Hi, 
I have permission to post;
A mom who initially had much overproduction, we got that mostly under control, had one plugged duct when baby slept longer but she was able to shake it without antibiotics. Had cracked nipples at first, both sides.  
This is 3rd baby, quit nursing 1st two at about 2-3 mo. - multiple problems inc. yeast. Now this baby is 9 weeks, mom and baby have not had any antibiotics.  
She has had what we think is yeast with shooting pains through breasts and now is on day 17 of diflucan 200 mg/day (had 400 mg loading dose).Baby has also been on diflucan.  The shooting pains are gone and nipples are better, but the right one is still painful. This is our present problem- she says it is bearable but afraid it is yeast related and afraid to go off the diflucan. We are wondering why it is puffy, and since this was the nipple with the worse crack, wondering about bacteria. Her MD does not think it's bacterial. Of course the mom does not want to go on systemic antibiotics anyway because of the yeast. She is having APNO made up because it's about the only thing we haven't tried yet. 
Yes, we're working on latch and management of OMER. 
I wonder if anyone has any insight on causes or treatment options for her right puffy, painful nipple? 
I am feeling out of ideas for this mom, have told her and referred, but noone has come up with anything else yet....
Thanks!
Mary Taylor, LLLL, new IBCLC in California

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