ok so I'm sure I've got ductal thrush. What now?

[madmomma]

Sorry for repeat post. Was diagnosed over the phone on Sunday with mastitis, and am on antibiotics for it. But I'm sure that in addition to/instead of mastitis, I have ductal thrush. Had a section 11 days ago, so IV antibiotics too. The main symptom is agonising pain for an hr after feeds. Just on one side. Baby has no white patches, but a very red, stubborn nappy rash.
At the time I was diagnosed with mastitis, I had a lump in the painful side, but that cleared very quickly, and it wasn't painful. I've no fluey symptoms, and the right breast is fine.
So I intend to see my GP tomorrow, but I don't want to get fobbed off. What do I need her to give me? Have got probiotics today so will take them. Am trying to keep nipples dry & not use nipple creams. Any advice?

Poor you madmomma .

Here is the 'thrush' leaflet from the Breastfeeding Network. It will give you ideas about the the best medications to take and it might be worth printing it out and showing your GP.

Hope you get some help and feel better soon.

Thanks crikeybadger

No prob, don't forget you'll need to get treatments for both yourself and LO if it is thrush.

just read the leaflet & am a bit concerned that the drug they recommend isn't licensed, even though it's widely used

Does it really hurt when you feed from the side you think you have thrush in. I have had thrush and it is bloody agony from latch, right through feed and then for a good while after. Also whole breast felt really itchy. If so - likely you have thrush. It may not have been mastitis but only a blocked duct so you could have been misdiagnosed from what you say - though still keep taking the ABs.

I got Canestan cream from GP but you will probably need more, the leaflet mentioned above is useful. It forced me to give up tbh, though I was almost 12 months in and ready to stop anyway.

ABs are a nightmare for causing thrush, suggest taking probiotics if you can at same time and eating lots of live yoghurt!

Good luck!

I don't want to give up, but am worried about taking an unlicensed drug whilst feeding. Yes it hurts during the latch and feed, but is worse afterwards. Yes it's an itchy, prickly shooting pain. Got the yoghurt and probiotics. It's a bit of a poor show if the duty doc's given me antib's for a blocked duct.

Yep, you need Diflucan. Take the leaflet to your doctor, and if they won't prescribe it for you ask to see another doctor who will.

There can sometimes be an issue because they have to take personal responsibility to do so - it hasn't been tested re. safety when breastfeeding, because the manufacturers haven't paid for the trials, but they know how much gets through in your milk and it's miniscule in comparison to what is safely given direct to neonates. Most doctors will prescribe when persuaded, so stick at it.

For what it's worth, my doctor wouldn't prescribe the very high dosage that the Breastfeeding Network recommend, but the amount I did take worked ok.

The other thing I think definitely helped me (though it may be cranky hippy shit) is grapefruit seed extract, which is supposed to be an anti-fungal - health food shops have it. Cutting out as much sugar as possible also helps.

But you need the Diflucan too, and quickly - it's not worth messing around. Make sure your baby's treated thoroughly too - there are a few different things that babies can have, so if whatever your doctor starts with seems slow to take effect go back and ask to try another treatment.

Hope you feel better soon - having thrush is really miserable, but when you get it cleared up you'll feel like a whole new person.

Sorry, cross posted - please don't worry about the licensing - it really is a technical thing. I have a relative who works in a prem baby unit who says that the amounts they give their preemies are far far higher than anything that gets through in your milk, and nobody worries about that at all.

You could give Wendy Jones (she's a pharmacist) at the Breastfeeding Network a call and chat this through with her. I think the amount of the drug that gets through to the baby via the breastmilk is much less than if it were given directly- but she'll be able to explain better.

The info is on this page.

hth

Oh yes - wasn't suggesting you give up! Just that it's horrible. Worse than Mastitis and that was bad! Thing about prescribing and diagnosing over the phone - it is easy to get it wrong. If your lump wasn't painful and no fluey symptoms may not have been Mastitis.

Oh you poor thing. I don't know the answer, but want to wish you the best with it.

Have you had bfing assessed by a qualified HCP (not just a MW or HV)?

