[full of it]

Tips on Thrush…from unfortunate personal experience.

Posted in Uncategorized by susieyarbs on August 20, 2011

I may be premature in writing this, because it isn’t gone yet.  But I finally actually believe it’s on its way out.

About two months ago I developed a bleb from a night nursing session where both baby and I fell asleep with a bad latch.  A bleb is a little blister that forms over one of the pores where your milk comes out.  The pore gets blocked and milk builds up behind it, hence its other name – milk blister.  In my case, I noticed the clogged duct before the bleb.  A large cone-shaped section of my right breast got more and more sore and hard throughout the day.  I tried the methods I knew for clearing a clogged duct – warmth, massage, cabbage, pumping, nursing…it all seemed to be making it worse.  I was mentally freaking out, knowing that for every hour it wasn’t clear I was that much closer to mastitis.

Finally, in the afternoon, I looked down and noticed a tiny little white spot at the very tip of my nipple.  A quick browsing of kellymom.com diagnosed it as a bleb.  It told me not to, but I lanced it.  Relief was immediate – I stood over the sink while milk poured from the duct.

Then two days later, the bleb re-sealed and I went through the whole thing all over again.  I went to a LLL meeting, where the leader so wisely told me, “Watch out for thrush.  It’s hot, it’s sweaty, and yeast loves a wound.”

Well.  I didn’t watch out.  First I noticed a little red patch on that same nipple – it popped up overnight just a few days after resolving the second bleb.  Then it faded.  Then it came back.  I thought he just had a funky latch.  Then the patch spread…then it got painful…then I got another patch on the other side.  It took me a shamefully long time to figure out it was thrush.  Once I did figure it out, after probably three weeks of the patches coming and going, I thought I could knock it out with some simple home remedies.

Oh, friends.  How wrong I was.  With every new remedy I tried, I would think, “This is it!  This will work, for sure.”  First, vinegar.  Not a thing happened.  Then I tried topical grapefruit seed extract…that seemed to make some difference, but only in concentrations so high that it was too drying and irritating.  Then I sent John to buy Monistat on his way home from work one day (he appreciated that – “There are too many!  3 day?  7 day?  Applicators?  Suppositories?  I have never wanted you with me more, ever.”).  Medicated cream, specifically for yeast!  Surely this would take care of it.  It did calm it down just enough to make it not painful, but I used it for three weeks religiously and it just would not go completely away.

I was also doing all the lifestyle stuff you’re supposed to do – no bra whenever possible, sun therapy (thank goodness we don’t have neighbors behind us), changing sheets, towels, sterilizing laundry.  Felix didn’t have patches in his mouth, but I was treating him with vinegar.  Probiotics for both of us, oral grapefruit seed extract (250mg 4x/day), topical probiotics, and as few carbohydrates as I could stand.

I knew about gentian violet, but honestly didn’t want to deal with having a purple-mouthed baby.  Rather, having to explain to people why he was purple-mouthed.  I went to the pediatrician for advice.  Sigh, he was woefully ignorant about thrush.  He’s woefully ignorant of breastfeeding in general.  He prescribed nystatin for Felix’s mouth (nystatin hasn’t been effective against thrush in like 15 years), and told me to keep using the miconazole, even though I’d already been doing it for three weeks.

I asked him about gentian violet.  He said he doesn’t recommend it.  Why?  Because it’s messy.  Does it work?  “Oh my, yes.  It’s extremely effective.  I remember working with AIDS patients who had thrush so bad they couldn’t swallow, and when meds didn’t work, gentian violet always did.”  Hm.  His course of action was to use the nystatin, and if that didn’t work to call back and he’d give me a prescription for diflucan (which also used to be great against yeast, but now has to be prescribed in such high doses as to be potentially hepatotoxic, not to mention that a course will run you $200+).  I’d also read great things about the Jack Newman APNO prescription – it’s an ointment with a steroid, an antibiotic, and two antifungals.  He recommends using it in conjunction with GV.  My pediatrician had never heard of it and wanted to try nystatin and diflucan first.

So I bought gentian violet.  Finally.  I started on Monday, and the thrush is almost gone.  I must have a particularly persistent case, because I’ll probably need to do a full 7 days of it, and usually it’s just 3-4 days.  Yeah, it’s messy, but it isn’t terrible.  I paint it on at night, put some towels on the bed, wear an old bra.  Felix’s lips stay really stained, but the stuff that gets around his mouth usually fades away by the next afternoon.

So, my advice –

>>If nursing becomes painful after weeks or months of pain-free feeding, immediately suspect thrush, even if you don’t see the tell-tale red shiny patches on you or the white patches in the baby’s mouth.  Thrush pain is a burning pain that lasts throughout and after a feed, rather than latch pain which tends to only last for the first minute or two of a feed and is more pinching/stinging.

>>Reach for the big guns first.  Yeast is becoming very resistant to virtually all of the standard treatments.  APNO + GV seems to be the swiftest cure.  Most people who commented seemed to know what the purple mouth meant and wished us well.

>>GV won’t immediately stain everything you cherish the moment you open the bottle.  It’s messy, but if you don’t knock over the bottle, the messiness isn’t a reason to put it off.  If you put it on at night, by the morning it will be dry enough to not stain everything.  Some does come off if it gets re-wet, like after nursing or when you use other topical ointments.

>>Keep using anti fungal ointment (like miconazole (Monistat, which has 2% miconazole nitrate) or clotrimazole (Lotrimin)) after daytime feeds.  Or the APNO if you get it prescribed.  I literally keep either miconazole or clotrimazole on at all times.  Yeast regrows after 90 minutes, so anything that tells you to use it only 4 times a day won’t do the trick.  Wipe of excess before nursing (they say this isn’t necessary as long as its been 10-15 minutes since the application, but I still do it).  Another mom told me that GV actually kills the yeast, whereas the other anti fungals only retard new growth.

>>Don’t get lazy.  If it starts to look better, awesome, but you can’t slow down your treatment even a little bit.  I did this several times – “Oh, it looks so much better today!” then I wouldn’t use the miconazole as often, and by the next morning it would be back in full force.  You should keep treating for two weeks after being symptom free.  GV can only be used for a max of 7 days in a row (if you need to keep going, take a 3 day break before starting up again), but keep using the anti fungal cream for another two weeks.

>>Starve the yeast.  Ketosis is your friend.  I noticed another significant difference after I bumped my carb intake down another notch.  I probably get in the range of 80-120g a day usually, which is already less than half of typical consumption, and when I went for 50g or fewer I noticed a positive change.  Not enough to wipe it out, obviously, but some.

>>Go to an LLL meeting.  Our leader had had thrush several times and was amazing support.  She empathized with the panicky, claustrophobic feeling of thinking it will never go away (I’m going on 8 weeks of dealing with this crap), depression with flare-ups, exhaustion at the constant effort to keep it at bay.  There should honestly be support groups specifically for thrush.

Thrush sucks.