kumichan83,
I PM'ed you. I realized that homemade APNO has two other active ingredients. I tried searching the recipe here. There are a couple of variations but the most important ingredient is the anti-fungal (Clotrimazole or better yet Miconazole) and an anti-inflammatory such as Hydrocortisone &/or a third ingredient, a triple anti-biotic ointment such as Neosporin.
Please PM me regarding my suggestion about those.
In the course of looking that up I stumbled across the post below. It is the most exhaustive list of Thrush/Yeast remedies I've ever seen. I'm hoping some of them may be more readily available to you in Japan.
I'm wondering if this is over in the Mega Thrush thread. I'm going to cross post this over there.
Good luck,
~Cath
MDC: Breastfeeding/Breastfeeding Board: If you have gotten RID OF THRUSH -- graye_pearl started thread on 7/4/07
3for_me, posted on 7/5/07 – see post #5
http://www.mothering.com/discussions...le#post8555056
FULL QUOTE OF POST # 5
Someone sent me this when I was dealing with thrush.
Good luck
To help mothers identify possible underlying causes of pain, any
lay support person should ask thorough histories of pregnancy, labor,
and delivery, as well as the nursing experience to date. Of course,
latch on should be verified and corrected (and if possible checked in
person).
Yeast red flags, as I call them, include: any procedure that nearly
always requires antibiotics such as C-section or tubal ligation after
delivery; corticosteriod use (terbutaline to delay labor or asthma
medications), prednisone for allergic reactions; any other immune
suppression (such as
being HIV positive), diabetes, or even long-term use of
Histamine-blockers such as Seldane. Other less clear clues range from
cravings of sugars and breads to extreme fatigue. Moms describe the
classic symptoms of breast yeast in various ways (these are eloquently
described in the La Leche League International Lactation Series #18),:
severe pain without nipple trauma; sharp, shooting pains radiating from
nipple--may extend to chest wall or back; nipples that may be red,
flaky, itchy, shiny, or burning (these are all relative signs so ask the
mother how what is normal for her); small, white, hard blisters on the
nipple (may be blocked pore also); and sometimes white fuzzy patches in
the folds of the nipple. When mom's describe nursing as an "ice pick or
glass" inside their breast, or pain that persists beyond latch-on, yeast
overgrowth in the milk ducts may be the cause. Babies may pull off the
breast, refuse to latch or make clicking sounds.
Breast yeast frequently does not have visible symptoms, but as
one author put it is "exquisitely painful" (Amir, Hoover, and
Mulford;Riordanand Auerbach). Low level thrush also may not have
visible signs. Nursing may have been going well and all of a sudden it
hurts or the baby is pulling off the breast (sometimes baby makes a
clicking or popping sound too). In most cases if the latch has been
assessed and/or corrected the offending agent is Candida Albicans, but
there are several other strains of Candida and not all grow fluffy
patches of cotton used as the harbinger of yeast or thrush. As a public
health professional, I saw several other agents of fungus
overgrowth--aspergillus and a few found usually in the garden (Benenson,
AS). These are much less likely causes of nipple and breast pain,
however they are possible and practitioners should be aware of them.
Over-the-counter and self-help approaches to yeast management
can be quite effective, particularly if they are part of a
comprehensive, holistic approach to this problem AND if the problem
hasn't become chronic. Because this tact is holistic, I believe it is
appropriate for us to
present this information as an option to mothers dealing with yeast.
Empowered and informed mothers can then decide for themselves what to
do. With a few caveats, there are no negative effects to this
approach. As with many health conditions, it is helpful for both the
support person and mother to understand why yeast overgrowth occurs so
that they aren't simply
chasing symptoms. First, understand that yeasts love dark, moist, warm
places (think of how bread rises). They also thrive in sweet
environments and they multiply faster than proverbial rabbits. These
factors account for why diabetics, pregnant and lactating women are all
prime candidates for yeast overgrowth. If you add any
immunosuppression of the natural forces that keep your body in balance--
such as broad spectrum antibiotics or corticosteriods taken within the
past few months (or even years if repeatedly)--the yeasts may grow
unchecked. Along with the common recommendations of changing breast
pads at each feeding, going braless, and topical treatments, dealing
with the underlying health status of the mother and baby, and sometimes
the entire family is essential. This means that regardless of the type
of treatmen--prescription, naturopathic, homeopathic, or other--we need
to address certain issues such as hygiene, diet, and laundry as well.
In a nursing relationship it is imperative that both the mother and the
baby be treated even if only one is symptomatic. Many times the father
and siblings require lower level treatment as well. In co-sleeping
arrangements all members who sleep in close contact should be treated.
