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Hi Aimee

Any time I read the heading "resistant thrush", and see that all the usual
treatments have been thoroughly investigated, I question whether it really
is thrush.  Or if thrush is the only issue.  It might be a good idea to look
at the situation afresh, to see if there is some other underlying condition,
instead of or as well as thrush. Some possibilities are a bacterial
infection, espec a Staph one, or dermatitis (perhaps in response to the
substances applied to the nipples.

A further possibility to investigate as regards the pain would be nipple
vasospasm - provided it is associated with biphasic or triphasic colour
changes (starting with blanching).  This wouldn't explain the cracks in the
skin of the nipple.

My guess would be a bacterial infection is complicating the situation, with
or without underlying thrush. There is an excellent Canadian study on this
by Livingstone and Stringer, which you can find if you search the JHL
archives.

Virginia

Dr Virginia Thorley, OAM, PhD, GDC, IBCLC, FILCA 
Brisbane, Qld, Australia 
E: [log in to unmask] 
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On Mon, 8 Mar 2010, Aimee Crane wrote:

I have read all the archives posts regarding resistant thrush, but still am
hopeful to find additional information I might use to help a mother I'm
working with. I have her permission to post.  I saw her initially when the
baby was 3 weeks old.  She complained of nipple pain, including itchiness on
the nipples. She said she had been using gel pads and lansinoh to treat her
nipple pain.   There was no evidence of yeast in the baby (either in the
mouth or diaper area).  After tweaking baby's position at latch, which was
basically sound, we discussed likely thrush, and I counseled her about
dietary changes (reducing simple sugars, white flour, fruit juices,
eliminating alcohol, and taking a high-quality probiotic blend, etc.) and
suggested she try the Grapefruit seed extract both orally and topically as
on Dr. Newman's protocol for yeast.  I also explained the necessity of
treating baby simultaneously even if baby was asymptomatic.  The baby's
pediatrician prescribed oral nystatin for baby, and mom began applying it to
baby's mouth while she was using the GSE.  She also began taking oral
diflucan for herself , taking a loading dose on day one, and then continuing
on with 200 mg. twice a day. After two days, she called back and said she
now had pain that radiated back into her breast.  I encouraged her to
continue the diflucan.  After 5 days on diflucan (baby is still on nystatin
at this point), she calls and says it is really no better, and she asks if
she can do gentian violet at the same time.  I say yes she can. The baby
began oral diflucan on mother's 6th day of diflucan treatment.   Now, this
morning she called and says she has now taken 10 days of the diflucan and
done GV for 5 days, and she still has burning pain, no longer on the nipple
surface but deep into the chest which comes and goes. She reports the
nipples are still very cracked and tender.   She says the pain is worse at
night, and is making it very difficult for her to sleep.  (She takes
ibuprofen for the pain).  Today she says she is contemplating weaning
because of the pain and sleep disturbance. This is a lovely, dedicated
first-time momma - I hate to see her quit.  If anyone could please offer
treatment suggestions at this point, I would be very grateful.
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