Erika, I would add to my comments that, when starting all over again in
identifying the issues, it might be worth checking for an incomplete cleft
of the soft palate (very hard to see) or a labial frenum, holding the top
lip to the gum and making it difficult to roll out the top lip.  I suggest
this because the baby has already had one midline anomaly treated (posterior
TT) and occasionally midline defects occur in twos or threes.
I know this mother will appreciate your care and concern.
Virginia
(in Brisbane)

Subject: Re: yeast, nipple infection, sucking issues

Erika, 
It seems to me a good idea to go back to base to start off taking a history
of symptoms from the beginning, before accepting the issues the mother has
identified herself.  After such prolonged nipple pain, I'd look for other
possibilities, rather than thrush, particularly a bacterial infection.  (See
the excellent study by Livingstone and Stringer, The treatment of
staphylococcus aureus infected sore nipples: a randomized comparative study.
Journal of Human Lactation 1999; 15: 241-245.)  A systemic antibiotic, plus
attention to latch, is effective if a bacterial infection is the case.  It
would make sense to stop the Diflucan in the interim.  Read this article for
details.
Raynaud's phenomenon isn't usually associated with going white (blanching)
alone.  Do her nipples also turn white in response to cold, and then change
colour?  Unless there is a biphasic (2 colours) or triphasic (3 colours)
colour change it would seem to me that the nipples are going white because
of pressure.  Mothers with nipple vasospasm are often inappropriately
treated with Diflucan, which doesn't solve the problem.
After experiencing nipple pain for so long, I'd also look to see if the
mother is flinching when she sees her baby's mouth open to feed.  This can
raise the baby and lower the breast, meaning the breast and mouth are no
longer lined up at the moment of latch - creating the pain a mother wants to
avoid.  Have a look at my long letter on this in JHL  (Thorley V. Mother's
behavior that undermines latch: the fear response. JHL 2005; 21: 243-244.)

 

I hope this helps.

Virginia

In Brisbane, Quenesland.

 

On Tue, 26 Oct 2010 Erika Lance wrote:

I have a mom who can really use some extra information. Permission to post.

Mom stated that she has systemic yeast and diflucan makes her really sick
even though she has a prescription for 2 pills.  She also has Raynaulds
because right after the baby came off the breast, it turned completely
white. She has had persistent sore, cracked and at times bleeding nipples
for 10 weeks now. She had pain using a nipple shield so she has D/Ced that.

Also more painful using a pump. I have suggested Dr. Newman's All Purpose

Nipple Ointment because of her risk for more yeast.   There was alot of

birth trauma to this 10 week old baby and mom states they live at the
chiropractor. I have sent them to one of my doctor friends and baby has
slight torticollis and suggested she continue with CST and chiropractor
work. Mom c/o shooting burning pains up into her arm pits. And now bleeding
nipples since the baby had a second posterior frenectomy. Any suggestions of
what she can do to combat the yeast without going to diflucan? What do we do
about her Raynaulds other than heat after a feed? She is going to breastfeed
regardless of the pain. The only true success with this baby in 10 weeks was
finally able to transfer milk using a shield after his first frenectomy and
gained weight for the first time. Second success was getting him off the
shield and mom experienced less pain at nipples. Now she not only has sore
bleeding nipples that are worse after the second frenectomy but had mastitis
last week.  She treated her mastitis with herbs and had success with it.  I
know there is a lot of issues going on...persistent sore nipples, shooting
pain in breasts, mastitis, I am sure a nipple infection, yeast and
Raynaulds. She is over whelmed but truly wants to do it even though alot of

issues are stacking against her.   Any information would be appreciated.

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