Dear Tamara,

This has been going on for a long time without resolution.  It seems appropriate to consider other possibilities, such as treating for vasospasm/Reynaud's.  Consulting a dermatologist seems appropriate, as does culturing mom's milk to rule out staph.  I've been taking the GOLD Lactation conference online and one session addressed persistent pain during breastfeeding.  Alexandra Glass MD, a breast surgeon and IBCLC, was concerned about over use of fluconazole as it is hard on the liver. She likes using an APNO-type ointment.  She gave ideas for treating for vasospasm that included Vitamin B6 @150mg, Calcium @2000mg with Magnesium @1000 mg (watch for diarrhea in mom), using nifedipine if true Raynaud's @30mg extended release per day.  She also mentioned using warmth and compression of the nipple to move blood into nipple by either compressing at base of nipple with warm fingers or at edge of areola and moving toward nipple.  If truly thrush, EVERYONE washes hands before and after touching baby; mom needs reminded to boil everything that enters baby's mouth; if she and husband are intimate, he also needs checked for yeast; and check the pets for yeast as well.  Other ideas I have found helpful is for mom to watch diet - low carb, low sugar. 

Cindy Garrison BS IBCLC

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