As you have already had mastitis and are only 11 days in it would be worthwhile getting bfing properly assessed by a BFC/IBCLC or an Infant Feeding Co-ordinator to make sure everything is spot on before proceeding with the Fluconazole/thrush treatment. I'd recommend getting things like Tongue Tie/Lip Tie checked for as well.

Some other bfing issues can appear as thrush type symptoms, and while Fluconazole is acceptable to take while bfing if it is clinically indicated, there is concerns going round the bfing community about mothers being given course after course of it with no results as other causes haven't been properly explored before hand.

Do you know why you have had mastitis? How well is baby feeding? Are there any concerns over weight gain/no. of wet & dirty nappies?

Thanks very much everyone, that's very reassuring. truthsweet Baby is feeding very well, is constantly pooing and weeing and gaining well. My breasts feel like they've been emptied after she feeds, and on the unaffected side, feeding is comfortable. That said, it's clearly a sensible idea to call the feeding coordinator and double check. I've no idea why I got mastitis, or even if I did get it

You'll have been quite engorged recently, I presume. That can cause mastitis (it was my cause too).

Good point from truthsweet. As you've seen already with your possible mastitis diagnosis, GP's are often not experts on breastfeeding.

You have my sympathies, I had it for 2 months when feeding dd1 because my GP wouldn't prescribe me the Fluconazole (not licensed but perfectly safe, the reason it's not licensed is because it was never officially tested on bfing women). It took a couple of consultants threatening to report her before she finally gave me the whole 10 day prescription with a larger first dose (she would only prescribe me one 150mg tablet before that).

The pain is very distinctive with ductal thrush, it feels like pins or glass travelling through your breast during/after feeding and is quite severe, I also had dry, cracked nipples from it too. My dd didn't ever get thrush in her mouth while I had it, she had it all over her bum though, I had it again (though no where near as severe) when I was feeding dd2 and she also had awful thrush in the nappy area, it was treated very quickly that time though (different GP).

Baby and I both have thrush at the mo, it's horrible my let down feels like needles. I had it a number of times with my last baby too but didn't realise that's what it was got mastitis 4 times I think this is because the thrush was affecting the babies latch and it was a viscous cycle with the ABs. One of the things I only found out recently is that along with the drugs you should also wash your clothes and babies clothes on at least a 60 degree wash to kill the thrush and boil all expressing stuff not just run through the steriliser. I hope you fell better soon, it's rubbish.

If you were diagnosed with mastitis I would assume you had a fever, chills/fluey feeling, red triangle/wedge/streaks on your breast's skin, pain in breast, lumps in breast, engorgement or any combination of the above.

Mastitis in an infection of a milk duct and is usually caused by milk stasis (literally milk staying in the breast which inflames the breast tissues) due to either baby not feeding well or not enough bfing or a plugged duct, it can also be caused by bacterial infection (or bacteria can exacerbate it) especially if there are cracks on the nipple (they act as an entry way for bacteria to get into the ducts).

Occasionally, it can be down to structural anomalies within the breast or from surgery (enlargements, reductions, growth removal, etc) leading to poor drainage from a particular duct or set of ducts, an recent injury to the breast or even an allergy.

sorry to hear you have thrush, I had it with DS1 and it killed breastfeeding, got it again with DS2 but managed to overcome it this time. Prompt treatment is really important because the longer it goes on the harder it is to get rid of (and the more painful)

Regarding the licensing, like many medications it has not been tested on breastfeeding women and never will be for the simple reason that trials like that are considered unethical (because it could affect a non consenting infant) however it is very widely used. Have a read of the info on the Kellymom website for more reassurance.
www.kellymom.com/bf/concerns/thrush/thrush-resources.html

I tried the low dose first (150mg) and it didnt work for me, I would go straight for the high dose (400mg first day, then 200mg per day for at least a week-10 days, perhaps more if pain doesnt go away)

Other "home" remedies that you can try in the meantime (and will help, but not cure all) are:

adding a large splash of vinegar to a small bowel of water - use this to rinse off your nipples after a feed, also dip baby wipes in it before cleaning babies bum. If you dont have vinegar try making a rinse with water+ baking soda. The acidity in these products inhibits bacterial thrush growth.

