Two months ago I worked with a whose layered problems we sorted through one
by one: positioning, *chomping*, slow-to-heal nipples, "globby" milk. She
ultimately opted to stop since, even though a chiropractor had improved the
baby's symmetry and suck, she didn't feel she had the emotional or
financial resources to continue.
But continue she did, weaning off the more painful side and finding that
the other side became almost completely comfortable and was supplying over
half her baby's needs.
But the weaned side still isn't right. We're both convinced it's the
nipple now, not the suck. The nipple doesn't give her trouble if she
doesn't use it, but if she nurses on that side, the pain is "like a razor
blade", the nipple shows damage afterwards, and there's residual pain.
*She* doesn't think it's thrush because it's unilateral, the baby has never
shown signs of oral or diaper thrush, and earlier use of nystatin and 2
weeks of diflucan brought no improvement.
*I* can't let go of the idea of thrush, because pumping with a Classic was
never fully comfortable, and because her nipple looks basically fine, just
pink (both are), with crevices. No flaking, rash, or pus. The latest
article in JHL - about a mom who finally cleared up her pain after 3 2-wk
courses of diflucan and other measures - also makes me wonder. I can't
talk her into experimenting with gentian violet.
She's making an appointment with a dermatologist who knows little about
breastfeeding. I want to make sure *she's* fully informed in case *he*
isn't.
What's the likelihood that she's dealing with thrush? What else could it
be? Baby is now 9 weeks old, the "weaned" side has been used no more than
once every few days for several weeks now. Mom is not prone to allergies
or to yeast infections, but was on antibiotics for 2 weeks for mastitis;
the diflucan began before the antibiotics stopped. Nursing was always
painful on the "bad" side, even before treatment for mastitis/thrush.
That's also the side with the globby milk, which was globby from the very
first pumping but which gradually cleared w/ lecithin and massage.
Diane Wiessinger, MS, IBCLC, LLLL Ithaca, NY
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