I have a client who had infertility problems and low supply with her
first child. I saw her for the first time with her second child.
Same problem with low supply, though no fertility problem this time.
She's pumping and using fenugreek but still needs 8-10 oz of formula a
day at 7 weeks.
With both babies, she's had terrible trouble with recurrent plugged
ducts. She's started lecithin - 2400 mg per day in gel caps which
she's just bumped up to 4800 mg per day. And she's also had sore
nipples - initially greatly improved with better positioning but now
getting worse. (Baby does a lot of tugging when he gets impatient,
which doesn't help. She has an SNS but prefers to use a bottle.)
Her nipples seem to get more sore in the hours before a plug, then
while she's nursing she feels a shooting pain in her breast "like a
rubber band snapping", her nipples get even more sore, and within a
few hours she has a plug - "3 inches of solid mass". No sign of
blebs.
What is the likelihood that that these plugs have a thrush component?
The baby's tongue is one of those maybe-maybe not tongues - a whitish
coating but not dramatic. He's fussy, gassy, congested, spits up, and
(sigh) had a barium swallow this week to rule out reflux (hey, it
wasn't *my* idea). The doctor wanted her to wean for a week and use
Alimentum exclusively. Instead, she's going to keep nursing,
eliminate dairy from her own diet, and supplement with the Alimentum.
She took Diflucan with her first baby, for thrush and a vaginal yeast
infection. It didn't help the plugs but the prescription ran less
than a week. That would be her treatment of choice this time as well,
rather than nystatin or gentian violet. I've given her Jack's sheet
on diflucan and said I'd ask the wise people of lactnet:
What would you do to try to clear up these plugs and address the
soreness?
Diane Wiessinger, MS, IBCLC Ithaca, NY
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