As an “experienced mom,” I didn’t anticipate needing intervention feeding the newest addition to our family. However, after two weeks of exclusive breastfeeding, my nipples looked like they’d been in a bar fight, my baby was struggling to return to birth weight, and I had a mysterious pain that would radiate down my arms when my little piranha would latch on. My mysterious pain was dubbed “Lightening Nipple,” by Sarah Lee, not an official diagnosis code, but you get the point… Feeling like I was nearly ready to throw in the towel and being an enneagram 7 suffering from a perpetual case of FOMO, I was more than willing to meet with Crystel, IBCLC, IFM’s very own lactation consultant.

I’m not going to lie, it’s weird showing your boobs to your co-worker, that is NOT OK in most workplaces, but IFM isn’t most workplaces. ;) Our session started off discussing my baby's normal eating patterns, and growth history. We took a pre-feeding weight, to better estimate how much milk baby is consuming in a feeding. Then Crystel assessed baby’s pallet, latch and my poor battered nipples. She had recommendations for all of our problems (not the annoying kind of recommendations, the helpful kind). During the feeding session, she offered me a drink, she looked over the breast pump I brought with me, and we just chatted away… almost as if I was fully dressed. Ha! After the feeding session, baby went back on the scale to see how much weight was gained. The weight change is equivalent to how many ounces consumed, hence the term “weighted feeds.”

You might think Crystel has a pretty easy gig cuddling sweet newborns and pampering their mama’s, but don’t be fooled we put her to work! By the end of our appointment, she was ready to change clothes after being exposed to poop, pee, and spit-up; in that order. It was like watching an episode of “Dirty Jobs.” Only much, much cuter.

It was determined my baby had a slight lip and tongue tie, so we were referred to a pediatric dentist for further evaluation. Often the referrals we give at IFM are to the exact same providers we take our own family to. So, I felt confident we would be going to the right place. We went to the pediatric dentist a couple weeks later. The lip and tongue tie revision was simple and by 2 weeks post op, my nipples were healed, my baby was gaining weight, and I was no longer afflicted with “Lightning Nipple.” Whew.
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I’m so thankful to work for (and personally utilize) a clinic that offers so many services that benefit patients of all ages. So, if you’re a new mom, an experienced mom; if you’re expecting, or you have a 6 month old; if your baby is struggling to gain weight or you’re finding yourself suffering from an awful case of “Lightening Nipple.” You need Crystel, IBCLC, she will guide you on your individual, beautiful breastfeeding journey. You have a choice in your healthcare, choose better, choose Integrative Family Medicine.
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Do you have sharp, stabbing pain in your nipples? Does your baby have a thick white coating on their tongue that is not easily removed with your clean finger?

You might want to be seen to evaluate for thrush in your baby's mouth and also yeast on your nipples. Mom and baby are almost always treated together unless mom exclusively pumps.

Thrush usually continues to worsen over time unless treated. Moms may not believe they have yeast on their nipples because they are waiting to see white plaques like the baby's tongue. Don't keep waiting for that to appear! Moms usually have shiny skin on their nipples, irritated red or bright pink nipples.

Many times, the first thing I hear is, "I think the latch has gone bad." If the latch was well established and randomly is painful-- and the baby may be refusing to latch, there's my sign to be particularly looking for yeast. If you have a brand-new baby, a newborn- yes, the baby can get yeast in the mouth right away. A 4-day old infant could possibly have yeast growing on their tongue.

If mom was leaking milk prior to delivery and may not have been changing her breast pads often or washing her bras in hot soapy water, then the yeast will grow.

Yeast is normally found on our bodies. It grows and flourishes in wet, warm, and dark places. Yep, your bra is a wonderful place for yeast to feel at home.

How do we prevent thrush/yeast infections? Air out your nipples whenever possible, especially at night. Change your nipple pads often, just like you would a feminine pad. Wash your bras every day, especially if they are damp. Wash in hot, soapy water.

How is thrush treated?
There are several ways to treat. It usually depends on what the provider is used to. Most commonly I see moms prescribed an oral antifungal called Diflucan. (Don't drink alcohol when you take this, it will make you sick!) Or they will prescribe APNO, also known as Jack Newman's all-purpose nipple ointment, also known as triple nipple ointment, also known as magic nipple cream (mostly by me, lol).

