Wishing a happy, productive and breastfeeding positive New Year to all of
you.

You know how thrush has been discussed recently AGAIN?  I have a mom
whose thrush has me scratching my head and needing input from you
experienced ones.

I was called in for a consult when baby Jake was 3 weeks old.  Mom told
me that breastfeeding was increasingly painful and she needed help.

History:
Mom is in her early thirties (I didn't ask exactly), baby #1, normal
pregnancy.  She was diagnosed as Strep B +, and when her water broke was
put on penicillin IV for 21 hours.  Fifteen hour pitocin induced delivery
with epidural help for 12 hours.  Mom doesn't think she was given any
meds postpartum.  She was discharged 3 days postpartum, exclusively BF,
but left hospital with already cracked  and bleeding nipples.  She was
diagnosed with vaginal yeast at 10 days postpartum and prescribed Terazol
7, a topical antifungal.  Mom's doctor prescribed nystatin cream for
mom's painful nipples 15 days postpartum, also baby got nystatin gel for
possible thrush diaper rash.  Mom was/is rinsing nipples with vinegar
water solution after nursing and before applying the nystatin.  Diaper
rash cleared up right away.  I was called at 21 days postpartum and did
an in home consult.  Baby was doing OK, had gained at the 2 week check,
but breastfeeding was painful during the feed and then intense burning,
stabbing breast pain about 5 minutes after bf'ing.  Mom had been taking
Motrin 400 mg (ibuprophen based pain reliever) several times a day to
control the pain.  After some fixes in positioning and latch, mom says
that breastfeeding itself is not painful now.  But the very painful
burning, stabbing pain has not let up.  Mom's breasts were pink on the
nipple and part of the areola, but not "angry" pink or obviously shiny.
I was hesitant to say I saw thrush on the nipples.  But the type of pain
mom was describing "yelled" intraductal thrush to me.  Baby was not on
anything for his mouth and I recommended oral nystatin for him and that
was started next day (but a fruit flavored variety, not the clear one).
Thanks to Barbara Wilson-Clay for saying again and again to fax those
reports to the doctors, I faxed a report of my visit the next morning.
After mulling over the fact that mom had had this pain from the beginning
and topical nystatin was not doing anything, I diplomatically put in the
report that many moms had gotten good results with difulucan-stating the
exact dosage and length of same.  The next day after that mom's doc
prescribed the difulcan-but only 1-150 mg dose.  Mom and I had already
discussed how one dose wasn't enough and she called doc back and got the
right dose-200 mg loading, but 100 mg/day for only 9 more days.  Today is
day  10 and mom says she feels NO relief.  She has Kay Hoover's sheet
(and even called and talked to Kay) and on the 28th started Pat Gima's
regime with acidophilus 4x/day, garlic capsules 3x/day, no dairy, and no
sugar.  She is very discouraged.  She was told if she stopped BF, the
thrush would eventually go away.  She has not enjoyed this breastfeeding
time with her baby because of the pain and wonders if the pain would go
away if she went to formula.

What would you recommend for this mom?

Pat Bucknell, IBCLC
Avon Lake, Ohio (on the west side of Cleveland where it's cold and gray
with a light coating of snow on the ground)

___________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at http://www.juno.com/getjuno.html
or call Juno at (800) 654-JUNO [654-5866]