Thursday, October 26, 2006

More burning questions

What's even less fun than recurrent mastitis?


Yep, that's right, apparently I have thrush on top of everything else. Y'know, I thought we were doing well with this whole breastfeeding thing -- Dr. Clueless even commented that my nipples looked good during my six-week checkup last week (she's my new OB, as Dr. Dreamboat left the practice recently under some rather upsetting circumstances). However, given that I subsequently got mastitis, my baby spat up blood, and I got chewed up to the point where one nipple blistered, popped, blistered, and popped again, I decided it just might be time to reassess that. Therefore, we went off to the Dixieland Breastfeeding Medicine Clinic yesterday afternoon.

Turns out that the recurrent mastitis is because I wasn't treated right on the first round -- not the right antibiotic, and I didn't take it for long enough. I had just finished up the 7-day course originally prescribed, but now I'll have ten more days of cephalexin. This makes sense to me, as I have had problems with recurrent strep in the past, and it usually takes a longer course of abx to knock it out. Hopefully, the cephalexin will render me germ-free, and treatment of the cracked nipples will make sure I don't reacquire more germs down the road. We're also treating my nipples and the babies' noses with an antibacterial ointment, as the doctor said that recent studies show that babies are often carriers of the offending bacteria in recurrent mastitis.

Given that I had some cracking at the base of the nipple, and that one of the cracks looked yeasty, and that the babies' mouths were a little suspect as well, the doctor diagnosed all three of us with thrush. This might explain the nipple soreness I had even when they weren't badly cracked, though latching has to take some blame there too. We have a terrifyingly complete protocol of how to get rid of it, involving antifungal creams, Nystatin, grapefruit seed extract, and gentian violet. It seems like a truly daunting amount of work, especially considering I have to do it for two babies, but it's worth it to stop the thrush before it gets really seriously embedded.

I got the most immediate relief from the latching and positioning work we did. I'd been using football hold since the babies were born, as at that time it was the easiest and most comfortable way. I tried cradle a couple times, but couldn't seem to get the hang of it -- there were too many arms and legs and hands in the way, somehow. When she had me try it again yesterday, though, it just worked sooooo much better. The babies did a much better job of getting enough nipple, even little Claire with her tiny mouth, and they seemed very comfortable with it. As for me, it's made a noticeable difference in the state of my nipples in less than 24 hours. Feeding is markedly more comfortable already, and the cracked skin is already showing signs of healing. I guess you mend pretty quickly when you're not being re-chewed-up every two or three hours, hey?

The cradle hold is also helpful with our oversupply/overactive letdown problems. I've been feeding each baby on a single breast per 24 hours for a couple weeks now, but they were still choking and pulling off the nipple. With cradle hold, it's easier for me to lean back just a little bit so they're actually above the nipple, which gets gravity working in our favor. For the first time in forever, neither baby is strangling or pulling their heads back, which has also got to be helping me heal. On the down side, feedings are taking more like 20-25 minutes rather than 10-15, but it's a small price to pay. If you're nursing twins and have oversupply problems, I'd really encourage you to try this -- it's working great for us already.

The other downside to all of this is that I'm currently a walking pharmacy. In addition to my usual routine (thyroid meds, prenatals, iron, calcium, and b-complex), I'm now taking antibiotics, Vitamin C, probiotics (to help prevent yeast overgrowth from the abx), lethicin capsules to help keep the ducts from plugging, and ibuprofen round the clock. Then there's the antifungal and antibacterial nipple ointments, the gentian violet, and the grapefruit seed extract. It's like rocket science to figure out which pills need to be taken before meals, with meals, and separate from each other, and to figure out what to put on my nipples and in the babies' mouths, in what order.

I'm really glad I decided to go in and get seen yesterday, and I feel like all my boob-related problems are going to work themselves out quickly. Seriously, people, if you're nursing and having any issues, do yourself a favor and call a lactation consultant already. I know that's the all-purpose answer and you're probably tired of hearing it, but it has made a big difference for us already. Insurance covered my visit to the clinic, but even if you have to pay out of pocket, it's worth it.

Now, if only my upcoming visit to the knee doctor goes as well as the visit to the breast doctor!

1 comment:

Eva said...

Emma, you are doing amazing things! You are breastfeeding twins, and even have food to spare (bring on those triplets). My husband keeps reminding me that at discharge, the NICU doc, otherwise quite competent, was very skeptical about BFing twins. You are going through a lot to do it, but I know it will all fall into place for you soon. And I so appreciate your sharing all of your trials and difficulties, as I'm having my own challenges, but can't post about them all on the blog, as friends and family read it... but I appreciated your description of not being able to do it in public to date because I started going to a mommy group but only between feedings because I can't have the latch saga on display there... and I watch all these moms of singleton full termers BF with little fanfare and can't help but feel jealous. But again, yay you! Pat yourself on the back.