Back again - please help!

[@llli*lizm]

So I posted a while back about having thrush. Well, I finally got some difulcan for it and started it a week ago today. I was so excited because I thought our problems were finally coming to an end. Well, I am sad to report that after 3 weeks of battling thrush and 1 week on the difulcan - I have no noticeable improvement! How long is this stuff supposed to take to work? Sometimes I *think* the pain is improving...only for it to get worse again. I'm taking the difulcan, GSE, GSE on the nips, probiotics, changing my bra every day, washing my bras with vinegar, drying my hands with paper towels, baby is still using nystatin a couple times a day (he has no symptoms), I've even eliminated sweets from my diet! Nothing is working and I pain is so bad at times I feel like Im going to throw up. Is there anything I can do to at least manage the pain until the meds start working? I've tried tylenol (can't take ibuprofen) and it doesn't seem to touch the pain.

I'm afraid maybe the antibiotic I'm on for a case of mastitis last week might be whats making this take so long to go away - I'm ready to just throw my last 2 1/2 days worth out the window!

I'm to the point where I'm ready to go out and buy a pump and just pump from the side that hurts so bad. Would that not hurt as much? My son is 1 mo old today, so I don't think I would be too afraid to give him a bottle, especially since he would still be breastfeeding from the other side and he is doing a really good job with his latch. I just don't know - I don't even know how to go about the pumping thing, that's why I've avoided it thus far. I don't know if it is a good idea or not - and I don't really want to deal with having to sterilize everything every day. However, the pain is getting ridiculous and I don't know if pumping would give the nipple a little bit of a break to heal faster?

Ah! Help! This is not how I envisioned our first month going! I just want to get past this!

[@llli*katmar]

Im sorry for your troubles, though you arent alone in having a challenging first month, at least not around here. I have had many and long cases of thrush. Yes, sadly, those antibiotics are probably responsible. At least they arent helping. I dont think i would stop them, but I would lower my expectations about the trush going away while on them. You have to giveyour body time to rebalance on the other side. That said, you may be keeping the thrushbfrom getting worse or spreading (which is TERRIBLE), so stick with it. Somethrush cases take a month to get through.

How about hand expressing, have you learned how to do that? I do that on one side when it hurts too much. It's easy when you are nursing on the other side. Plus nothing to wash. Your supply might dip a little on that side if you sub that for nursing a lot, but you'll be able to get it back up. I think even a few breaks a day can really help when it hurts that much. Good luck! Stick around for support.

[@llli*aprilsmagic]

If it is thrush, pumping might prolong the whole thing because if you don't keep it clean enough, you can just reinfect yourself and baby. And pumping and feeding is just a hassle. And yes, thrush can take a while to get better. I had it like 4 times with this whole pumping gig this time (I only had it one other time with a baby) and it took a couple months to go away

Have you seen an IBCLC?

There have been a couple mamas here who experienced severe pain for some time with their babies, and they ended up gutting it out essentially. IIRC, the babies had high palates, and the babies had to get a bit bigger before it didn't hurt. Nothing else was wrong; it was just the palate was so high that it was very painful to nurse until the baby's mouth got bigger.

[@llli*lllmeg]

If you have not already done so, you may want to rule out everything besides thrush. Since there is no test for it, thursh is overdiagnosed. I am particularly suspicious because I think you are saying you only have pain on one side? That is rare with thrush. Bacterial infection of the nipple, which would be treated with oral antibiotics, can seem a lot like thrush, and I believe it can be tested by having a culture done. Latch pain can be due to a poor latch and nipple damage from that. Vasospasm is something else to rule out. If you have not seen a board certified lactation consultant (IBCLC) I suggest that you do.

For thrush, the suggested dosage according to the lactation textbook Breastfeeding Answers Made Simple for mom taking oral fluconazole (aka Dilfucan) is to take a 400 mg loading dose, then 100 mg 2 X a day for at least 2 weeks, and to continue for one week after pain is gone.

If baby is being treated with Nystatin, baby is not being treated with the best prescription medication, studies show fluconazole (in an oral suspension) is most effective for baby as well. It does not matter if baby has symptoms, baby needs to be treated as well or the thrush will not go away.

The OTC treatment for both baby and mother suggested in BAMS for thrush is gentian violet.

[@llli*redpowerlady]

All Purpose Nipple Ointment works miracles. I'd see if you can get a script for it.

[@llli*lizm]

If you have not already done so, you may want to rule out everything besides thrush. Since there is no test for it, thursh is overdiagnosed. I am particularly suspicious because I think you are saying you only have pain on one side? That is rare with thrush. Bacterial infection of the nipple, which would be treated with oral antibiotics, can seem a lot like thrush, and I believe it can be tested by having a culture done. Latch pain can be due to a poor latch and nipple damage from that. Vasospasm is something else to rule out. If you have not seen a board certified lactation consultant (IBCLC) I suggest that you do.

