I'm stumped.  Working with a mom who's 11 wks postpartum and has had sore
nipples since the 2nd day postpartum.  After several nystatin treatments
for candidiasis, she finally (last week) took Diflucan and gave the baby
Nizoral PO.  The burning pain (and the baby's white tongue) was relieved
but she is still in pain (pain score 5 out of 10 when baby feeds, and 8 on
electric pump).  Today my findings are:  13 lb. baby with strong
compression but weak suction; a "sandpaper" feel to tongue, which moves
back and forth during sucking; and a palate with ridges that are
uncomfortable to my gloved finger.  He also tends to draw in both lips.
Mom's nipples and areolae are normal (no redness, no fissures, no herpes,
no eczema, no signs of yeast nor bacterial infection--nothing) except for
being slightly dry.  No trauma visible even immediately after nursing.
She also has an axillary rash that's dry and pimply in the areas of hair
growth and slightly beyond.  She discontinued all deodorant use a week
ago.

My plan:  She'll see a dermatologist on Monday.  Went home with breast
shells, and vaseline.  In the meantime, any ideas?

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Ginna Wall, MN, RN, IBCLC                       Phone (206)548-6368
Lactation Services Coordinator                  Fax (206)548-4809
University of Washington Medical Center         Mailbox 356153
1959 NE Pacific Street, Seattle WA 98195
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