​I prefer to see moms treated for yeast on nipples locally with APNO, so the other healthy yeast in their body stays put.
APNO needs to be sent to a compound pharmacy which is a special pharmacy that puts powders and liquid medication together and makes special creams and concoctions. They're pretty much wizards. It may take several hours before your APNO is ready for pick up.

Compound pharmacies in the Des Moines area include:
Hy-vee Windsor Heights
5 Star Pharmacy Des Moines
Central Iowa Compounding Urbandale
Precision Compounding Urbandale

On top of APNO after feeds, clotrimazole 1% is usually encouraged prior to feeds on your nipples. This way it also coats the baby's mouth when they latch. Where do we buy clotrimazole? Pretty much any pharmacy or store. It is over the counter and may be found in the foot fungus isle. Yes, it could be used for foot fungus. Not that foot fungus is on your nipple--or is it :)

For oral thrush in babies the go to medication used to be liquid nystatin. Yay Nystatin! Recently doctors realized that babies kept returning after being treated with nystatin. So, sometimes they treat with fluconazole or gentian violet. But it is a practical option to start out with the least invasive antifungal, so yes, your baby may start out with Nystatin treatment.

They will tell you to use the dropper to drop the liquid in the sides of their cheeks and on the tongue. We don't want the medicine to be put in a bottle and bypass the mouth all together, then we are defeating the purpose, TREATING THE MOUTH!

Speaking of the mouth. Commonly we see the yeast travel down the digestive tract all the way to the anus.  The yeast will set up shop around the rectum and look bright red with red raised spots. Oh yeah, it's very contagious and will find other warm, dark, wet places to grow.

Wash any binkies or nipples with hot soapy water and boil them every day. Change your nipple pads often, wash your bras often, air out your nipples at night, even if it gets messy!

Thanks for reading!

​There are several types of anemia. Anemia has a significant impact on your overall health and well being—primarily your heart. Today we are going over a few common types of anemia, their causes, symptoms, and what to expect if you are found to be anemic.

Anemia due to lack of B-12 can occur in people who have had gastric bypass/gastric sleeve surgery, chronic inflammatory bowel disease, long term PPI use (Omeprazole, pantoprazole, etc.,) and long term use of certain other medications. B12 plays a vital role in the development of red blood cells. B12 is found mainly in red meat, fish, eggs and dairy. B-complex vitamins are commonly taken for energy and focus (think Red Bull!)

Anemia due to lack of red blood cells from loss of blood: This includes women during pregnancy, after the baby is born, if they have heavy, frequent periods, and patients that have undergone recent surgery. It can also happen if there is internal bleeding, most often in the intestines.

Iron-deficiency Anemia: Iron is a vital element used to bind oxygen to hemoglobin. This is what carries oxygen to all of the cells in your body. This means that without enough iron, your heart needs to work harder to cycle the anemic cells throughout your body to provide them the necessary oxygen.

Children can also become anemic if they drink too much milk, don’t eat enough iron-rich foods, or have an increased lead level. This is why we check a lead level and hemoglobin around age one.

Although a direct link has not been completely established between anemia and heart failure, there seems to be a correlation. Low iron storage causes people to have a low capacity for aerobic activity. This means that your heart has to work harder to give you enough oxygen to exercise, walk up the stairs, push a shopping cart at the store—basically anything! 

• Symptoms of anemia can include:
• Chronic Fatigue
• Shortness of breath without exertion
• Dizziness
• Palpitations/fast heart rate
• Chest pain
• Cold intolerance

So what can we do?
Work with your provider to get your blood count and iron panel checked if you are symptomatic or in one of the high risk categories listed above. Many times we will recommend iron supplements or B vitamin supplements/injections. If you have great difficulty absorbing oral iron, you may need to have IV infusions of iron. For B vitamins, we have injections available for replacement for those who can’t absorb it orally. 

For kids, they should not have more than 24 ounces (3 cups) of milk per day. If a woman is having problems with heavy periods, it is important to treat the cause of the blood loss in addition to treating the deficiency.

Our hearts are very important, so let’s take good care of them!
​Stay Well !!!