I was really interested in Maureen Minchion's discussion about nerve pain.
I talk to clients about that a lot -- I describe it as the same kind of
phenomenon that goes on when you have a smashed finger. Due to the nerve
sensitivity in the finger tips (and nipples!), the pain is likely to radiate
beyond the actual area of injury. I often suggest talking to the doctor
about use of anti-inflammatory meds such as ibuprofen during the time it
takes to clear up a superficial nipple infection, be it fungal or bacterial.
However, my pet theory is that there often is an untreated low-grade
bacterial infection of the breast implicated in deep pain. The infection is
probably introduced through the fissured nipples. Postpartum women have
slightly supressed immune systems, so it is possible they have difficulty
managing to overcome both bacterial and fungal infections. Antibiotics DO
and antifungal meds MAY be anti-inflammatory agents, explaining why some
women seem to do better on meds, but worsen when they come off. Poor breast
emptying probably contributes to ineffective flushing of the gland, raising
issues of inflammatory sx including pain, complicating the picture. Given
the long courses of oral antifungals often prescribed, it may be coincidence
that the woman finally stabilizes over time. I do agree with Maureen that
topical gentian violet (.5% strength) is a wonderful topical nipple
treatment. It's probably as useful as an antimicrobial as an antifungal,
just as mupirocin (Bactroban) seems to be a useful antifungal as well as an
antibiotic.
By the way, I just read an interesting article while researching for the 2nd
edition of The Breastfeeding Atlas: P Thomassen, V Johansson, C Wassberg, B
Petrini: Breast-Feeding, Pain and Infection, Gynecol Obstet Invest 1998;
46:73-74.
Abstract: "A syndrome of deep pain in the breast during an immediately
after lactation has been ascribed to an infection with Candida albicans. A
series of 20 patients with deep pain, another 20 with superficial infection
and 20 health women were compared with respect to the growth of bacteria and
fungi. C. albicans was found twice as often in the milk of women with
superficial lesions as compared to those with deep pain. Bacteria were
often found on the nipple and in the milk of those complaining of deep pain.
Thus, if the deep pain syndrome is caused by micorbes, this study point to a
pathogenic role of bacteria rather than fungi."
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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