Permission to post. A former colleage has called me to get my opinion on her situation. I am stumped. She nursed her first child for over a year and had a wonderful and uneventful time. She does not want to stop nursing. She has been told by a few professionals "it just may not work this time" She says this is an unexceptable choice for her.
Below is her story. She said the LC at the hospital she delivered said the latch was great,there was no sign of TT and her daughter is growing well. I did ask her if she ever pumps. She said she does and the pain is significantly less with pumping but the pain between pumping is almost constant. No nipple damage. I have not personally seen the baby because we are not in the same town. I would really appreciate any suggestions if someone has encountered a similar situation in their practice.
Amy Macke RN, IBCLC
Here is her account in her words:

Shortly after my milk came in, I began feeling like I had broken glass in my nipples while nursing. Between feedings it felt like my breasts were on fire. I started a 10 day course of diflucan. After no relief, the doctor added a second 10 day course of diflucan and I also treated the baby with oral nystatin after seeing Lactation. 5 days into the second round of diflucan I was still not feeling any relief and the doctor prescribed a 7 day course of keflex to rule out mastitis and I was given APNO cream to apply after each feeding for two weeks. This also provided no relief. I again talked with Lactation and the possibility of Raynaud's was discussed. Three weeks post-partum, the doctor sent me to a Breast Care Center for more specialized care. I was told I did not have an overwhelming infection and that if I couldn't handle the pain I should stop nursing. I again called the doctor and was told to wait it out over the weekend and if it was still painful the following week, I would be prescribed a two week course of procardia to rule out Raynaud's. Four days into the procardia and six days off of diflucan, the pain became almost unbearable to breastfeed through and I was not sleeping due to the burning between feedings. I called the doctor and was told to wait it out. I then talked to a family friend and FNP and she called in a 14 day course of diflucan with a 400 mg loading dose on the first day. The baby is also being treated again with nystatin to prevent passing it back and forth, although she shows no signs of thrush. Five days into the 3rd round of diflucan I am feeling quite a bit of relief. The left side is now pain free during breastfeeding and the right side is at least bearable. I still feel some burning between feedings. I also seem to get plugged ducts easily, even though the baby completely empties both breasts at each feeding. Am I missing something?

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