look for this), and a risk for bacterial mastitis. If
the nipples resolved easily and one month later the soreness occurred I
would think of thrush. But if the nipple cracks resolved, but there was
ongoing pain, I would think mastitis, continued trauma of some degree
(though less severe than early days), and nerve pain due to the ongoing
trauma. Mastitis is *usually* unilateral in its presentation, but can be
bilateral and one tends to think of strep bacteria (vs the *usual* staph)
when bilateral. Hope this helps in your client's case.

<<Her symptoms are on both breasts, and she feels pain 'radiating'
between feeds, often if she is going over a speed bump in the car,
she says. It is also painful to feed, though the sore cracked nipples
she had in the first days are now ok. Baby is fine, thriving, no
issues with him.>>

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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