Thrush? Or something else?

[@llli*triciajoy]

This is my first post, so be kind!

My daughter was born at 35 weeks via c-section. She did extremely well at birth and was able to room in from the beginning. She had a great latch with little discomfort on my part right from the start. She was slow to gain the first 2 weeks, but has since been gaining exceptionally well (averaging an oz/day or more) so clearly she's transferring milk well.

Everything was going swimmingly until 5 weeks when suddenly both nipples were a bit sore. Rightie wasn't terrible, but leftie was pretty uncomfortable. And by the 2nd day of this, it was excrutiating.

As I did some reading, I suspected thrush.
-I had antibiotics with my section
-I had another round of antibiotics with a severe sinus infection right afterward
-I had a vaginal yeast infection at the end of the 2nd round of antibiotics (shocker, right?)
-the pain is not just at latch, but continues throughout the feeding and sometimes after
-it is worse at night than during the day


My daughter does not have any signs of thrush herself, though. And when I called my OB, she didn't think it was thrush.

I was extra cautious with her latch, varied my nursing position and started doing vinegar washes after each nursing session and taking a probiotic. I had a little improvement, but still had pretty severe pain at night on the left. The right side completely cleared up and is still pain free.

I then decided to try gentian violet. I've now down 4 nights of GV on my nipples and the only thing I can say is that we're both very blue and I hope I can get it out of my bedding. She only occasionally takes a pacifier, but I've boiled them for 20 minutes daily as well.

But I'm still in severe pain.
My reading says if 4 days of GV doesn't improve the pain, it wasn't yeast, but I really don't know what else to say. I really don't think it's a latch problem because everything was fine for 5 full weeks, and my right side doesn't hurt at all. (Though to be fair, my right nipple is significantly smaller than my left, so I'm sure he latch is different on each side.)

I don't see a crack or bleb. The only thing I can *MAYBE* see is that by the end fo the night when the GV is mostly worn off, there is one little "dot" of GV left, like perhaps it's still in a milk pour that is blocked? It looks fine otherwise. I just don't know.

The tips of my nipples do feel a little "tough" for lack of a better explanation, but I would assume that's somewhat normal after 6 weeks of EBFing. But I don't know how I would know if it's a callous or not?

I would love anyone's thoughts. I am seeing my OB for my 6 weeks PP check tomorrow and will discuss it with her as well, but I'm in a lot of pain and hoping someone has some advice!

[@llli*mommal]

Welcome and congratulations on the new baby! Your post leaves me scratching my head a bit. What you're experiencing could certainly be thrush, but it could also be something else. To me, the following are very suggestive of thrush:
- sudden onset after weeks of trouble-free nursing
- coincident with double round of antibiotics and a yeast infection
- pain continues after the feeding

However, there are other possible explanations for pain during and after feeding:
- nipple bleb/blister http://www.kellymom.com/bf/concerns/mom/nipplebleb.html (this possibility would mesh well with the "dot" that has persisted on one side- that could easily be a small bleb)
- vasospasm http://kellymom.com/bf/concerns/mom/...blanching.html (often mistaken for thrush, can cause severe pain after feedings, onset often coincides with colder weather)
Do either of those possibilities make sense?

[@llli*triciajoy]

Thanks for the reply. I'm also at a loss. And recognize that there could be more than one thing going on.
I mostly wondered if anyone had used gentian violet, had no luck but it did turn out to be thrush, which then responded to something else (diflucan, for example.)

I just know that this pain is excrutiating. There is no way I can keep going for long like this. It's already starting to affect my ability to let down. I can tell Charlotte is getting frustrated at the breast and while i'm normally more than happy to let her linger at the boob comfort nursing as long as she wants, I can only take so much before I have to stop her.

If it really comes down to it, I could feed her from the right side alone, but that seems silly if this is something fixable.

The bleb is a maybe, with the "dot".
The vasospasm, no, because the pain is also while she's nursing, not just in between.

[@llli*maddieb]

I then decided to try gentian violet. I've now down 4 nights of GV on my nipples and the only thing I can say is that we're both very blue and I hope I can get it out of my bedding. She only occasionally takes a pacifier, but I've boiled them for 20 minutes daily as well.

