Thursday, August 6, 2015

Breastfeeding: Managing Breast and Oral Thrush

When my first child was a few months old, I got thrush. I went to 9 different appointments in 2 weeks with different practitioners. The only one that listened to me was an IBCLC. 

My OBGYN passed the buck to my primary care physician, who of course passed the buck back. I saw multiple nurse practitioners between offices, my daughter's pediatrician diagnosed HER with oral thrush. I even saw two infectious disease practitioners and a general surgeon (who supposedly said it appeared as though it didn't think it was yeast until we treated it and the symptoms went away... Here's what I had to do in order to treat my thrush. Please know this is not medical advice, this is just what I do for my breast yeasty issues. With my first, I had it three times and once for three months long. I had it once with my twins and the NICU refused to give my milk, although it is PERFECTLY SAFE to feed baby thrush milk. There is a technique to flash pasteurize your milk to kill the yeasties but that's another post all together.

Thrush is a fungal infection, and must be treated by anti fungal medications and methods. It is extremely painful. One time, after a ridiculous decision to pierce my tongue, I got a yeast infection. I thought my piercing infected my mouth with MRSA. It was thrush. It hurt so badly. 
Another time, Nugget was refusing to eat... Thrush.  
This year? When exclusively pumping for my twins? I got oral thrush again. It literally felt like strep throat... I said if my throat wasn't better in a couple days I'd go in to be seen... It ended up covering my entire mouth and it sucked. Strep all over the mouth was the feeling. It. HURT. SO. BADLY. 

You both want to be treated at the same time to get everything out if the house and get it gone. I took all of the porous toys away that she would put in her mouth, only let her play with things I could easily disinfect and then run in a 15 min boil cycle minimum, each night.
Also, you'll want to sterilize your bras- toss in a SUPER hot dryer. You *could* do a vinegar soak, but I never really did. Use disposable nursing pads so that you can keep the yeasties off your bras and shirts, whether or not you have symptoms.   

For pumping, grab those Medela steam bags to sterilize during the day between uses. Or toss your parts in the fridge in a Baggie so you don't have to wash and sterilize after each pump session- but don't go more than 2 pumps without rinsing and sterilizing. You could grab extra pump parts to make this easier on you. You really only need extra flanges. Make sure if you pump, do an evening boil on the stove for all boob stuffs. 

I'd call your OBGYN (or midwife or PCP- whoever has boobs and will help you), and tell them you have spoken to a CLC and/or an IBCLC, and they agreed the symptoms appear to line up with what appears with thrush in the breasts. We cannot diagnose but we can say what it looks similar to, etc. 

***important to note, baby has had prednisolone or any oral steroid breathing treatment recently, that can weaken the immune system to yeast. Additionally, it is extremely common to end up with yeast following antibiotic use. 

If you've tried treating with nystatin, and it's not working (which is not a surprise), then you'll want to talk with your doctor about getting a prescription of fluconazole. There was recently a study that 40% of thrush cases did not clear up with Nystatin alone.

Ask the dr for a script for 7-day fluconazole 200mg. (it's much, much cheaper for the 200mg than the 150mg). You and baby need to be treated at the same time to get everything out if the house and get it gone. Remove porous toys, let baby only play with things I could easily disinfect and run in a 15 min boil cycle for the week or two. If you pump, grab those Medela steam bags to sterilize during the day between uses (super easy hack for if you're working, or forget things on the stove). You can toss them in the fridge in a Baggie so you don't have to wash and sterilize after each pump session. Just be sure not to go more than 2 sessions in between sterilizations. At night, I did a thorough 15 minute evening boil on the stove. 

You can do a Gentian Violet (GV) treatment, continuing to take and give meds to baby as prescribed, then treat with GV. 

Get Gentian Violet, apply like I describe below. HUGE TIP!!! Use a fresh cotton swab every single time you dip in the bottle to get more when applying.  Every single time you dip into the bottle of GV, you want to use a new q-tip. No double dipping b/c it *could* cross contaminate.I would sometimes use 3-4 per application between me and my kiddo. Call pediatrician and let them know that you need fluconazole for baby (it works faster and much, much more efficiently than nystatin- by more than 60% of cases), especially if the nystatin has not gotten rid of the thrush quickly in the past. It seems candida is building up a tolerance to nystatin (personal opinion). 

I take 3 days off of treatment, and if you're still having symptoms, you will then repeat for a second week. Protect your stuff (bras, etc) from getting stained by using disposable nursing pads. I used fresh  disposable breast pads after each application. 

NURSING APPLICATION: To apply to baby's mouth, you take a fresh q-tip with the Gentian Violet, rub it on your nipple and entire areola. Clean baby's tongue as best as you can with a wet wash cloth to rub off as much thrush coating as possible. You might see a *little* blood, but that's okay. Next, put Vaseline around Baby's mouth, then nurse for a few minutes to make sure it gets all around the mouth. Gentian Violet on FRESH q-tip and then rub around baby's mouth (the inside of the lips, cheeks, as best as you can, but I personally feel like nursing baby gets it around the mouth better than the q-tip method.  

EP/Q-TIP APPLICATION: 
APPLYING TO BABY: 
Clean baby's tongue as best as you can with a wet wash cloth to rub off as much thrush coating as possible. You might see a *little* blood, but that's okay. Next, put Vaseline around Baby's mouth, then nurse for a few minutes to make sure it gets all around the mouth. Gentian Violet on FRESH q-tip and then rub around baby's mouth (the inside of the lips, cheeks, as best as you can. 
APPLYING TO MAMA: 
To apply to mama, you take a fresh q-tip with the Gentian Violet, rub it on your nipple and entire areola. Every single time you dip into the bottle, use a fresh cotton swab. Let dry, then put on your disposable or dark nursing pads to protect your bras. 
Every single time you pump, you need to be wiping your breast off with Apple Cider Vinegar and a towel before you pump, and put your bra back on. I just get one of those little travel size bottles filled with 2 parts water to 1 part Apple Cider Vinegar. I recommend reapplying Gentian Violet up to 4-6 times a day AFTER PUMPING WHEN you pump. I recommend this higher application from personal experience of realizing how easily the gentian violet washes off the breast. So you'll wipe with Apple Cider Vinegar, then reapply GV. This is in case you have ductal thrush and need to clear the thrush off your nipples. Then reapply treatment. If you're using a healing balm after pumping, do so after you've let the GV dry. 

Additionally, add children's probiotics in baby's cups and make sure you're taking them as well. You can basically put any probiotics in any of your kiddo's stuff, just open the capsules or use the kid kind. If baby only suckles at breast, you can dip your pinkie finger in milk, then into the probiotic and let baby suck it off. Do that a couple fewsome times until the dose is consumed. 

Cut out sugars, excess carbs, breads, etc. You'll want to add lecithin to help thin the gunk in your ducts and empty everything faster. I'm also not opposed to safe ingestion of oregano oil and fresh garlic to mama to help your immune system. If mama isn't on probiotics, you need probiotic Restore Ultra ASAP. 

Diflucan is a L2 class medication (pregnancy class C). L2 is basically equivalent to class B- it's extremely safe for infants. L2 PROBABLY COMPATIBLE:  Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

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