Dear Lactnetters,
I have been working with a mum who has been having classic symptoms of yeast
overgrowth. I have her permission to post.
She gave birth 9 wks ago.
After the first week postpartum, she was given antibiotics (Augmentin) for 7
days, due to a vaginal infection.
The second week she started to have severe pain in nipples and breasts. Also
had shooting pains up back and into shoulders and a burning, stinging/
throbbing sensation in nipples during feeding and especially after feeding,
and at night. Nipples and breasts look completely normal according to her GP
and OB/GYN. I did not examine her breasts. Samples of breastmilk and blood
tests were sent in to be tested for candida albicans and came back negative,
however her GP still agreed it was thrush and began treatment with low doses
of Diflucan (50mg). Baby had a nappy rash which disappeared soon after being
treated him with Sudocream.
Following are the measures taken by this very determined mum so far:
3rd week after birth:
- 1 day 150mg Diflucan
- followed by 7 days 50mg Diflucan
- Nystatin Oral Suspension (100,000 units/ml) on nipples and into baby's
mouth
==> No relief of pain
4th week after birth changed to:
Nizoral, 4 days of 200mg Nizoral/day
- continued with Nystatin for baby, drops into mouth of baby directly.
==> No relief of pain
By now the pain had become more severe and was spreading through whole
breast area. Sleeping became difficult and feeding almost impossible,
however she continued to breastfeed every feed. A midwife recommended
pumping, but no relief or change in pain level.
5th week after birth stopped all oral medication, including the Nystatin for
the baby and changed to applying creams after every feed for 7 days:
- Kamillosan
- Mycostatin (Nystatin Ph. Eur 100,000 units/g)
==> No relief of pain
6th week after birth mum called LLL and I shared Dr. Newman's Candida
Protocol with her via email as well as the link to an extensive article on
the LLL website. Then I photocopied this info and brought it to the mum's
GP, who happens to be my own GP as well. I was seeing her for a check-up (I
just gave birth to my third baby!) The doctor had heard of Jack Newman and
was very open and receptive to having this information. She read it in
front of me and was very appreciative. She even had Grapefruit Seed extract
in her dispensary. She was willing the give an approximate equivalent of the
All Purpose Nipple Ointment (APNO) Mupirocin 2% ointment (15 grams),
Hydrocortisone 1% (15 grams), Nystatin Ph. Eur 100,000 units/g. She wasn't
keen on giving the high doses of Diflucan due to a concern that it would be
quite taxing on the baby's liver.
At this point, mum used:
- Gentian Violet on nipples and baby's mouth for 4 days.
- Acidophilus (500 million cells) 3x/day
- infant probiotics for baby
- Grapefruit Seed Extract (two 40mg capsules, 3x/day), each capsule includes
300mg of Pau D'Arco
- Change of diet: Complete elimination of dairy products, all sugars,
bakery, carbohydrates (except for rice), products with yeast, fermented
foods - mum is vegetarian, so there is little left for her to eat!
- An equivalent of the All Purpose Nipple Ointment (APNO) after every feed
(except for the time Gentian Violet is applied); Mupirocin 2% ointment (15
grams), Hydrocortisone 1% (15 grams), Nystatin Ph. Eur 100,000 units/g
- washes all clothes, pads etc in Milton solution (sterilizing fluid) and
boils bras.
==> No relief of pain
7th week after birth:
- same as 6th week, except stopped Gentian Violet and the APNO I encouraged
her to ask the GP for the higher Diflucan dose, in spite of the negative
test results for Candida. She is aware from our research that the tests are
not reliable.
8th and 9th week after birth:
- Acidophilus (500 million cells) 3x/day
- Grapefruit Seed Extract (two 40mg capsules, 3x/day), each capsule includes
300mg of Pau D'Arco
- Change of diet: Complete elimination of dairy products, all sugars,
bakery, carbohydrates except for rice, products with yeast, fermented foods
- 400mg of Diflucan first day. Consecutive 13 days until today: 200mg of
Diflucan (100mg in the morning, 100mg in the evening)
- APNO
==> Slight relief of pain after 7 days; no more shooting pains up the back
and shoulders. Pain seems to have localized to the nipple area. Pain at
night has become less.
My question now:
After 2 weeks of taking the high dosage of Diflucan, should she continue
taking 200mg of Diflucan for a 3rd and possibly 4th week? Increase/decrease
dosage? What about restarting Gentian Violet? She feels the Difluscan is
helping and the pain is definitely less. But she still doesn't feel that
she could continue breastfeeding for much longer if the pain endures. This
is a mum who attended 3 LLL mtgs prior to giving birth, and has persisted in
feeding her little one, even though it means crying in pain at just about
every feed. Her determination inspires me and I really would love to help
her get to the point where she enjoys breastfeeding.
She has consulted 2 of the 3 English-speaking IBCLC's here in Hong Kong, and
they don't have any further answers or information for her. Her GP has
given up hope in her opinion. So she is beginning to feel at a brick wall
at this time, in spite of the minor improvements. I have had a rather
peripheral role in this, as I am just an LLLL. I have been more of a
research assistant to her than anything. But my hope is that through the
collective experience and wisdom here on Lactnet, we can offer her some
unexplored avenues to keep her going.
Looking forward to your replies.
Thank you,
Tanja Knutson
La Leche League Hong Kong
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