For thrush, the suggested dosage according to the lactation textbook Breastfeeding Answers Made Simple for mom taking oral fluconazole (aka Dilfucan) is to take a 400 mg loading dose, then 100 mg 2 X a day for at least 2 weeks, and to continue for one week after pain is gone.

If baby is being treated with Nystatin, baby is not being treated with the best prescription medication, studies show fluconazole (in an oral suspension) is most effective for baby as well. It does not matter if baby has symptoms, baby needs to be treated as well or the thrush will not go away.

The OTC treatment for both baby and mother suggested in BAMS for thrush is gentian violet.

I keep trying to think through if it could be something else other than thrush - but I can't think of anything. I don't think it is bacterial since I have been on antibiotics as well and that hasn't helped either. His latch seems fine to me and my nipple doesn't really have any damage other than being bright pink and feeling like it has an extreme rug burn. Would a vasospasm burn and shoot pain through the breast for 2 hours after a feeding like it did for me this morning?

I do have pain on the other side - its just not as severe. A little sharp pain at the beginning of the feeding and occasional pinching during the feeding - but usually it feels great during. That nipple is also a little pink and tender like a rug burn when something rubs against it - especially shortly after a feeding. It is just the tiniest bit cracked, which I figure is the cause of the beginning of latch pain - and it probably comes from his small mouth, although he has a great latch usually?

I think I probably will get in touch with a LC - one of my co-workers recommended one while I was still pregnant. I know this has to come to an end eventually - I just have to make it there!

[@llli*lizm]

I keep trying to think through if it could be something else other than thrush - but I can't think of anything. I don't think it is bacterial since I have been on antibiotics as well and that hasn't helped either. His latch seems fine to me and my nipple doesn't really have any damage other than being bright pink and feeling like it has an extreme rug burn. Would a vasospasm burn and shoot pain through the breast for 2 hours after a feeding like it did for me this morning?

I do have pain on the other side - its just not as severe. A little sharp pain at the beginning of the feeding and occasional pinching during the feeding - but usually it feels great during. That nipple is also a little pink and tender like a rug burn when something rubs against it - especially shortly after a feeding. It is just the tiniest bit cracked, which I figure is the cause of the beginning of latch pain - and it probably comes from his small mouth, although he has a great latch usually?

I think I probably will get in touch with a LC - one of my co-workers recommended one while I was still pregnant. I know this has to come to an end eventually - I just have to make it there!

oh, I forgot - the nipple on the other side will burn after he eats as well, but no deep shooting pains.

[@llli*lllmeg]

Deep shooting pain after nursing is consistent with vasospasm. (I don't know how long it would last but that is the primary symptom.) But with vasospasm you would also see the nipple blanching (turning white) after nursing as well.

I really am not sure how to be absolutely sure it is thrush, but according to Breastfeeding Answers Made Simple, thrush is to be most suspected when a mom has stabbing pain AND shiny nipple and/or areola skin or pain AND flaky nipple and/or areola skin. Color is not mentioned, but a nipple that is being damaged by a shallow latch is also going to appear pink or red, inflamed.

Are you using a nipple cream? If you are, this is a long shot but maybe you could try not using it for a few days and see if it helps? Some creams irritate and even purified lanolin, which is fine for most moms, can irritate in rare cases. This is tricky since you have nipple injury and of course lanolin is recommended to speed healing.

Also have you tried using breast shells? These are hard plastic thingamajobs that you wear when you are not nursing, under your clothes, to prevent your clothes from rubbing and irritating the nipple. Not attractive but they can really help with healing.

I just don't think the cracking you describe is consistent with thrush. That sounds like a latch issue or some other irritant. Of course, you can have pain/damage from a shallow latch AND thrush. But I am betting there is still some damage happening. When you say the latch is good, do you mean it looks good or feels good? Looks tell us something but feel is much more important, if there is latch pain that is a sign something is wrong there. Also, a latch can be 'worse' on one side than the other. Have you tried nursing in a laid back position? typical nursing positions where mom is sitting bolt upright can cause nipple pain, as gravity is pulling baby off the nipple.

Do try to see an IBCLC (or a highly recommended and experienced LC.) Sometimes we really need that trained eye to help us get to the bottom of what is going on. Also an IBCLC should be able to assess baby and see if she suspects tongue or lip tie. I always suggest moms talk to two or three if possible before hiring one, you want someone who you feel confident in and comfortable with.

I never answered your ? about pumping-if you absolutely cannot standf the pain of nursing on that one side, then you can pump instead. Baby may be able to get enough from the less painful side so you may even be able to avoid bottles if you just want to pump for a day or two to give the very painful side a break. I would suggest you stay away from bottles if at all possible, bottle introduction when there is possible latch issues is not a good idea if it can be avoided. Also as aprilsmagic mentioned above, you will need to be very careful about washing the pump parts due to the thrush concern. But if you cannot nurse, then it is better to pump than not pump. You could also consider cup feeding if baby cannot get enough nursing one side. But all in all, if you can continue to nurse, that would be less complicated.