Debby,

Just finished plowing through 500+ messages from when I was on vacation, and
noticed that you didn't get a lot of replies to your query of 6/24 (or maybe you
did and I was just too brain-dead to notice).  Anyway, if this mother is still
persevering and sore, I do think you should take a closer look at the
possibility of thrush.  You mentioned that she had been treated with some kind
of cream, but what and how long?  In the chronology you detailed she had
mastitis and was put on antibiotics the day after she started on the yeast
treatment, so I'm not sure how much of a chance it got to be effective.

You mentioned that the positioning looked correct and the digital suck
assessment you did felt normal, but you didn't mention the shape of the nipple
after nursing.  I think that tells a whole lot more about what the baby is doing
with the tongue while nursing on her breast than what I feel on my finger (not
that I never do them).  If the baby's suck is abnormal enough to cause that kind
of damage, her nipple should be really misshapen when it comes out!  If the
shape of the nipple is normal, I would want them treated thoroughly for yeast.
If her nipple and areolar tissue is very macerated and moist, you might consider
nystatin powder--it worked great for a hideous case of nipple thrush that I'd
tried everything under the sun on.

I'd be interested in the outcome.

Becky Krumwiede, RN, IBCLC
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