In response to your situation - I have seen three mothers with similar
situations lately - one was strictly pumping for a baby in the NICU and the
other two were breastfeeding.  No clear cut signs of thrush and yet not full
blown mastitis - they would all develop hard areas in the breast
periodically and lots of pain in the breast - not just the nipples - two
used short term diflucan as well as long term nystatin - no help.
One common thread was that they all used a hydrogel pad - I have wondered if
using it for a long period of time caused a bacterial infection - any other
thoughts? comments? ideas?

Rose

 Date:    Mon, 19 Nov 2001 01:30:38 -0500
From:    laurie wheeler <[log in to unmask]>
Subject: mastitis vs thrush

I am trying to help a mom who at 4 wks postpartum developed breast and
nipple pain. She is pumping for a small premie baby who has never bf yet. No
visible signs of yeast anywhere in mom or baby, but mom had just finished
antibiotics for endometritis. She did not have typical presentation, but did
describe some itching and pain worse between feedings. (p.s. she says her
uterine infection was not quickly identified, she had atypical
presentation). Her doc would not give her anything but nystatin cream, and I
suggested she see a dermatologist but she did not. The nystatin did not
help. *However the confounding thing is that she has experienced
intermittent fever, chills, and headache, which she manages to keep at bay
with antipyretics.* I examined her closely and her breasts and nipples
appear normal. No peeling, flaking, no redness, heat, no lumps, etc. Her
exquisite "bilateral" pain is on her nipples and right under the areolas
with a "9" rating on a 0-10 pain scale. Another LC watched her pump and says
everything looks good with that. She uses Lactina double and appears to use
it, clean it, sterilize correctly. Last week another LC found a clogged duct
and that resolved with standard measures. Her doc says to me she does not
have yeast and she does not have mastitis. He believes she is pumping too
much and says he is sending her to a breast specialist. I sent my report to
him stating I feel she is pumping appropriately and that is not the problem.
I think it may be mastitis (an atypical presentation?) and could be a yeast
co-infection. Have any of you seen fever, chills, malaise just with a yeast
problem? She is in her twenties and not known to be a diabetic.

Laurie Wheeler, IBCLC, MN, RN
Violet Louisiana, s.e. USA

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