Persistent nipple duct thrush - help? (long)

[notcitrus]

Summary - what should I ask the doc for today?

Squirmy is 7 weeks. For the last few weeks I've had knifing pain in my breasts. First GP gave me antibiotics for possible mastitis and Daktarin cream for my nipples. Felt a bit less ill but breast pain worsened and bf counsellor said was thrush.
2nd GP prescribed only 150mg flucanazole despite my showing her the NBT thrush leaflet as she claimed 150mg was a 'high dose' and I wouldn't need any more. And refused to look at Squirmy. So the next day I went to a walkin clinic and got 400mg flucanazole followed by 7 days of 100mg, plus nystatin drops for him.

It's helped a fair bit (after one evening off when it was too painful, I've been able to bf since), but the thrush hasn't gone (two bf counsellor midwives have confirmed it's thrush, plus one cracked nipple that hasn't healed in 3 weeks, and that my latch looks perfect).

I'm seeing my pet GP tonight who will prescribe anything I ask for if I show him the research or guidelines - should I get the same amounts of flucanazole again? Or what?

I'm allergic to clotrimazole (canasten cream), and have had persistent vaginal thrust in the past (gynae prescribed 150mg flucanazole weekly for 4 months).

Really want to continue bf seeing as I've finally got it pain-free etc. Although could do without the lightheadedness and difficulty getting enough food in me (have to eat low-fat low-sugar diet and the cooker's broken...), not to mention that 3-hourly feeds at night are pretty wearing (growth spurt has had him feeding 1-2 hours in the day, but finally getting back to 3-4 hours).

bump before going to doc...

When I had thrush it led to a blocked duct which I managed to sort with olive oil soacked cotton wool in bra and lots of warm baths with breast massage. There was a fatty deposit which I kind of had to pop out (that sounds gross and really hurt) but I have been pain free since.
I can sympathise as when I first went to see the GP he told me it was my fault for not 'toughening' my nipples before birth (Male US physician assistant) ahhhh

I did take flucanozole (400mg 2 tabs taken a week apart) and had to dose DS1 with nystatin which was fun

Good Luck

Luckily Squirmy likes Nystatin! It's cherry+cinnamon flavour...

Saw my lovely GP who said 'I've heard that's horrible', checked compatibility with bf, and prescribed same again - 400mg loading dose + 7 days 100mg/day.
and, because he's lovely, prescribed Squirmy more Nystatin despite him being registered at a different surgery.

hope to get better soon...

Good luck notcitrus! You're doing brilliantly and with additional challenges most of us don't have. It'll all get better!

Well done for getting as far as you have!

I have a question for that has used the Canasten. It says for external use only, but surely when you feed the baby they're taking it in from you? Are you meant to wash it off before feeding or is it absorbed into the skin?

Thanks starlight. Still having pain so have embarked on the no-sugar diet. Which combined with low-fat, is Not Fun.

Local bfc-midwife says I need to see a specialist lactation consultant and made an appt for me - but that's not until December. Apparently there's one who attends a drop-in clinic in Croydon on Monday so will try that.
Feeding is going better, but being woken with pain when A is finally sleeping longer stretches really sucks.

Keep it up, nystatin is really good. Make sure you use it after EVERY feed, even though it says 3 or 4 times a day on the bottle!!! That comes straight from the mouth of a breastfeeding guru by the way, not just my opinion. It is a real bugger to get rid of completely, so you may need to go abck for more, but the pain will go completely in a day or two. Well done for persisting!!

i was told to use it 4x daily before feeds!

also given the pain is still thwere after 2 weeks of flucanazole, how can you predict it will go in a day or two? (as far as we can tell, a doesn't actually have it, just me)

After EVERY feed?! Shame he hates the taste of it then! (At least my HV said after feeds and not before so it wouldn't be washed away by the milk. Though, given that he just brought up a good proportion of the last feed it probably has been washed away anyway, albeit in the opposite direction to expected)

Update:
Made it to the depths of Croydon on Monday. Lovely baby cafe where you're actually allowed hot tea/coffee and they give you chocolate biscuits, and lovely lactation consultant who looked at A and confirmed that actually, he blatantly has thrush in his mouth, pointed out the white patches and where it has come off, explained that most thrush nowadays is immune to Nystatin, and wrote out a long letter to give to my GP, so that I could get miconazole gel for A's mouth instead.

Amazingly, got GP appt within 30 min of getting home. GP said she couldn't see any thrush. I said it was there 2 hours ago. Eventually I got A to open wide (he screams 'eee' which is a very narrow mouth) and GP said 'ah. you're quite right'... Some confusion in the BNF about how often to use the gel (2 or 4x daily), but it seems to be working, touch wood.

GP wanted to confirm how much fluconazole I was on before giving me another week (thought it was 100mg 2x daily, but in fact 50mg 2x daily). So went back to get the scrip, but she was away and other doc insisted on talking to me first.

Until I argued for 15 min, he refused to give me the repeat flucanazole scrip - he said I should stop bf for the week if taking it (!) and should have blood tests first. I pointed out what the BNF said about the dose in milk being less than that allowed to be given to babies and that stopping it would defeat the purpose of taking it until 7 days after symptoms cease. He argued that just because midwives recommended fluc didn't mean there was any evidence it worked and said it doesn't work. (?)
I managed to avoid asking if he was calling his colleague I'd seen on monday incompetent. He eventually agreed to write it if I confirmed I was aware that the dose could cause liver damage if taken for over a week (I didn't tell him I'd already been on it for 3 weeks...).

Eventually picked scrip up to find it's for half the dose I was on... but turns out my original scrip was for 2 weeks anyway, just the 'pills owing' note implied it wasn't.

Now we have nurse practictioners, it would be dead handy if midwife-bfcs and lactation consultants could write prescriptions themselves. It's lucky I still have a Travelcard - I worked out I would otherwise have spent over £50 on bus fares seeking bf help. Add in the costs of pillows, pads, painkillers, boil-washing and a pump, and I'm not sure formula wouldn't have been cheaper...

I've also been taking acidophilus capsules and grapefruitseed extract and washing my breasts in the latter, and sticking to the sugar-free diet- fortunately my local health food shop also sells sugar-free chocolate!

Fingers crossed...

been reading lots at the moment about breastfeeding that is and found this

www.babycentre.co.uk/baby/breastfeeding/problemsandsolutions/thrush/

www.babyce ntre.co.uk/baby/breastfeeding/problemsandsolutions/

www.breastfeedingheaven.co.uk/breastfe edingproblems/info_7.html

www.thinknatural.com/articles.php?id=10490

if that is any good. Hope it is. Poor you hope that is gets solved quickly for you and baby. The thinknatural site might give you some ideas to try like live yoghurt.