I don't have personal exp with thrush. But I looked up the protocol for gentian violet in the lacation textbook Breastfeeding Answers Made Simple (2010), and it says: For mothers: Dip a cotton swab in 0.5% or 1% solution and swab nipple/areola area once or twice a day for 3 to 7 days. Stop after 4 days IF THE PAIN IS GONE. (emphasis mine) It can be used in combination with other antifungals.

For baby: dip cotton swab in a 0.5% or 1% solution and swab inside baby's mouth on cheeks, gums, and tongue once or twice daily for 3 to 7 days. (Avoid stronger concentration, which can cause sores in baby's mouth.) Stop after 4 days IF THE SYMPTOMS ARE GONE. (again, emphasis mine.)


I made the emphasis because I have heard or seen many times that GV "should work in 3-4 days" but as you can see, that is not actually what the published reccomendation is.
IN any thrush case, both mom and baby must be treated, even if baby is asymptomatic.

Some cases of thrush respond to GV, some don't. If GV does not work, that does not mean it is not thrush. As far as prescription treatments go, Nystatin is probably the least clinically effective. There are other options. One that seems to be very effective in both mom and baby is oral Fluconazole, I have the protocol from this text too I will type it out if you are interested.

Another thing that BAMS says is that thrush is very difficult to diagnose and is frequently misdiagnosed. It says thrush is most often persent if a mom is experincing breast pain AND either shiny nipple/areola skin or Flaky nipple/areola skin.

Something that commonly mimics thrush (besides the possibilities mommal mentioned) is a bacterial infection. This presents as moderate to severe nipple pain along with nipple cracks, fissures, ulcers, and/or visible pus (oh owie, not to mention yuck)

With a bacteral infection, the threatment is-your guessed it, oral antibiotics. (Once a full-on infection is present, topical antibiocs are less likley to be effective.) So, this is probably unlikely in your case, but I just wanted to throw it out there.

Lets hope it is a bleb! tips for blebs: http://www.llli.org/docs/00000000000...plugsblebs.pdf

You could just see if you can find a doctor who will prescribe the components and a compunding pharmacist who can whip you up some All-Purpose Nipple Ointment and give that a whirl. My understanding is some moms make it out of OTC ingredients but I have no idea how effective that is.

[@llli*triciajoy]

Thanks so much! My understanding with the GV was that if the pain was gone in 4 days, to continue it for 7, but if it's not helping by then, it's not going to.
I have been treating Charlotte as well, even though she's asymptomatic.


I've been paying exceptional attention to her latch and it really COULD be deeper, but it wasn't any trouble for the first 5 weeks and then this.

I think my plan is to talk to my doc today (I'm going to take her the print out of the APNO) and see what she says, and try to get out to see a LC in the next few days. It's difficult because Charlotte isn't supposed to be out and about until mid-February because of her prematurity, but I'm going to put her in a wrap and practice my "don't come near us" speech and go out to a local place with a LC on staff.


This isn't thrush related, but do some women just have shallow nipples? I have large aereolas, but my nipples really do not protrude much (I was using a therashell for the first few days post partum to help) and even really trying to stuff as much in her mouth as possible, she just goesn't get a ton. But again, it wasn't hurting at all until last week.

[@llli*mommal]

Yes, nipple shape can vary tremendously among women! It's something I wish I had known prior to nursing my first baby, but we live in a society that covers breasts so assiduously that I think it's rare for a woman to realize just how much variety there is in nipple shape/size/color/etc.

Nipples general come in 3 varieties:
- Erect or everted. Rarely or never entirely flush with the skin of the areola.
- Flat or semi-flat (short). Frequently flush with the skin of the areola.
- Inverted. Nipple retracts into the breast when stimulated. This is generally the most problematic type of nipple for a breastfeeding mom, as it may be hard for the baby to latch, and because inverted nipples have the hardest time reaching the "sweet spot" at the back of the baby's tongue and are therefore more vulnerable to trauma.

It is possible to nurse with any of the 3 types of nipples. And the best treatment for short or inverted nipples is nursing, since constant use helps break the adhesions under the skin which hold the nipples down. I started nursing with flat/short nipples and had a great deal of trouble in part because they were so short. But after about a year of nursing, I noticed that my nipples were erect/everted all the time.

[@llli*triciajoy]

Yeah, I think mine are shallow. And a YEAR to fix? Oh boy.

