IMO, many of the treatments this mom have used could be as much a part of the problem as the solution. if she had herpes (which it sounds like is only theoretical), then her immune system was already suppressed. So, a systemic approach to healing would make sense, yet all the treatments were topical and some were, IMO destructive. Further, her immune system was whacked w abx, no doubt unnecessarily, as mastitis rarely needs abx treatment. 


I am guessing candida treatment included nystatin, possibly even diflucan--which is an assault on the liver. All of this following surgical birth, which in an of itself was detrimental to her immune system and predisposed her to thrush (abx at birth). 


I never use APNO anymore, but even when I did, found it began to break down tissue if used for more than a week or so. GV is coal tar and toxic to the body. Medical grade honey is another good treatment as is calendula succus or oil. 


I agree with the person who suggested you take a step back and look at the situation afresh. 


I think nutrition needs to be the first question. I would use organic coconut oil on the nipples first and foremost. It it nourishing and healing and anti-bacterial. Deep fissures require good nourishment to heal--zinc, magnesium, vit D, biotin to begin with. Lots of healthy fat in her diet. Avoid ALL sugar and simple carbs and dairy. Probiotics are a must for momma and baby. 


I would suggest she see an ND or good herbalist for an anti-bacterial blend which would include goldenseal, possibly oregano and so on. Allicin is an alternative treatment for bacteria that she could use--it known to be effective against MRSA . 


I would use the homeopathic tissue salts calc fluor and calc phos, which help wounds to heal.


Exercises and CST to prevent reattachment are really important with revision of either frenulum.


I did a quick google search for chiropractors in your area who specialize in peds. several came up. Here is one:
http://www.drdianemeyer.com/
I do not know this person, but you can ask the right questions to evaluate. 


Jennifer Tow, IBCLC, Toulouse, FR
Intuitive Parenting Network, LLC





Date:    Thu, 4 Nov 2010 23:29:01 -0400
From:    Camilla Aviss <[log in to unmask]>
Subject: staphylococcus epidermidis infection of nipples (LONG)

Hello,

I'm turning to you all for some clarification, ideas, questions, etc. 

A client was just referred to me after seeing many, many IBCLC's over the past 4 
1/2 months with severe nipple trauma, tissue breakdown. I have her permission to 
post. It's a very long post, but I'm hoping that with all the details some of 
you can confirm what I'm leaning towards or point me in a new direction.

Some History:
1st baby, born at 41 weeks via c/s due to outbreak of vaginal herpes lesions 
(appears to be herpes simplex virus 1, not 2 but not confirmed, swab was lost by 
lab!) Mom has history cold sores on mouth prior to pregnancy, but never had 
vaginal outbreak until just before delivery. Midwife referred to OB/GYN who 
confirmed he thought it was herpes based upon appearance and c/s was scheduled. 
Swab taken at time and lost, so cannot confirm. Client stated it took approx. 
3-4 weeks for all the lesions to heal, disappear. Otherwise no other health 
concerns during pregnancy, mom has no other significant health history. 
Has had sore, cracked nipples from very beginning. Told baby was tongue tied and 
frenectomy was performed, subsequently at 7 weeks postpartum developed mastitis 
and treated with antibiotics (client could not recall name of antibiotic 
prescribed), then following this received treatment for Candida for the ongoing 
nipple pain. Has also been told she has vasospasm, although I saw no visual 
signs of this when I examined her. She has been using Dr. Jack Newman's APNO 
recipe for over 4 months with little effect, has done gentian violet, grapefruit 
seed extract, omega 3 fish oil, probiotics. She also has been using mepilex (a 
type of hydrogel dressing is the best way I can describe it) for months and has 
spent over $600 buying this and cutting it into squares (with her regular 
unsterile scissors) and putting it over her nipples to "help heal them". She did 
quit nursing for one month because she "couldn't take the pain any longer" but 
when I ask her if it helped her heal, she said "a little, not much". She decided 
to try and put the baby back to breast again and luckily he did so with no 
hesitation. 

Basically if it has been suggested to this mom she has tried it. 

When I met with her the other day for the first time, it was because she was 
told the lingual frenulum had reattached (which it had based on my exam) and the 
labial frenulum was "tight" and should have been clipped as well. 
When I examined her breasts/nipples she had very, very deep nipple fissures on 
both nipple faces basically right down to the dermal layer with some serous 
drainage.

Baby is thriving as mom has an ++abundant supply, which I think may be one of 
the reasons baby is still clamping down and "chewing" to cope with her OAL. 
Postural tips, herbals for slowly decreasing supply have been 
discussed/suggested. 
Basic deep asymmetrical latching techniques have been shown, but even so baby is 
still chewing and still seems to slip right back up. Baby did undergo another 
lingual & labial frenetomy was done as well earlier this week, post frenectomy 
oral exercises are being done several times/daily with baby. Cranial Sacral 
Therapy would perhaps help, but I cannot find anyone in my area with this area 
of expertise. 

I suggested to mom that she HAD to see her MD to get nipple swabs & EBM samples 
done for C&S, which she did do, and to discontinue using the mepilex dressings 
and just use sterile 2x2's. 

She received her results yesterday: Breast Milk & Nipple swabs showed a moderate 
growth of Staphylococcus epidermidis, Rare Gram Positive Cocci

Doctor did prescribe 30g of Fucidin Cream (Fusidic acid cream 2%) topical 
antibiotic which she said she was applying and wiping off before feeds. Today 
she said it was causing burning and had to discontinue it. Doctor didn't 
prescribe anything else and told her to wait to see a dermatologist. (Can't see 
her waiting, who could blame her?)

From what I can tell looking on-line, in journals etc. it appears that 
Staphyrococcus epidermidis infections are becoming one of those resistant 
organisms like MRSA and difficult to treat when it causes an infection. (Tell me 
if I understand it wrong please)

Any suggestions for what medications would work best to treat this? She has 
started to pump and feed a few times today with a bottle because the pain is so 
severe.

Thank you in advance for any help/suggestions!
Camilla Aviss RN,BHSc(N),CCCE,IBCLC
www.multiplereasons.com





 

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