30 August 2010
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
-Sarah
Dear Sarah: I get the sense that no doctor has actually taken the time to sit with you and explain all this. That is unfortunate because asthma is a clinical diagnosis. There is no simple test to diagnose asthma at any age. Please read my article, What is Asthma? for a better understanding of what asthma is. You can also follow the links to my other articles about asthma to learn about asthma management. Not all asthmatics follow the same course. Wheezing with respiratory distress is only one presentation of asthma, although it is by far the most common impression that most people have of what asthma is. Frequent cough, especially associated with activity, can also be a manifestation of asthma. In that situation, the wheeze is only audible with a stethoscope.
Your son's history of eczema certainly increases his risk of having or developing asthma. Asthma is diagnosed primarily on the basis of recurrent wheezing which responds to bronchodilators like albuterol. Few situations require a laboratory diagnosis in which the doctor measures pulmonary function tests, tries to provoke wheezing and remeasures PFTs, and finally treats the wheeze and measures the response. If your son has had recurrent wheeze or cough which responds to albuterol, then he most likely has asthma.
Asthma certainly increases the risk of pneumonia. My daughter, who is an asthmatic has had a few. Asthma is not the only cause of recurrent pneumonia. Unless it is 100% clear that that is what's going on your son should have a sweat test to check for cystic fibrosis. If your son's diagnosis is in question, you should consult a pediatric pulmonologist (lung specialist).
The diagnosis of asthma does not predict the course or the treatment. Some children have severe symptoms, some mild, some frequent, some persistent. The management is entirely dependent on the frequency and severity of symptoms. Before you reject the idea of long-term medication, if your son has asthma, it is important to recognize and control the minor symptoms of asthma before they become major symptoms (asthma attacks).
Sincerely,
Dr. Warren
Thanking you.
-Vee
Dear Vee: Rheumatoid arthritis is a complex disorder. At this time, doctors don't know what causes it to happen. Although some forms may be associated with a genetic predisposition, a family history is not necessary for it to happen. I am not aware of any association between any chemical and rheumatoid arthritis.
Sincerely,
Dr. Warren
-AG
Dear AG: There are a few things that come to mind from your description of your lump since it was tender to begin with. You could have a sebaceous cyst which had become infected and resolved leaving the cyst behind. If you had an inflammatory lymph node which came to your attention because it was tender, it might not be unusual to always feel a small lymph node remaining in that area after the inflammation has subsided. One thing you didn't tell me was the size of the lump. That makes it harder for me to be sure if it is something that requires further evaluation. Besides reassuring you that everything was okay, one of your doctors should have explained what the lump could be so that you could have complete faith in the reassurances you've received.
Why do people worry about lumps? Primarily, they worry about cancer. If your lump has not changed in size for almost six years, the chance of it's being malignant is nil. Cancers grow rapidly and take less than 6 years to cause trouble.
At this point your have several choices. As long as you are healthy you could just keep an eye on it if you feel comfortable with it. You could seek another opinion, perhaps with an oncologist (a cancer specialist) for complete evaluation and reassurance. Or you could consult a surgeon about having the lump removed and biopsied, which is the only way to know exactly what it is and be rid of it. I am not suggesting that I think surgery is necessary. I'm just presenting your options.
Sincerely,
Dr. Warren
Dear Readers: One other option I could have mentioned was imaging. An ultrasound or CT scan might make it clearer what the lump is.Sincerely,
Dr. Warren
Thanks.
-T
Dear T: Although I'm happy to answer questions on any subject, you've found one I don't know anything about. You should look at schools on-line to see if you can find one that has the program you're looking for. Once you find a few schools you should be able to get information from them about the program and the costs. College View at http://www.collegeview.com/ would be a good place to start. If the program you're looking for is not a college level program but rather, a technical program, you might explore schools which provide specific job related training like DeVry. If you are still in high school, your guidance counselor should be able to help you.
