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From:
Ellen Rubin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 22 Aug 2010 18:38:09 -0400
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This question is very pertinent for a Mom who I've been speaking with.  She's been on diflucan for 2 months and pain has not resolved.  She plans to travel several hours to see a new IBCLC.  Her outline of symptoms & treatments are below.  I'd appreciate hearing ideas / thoughts.

I'm wondering if pain could be caused by:
1.  allergy to something in APNO
2.  baby is asymptomatic carrier of thrush and nystatin drops did not treat him soon enough or sufficiently, reinfecting Mom
3.  too many medications, nipples need to take a rest from everything

Ellen Rubin, MA, IBCLC, LLLL

> Natural birth, Antibiotics because GBS+, began using APNO for minor sore nipples (resolved after leaving hospital)
> 2 weeks:  antibiotics for possible uterine infection with minor clotting
> 3 weeks:  engorgement and oversupply, but no other nursing issues (no sore nipples)
> 4 weeks:  right areola sore, cracked, stabbing pains in breast, doctor ruled out mastitis and plugged ducts and recommended no treatment
> lactation consultant suspected yeast:  grapefruit seed extract, APNO, GFS capsules, reduced sugar intake
> pain worsened – searing, feeling of knives & nails when nursing particularly during let down, stabbing pain intensified when hot or sweaty
> ob persuaded to prescribe 2 wks of Diflucan at 150 mg
> primary care doctor prescribed topical clotrimazole and betamethason dipropionate lotion, nipples began to crack and bleed
> pediatrician saw no thrush in baby and didn’t treat, recommended Lotriman for nipples
> dermatologist said Diflucan should be sufficient and to keep nipples moist with Vaseline
> nursing pain free after first couple of pills of Diflucan but still intermittent stabbing pains in breast wall when not nursing, back to Lotriman and APNO
>  doctor agreed to 2 more wks of Diflucan at same dosage
>  pedi did not want to treat baby (no symptoms)
> tried baking soda mixed with water, then vinegar, started taking acidophilus twice/day
> shooting stabbing shocks of pain back through my breast and my nipples got worse again, like it came back with a vengeance, nipples aggravated/yucky feeling...cringed if they rubbed against anything. 
> went to new ob who saw pinkness around areola and nipples right away and prescribed 400 mg loading dose of Diflucan and 200mg/day for a week and repeated for second week. 
> tried Gentian Violet as well
> 5 or 6 wks into Diflucan treatments, saw a nurse practitioner b/c deep bruising pain (diff than yeast pain) and felt plugged ducts and a large round hard spot behind nipple area on left side, prescribed antibiotics and Nystatin cream for nipples
> had bloodwork at 6 wks on it to check liver enzymes which were ok
> pedi put baby on Nystatin drops but NOT Diflucan
> 3 dys later I saw my Dr again who stopped the antibiotics and sent me to get ultrasound of hard spot in breast, which was resolving didn't really find anything, but it started coming back and forth in both breasts weekly
> pains seemed most prominent after the plugging episodes
> stopped using genetian violet b/c was told it had to be removed from nipples before nursing and supply was dropping
> after two weeks on diflucan, saw Infectious Disease Physician who "didn't see any signs of yeast", stated would need to wean to resolve pain

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