10 April 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
Please write back.
-JV
Dear JV: Both testicles should be relatively even in size. Since you haven't given me many details, I don't know if your son's right testicle is abnormally large, which may occur with a hydrocoele or a tumor, or if his left testicle is abnormally small which could be a result of damage from a prior illness or surgery. A hernia or varicocoele might create the impression that a testicle is larger when the swelling in the scrotum is actually not the testicle. An acute painful swelling of the testicle could be a result of a torsion and requires immediate medical attention. There are many possibilities, some of which require treatment, therefore, your son should see his doctor.
Sincerely,
Dr. Warren
-(unsigned)
Dear Grandparent: With such incomplete and confusing information it is not possible for me to tell you what is going on with your granddaughter. I can try to explain some of what you told me.
Spots which reacted the "wrong" way. Presumably when pressure was applied the spots did not blanch (turn white) implying that there was blood pigment in the skin. These are called petechiae and may occur with blood infections, particularly meningococcus.
Pneumococcal bacteria do cause pneumonia, but may also cause blood infections and even ear infections. By the way you describe the situation, it sounds like some bacteria were growing in the blood.
Hemophilus bacteria, which can cause ear infections can grow in the blood as well. Usually the strain that causes blood infection is Hemophilus influenza B which has been largely eliminated as a cause of infection by the HIB vaccine.
The doctors apparently thought that your granddaughter had a serious infection, possibly sepsis (blood infection). The treatment with IV antibiotics is aimed at eliminating the infection, not at preventing an ear infection.
Even if the doctors aren't sure what your granddaughter has, they should be able to explain the possibilities and what their tests rule in or out. If they have established that there is (or may be) a bacterial infection and your granddaughter's response to antibiotics has not been satisfactory, they should consult an infectious disease specialist just in case they are dealing with a strain which is resistant to multiple antibiotics.
Sincerely,
Dr. Warren
-CG
Dear CG: Your niece must avoid foods with sucrose (table sugar) or fructose (fruit sugar). She may tolerate small amounts. The more of it she consumes, the more likely she will have diarrhea and gas. She should avoid all sweetened foods including naturally sweet foods which get their sweetness from fruit, and she should avoid fruit juice and all sweetened drinks. She can use artificially sweetened products (those containing Nutrasweet [aspartame]). She may tolerate corn syrup which is essentially glucose.
Your niece may eat starches (breads, pasta, rice, potato), vegetables, protein foods (meat, eggs, fish, milk, yogurt, cheese), and fats (butter, cream, oils, nuts, dressings). If she is lactose intolerant as well, she should avoid milk and yogurt. She must read all labels of multi-ingredient foods such as dressings because you would be amazed at how many foods we don't think of as sweet have sugar in them.
Sincerely,
Dr. Warren
-MJ
Dear MJ: It is possible that you might benefit from special exercises or a pessary. But you may also need surgery. The best way to find out what your treatment options are is to see your doctor. And why not see your doctor? If he says you need surgery and you decide not to do it, you're no worse off than if you didn't see him. But if he presents you with a variety of treatment options, you get to choose the treatment based on information about risks, benefits, and your own personal needs.
When you go to a doctor, he can advise you of what you ought to do, and it's good that you respect his opinion. But you shouldn't be afraid to hear his opinion. YOU decide what should happen to your body. The doctor can only advise you. He does NOT decide for you. The doctor is NOT in charge.
When you seek a physician's advice if he recommends a treatment, you are entitled to get information about alternatives, risks, and benefits, and what the risks of doing nothing are. And if you are not satisfied that you are able to make an informed decision, you should get another opinion.
Sincerely,
Dr. Warren
I believe that we need to have documentation of temperatures and research studies which show that these extremes affect the learning, performance, behaviors, etc. in a negative way. Common sense hasn't lead to a permanent solution. Complaining on the part of the teachers is not enough to find a permanent solution.
If you can point me toward any research or information that you might know of our student population of 1200 will be forever grateful.
Thanks.
-SN
Dear SN: I know of no study about the effects of temperature on learning, but that should be no surprise since everyone's experience is that they are lethargic when overheated. Common sense would preclude doing an experiment on human beings to confirm common knowledge.
Does your school have a PTA? It's time for the parents to get involved. A few parents won't make a difference, but the principal won't ignore the PTA, and if the principal can't help, the next step is the superintendent and/or the school board.
Sincerely,
Dr. Warren
Sincerely,
-KR
Dear KR: You can find a list of helpful books for parents on National Parent Information Network at http://npin.org/books.html. You'll also find a variety of other useful resources for parents on the National Parent Information Network homepage at http://npin.org/.
There are two well known parent support groups on the Web, Parents' Soup at http://www.parentsoup.com/, and Parents Helping Parents at http://www.php.com/
Check The Baby Zone: Pregnancy, Birth and Babies at http://www.babyzone.com/caring.htm for a variety of topics.
The Home page for the US Department of Health and Human Services at http://www.hhs.gov/ might lead you to information about federal programs.
Sincerely,
Dr. Warren
-(unsigned)
Dear Parent: Please read my article Bed Wetting. It explains DDAVP plus other useful information you should know about enuresis. Transient headache, nausea, nasal congestion, runny nose and abdominal cramps have been reported with DDAVP. There are no special long term consequences to its use.
Sincerely,
Dr. Warren
Thank you for your time.
-A Very Frustrated Mom
Dear Frustrated Mom: I'm not sure why you feel that antibiotics have done more harm than good. Early antibiotic treatment of certain bacterial infections may decrease the body's opportunity to develop immunity to certain bacteria, but antibiotics do NOT adversely affect the immune system as a whole and so would not be responsible for your son having low immunoglobulin levels. While the laboratory tests are important in pointing toward a possible immune deficiency, I would advise consulting a pediatric immunologist for further evaluation before accepting that diagnosis or the treatment. Since many immunologists also evaluate for allergies, you might want to consider the role that allergy may play in the chronic ear problem even though the IgE levels were normal, since tubes have not helped.
Sincerely,
Dr. Warren
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