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Subject:
From:
Jamie Huddleston <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 23 Jan 2008 13:39:23 -0500
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Hi All,

I am working with a client, permission to post, who has battled thrush for the 
past 3 months.  She has been told to stop nursing by her doctor and doesn't 
want to.  I have to wonder if she has something other than thrush, as all the 
tricks I know and have suggested have not worked.  I am hoping you all have 
some other insight that I can share with this mother.

Here are the details:
Baby was first diagnosed in November (at 1 month of age) with oral thrush by 
babies pediatrician, baby was given Nystatin.  Mom's doctor gave her Nystatin 
cream for nipples.  At that time, Mom had sore nipples but no thrush rash.   
No relief of symptoms for 6 or 7 weeks with use of Nystatin for Mom and baby, 
had refilled prescription and continued to use this entire time.   

In December, Mom saw babies doctor again, and baby was given diflucan and 
Mom was told to stop nursing.  Mom also contacted her ob-gyn at the time 
and her doctor didn't want to prescribe diflucan for her.  

This is when I was brought in.  Mom called me, didn't want to stop 
breastfeeding and wondered what to do to treat the thrush.  I discussed 
simultaneous treatment.  Mom called her doctor back and after trying a 
different Nystatin cream, was able to get a prescription for Diflucan 
(150mg/day 1 time a week for 2 weeks) from another doctor in the practice.  
Babies doctor also gave a prescription for Gentian Violet in December, babies 
symptoms have improved significantly with this.  

Mom then visited her doctor in January (diagnosis for Mom had been over the 
phone because she has no insurance and can't pay for the doctor's visits) and 
was confirmed that Mom had thrush.  Her dose of diflucan at this time was 
increased to 150mg/day for 7 days.  No improvement of symptoms, so 
prescription changed to 100mg/day for 14 days.  No improvement again.  Rash 
would worsen, then improve next day, then worsen- continued like this for the 
course of treatment.  

Now, doctor will not see Mother or prescribe any more meds until mom stops 
breastfeeding.  She does not have a primary care physician, so has been 
seeing her ob-gyn.  She does not want to stop nursing, but continues to be in 
a lot of pain.  Rash has worsened since diflucan treatment has stopped.

Some more pertinent details:
Rash on Mom is red, scattered, patchy bumps.  Look like water filled sacs, 
pustule, that are the size of a pin head.  Nipples are raw, open and visible 
bumps when baby comes off breast after a feeding.  Between feeding, rash is 
dry and sore.  Rash is around and on nipples, areola, under and on sides of 
breast.  Not on the top of breast.

Pain at nursing is described as "someone's fingers under my skin", very itchy 
and sucking feels like something is pulling and itching through the milk duct.  
Mom can feel the pain from the base of her breast and work it's way to the tip 
of her nipple with baby nursing.

Mom has a vaginal yeast infection as well, which she has had since June/July.  
She is treating this with topical cream, over the counter.  Has not helped mom 
at all.  She was also diagnosed as a child with "allergy to yeast".  She admits 
being a heavy alcohol user in college, with no yeast problems during this time

Mom is washing all clothes in vinegar. Has changed diet also- cut down on 
sugary foods, eats more whole grain, increased yogurt (eats 6lbs per week), 
more green vegetables, cut down on fatty foods.  Mom and Dad are also 
taking acidophilus capsules daily.  Dad shows no symptoms of thrush but has 
been taking the acidophilus and following the other dietary changes.

Mom has started to introduce formula, but baby doesn't like it and doesn't 
want it.  Mom continues to breastfeed as long as she can tolerate the pain.  
She is also pumping 4-6 times a day, and offering her milk in a bottle.

I hope you all can help.  If you need additional information, please contact me.

Jamie Huddleston, IBCLC
York County WIC Program
Sanford, Maine

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