Sincerely,
Dr. Warren
-JC
Dear JC: Most breast fed infants start out having a bowel movement with every feeding. Because human milk is a low residue milk, it is not unusual by 2 - 3 months of age for some nursing infants to have a decreased frequency of stools to a bowel movement every 3 - 5 days or longer. As long as the stools remain soft, the baby continues to feed well and is comfortable, and the baby's belly is not distended, there is no cause for concern or intervention. It is okay to use a glycerin suppository to induce a bowel movement if necessary, but it is preferable to let the baby develop his own natural rhythm as long as he is doing well.
Sincerely,
Dr. Warren
Yhank you .
-N
Dear N: Your son is experiencing separation anxiety. He doesn't cry because he dislikes the nursery. He cries because he doesn't want you to leave him. Only time and maturity will get him past that. His anxiety occurs primarily in anticipation of your departure. Once you are gone he probably gets involved in the activities around him. If you are not sure that he is doing well in the nursery, arrange to observe him without his knowing you are there.
There is no magic age at which children are ready to separate from their mothers. My children went happily to nursery at 3 years of age. I have seen 5 year olds scream and cry when their mothers left them at kindergarten. Since you know what advantages you had hoped to provide your son in nursery, and you know what your own need is to have him in nursery, you are the only one who can decide if he should continue. Some children continue to fight separation for a long time but do well ins spite of it. The experience teaches them that Mom always returns. If your son is showing signs of stress or maladjustment at home because of his separation issues, then you may have to reevaluate your needs and goals in order to decide what is best.
Sincerely,
Dr. Warren
-AB
Dear AB: Rashes are almost impossible to diagnose without seeing them, and without a diagnosis, there is no way to recommend proper treatment. The fact that you are using Bactroban suggests that your pediatrician felt there was a skin infection. If that is the case, waiting until it blisters to treat it does not make sense. You need to find out what kind of rash your pediatrician thinks he's treating.
Some rashes are recurrent in nature and may require ongoing management to keep them at bay. Your daughter's skin may have become sensitive to something, or the composition of her urine or stool may have changes as her diet progressed.
If you generally like your pediatrician and find that he takes good care of your baby, don't leave him over a diaper rash that won't clear. Ask him to refer you to a dermatologist.
Sincerely,
Dr. Warren
Thank you.
-ND
Dear ND: Your daughter's weight (13 kg.) is in the 92nd percentile for an 18 month old. That is certainly well nourished. Since you didn't tell me her height, I can't tell you if she is overweight or the right weight. Unless she is extraordinarily tall, with her weight in the 92nd percentile, she cannot be underweight.
Weight loss is never normal in a healthy child because growing children should gain weight from getting taller; however, it is not unusual for a toddler to become slimmer as he grows and gets older. The body shape changes as children grow. If that is what you are seeing then you may have unrealistic expectations regarding what an 18 month old should be eating. If that is the case you should read my article, Nutrition Without Tears to get some pointers on feeding your child.
If your daughter is losing weight, there is a bigger problem than what she likes to eat. A child who is sick or not growing properly will have a small appetite, but the small appetite is a symptom of the problem and rarely the cause. You should review your daughter's growth chart with your pediatrician. If your daughter is indeed losing weight, or if her growth percentile has been steadily declining, she needs a thorough medical evaluation to determine the cause of the problem.
Sincerely,
Dr. Warren
Dear Dr. Warren: Thank you for your advice on my child's lack of appetite. I realised I made a mistake. She is 24 months, not 18, and 12 kg not 13 kg. Her height is 85 cm.
I am preparing to visit the paediatrician very soon.
Thank you.
-ND
Dear ND: Even with your revised figures, your child's size does not indicate a problem. Her weight is in the 45th percentile (average for her age), height in the 36th percentile (low average for age and still well within the normal range, and BMI in the 56th percentile, indicating that your daughter's weight is good for her current height. Based on your daughter's height and weight, I don't see a problem, but as I said, if your daughter is losing weight, she must be evaluated by her pediatrician.
Sincerely,
Dr. Warren
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