Two interesting cases came into my clinic today.

 #1.  An update on a successful treatment with Diflucan.  I saw this child
who was exclusively breastfeed at 2  months, mother was complaining of sore
nipples, I thought maybe the pacifier, maybe the bottles of EBM...looked into
the kids mouth and low and behold, big bad thrush.  Well, we treated and
treated and treated them with Nystatin, plus, she put it on her nipples and
sterilized and then just through away her teething toys.  It would clear up
and then come back.  At 5 months she came in with her child:  his mouth was
totally purple.  She had been applying gentian violet DAILY for weeks.  When
she stopped the thrush returned.  I immediately called poison control to find
out if this was dangerous.  There was no worry in terms of a systemic
absorbtion, or other reaction, just the fact that it can be toxic to the
mucus membranes in the mouth.  I looked in the kids mouth again, but no
ulcers.  Then I called the pediatric infectious disease specialist at our
children's hospital and he recommend Diflucan!  We treated both mom and baby.
 I saw her today, baby is 7 months old and totally clear!


#2  20 year old single woman having her first baby in for 36 week check up.
 Mentions to me,  "I've decided to bottle feed because I'm going back to work
at 6 weeks, so just put me down in the chart as bottle feeding"  Well, she
didn't know whose office she had just stumbled into!  Armed with months of
reading LACTNET, I was ready to educate!  She told me she was bringing work
to do at home until 6 weeks, and then going back full time to work at 6
weeks.  Not interested in pumping.  She was told it would be too hard to just
stop at 6 weeks and better off just not starting in the first place.  First I
talked about the benefits to her--emphasis on wt loss, burning calories, less
postpartum bleeding.  Then I talked about baby having less colic, less
allergies, less ear infections and illnesses, and easier to deal with (night
time bottles etc.)  I was flustered and my mind was racing.  In a manner of
seconds I had to size up what might be important for her and communicate
it--I felt to tongue tied!  I now think of  million things I want to say to
her.  Then I told her she could do both, bottle and breast, also that she
could just nurse for as long as she wanted and that 6 weeks would be a
tremendous benefit for her baby.  She said she would be willing to try it.  I
hope to visit her in the hospital and try to provide support, but I fear with
out a bigger commitment she will not nurse very long or at all.
I felt like with this woman I needed some pretty clear,  easy to grasp
benefits.  Next visit I plan on giving her some handouts.  I have a pretty
advanced one from LLL about the benefits with journal article quoted.  I'm
looking into some other simpler ones.  We need a NIKE-like commercial that
shows breastfeeding moms and says "JUST DO IT"

I'll be interested in you-all's thoughts on this.

Sincerely,  Jennifer Coombs, Physician Assistant