14 February 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
-Mary
Dear Mary: The main risk of diarrhea is dehydration. Once the frequency of the stools decreases and the stools become less watery, the patient is on the mend and the risk of dehydration is past as long as the patient is drinking adequately. Milk and fruit juice are the two things that will most likely aggravate the diarrhea. If he is tolerating those, your son should be able to go back to his regular diet; however, avoid spicy or greasy foods.
Mucus protects the intestinal membrane and is not unusual in diarrhea. In a child who is recovering, it is of no significance. If your child is running fever and having cramps, excessively mucusy stools could suggest a bacterial infection, in which case a stool culture would be advisable.
Sincerely,
Dr. Warren
Sincerely,
-WK
Dear WK: I cannot diagnose what you have by e-mail, but I can tell you that a 7 pound weight loss caused by illness demands thorough evaluation. Your symptoms could be related to a sinus infection, pneumonia, or bronchitis. A change in antibiotics may be necessary. You certainly should have a chest x-ray. Considering the 7 pound weight loss and the lack of response to antibiotics, you should have a PPD to test for tuberculosis. Pulmonary function tests may rule in or out the possibility of asthma contributing to your chronic cough. With your description of thick mucus in your throat, an examination by an ENT to check your sinuses may be useful. Depending on what he finds, he might suggest an allergy evaluation.
There are many possibilities. You need to see your doctor.
Sincerely,
Dr. Warren
I am concerned that the infants might be especially hard hit by this. Is there anything I can do to prevent complications. I have read many articles on this disease and the complications that can exist. My babies are extremely healthy at this point and I would like to keep it that way. Also, regarding scarring, is this likely to occur on the children if they don't scratch, or is it inevitable?
Thank you so much for your response to a worried mom :)
-DC
Dear DC: Chicken pox is a highly contagious illness. Unless you have someone else caring for your children and you're keeping away from them, there is a high likelihood they will all get it. Children generally do reasonably well with chicken pox. There is no good way to prevent complications. Zovirax, an antiviral medication, is used to shorten the illness and decrease its severity in adults, but it is not recommended for healthy children.
Chicken pox causes mild scarring even if you don't scratch. After a case of chicken pox, many of the marks may be visible for up to a year. These are not necessarily scars.
Sincerely,
Dr. Warren
THANK YOU SO MUCH FOR YOUR TIME!
This really means a lot to me.
Yours Truly,
-JL
Dear JL: Most swellings of the neck do not come and go. Possible swellings in the neck may include lymph nodes, thyroid gland, thyroglossal duct cyst, branchial cleft cyst, hemangioma, arteriovenous malformation, salivary gland, cystic hygroma, and angioneurotic edema. I'm sure my colleagues could come up with some I haven't thought of. I could not even guess at the diagnosis without seeing it. As a general rule lymph nodes, thyrogolossal duct cysts, and branchial cleft cysts do not swell quickly or dramatically unless they become infected. Hemangiomas and A-V malformations may enlarge with bleeding. Salivary glands may enlarge with infection or obstruction. The thyroid can enlarge significantly due to iodine deficiency or other causes of hypothyroidism, but the enlargement is progressive rather than sudden. Angioneurotic edema is a form of hive, or allergic reaction which may occur anywhere. When it occurs in the throat it can cause significant difficulty breathing. Angioneurotic edema may be recurrent and progress rapidly.
I hope this information is of some use to you.
Sincerely,
Dr. Warren
If you don't mind my asking, I would really appreciate any advice or opinions on this matter. Should I have the mass surgically removed if it is a lymph node and is it safe?
I greatly thank you for your time and I appreciate your writing me back. Thank you so much. I wish you well and thanks again!
-D
Dear D: When faced with a medical problem where you question the advice of your physician, the best thing to do is get a second opinion. By that, I mean a physician who has examined you and not this e-mail. You should see a surgeon. Removal of the mass can both eliminate it as well as serve as a biopsy, but only a surgeon can tell you if removal is appropriate and what risks would be associated with the surgery. Any surgery risks infection and damage to surrounding tissue which could include nerves. It may be possible to remove the lump through the inside of your cheek so you won't have a scar.
Since I haven't examined you, I can't tell you for certain whether or not putting a needle in the mass is appropriate, but given your reservations, you should seek another opinion before agreeing to a procedure. Removal would probably be a better way to biopsy the lump than using a needle. A needle would be useful if the mass was filled with fluid or pus which could be withdrawn through the needle for culture and analysis. An ultrasound of the lump could help determine if it is fluid filled or solid.
Sincerely,
Dr. Warren
Thank you for your time!
-CB
Dear CB: There is no relationship between yeast infections and kidney or bladder problems. Little girls do not get vaginal yeast infections although they may get yeast infections in the diaper area. If, when your daughter complains about burning and difficulty urinating, she is red and inflamed in the vaginal area, then local inflammation may be causing her symptoms and treatment with sitz baths may help. Vaginitis does not cause fever, but during febrile episodes, the urine may be more concentrated causing greater discomfort.
Urine infections often cause increased amount of urination. Even though urination may be uncomfortable, the bladder is so irritable that the patient has a frequent and urgent need to urinate. If there is any reason to suspect that your daughter is having recurrent fevers on the basis of urinary tract infections, it is essential that she have a thorough diagnostic evaluation. I'm not sure what you mean by it being "almost too late" when you get to your pediatrician. If a urinary tract infection is suspected, your daughter must have a urinalysis and a urine culture. If your daughter is not potty trained or not able to cooperate with specimen collection, she should have a bag applied to collect a specimen. If you are not immediately successful, you and your doctor must keep trying until an adequate specimen is obtained. If necessary, your daughter should be catheterized to obtain the specimen. Documentation of urinary tract infections with fever would indicate a need for further evaluation of the urinary tract including a VCU to check for reflux.
A final note: whatever the cause, make sure your daughter isn't taking bubble baths.... ever!
Sincerely,
Dr. Warren
-The Rs
Dear Mr. & Mrs. R: The condition of premature closure of the sutures (the growth lines in the skull) is called craniosynostosis. It would be very unusual for all the sutures to fuse prematurely. If some of the sutures fuse prematurely, growth continues in the other sutures resulting in an asymmetry or an unusual shape to the head. If the head shape is normal and head growth is normal, even if the fontanel (soft spot) is small, everything is probably okay. However; if the fontanel closes prematurely, it might suggest premature closure of the sutures, and so an x-ray may be useful to rule that out. If there is any doubt, a CAT scan should be done. Early diagnosis and treatment of craniosynostosis helps prevent impingement on brain growth. Treatment is surgical.
At this point, you should have the diagnostic x-rays done. For your information, and hopefully reassurance, review your son's head growth curve with your pediatrician. A small fontanel that remains open until at least 10 months associated with normal head growth is not a problem.
Sincerely,
Dr. Warren
-W
Dear W: The diagnosis of mycoplasma might be suspected by the clinical presentation or by the appearance of an x-ray, but the only way to determine with certainty whether a patient has mycoplasma is with a blood test. The same thing would be true of influenza. In either case, the illness would not last a month, which raises the question of whether or not you had more than one illness in your house.
Since most of the organisms that cause pneumonia or bronchitis, including mycoplasma, are sensitive to erythromycins and related antibiotics like Biaxin and Zithromax, that makes them the drugs of choice even without testing to determine if the infection is caused by mycoplasma.
Sincerely,
Dr. Warren
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