I EPed for my son (he was a tube-fed 26 weeks preemie) for almost 15 months, but of course, that motion is SO completely different than nursing. I don't think it really pulled my nipple out the "right" way.


Just FYI, my doc still isn't 100% convinced it's thrush (much like us) but also can't see anything else causing the trouble so she wrote for a round of Diflucan and is hoping for the best. Getting it filled and started today. REALLY hoping this works.

I kinda babied that breast yesterday nursing on the other side as much as possible and ended up with a nasty clogged duct this morning. I feel like I can't win.

[@llli*maddieb]

What is interesting here is something has changed, right? Nursing did not hurt for the first few weeks, and then it began to? So I don't think its your nipple shape, or if it is, that is not an enormous factor. Babies can nurse comfortably on all kinds of nipple shapes. My nipples were also flat and it was so bad I used a nipple shield at first, but nursing became comfortable long, long before I noticed any appreciable difference in my nipple shape.
Any engorgement can make latch issues worse, just FYI.

What positions have you tried? Have you tried laid back positioning? (biological nurturing?) Did anything change in where you nursed or in what position you nursed baby?

Is baby being treated for thrush too?

Bummer about the plugged duct. If you have to pump on that side in order to give the nipple a chance to heal, you can try that. But you will want to pump or hand express pretty frequently.

You EPed so long with your first-that is really amazing. And after that you rightfully should have had things trouble free this time, so this turn of events is understandably very disheartening! But remember this is still very early days. Whatever is going on here, there must be a cause and hence there must be a solution, and when you are past this, then you can enjoy the benefits to MOM of nursing. I have sometimes seen with moms who EPed with one baby give up on breastfeeding a subsequent baby perhaps a tad prematurely, because they know the world of EPing and are confident they can do that, and give their babies the wonderful benefit of momma milk. Of course, if that is what will work best for you and your family, then that is the right choice for you. But since you seem to want to keep nursing, try to hang in there a bit longer, as the benefits for both mom and baby truly multiply when baby can nurse at the breast.

[@llli*joe.s.mom]

Ugh. Here's what I do know: Thrush sucks and it can be extremely stubborn and resist treatment. I hope the Diflucan does the trick!

Are you taking probiotics? I put infant probiotic powder in my baby's mouth and directly on my breasts, in addition to giving us both the max. rec'd dose when I had thrush and it really seemed to help.

[@llli*yoginimama]

Thanks for the reply. I'm also at a loss. And recognize that there could be more than one thing going on.
I mostly wondered if anyone had used gentian violet, had no luck but it did turn out to be thrush, which then responded to something else (diflucan, for example.)
.

I had a terrible case of thrush that lasted 8 freaking weeks. It didn't respond to GV for 31 days. The only thing that cured it was:

- GV for me and babe
- Diflucan for me and babe
- I used Medela quick clean bags to clean everything. I feel these were more effective than boiling.
-Probiotics for me and babe
- Grapefruit seed extract for me orally and on my nipple after every single feeding **this was essential, I think.
-changing my bra every single day and treating it in GSE wash and then laying in it the sun to dry
-treating every single piece of clothing that touched my bare breast and that touched my baby's mouth (spit up cloths, blankets, toys, etc) with GSE/vinegar/sunlight

It was hell on earth, but I overcame. I also was working FT and pumping. So there were pump parts to sterilize as well. *good times*

I even emailed Dr. Jack Newman, who said to keep going with the GV even after the 4 days and 7 days. It was kind of insane.

I suggest reading this article.

I also would suggest asking your pedi to swab your baby's mouth and see if yeast grows. My pedi resorted to this after we called in an infectious disease specialist. It was, oh, so much fun.

I wish you lots of luck, mama. If this is thrush, it sounds like a tough one. But you are tougher.

Also, FWIW, I think this is the nicest bunch of people you will find in online forums. These forums are not like the usual ones where you'd get flamed. I adore the women here, and I think you will too. Welcome to you, mama.

ETA: If you get the GSE in pill form, you MUST take the GSE several hours away from any other medication. I believe the window is 4-6 hours. The reason is that the GSE is so powerful it will basically "kill off" the good part of the other meds you need. This INCLUDES take the GSE AWAY from the probiotics. This is critical.