>>> "got new batch of APNO this time with ibuprofen in the ointment."

I have time to comment only on this now.
Mmh, this scares me a bit. Systemic ibuprofen is OK during breastfeeding
because quantities found in milk are really minimal,
but topical treatment on the nipple...

Micaela Notarangelo
Italy

On Thu, Jun 11, 2015 at 12:53 AM, Molly McMillion <[log in to unmask]>
wrote:

> Okay my Lactnet peers I am stumped again and need your help.  I have a
> client who has been trying to nurse her 2nd baby after abruptly weaning for
> similar reasons with the first baby. In short she has extremely sore
> nipples.
> Here is the course of events: (posted with mom's permission of course!)
> Baby born 4/21/15, per mom-- uncomplicated vaginal delivery with skin to
> skin immediately after delivery and nursed. Mom describes hospital course
> as "latching sometimes better than others" but increasing soreness.  Before
> discharge the pediatrician told parents that the baby was 'tongue tied' and
> with their permission clipped the tie.  I  thought WOW because usually in
> our area (rural WV) you are hard pressed to get even an ENT doc to clip.
> Mom still had concerns so I saw them immediately after they got home (they
> delivered a couple hours away from here at another community hospital).
> Mom sore, but no open wounds, some compression (&bruise) noted on one
> side.  Baby's tongue is coming out over lower lip and lip is indeed not
> tied. Latch more comfortable with correction of lower lip ("untucking" it),
> worked with mom on positioning, baby led latching and breast care.
> By day  4 milk was in but mom was much more sore even though she felt he
> was latching better.  She was using ice packs just prior to feeds and pain
> meds (ibuprofen or tylenol) and 'lanolin nipple ointment'  I went to see
> her again and nipples red and tender but no open areas. Again, we worked on
> latch and suggested she use only expressed milk on her nipples instead of
> the "tons of lanolin ointment" she had been using.
> Day 5 she was engorged I suggested hand expression but she ended up pumping
> small amounts.  Some clogged ducts noted.  By day 6 she reported latch was
> much better and that her nipples were healing.
> May 1st (day 10) mom reports baby 'chomping down while nursing'  she had
> been using a pacifier up to that point and was convinced it was the kind of
> pacifier they were using (the shape of it ) and were trying several other
> kinds"  I reminded her that it was more likely the latch and to hold off on
> pacifier -period- for now and discussed possibility of oversupply/forceful
> letdown which seemed to be at least part of the problem.  I saw her the
> next day and latch was painful, improved some with positioning and work on
> latch but nipples very tender.
> the next day (day 12/May 3) after baby nursing a lot over night (and no
> pacifier and no pumping) and stools that were yellow went back to green.  I
> encouraged her to nurse one side at a time (modified block nursing) both to
> temper down supply a bit and to give nipples a rest.   This helped for a
> couple of days until he started cluster feeding and the healing that had
> taken place turned to sore nipples again.  With work on latch stools
> returned to normal and soreness improved.
> 5/10/15 (Day 24) mom reports being diagnosed with thrush by pediatrician --
> it is unclear as to whether she described symptoms to them or they actually
> saw her.  Both mom and baby started on nystatin.
> 5/12/15 mom spiked a fever of 102 and had already seen family physician who
> diagnosed mastitis and prescribed antibiotic and pumping.  I recommended
> that instead she should nurse as much as possible and rest a lot(though she
> has a 2 year old) We discussed Jack Newman protocol for thrush and also
> breast/nipple pain.  She already by that point had prescription for APNO.
> We came up with a schedule for antibiotic, probiotic, grapefruit seed
> extract (topical) and APNO -- she did not want to do gentian violet.
> Day 28 May 14 she reported that the grapefruit seed  extract solution
> seemed to be helping
> Day 29 May 15 reports that she thinks mastitis is better but thrush/nipple
> irritation is really painful especially the 'little bumps on areola'.   Can
> nurse about 10 minutes before it becomes too painful. Baby's # of stools
> have decreased.  I suggested pumping after feeding and either cup or
> carefully bottle feeding expressed milk -- this helped.  I saw them again
> on 5/18/15 and nipples are red and tender appearing but appears thrush has
> resolved.  Nipples seem to be very irritated. Encouraged her to go back to
> expressed milk or APNO only on  breasts.
> 5/19 still complains of the 'soreness around the edges of areola and
> inflamed 'bumps' on the areola.
> 5/21 able to nurse for periods of time before becoming too sore and having
> to give it a rest and pump.  Re-evaluated for other causes of nipple
> pain/tenderness.  Denies extreme sensitivity to hot/cold, baby's mouth &
> tongue extension and suck do not appear to be problematic.
> 5/28 pain no better, no worse. Mom asking questions about weaning.
> 5/29 mom rallied with stronger resolve to 'fix' problem, got new batch of
> APNO this time with ibuprofen in the ointment.
> 6/1 no improvement mom feeling that this has all become too much.  I
> encouraged SLOW wean of the pumping that she has been doing in order to
> give her more time to acclimate
> 6/3 since she is only pumping mom has 'healed' and is wondering about
> trying to nurse but very apprehensive
> 6/5 supply is still good (and has been this entire ordeal!) mom gets
> plugged ducts if she tries to go more than 6 hours between pumping.  I
> encouraged her to continue pumping but she now stated that her nipples are
> staying "bruised and purple" from the pump (Ameda) -- this was new news as
> she had not reported this before.  Mom tried another style pump (Medela
> pump and style advanced) but it was not any more comfortable.  We AGAIN
> discussed the possibility of vasospasm.
> 6/10 Mom is nursing again.  after reading about vasospasm (resources I
> provided her) she sent me pics of her nipple pre and post feed (OH the joy
> of technology today!!)  There is definitely a color difference -- dark and
> purply to pink. But also nipple tissue still looks irritated and fryable.
> I am at a loss here as to exactly what this is (or combination of things it
> is).  This has been really hard because even though I've done many home
> visits and worked on latch I did not personally make the thrush or mastitis
> diagnosis.  Mom is very savvy and searches the internet in between
> contacting me.  HELP!!
>
>
>
> Molly Scarborough McMillion RN, BSN, IBCLC, CCE, CPST
> Lactation Consultant, Childbirth Educator
> Special Projects Consultant - West Virginia Perinatal Partnership
> Right from the Start - Direct Care Coordinator
> 304.667.4362   www.babylovegbv.com
>
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