A particularly frustrating aspect of yeast management
stems from the fact that treatment needs to be continued for two weeks
after symptoms subside.
Personal hygiene matters in yeast control. While antibacterial
soaps are promoted for new parents, they may contribute to yeast
overgrowth by killing the "good" bacteria. Still, hands do need to be
washed with warm water and soap after diaper changes and using the
bathroom. In
addition, short term switching to paper towels (used only once) as a
drying method can help stop the spread. Temporary use of disposable
diapers may help too. A spray bottle of vinegar solution (1/4 cup to one
cup of water) should be available for all family members to spray any
areas on their bodies that stay or get moist (pubic areas, arm pits,
under breasts and
under any folds of skin). This routine should be used at least twice a
day by those not symptomatic and four times a day by those with
symptoms, and continued for two weeks beyond the time anyone shows
symptoms. Bath towels should not be shared and they ideally should only
be used once. If that seems extreme, then they must be allowed to
thoroughly dry after each
use. In addition, items such as toothbrushes and make-up can also harbor
yeast spores. Once the anti-yeast regimen is begun, every family member
should get new tooth brushes and then again once all symptoms
disappear. No cornstach powders or deodorants should be used as they
are a food source for yeast. As for make-up, well as expensive as it is
one might try not wearing it during the early treatment time, then
dispose of all make-up and buy new supplies. Since the eyes lids have
folds and the mouth may harbor yeast, the minimum would be to replace
eye liner, shadows, mascara, lipstick/pencils, and foundations, as well
as any applicators that cannot be treated.
Household treatment clearly means more work, not something
relished by new mothers or anyone, but must occur for chronic cases to
be cleared. This means that sources of mold--wet window sills, damp
laundry hampers, and bath tubs (especially the jetted kind) need to be
cleaned with either a 10% bleach solution or white vinegar in water.
Floors, baseboards and
walls may all be cleaned by the same method. Laundry should be washed
in the hottest possible water and a cup of white distilled vinegar added
to the final rinse. Relying on bleach in the washer is not sufficient
since it would take a gallon of bleach in a standard washer to kill
yeast
spores and that would result in Swiss cheese clothing. Boiling
clothing and other items of close contact (such as underwear and sheets)
for five minutes will work, as will microwaving on high for five
minutes, butfreezing will not kill yeast spores. Cloth diapers, either
from a service or your own should also be microwaved for five minutes on
high. Toys and any items babies mouth or chew should also be cleaned
this way. They may be put in the dishwasher if your water is hot enough
(over 130 degrees) and you add vinegar to the rinse. (I strongly
suggest enlisting help for
thisso the mother can get needed rest) In addition to the hygiene and
household measures described and the dietary recommendations in the
references listed, a number of naturopathic
treatments are available for mothers. The range of naturopathic
treatments used for yeast includes: acidophilus, vinegar, baking soda,
garlic capsules, non-yeast based B-complex, zinc, vitamin C, caprylic
acid, citrus seed oil, tee tree oil, pau-d-arco, echinacea, maitake tea,
heparsulfur, and gentian violet (which is the one that needs to be used
with caution). The following is a very brief overview of how to utilize
these in the case of breast yeast, but may be applied to other various
parts of the body and/or household. For more detailed information on
their general use see the sources listed.
*Acidophilus (Lactobacillus acidophilus)--Work up to three capsules
three times daily; Babies may be treated with diluted acidophilus in
breast milk swabbed or dropped in their mouths or mom may dip a finger
in the powder and let baby suck. It may also be applied to breast and
diaper areas directly. The intent of acidophilus treatment is to
rebalance your body so don't expect instant results. Yogurt made with
live cultures also has a therapeutic effect, but is considerably
slower. Used in conjunction with the capsules and even as a soothing
breast paste, yogurt can help rebalance the body; however it is unlikely
that acute cases will be cleared with
this method alone. Sometimes lactobacilli need a bit of help getting
hold in the intestines and some practitioners recommend FOS
(fructo-oligo-saccharides) to enhance colonization.
*Vinegar--start with 1/4 cup white vinegar in one cup water. If this is
too strong, a dilution as weak as one tablespoon in one cup of water,
applied topically to the breast. Allow to air dry. Do not wash it off
before nursing unless baby protests. This must be done at least four
times
a day and maintained for two weeks after all symptoms are gone. Families
may take baths with vinegar in the water to hit more than one source at
a time. White distilled vinegar must be used because it has been
boiled/distilled and has no active fungus spores. Arguments about the
logic of using vinegar (which is fermented) abound, but yeast cannot
survive in the pH created by this and the temperature needed to distill
it.
