I need to introduce myself.  My name is Cher Sealy.  I'm a La Leche League
Leader, an IBCLC, and an RN, and have been in private practice in Montgomery,
AL as an LC for the past 10 years.  I am thrilled to finally be on LACTNET!
 I have a mom who needs some of your collective help.  She is currently BF
her 5th child (7 lb 5 oz girl, born 5/16/97, normal vaginal birth.)  All
others were BF, and babies 2,3,& 4 BF until babies initiated weaning.  She
reports her nipples became very sore at 1 week.  Blisters, cracks, bruising,
and bleeding occurred.  Dr. tried lanolin and then cortisone cream--no
improvement.  At 5 weeks, Dr. suspected yeast as mom had had a vaginal yeast
infection just prior to delivery and baby had both thrush in mouth and a
yeast diaper rash.  Baby was put on oral Nystatin and mom on Mytrex cream.
 After 1 week - no improvement.  Cracks healed but new ones continually
developed.  Bleeding was so profuse that stools became tarry and baby spit up
"a good amount of fresh red blood from one feeding to the next."  Also mom
was experiencing deep breast pain. (Even with all this going on, baby was
gaining well--up to an ounce a day.)  Mom was referred to me at this point,
but lived an hour away, so I hadn't seen her yet.  Suggested she talk with
Dr. about Diflucan.  Also gave her info on Gentian Violet and other tips
(modifying diet, hand washing, boiling pacifiers, etc.).  She also tried a
nipple shield, but reported that it made pain worse.  After discussing with
doctor, mother tried three applications of Gentian Violet--no improvement.
 Dr. put mom and baby on Diflucan.  Mother has been taking 150 mg daily now
for 11 days.  Deep breast pain has stopped, bleeding has stopped, cracking is
better.  But nipples still look purple and bruised after feeding.  Also there
are blisters on tip and a horizontal crease in both nipples. (I find this
interesting since she uses different positions on each side--football hold on
left breast and cross-cradle on right.)  She has experimented with this and
these are only positions that are tolerable. Finally this past weekend I was
able to watch baby nurse.  Latch-on looks "picture perfect."  Baby actually
has a large mouth and opens wide drawing plenty of breast tissue in.  Baby's
tongue can be seen when bottom lip is pulled back.  Mom still reports that it
feels like baby is biting at base of nipple, but I cannot see how this could
be occurring, so feel it must be from yeast.
I have actually had a great deal of experience in working with yeast and have
seen some really stubborn cases, but this one is the worst. Has anyone seen
someone take longer than this to get relief?  Are there other things that
could be causing this pain that I am overlooking?  Any advice to pass on to
her would be so welcomed.  She desperately wants to nurse this "last baby."
 She reports pain is excruciating at times.  She has never been able to enjoy
a feeding with this baby and is "heartsick" because of it.   ---Thanks
everyone!