Try using talcom powder on babies bum instead of cream to keep it really dry (be very careful that baby doesnt inhale the powder, press it in gently so it doesnt fly everywhere)

Eat as much raw garlic as you can (or get some capsules)

good luck with your GP

well I've seen the GP, who confidently pronounced that there's no such thing as ductal thrush. Luckily I took the leaflet from the breastfeeding network with me, and to be fair she read it carefully and agreed that my symptoms matched up. So she's given me flucanozole and daktarin gel for my nipples, plus canestan for the baby's poor red bottom. She said I don't have mastitis and I should stop taking the antibiotics as they'll aggravate the thrush. So fingers crossed I'm on the right road now. Thanks very much for the advice all.x

Daktarin CREAM is the correct treatment for your nipples. The gel is for your baby's mouth. The gel carrier will not penetrate the skin properly. The gel needs to be given to your baby, but carefully in little smears, one smear per mouth section.

Canestan should very, very quickly clear up your baby's nappy rash (probably you will see an improvement within a few hours, and much better by tomorrow) - IF it's thrush. It's quite a good indicator of a systemic thrush infection, is that.

A couple of other things to try are grapefruit seed extract (NOT grape seed) which comes in a liquid, which is diluted and tastes foul, or tablets. I keep a stock of both, using a few drops of the liquid in the rinse cycle of the machine if we get an infection (I'm very, very prone to vaginal thrush while pregnant which I am now) and take the tablets. Acidophillus is also excellent. It's available in tablets and it's a probiotic which can help to re-populate the gut flora which overcomes the candida infection.

If you have even the slightest symptoms of vaginal thrush then I'd suggest getting yourself a Canesten combi, too (free on prescription) - and if you DTD before bub arrived (I'm assuming you've not within 11 days of a section ) then it's worth getting your OH to treat himself with cream for a few days. It's all going to help break the cycle.

Consider drying your nips and bits with facecloths (one each!) after a shower, then 60 degree washing it (facecloth means less machine washing than a full towel) - and anything that touches your nips, your bits and your baby's bottom needs to be washed at 60 degrees at least after each use. So, new bras daily, use disposable breast pads or wash them very regularly on a hot wash, and if the bras will take it iron them on the inside to kill the spores. Ditto washable breast pads.

It will get cleared and you will feel much better very quickly if it is ductal thrush. It really is worth hanging on in there.

Thanks occ. Dr said the gel for my nipples was to work on the baby's mouth via me iyswim. I'm taking the probiotics but couldn't get grapefruit seed extract from holland and barrett

Nah. In a sense that might work but it's just as easy and waaay less messy to apply it on your finger and let him suck it off, and also it needs to be wiped over all the mucous membranes as well. Either way it's not going to sink into your skin as effectively and efficiently as the cream will to treat YOU, and it's not going to coat the baby's mouth as effectively as rubbing it on his gums with your finger.

You need to find GSE online - it's quite specialist. This is the stuff: www.highernature.co.uk/Products/Citricidal?AgentID=422276&gclid=CLzg_IOQt60CFYEhtAod7lDzGw with citricidal in it.

I totally understand your concern (mentioned earlier) about taking fluconazole when it's not licensed for nursing mums. As has been mentioned, it's not licensed as most drugs aren't tested on nursing mums for ethical reasons, as opposed to there being known problems outside its normal side effects. What has been found is that significantly less comes through the milk than is licensed for use in babies - and not enough for a dose effect - so given an understanding of the wider side effects (which you'd check out on any drug) this hopefully gives you the info you need to make an informed choice. You've probably seen this on the BfN leaflet but I just wanted to point it out.

Something else you may come across online is gentian violet. It's pretty much impossible to get in the UK but if you're overseas you might find it. However, while it's still used in many countries due to its high efficacy (including the US) it's caused some really nasty side effects so is well worth seriously looking into before considering.

BTW I sort of inferred this but thrush is very, very contagious so avoid all towel sharing, etc, and take care with intimate contact (I don't just mean sexual - I mean both before and after nappy changing, bathing baby etc). I keep a bottle of hand sterilising gel by the nappy table to use before and after changes when I'm a carrier as I've passed it to mine before :( as well as hand washing.

Yeah I'm happy to take the flucanozole having read that it's given to neonates. Thanks for the highernature link. Do you think I'd be able to get the daktarin cream over the counter?