Dear fellow lactnetters:

Once again I am calling on your collective wisdom.

Saw this Mom and babe 1st time, Feb.15, 1999. Infants DOB Feb.5/99. 36 wks gest.
BW 3555 gms, DC 3170, Nurses asked me to see for wt. loss.
Infant presented with a weak, ineffective suck, however, vds and stools
good/other exam negative.

Mom has Lupus/Varicose veins. Takes Prednisone 15mg po,od; Heparin 5000
units sc bid. All well controlled, stable. However, has been on two courses
of antibiotics since birth for Bronchial and sinus infection.
 Treated with Nilstat gtts infant/ung for Mom at Moms request (this was
before I came on the scene), for s&s nipple yeast (prior to Feb. 15). Also
Mom has history of vaginal yeast.

No s&s yeast on my visit but I was wary. Follow up visits/calls showed
improved suck and good weight gain.

Saw Mom this past Monday, c/o "itchy nipples/some burning". Suggest GV
treatment
and discussed possible need for po antifungals. Didnt see infant feed(I was
busy at Babytime clinic). Followup today - 2 hour home visit showed infant
latching on initially wide but readjusting and come down closer to nipple.
Also clicks at times. I can see where the latch needs some work and can
manage this with Moms consistency: here are the questions: should this mom
start po antifungals? She is a Microbiologist and has a good handle on her
susceptibility to yeast. I can see that the latch needs some work and dont
believe the pain she is feeling is only yeast especially as she just
finished GV.
She had also been "treating herself" and am I wrong but can you get too much
of a good thing? She had been using Canestin to nipples pretty liberally/GV
at same time/Purelan/less than perfect latch. Id be itchy sore too.

She is on Keflex and wont be finished until Tues after next. Is it prudent
in lieu of her hx, diagnoses, to treat with oral antifungals? I felt that
she should eliminate some of these creams, be consistent with proper latch,
use l-------h for dry, itchy nipples. See if this eliminates some pain etc
and than treat for yeast if no improvement. Should she start now? Use how
long if will be on antbx for next 2 wks?

I am waiting for LC series 18 for help. Have also referred to Vancouver BF
Clinic.

Again I apologize for my inexperience. I am reading what I can. But this Mom
needed help asap. It has been an interesting/challenging experience as Mom
is a Scientist and is able to discredit any of my references/studies. At
least she appears to be able to because of my lack of confidence at times.
She isnt keen on Diflucan etc and BF.

Sorry this is so long.
Janet Black, RN, CBC
Mission, BC