Dear Lactnetters, please advise..
    I have been working with a motivated mother of a six week old.  At 4
weeks we treated her for yeast with Fluconazole for 2 weeks, baby was also
treated appropriately with Mycostatin rinse.  Vinegar rinses were used,
cleaning towels, boiling rubber items etc...  During the time of therapy she
had so much pain she could not breast feed for more than 3 times in a day.
The Rx helped reduce the pain considerably to being bearable.  Now she is
mostly double pumping.  I observed a feed today.  Baby is latched on well,
did not "hurt", but nipples were pink and very tender looking.   10 minutes
after  the feeding I notices a slight blanching at the very tip of the
nipple.  Prior to that the nipple was flattened slightly.   No other color
changes seen.  Mom says the pain worsens throughout the day but she no
longer has the pain going through to her back.
    Baby's suck appears appropriate, although the palate seems low.
(However, I'm not as experienced with assessing palates as I would like to
be) .  Could this (a low palate?) be the cause of her continued pain?  Is
there such a problem as a low palate??   Would you try another 2 weeks of
Fluconozole. Or am I overlooking something else. I'm stumped.  If you have
any please let me know.
Much Aloha,
Tina RN IBCLC
Kailua, Hawaii