This past week I worked with an out-of-state mom (and her 10 month old) referred by a local (in Coco Beach) oral motor therapist whom mom had been in contact with. This is the history I received:
· frequent bouts of plugged ducts (but not mastitis)
· constant pain ranging from sharp to deep to burning beginning with feeding and up to 15 minutes afterwards.
· Shooting pains deep in the breast tissue
· Mom is on week 2 of Diflucan 100mg, 600mg Motrin, occasional Nystatin on nipple (which burns according to Mom) and most recently alternating ice/heat per her ob/gyn with further instruction to wean entirely and “if the pain continues, a referral to a breast specialist for a possible ultrasound”.
· Baby, 10 months of age, receives Nystatin 4 times/day and is receiving increasing amounts of formula due to the ‘unbearable’ pain of nursing yet weaning is described as painful as well. Mom had been treated with one round of Augmentin.
After talking to the mom, made these recommendations:
Bilateral Breast Milk Cultures, Gram stain, sensitivity, fungal elements. ( I can make specific recommendations compatible with continued nursing a 10 month old after I see culture results). I explained to mom how simple it is to send milk off for these tests. In my office we use a sterile urine cup. One for each breast. Labeled right and left. The lab only needs a small amount to complete the tests. I suggest a cluster of milk about the size of a dime or nickel collected on the bottom of the cup. (With this history I am less suspicious of a yeast infection and more suspecting a sub clinical (chronic ) mastitis requiring a prolonged course of antibiotic or stronger more uncommonly used antibiotic.
Bilateral Breast Ultrasound and breast exam (Rules out a mass causing the problem or an abscess that needs to be drained.)
The dose of Diflucan wasn't as high as I usually use. Diflucan 400mg first day and 200mg each day for a minimum of two weeks. I often treat up to 4 weeks.
Probiotics (Mom later told me she is also using Grape Seed Extract which re-establishes a normal flora and I agree with.)
All Purpose Nipple Ointment (APNO) per Jack Newman MD's website.
FYI- Lecithin is a supplement to help prevent plugged ducts. (Lecithin's value during an active infection may be minimal, but may be preventative towards future plugged ducts.)
Good Nutrition-- High Quality Grains and Raw Fruits and vegetables.
Attend La Leche League Meetings
The mom brought these recommendations to her ob/gyn and sent me an update.
Dr. Punger, Good news. My doctor agreed to test my milk today and also ordered me an ultrasound. I also am currently getting a prescription for APNO filled at a compounding pharmacist and also received a 2 week prescription for 100mg (2x a day) of Diflucan. I have asked to receive a copy of the culture and will forward you any interesting information. I thank you again for your time and giving me the courage to really ask the doctor for what I need. I am hopeful that these next steps will bring me closer to resolving this.