And, many mothers have found this works quite well when used with thrice
daily oral acidophilus to rebalance the intestines--if they catch the
overgrowth early.
*Olive Oil--applied topically to breasts after each feeding. Olive oil
contains linoleic acids, which are antifungal, and may cut off oxygen
supply.
*Baking Soda--make a paste in water and swab the baby's mouth after each
feeding (if baby always falls asleep, then do it whenever possible but
atleast four times a day). This also changes the pH of the environment
(but more toward the alkali side) making it unhospitable to yeasts.
*Potassium Sorbate: 1 TBSP dissolved in 1 quart warm water applied
topically; This product is commonly used to stop fermentation and is
available at wine making stores and pharmacies.
*B-Complex--A set of strong immune system booster that may be lacking in
the mother and baby's intestines if they have had antibiotics. B-complex
(100 mg of each B vitamein) is water soluble and needs to be time
released or taken throughout the day in three doses. It may turn
breastmilk yellow (as well as urine).
*Zinc--another immune system booster; 45 mg per day.
*Vitamin C--up to the point where loose stools occur, then back off the
dosage a bit; Since Vitamin C is water soluble it must be consumed
throughout the day. Echinacea capsules or tincture can be taken
simultaneously to boost the immune system.
*Garlic--Although increasing dietary garlic may be useful, clinically
effective doses are easier to get if you take triple strength deodorized
garlic tablets (three, three times daily for two weeks or more). The
liquid, cold pressed, aged garlic is thought to be most potent. Kyolic
is the brand from which the most conclusive research was published (Lau;
Tadi, Teel and Lau; Lucas ). These may cause gas, although some
researchers believe that this is a sign that the yeast is dying off in
the intestines. Contrary to old myths, garlic has been shown to increase
the amount of
breast milk babies consume. Note, ginger and cinnamon also have
reported antifungal activity, but their use is infrequently reported and
primarily unstudied.
*Caprylic Acid--A strong antifungal taken orally; two to three capsules
three to four times per day for two weeks (or 1 gram at meals). These
capsules must be enterically coated so that they release their
activeingredient in the intestines.
*Citrus Seed Oil--A strong, but natural, antifungal, antibacterial, and
antiviral; May be used topically but must be diluted before use on
breast or on any mucous membrane; Try 10 drops in a 1/4 cup of water
swallowed at once, twice daily;
*Tea Tree Oil--an Australian antiseptic oil though to have antifungal
properties; A few drops may be added to bath water or diluted and
applied to breast. The bath method may be used with vinegar and has the
added benefit of helping clear the sinuses.
*Barberry (Berberis vulgaris): Consume three times a day either 1-2
grams dried bark, or 1.5 tsp (4-6 ml) of tincture (1:5), or 250-500 mg
of powdered extract. (Murray and Pizzorno)
*Hydrastis candadensis: Consume three times a day either 1-2 grams
dried bark, or 1.5 tsp (4-6 ml) of tincture (1:5), or 250-500 mg of
powdered extract. (Murray and Pizzorno)
*Pau D'Arco (Tabebuia impetiginosa)--an antifungal tincture with a long
history of use in developing countries; It tastes horrible and must be
taken four times a day (20-30 drops);
*Maitake Tea--an antifungal tea that also helps to rebalance the
intestines. Drink several cups per day at the strongest possible brew.
*Plantain Seeds (Plantago major): soak seeds over night in warm water,
then apply the resultant gel topically and/or orally. (Weed)
*Golden Seal powder (CAUTION): Although very bitter, this herb is very
effective at clearing yeast from the body. A tea of 1/2 tsp per cup of
boiling water is consumed at the rate of 1/2 tsp Golden Seal per 10 lbs
of body weight. Susan Weed (see refences) suggests this as a last
resort
because it kills the beneficial bacteria in the intestines and may cause
diarrhea and colic.
*Over-the-Counter Vaginal Yeast Creams with Miconozole or
Clotrimazole--some practitioners have started suggesting these be used
for breast yeast. While they may be effective and the active
ingredients are compatible with nursing, there may be other ingredients
not appropriate
for babies to consume. Use this approach with caution (perhaps rinsing
the cream off before nursing and definitely if baby reacts with a rash
around the mouth).
*Gentian Violet--one of the oldest (preceding topical iodine)
antifungal, antiseptics available is still an over-the-counter and
inexpensive method available (less than $2). It is very effective and
extremely messy, staining everything it comes in its path. Gentian
Violet should only be used for a maximum of 2-3 days (two treatments per
day) by coating the nipple, areola and surrounding breast tissue (plus
underside of breast) with the liquid on a cotton ball. The long-term
toxicity of this treatment is still being debated, but short term
treatment appears to cause no ill effects. Still, this is a treatment
of latter resort as an over-the-counter method because of the mess.
