31 January 2000
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
She is ADHD and is on adderall, recently switched from Ritalin. This may or may not contribute to the problem. She also craves sweet things. Personal hygiene is sometimes lacking due to her age, possibly another factor. I have addressed this issue with her doctor before and was always told to continue using the monistat cream and not to worry about it. PID is a concern of mine and I know that having a lot of these infections cannot be healthy for her reproductive tract. HELP!!!
-Paige
Dear Paige: I know of no good reason why a whole family should be prone to chronic yeast infections. Diabetes and immune deficiencies may cause problems with yeast infections. Prepubertal girls generally do not get vaginal yeast infection. If hygiene is a problem, perhaps your daughter should take sitz baths (plain water) regularly. If she has a yeast infection which isn't clearing adequately with miconazole cream, she might do better with a systemic antifungal like Diflucan.
Eating starches does not contribute to yeast infections. Complex carbohydrates are an important part of a child's diet. On the other hand, corn starch powder certainly would feed any yeast in the area that gets powdered.
Yeast infections do not lead to PID. They may be a nuisance, but they are not serious.
Sincerely,
Dr. Warren
Thanks
-B
Dear B: Some children may be naturally more active than others and may have difficulty sitting still when they are bored or not stimulated. This may happen with bright children who are not challenged. However, bright children may also have ADD. They may do well in school because of their intelligence, but even when the material is challenging, they may have difficulty focusing and paying attention. ADD does run in families, although the genetics is not yet fully known. There are a variety of rating scales that teachers and psychologist use to help diagnose ADD.
Attention difficulties and hyperactivity may sometimes be seen associated with other neurological or psychiatric conditions besides ADD. These other conditions should be suspected because of their other symptoms. ADD may exist without hyperactivity, but I am not aware of a condition of hyperactivity without ADD.
I would suggest evaluation by a psychologist. If there is no evidence of ADD (and even if there is), the psychologist can recommend a behavioral management program.
Sincerely,
Dr. Warren
-M
Dear M: The most likely things to cause a lump under the chin as you described are a swollen lymph node (gland) which could be present from a viral infection or a dental infection, or a thyroglossal duct cyst, which is a congenital cyst. Thyroglossal duct cysts are not dangerous, but may sometimes swell and become infected requiring antibiotics or surgery.
Sincerely,
Dr. Warren
Thank You.
-LM
Dear LM: From your e-mail I wasn't sure whether or not you actually had an infection of your breasts. If the skin is red, bumpy, and itchy, you may have a yeast infection (Thrush, Monilia), in which case, it should be okay to use the Lotrimin as long as you remove it completely before nursing. It is much more likely that the baby's persistent thrush is causing you a problem than that an infection of your breasts is causing the thrush to persist. Sometimes thrush is difficult to get rid of. If it's causing a problem with the nursing, your pediatrician could prescribe a systemic antifungal called Diflucan for the thrush.
Sincerely,
Dr. Warren
Sincerely,
-Jeff
Dear Jeff: Your description of what you are coughing up sounds like an enlarged tonsillar follicle. If this happens frequently, it could be related to chronically inflamed tonsils. This could possibly affect your breath. Other conditions which could affect your breath include sinus infection and dental conditions. If your dentist finds nothing affecting your breath, you might want to have your tonsils and sinuses checked by your doctor or an ENT specialist.
Sincerely,
Dr. Warren
Thanks.
-Jeri
Dear Jeri: An elevated sedimentation rate means that there is an inflammatory process going on in your daughter's body. It is a nonspecific test which basically says to keep looking further to find out what's going on. Infections can cause an elevation of the sedimentation rate. So can rheumatic diseases like lupus and JRA. The elevated ANA is not diagnostic of lupus, but could be seen with lupus. Since lupus is a multisystem inflammatory disease, it could conceivably be responsible for your daughter's abdominal pains. Inflammatory bowel disease can also cause an elevation of the sedimentation rate and sometimes fever and joint symptoms. Inflammatory bowel disease is not generally suspected until the patient develops bloody diarrhea.
At this point it would be a good idea to see a rheumatologist. If the rheumatologist concludes that your daughter does not have any rheumatic disorders, she should probably see a gastroenterologist since her main complaint is abdominal.
Sincerely,
Dr. Warren
Thank you.
-Paul
Dear Paul: Two and a half weeks is a long time to have abdominal pains from a stomach virus. Abdominal pain may certainly be a stress symptoms. It may help to keep a diary of when she has pain to see if there is a pattern. For example, children who have morning abdominal pain but then do fine all day sometimes are stressed about getting their day started. Children who have weekday pain only are usually stressed about school or stressed about leaving home (which may be more about what's going on at home than school). Sometimes certain foods may be the cause of the problem. Lactose intolerance can cause gas pains and soft to diarrheal stools. Eliminating lactose cures the problem. A consultation with a gastroenterologist may help you sort this all out. A consultation with a specialist does not obligate you to any invasive testing. In fact, the point of the consultation is to hear from the doctor what he thinks might be going on or needs to be ruled out and why. After that, you should be able to explore with the consultant, the pros and cons of doing tests, trying treatments, or doing nothing.
Sincerely,
Dr. Warren
-Mr. & Mrs. L
Dear Mr. & Mrs. L: I cannot understand why a doctor would tell you laboratory results without fully explaining their significance. There are two possible things you may be talking about. If your son has a high SEG count, meaning a higher than normal number of segmented white cells in his blood stream, it suggests a bacterial infection. Segmented cells may also be increased in the early stages of virus infections, after seizures, in response to adrenalin, with inflammation, with appendicitis, etc.
A high SED rate, meaning sedimentation rate, is an indicator of inflammation. It is a nonspecific test that suggests a need to look further. Sedimentation rates tend to be very high with rheumatic diseases like JRA, with severe infections, with bone infections.
Sincerely,
Dr. Warren
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