Nursing babies will get a purple mouth, which will wear off in a few
days. Suggest that the mother wear clothing that can be thrown away or
bleached.
*Massage and Warm Compresses ( either soaked with vinegar and water OR
with olive oil); plus deeply massaging out any possible plugged ducts
with Arnica oil as a lubricant. Massage while baby nurses, taking
advantage of gravity if possible.
*Ibuprophen--an over-the-counter anti-inflammatory that might be
appropriate for both pain relief and reducing ductile inflammation. If
the mother is in tremendous pain, an anti-inflammatory may help until
the treatment addresses the cause. (Acetaminophen does not address the
inflammation.) Of course the baby's reactions should be closely
monitored with any treatment.
If this all seems like a fanatical effort to eliminate yeast,
well it may be, but yeasts are extremely persistent in the right
environment. If this isn't a reasonable course of action and/or you are
working with a practitioner who believes pharmaceutical treatment should
be used in
conjunction, then some of the following may be helpful. However, many
moms often report not being able to find a practitioner willing to work
with them on this. Also, lay support must be aware that yeast may
co-exist with bacteria and that it is possible to have either
yeast/fungal
mastitis or bacterial mastitis coupled with yeast. If the mother
reports any symptoms of bacterial mastitis (fever over 102 degrees,
flu-like symptoms, red streaks on the breast, hot spots on the breast,
etc.) she should seek medical attention immediately and get lots of rest
(nurse lying down
too). If yeast and bacteria are the joint cause, then in addition to
taking antibiotics the mom may want to request oral Nystatin tablets to
be taken along with the antibiotics.
Treatments Prescribed by Licensed Practitioners
If a health care practitioner is involved, the first usual line
of defense prescribed for yeast is Nystatin (either cream or
suspension). Nystatin is an exceptionally safe pharmaceutical that acts
by disrupting the necessary enzymes yeasts need to reproduce, but
doesn't interfere with our systems. However, it's effectiveness in
killing yeast may cause side effects (nausea, gas, and fatigue) as the
yeast die off. Nystatin must be religiously applied after every nursing
since yeast multiplies rapidly. Some researchers believe that Nystatin
suspension is not very effective because it is mixed in a sucrose base
(in which yeast thrive); instead, they recommend using Nystatin powder
mixed in water or other liquids (breast milk for babies).
If Nystatin is not effective initially, or the yeast becomes
chronic or invades the ducts of the breast other methods are available.
Mycelex troches are often prescribed for the nursing pair. These
tablets are crushed, mixed with breast milk and applied to the thrush.
Older babies may like chewing on the troches directly. The active
ingredient in these is miconazole, which is also the ingredient in many
over-the-counter vaginal yeast medication. If applied to the breast,
the drug will be taken into the baby's mouth as would any topical that
is not washed off. As a third line of defense in the topical war
against yeast, some practitioners may resort to Nizoral 2% cream for the
breast and diaper areas (Ketoconazole is it's active ingredient).
Nizoral is also available systemically, although the effects of it have
not been studied on infants. Nizoral tablets are a potent chemical whose
side effects should be weighed against its possible benefits. Lastly,
a new and now commonly prescribed vaginal yeast treatment, Diflucan
(fluconazole), is being used to treat breast yeast. One dosage is used
in cases of vaginal yeast, but experience
has shown that breast yeast requires many more doses to fully clear the
overgrowth. Diflucan has few side effects, is taken once per day, and
is quite effective if given for a long enough period (usually 2-4
weeks--not one or two days) while the baby's mouth is simultaneously
treated with another anti-yeast treatment. Other drugs are available
such as Sporonax, but little is known about how they affect the nursing
relationship so mothers might want to ask for another alternative. If
a mother chooses to use a prescribed pharmaceutical whose effects are
unknown (check with the Professional Liaison Department of your local
La Leche League), remember
to let her know that she may be able to pump and dump instead of
permanently weaning; however, most pharmaceuticals in this class do not
require weaning (Newman; Hales)
All told, managing yeast can be an exasperating experience for
mothers, lay support persons, and practitioners. The research on
yeast, and in particular breast yeast, has not yet disseminated
throughout the medical community. One way to actively help this
dissemination is to suggest to practitioners that they order both the
full color yeast addendum page and the Lactation Series #18 Candidiasis
and Lactation, available from La Leche League International.
Sucks.
